SSA administers two disability programs under the Social Security Act:
Social Security Disability Insurance (SSDI) (Title II)
Supplemental Security Income (SSI) (Title XVI)
2
We consider you disabled under Social Security
rules if:
You cannot do work that you did before
We decide that you cannot adjust to other work
because of your medical condition(s); and
Your disability has lasted or is expected to last for at
least one year or to result in death
SSA does not pay partial or
short-term disability benefits
Goal-- Quickly identify conditions that invariably meet Social
Security disability standards
CAL moves individuals to the head of the line for a disability
decision
It is not a separate program from the SSDI and SSI programs
Initiative began with public outreach hearing in 2007
50 conditions selected for initial rollout (October 27, 2008)
113 conditions as of December 10, 2011
52 new conditions effective August 2012
SSA identifies and develops CAL conditions based on
information and feedback from:
Public outreach hearings
Advocacy groups
Social Security and Disability Determination Service
communities
Counsel of medical and scientific experts
Research with the National Institutes of Health (NIH)
Seven hearings since 2007
Hearings on rare diseases, cancers, traumatic brain injury/stroke,
early onset dementias, schizophrenia, cardiovascular diseases and
multiple organ transplants, and autoimmune diseases
Obtain medical expert and lay opinion on various possible
conditions
National Institutes of Health co-hosted each hearing
Hearings are free and open to the public
Information and archived webcasts of the hearings available on our
website
6
Relationships with advocacy groups include:
Alzheimer’s Association
American Cancer Society
American Heart Association
Lupus Foundation
National Alliance for the Mentally Ill
National Multiple Sclerosis Society
National Organization for Rare Disorders
7
There are several ways to apply for benefits:
Visit our website at www.socialsecurity.gov to apply online
Call or visit any Social Security office to schedule an
appointment
Contact us toll-free at 1-800-772-1213
(TTY 1-800-325-0778)
We ask claimants to:
tell us about your condition
the treatment you’ve received for your condition
any medications that you are taking
your educational background
past work history
provide us permission to request medical records
from your doctors
Application forwarded to the State Disability
Determination Services (DDS) agency
DDS contacts the medical sources
DDS reviews statement of your daily activities
Applicants may need to attend a consultative
examination
DDS makes a disability decision on your claim
1. Is there substantial gainful activity?
2. Is the impairment severe?
3. Does the impairment meet or equal a medical
listing?
4. Can the claimant perform any of their past
relevant work?
5. Can the claimant perform any other type of
work?
Impairment summaries guide adjudicators in evaluation of
evidence and policy application
Adjudicator has the option to click on hyperlink to an
impairment summary
Case gets a CAL indicator alerting adjudicator that a case
need to be fast-tracked
“Search and find” software identifies CAL condition
Claimant applies alleging a CAL condition
12
The impairment summaries are available to adjudicators at all levels (initial – appeals).
CALS may be manually added/removed at all adjudicative levels.
We apply the same standard of disability to all claims, including claims identified for the CAL process.
13
MALIGNANT MULTIPLE SCLEROSIS
ALTERNATE
NAMES
Malignant MS; Marburg Variant Multiple Sclerosis; Marburg Variant MS; Fulminant Multiple Sclerosis; Aggressive
MS; Advanced MS
DESCRIPTION
Malignant Multiple Sclerosis (Malignant MS) is an aggressive and rare form of MS. It is characterized by rapidly
progressive inflammation and destruction of myelin (protective covering surrounding the nerves) and increased
formation of lesions and plaque in the brain and spine. The loss of myelin affects the brain’s ability to transmit
electrochemical impulses between the nerve cells of the brain, and the spinal cord, resulting in diminished or loss
of neurological functioning. People with this form of MS experience weakness in their extremities, difficulties with
coordination and balance, spasticity, and paresthesias (abnormal sensory feelings of numbness and prickling
sensations). Speech impediments, tremors, dizziness, hearing loss, changes in vision, bowel and bladder
difficulties, falls, and cognitive impairments are other frequent complaints. As the disease progresses lesions
develop in the areas of the brain responsible for information processing, resulting in cognitive impairments such
as difficulties with concentration, attention, memory, language, and judgment. People with malignant MS can
have damage to regions of the brain responsible for behavior and emotions resulting in psychotic disorders such
as manic depression and paranoia.
DIAGNOSTIC
TESTING,
PHYSICAL
FINDINGS, AND
ICD-9-CM
CODING
There is no single test to detect malignant MS. It may be difficult to distinguish between a diagnosis of malignant
MS and acute disseminated encephalomyelitis (ADEM) because of timing of the occurrence of plaques in the
brain tissue. A neurological exam is performed to assess symptoms and to rule out other possible disorders.
Analysis of the cerebrospinal fluid is also helpful for the diagnosis of malignant MS. Neuro-imaging technologies,
such as magnetic resonance imaging (MRI), diffusion-tensor magnetic resonance imaging (DT-MRI), and
computerized brain tomography are used to detect central nervous system lesions, myelin loss, white matter
abnormalities, and other physical changes in the brain. . ICD-9: 340 AL, 340 AZ, 341.8 and 341.9
https://secure.ssa.gov/apps10/poms.nsf/lnx/0423022620
No CAL Hearings planned in the near future due to budget
restraints
Reach out to advocacy organizations via a variety of meeting
formats
You may submit written comments or provide the names of
potential conditions to:
1. Acute Leukemia
2. Adrenal Cancer, with distant metastases or inoperable, unresectable
or recurrent
3. Aicardi-Goutieres Syndrome
4. Alexander Disease (ALX), Neonatal and Infantile
5. Alobar Holoprosencephaly
6. Alpers Disease
7. Alpha Mannosidosis – Type II/III
8. ALS/Parkinsonism Dementia Complex
9. Alstrom Syndrome
10. Amegakaryocytic Thrombocytopenia
11. Amyotrophic Lateral Sclerosis (ALS)
12. Anaplastic Adrenal Cancer, with distant metastases or
inoperable, unresectable or recurrent
13. Angelman Syndrome
14. Aortic Atresia
15. Astrocytoma, Grade III and IV
16. Ataxia Telangiectasia
17. Batten Disease
18. Bilateral Retinoblastoma
19. Bladder Cancer, with distant metastases or inoperable or unresectable
20. Breast Cancer, with distant metastases or inoperable or unresectable
21. Canavan Disease (CD)
22. Carcinoma of Unknown Primary Site
23. Cerebro Oculo Facio Skeletal (COFS) Syndrome
24. Cerebrotendinous Xanthomatosis
25. Child Neuroblastoma
26. Child Non-Hodgkin Lymphoma
27. Chondrosarcoma with Multimodal therapy
28. Chronic Myelogenous Leukemia (CML), Blast Phase
29. Cornelia de Lange Syndrome-Classic Form
30. Corticobasal Degeneration
31. Creutzfeldt-Jakob Disease (CJD), Adult
32. Cri du Chat Syndrome
33. Degos Disease, Systemic
34. Early-Onset Alzheimer’s Disease
35. Edwards Syndrome, Trisomy 18
36. Eisenmenger Syndrome
37. Endomyocardial Fibrosis
38. Ependymoblastoma, Child Brain Tumor
39. Esophageal Cancer
40. Ewings Sarcoma
41. Farber's Disease (FD), Infantile
42. Fibrodysplasia Ossificans Progressiva
43. Follicular Dendritic Cell Sarcoma, with metastases
44. Friedreichs Ataxia (FRDA)
45. Frontotemporal Dementia (FTD), Picks Disease, Type A, Adult
46. Fucosidosis – Type 1
47. Fukuyama Congenital Muscular Dystrophy
48. Galactosialidosis – Early Infantile Type
49. Gallbladder Cancer
50. Gaucher Disease (GD) Type II
51. Glioblastoma Multiforme, Adult Brain Tumor
52. Glioma Grade III and IV
53. Glutaric Acidemia Type II, Neonatal
54. Hallervorden-Spatz Disease
55. Head and Neck Cancers, with distant metastasis or inoperable or
uresectable
84. Liver Cancer
85. Lowe Syndrome
86. Lymphomatoid Granulomatosis Grade III
87. Malignant Brain Stem Glioma – Childhood
88. Malignant Melanoma with metastases
89. Malignant Multiple Sclerosis
90. Mantle Cell Lymphoma (MCL)
91. Maple Syrup Urine Disease
92. Mastocytosis Type IV
93. Medulloblastoma with metastasis
94. Merkel Cell Carcinoma with metastases
95. Merosin Deficient Congenital Muscular Dystrophy
96. Metachromatic Leukodystrophy (MLD), Late Infantile
97. Mitral Valve Atresia
98. Mixed Dementias
99. MPS I Hurler Syndrome
100. MPS II Hunter Syndrome
101. MPS III Sanfilippo Syndrome
102. Mucosal Malignant Melanoma
103. Multicentric Castleman Disease
104. Multiple System Atrophy
105. Myocolonic Epilepsy and Ragged Red Fibers Syndrome
106. Neonatal Adrenoleukodystrophy
107. Nephrogenic Systemic Fibrosis
108. Niemann-Pick Disease (NPD), Type A
109. Niemann-Pick Disease, Type C
110. Non-Small Cell Lung Cancer, with metastases to or beyond the
hilar nodes or inoperable or recurrent
56. Heart Transplant Graft Failure
57. Heart Transplant Wait List, 1A/1B
58. Hemophagocytic Lymphohistiocytosis (HLH), Familial Type
59. Hepatoblastoma
60. Histiocytosis
61. Hutchinson-Gilford Progeria Syndrome
62. Hydranencephaly
63. Hypocomplementemic Urticarial Vasculitis
64. Hypophosphatasia Perinatal lethal form
65. Hypoplastic Left Heart Syndrome
66. I Cell Disease
67. Idiopathic Pulmonary Fibrosis
68. Infantile Free Sialic Acid Storage Disease
69. Infantile Neuroaxonal Dystrophy (INAD)
70. Infantile Neuronal Ceroid Lipofuscinoses
71. Inflammatory Breast Cancer (IBC)
72. Junctional Epidermolysis Bullosa, Lethal Type
73. Juvenile Onset Huntington Disease
74. Kidney Cancer, inoperable or unresectable
75. Krabbe Disease (KD), Infantile
76. Kufs Disease Type A and B
77. Large Intestine Cancer, with distant metastasis or inoperable,
unresectable or recurrent
78. Late Infantile Neuronal Ceroid Lipofuscinoses
79. Left Ventricular Assist Device (LVAD) Recipient
80. Leigh’s Disease
81. Lesch-Nyhan Syndrome (LNS)
82. Lewy Body Dementia
83. Lissencephaly
111. Obliterative Bronchiolitis
112. Ohtahara Syndrome
113. Ornithine Transcarbamylase (OTC) Deficiency
114. Orthochromatic Leukodystrophy with Pigmented Glia
115. Osteogenesis Imperfecta (OI), Type II
116. Osteosarcoma, formerly known as Bone Cancer - with
distant metastases or inoperable or unresectable
117. Ovarian Cancer,
118. Pancreatic Cancer
119. Paraneoplastic Pemphigus
120. Patau Syndrome, Trisomy 13
121. Pearson Syndrome
122. Pelizaeus-Merzbacher Disease – Classic Form
123. Pelizaeus-Merzbacher Disease – Connatal Form
124. Peripheral Nerve Cancer – metastatic or recurrent
125. Peritoneal Mesothelioma
126. Perry Syndrome
127. Pleural Mesothelioma
128. Pompe Disease, Infantile
129. Primary Cardiac Amyloidosis
130. Primary Central Nervous System Lymphoma
131. Primary Effusion Lymphoma
132. Primary Progressive Aphasia
133. Progressive Multifocal Leukoencephalopathy
134. Progressive Supranuclear Palsy
135. Pulmonary Atresia
136. Pulmonary Kaposi Sarcoma
137. Rett (RTT) Syndrome
138. Rhabdomyosarcoma
139. Rhizomelic Chondrodysplasia Punctata
140. Salivary Tumors
141. Sandhoff Disease
142. Schindler Disease Type 1
143. Single Ventricle
144. Small Cell Cancer, of the Large Intestine, Ovary, Prostate, or Uterus
145. Small Cell Lung Cancer
146. Small Intestine Cancer, with distant metastases or inoperable,
unresectable or recurrent
147. Smith Lemli Optiz Syndrome
148. Spinal Muscular Atrophy (SMA), Types 0 and 1
149. Spinal Nerve Root Cancer – metastatic or recurrent
150. Spinocerebellar Ataxia
151. Stiff Person Syndrome
152. Stomach Cancer, with distant metastases or inoperable, unresectable or
recurrent
153. Subacute Sclerosing Panencephalitis
154. Tabes Dorsalis
155. Tay Sachs Disease, Infantile Type
156. Thanatophoric Dysplasia, Type 1
157. Thyroid Cancer
158. Tricuspid Atresia
159. Ullrich Congenital Muscular Dystrophy
160. Ureter Cancer, with distant metastases or inoperable, unresectable or
recurrent
161. Walker Warburg Syndrome
162. Wolf-Hirschhorn Syndrome
163. Wolman Disease
164. Xeroderma Pigmentosum
165. Zellweger Syndrome
For more information on Compassionate Allowances and to view the list of CAL conditions visit :
18
www.socialsecurity.gov/compassionateallowances/