b'TThheeYYeeaarrsslloonnggFFiigghhttffoorrSSSSDDIIHHaavveeaaffrraannkkccoonnvveerrssaattiioonnwwiitthhyyoouurrnneeuurroollooggyyMMSSpprroovviiddeerrbbeeffoorreessttaarrttiinnggtthheepprroocceessssBy Adam Chaifetz, DC, MSCSIt should be no surprise to anyone that theMS is a progressive neurologic conditioncurrent disability system is a broken governmentalIt is incumbent on the patient to make sure program. There are several characteristics of thistheir condition is well documented over time system that make it very difficult to navigate.with objective data. I feel that when a new Patients who believe they are disabled haveprovider sees an MS patient, they should an inherent belief that it may be obvious toestablish measurable baseline characteristics others, and most importantly to their neurology- of the patients physical profile. The most multiple sclerosis provider. obvious, providers will obtain MRIs. This But in fact, if you were to ask any physicianis powerful objective evidence of disease about disability you may be surprised to knowprogression over time.that many do not understand the process. ManyHaving additional baseline exams gives do not or will not participate in it. Patients mayyou a way to measure various conditions.For not understand that when your providerexample, an optical coherence tomography examines you, takes your history and reportsin ophthalmology gives a baseline of the the clinical data of your visit, any mention ofretinal fibers of the eye. Having a postvoid disability is rarely in the record. Instead, oneultrasound of the bladder done and a urological must sort through the history and neurologicexamination helps to establish if a patient has examination to nd determinants of impairmentdifficulty voiding because of a neurogenic that further qualify if a person is disabled. bladder. A cognitive-neuropsychological exam Impairment versus disability over time helps to document unseen decits. Impairment is the decit a person possessesHaving physical therapy and rehabilitation from a medical standpoint. The percentageperformed for a thorough exam that focuses of impairment is a determinant of disability.on the neurologic components of muscle For instance, if an airline pilot completely loststrength, gait abilities, balance, and physical his vision, he would be 100 percent disabled fromcapabilities documents your physical capabilities ying an airplane. But would he be disabledat baseline.from doing any occupation? That is what anyOur comprehensive MS center has seen patient seeking disability must face. patient transitions from walking to assistive It is a system Americans pay into, many theirdevices such as walkers, rolling walkers, and entire working life. When politicians refer to yourwheelchairs. The Expanded Disability Status paid benet as an entitlement that citizensScale is the disability scale in MS that denes should have taken away, they do not realize howcharacteristics of impairment relating mostly difficult it is to receive Social Security Disability.to mobility. A sign of progression would be seeing SSDI is not given to Americans; they have earnedthe EDSS score go from one to a six out of 10 it because they paid into it for a minimum ofover time. The length of time will dene the ve out of the last 10 years to be eligible.aggressiveness and the anticipated course of 27 msfocusmagazine.org'