SSA administers two disability programs under the Social Security Act:

Social Security Disability Insurance (SSDI) (Title II)

Supplemental Security Income (SSI) (Title XVI)

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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

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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

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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

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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.

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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:

Compassionate.Allowances@ssa.gov

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 :

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www.socialsecurity.gov/compassionateallowances/