Myasthenia Gravis (MG) is a chronic, fluctuating neuromuscular autoimmune disorder that disrupts communication between nerves and muscles, causing muscle weakness that worsens with activity and improves with rest. It primarily affects voluntary skeletal muscles, often causing symptoms like drooping eyelids, double vision, slurred speech, difficulty swallowing, and generalized weakness in the limbs. This unpredictable condition raises questions about its recognition under the law, particularly concerning disability status and workplace protections. This article explores how Myasthenia Gravis is legally defined in the United States for obtaining financial benefits and securing workplace accommodations.
Defining Disability Status
The legal definition of “disability” is not universal and shifts depending on the context, such as insurance policies, workplace protections, or government benefit programs. For federal programs like Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), the Social Security Administration (SSA) uses a specific, strict definition. To be considered disabled by the SSA, an individual must have a medically determinable physical or mental impairment that prevents them from engaging in any Substantial Gainful Activity (SGA).
SGA is defined as a level of work activity and earnings the SSA considers significant. The impairment must also be expected to last for a continuous period of at least 12 months or result in death. This standard focuses on functional limitations and the inability to work, rather than just the diagnosis.
Myasthenia Gravis and the Qualification Criteria
Myasthenia Gravis is recognized by the SSA and is included in the Listing of Impairments, often called the “Blue Book,” under Section 11.12 for Neurological Disorders. Meeting this listing means the condition is considered severe enough to automatically qualify the individual for benefits, provided specific criteria are met despite adherence to prescribed treatment for at least three months. Qualification is based on documented, severe functional limitations, not simply the diagnosis.
One way to meet the listing is by showing a disorganization of motor function in two or more extremities (e.g., arms and legs) that results in an extreme limitation. This limitation must severely restrict the ability to stand up from a seated position, maintain balance while walking or standing, or effectively use the upper extremities for fine and gross motor movements. The second path involves severe bulbar and neuromuscular dysfunction, which refers to weakness in the muscles controlling the throat, tongue, jaw, and face. This leads to impairments in speaking, swallowing, and breathing.
This severe bulbar dysfunction must have resulted in at least one myasthenic crisis requiring mechanical ventilation, or necessitate supplemental enteral or parenteral nutrition via a gastrostomy or catheter. The third criterion involves a marked limitation in physical functioning alongside a marked limitation in one of four areas of mental functioning. These mental areas include understanding and applying information, interacting with others, concentrating and maintaining pace, or adapting and managing oneself. Medical documentation must capture the maximum severity and persistence of limitations over time due to the fluctuating nature of MG symptoms.
The Process for Disability Application
The administrative process for seeking SSDI or SSI benefits begins with a comprehensive application supported by extensive medical evidence. Applicants must provide a complete medical history, including diagnostic tests, hospitalization records, and detailed medication lists, noting unsuccessful treatments. A key part of the evaluation is the Residual Functional Capacity (RFC) assessment, performed if the condition does not meet the specific criteria of the Blue Book listing.
The RFC assessment evaluates what an applicant can still physically and mentally do in a work setting despite their limitations. This involves determining remaining abilities for tasks like sitting, standing, walking, lifting, carrying, and fine motor skills, as well as mental capacities like concentration and managing work pressures. Medical source statements from treating physicians are helpful because they provide an expert opinion on functional limitations that might not be clearly detailed in standard medical records.
If a claim is initially denied, which is common, the applicant has the right to appeal through a multi-level process. The SSA uses a sequential evaluation process to determine disability, which includes reviewing the claimant’s current work activity, the severity of the impairment, whether the impairment meets a listing, and the ability to perform past work or adjust to other work. The entire process can be lengthy, often involving months or years.
Workplace Accommodations and Protections
Separate from the SSA’s financial benefits programs, the Americans with Disabilities Act (ADA) provides workplace protections for individuals with disabilities. The ADA applies to employers with 15 or more employees and prohibits discrimination against qualified individuals. Myasthenia Gravis often meets the ADA’s definition because it is a physical impairment that can substantially limit one or more major life activities, such as seeing, speaking, breathing, or walking.
Under the ADA, employers must provide “reasonable accommodations” to enable an employee with MG to perform the essential functions of their job, unless doing so would cause an undue hardship. Accommodations are highly individualized due to the variable nature of MG, sometimes referred to as the “snowflake disease.” Examples include flexible scheduling, modified break times, or ergonomic adjustments like a specialized chair or keyboard.
Other common accommodations may involve allowing for periods of rest, reducing physical exertion requirements, or utilizing remote work options. For those with ocular symptoms like double vision, accommodations might include adjusting monitor settings or temporarily reassigning visually intensive tasks. The ADA ensures that individuals with MG who can still work are protected from employment discrimination.