Welcome to Season 3, Episode 31 of "Winning Isn't Easy"! 🎙️
In this episode, we delve into an important topic: "MS Claims" with a special guest, Dr. Natalie Moreo from USF Health. Join your host, Nancy L. Cavey, a seasoned ERISA Disability Attorney, and Dr. Moreo, an expert in the field of MS (Multiple Sclerosis), as they explore the intricacies of MS claims and how they impact individuals seeking disability benefits.
We'll cover:
🧠 An overview of Multiple Sclerosis and its various manifestations.
📄 The crucial medical evidence required for a successful MS disability claim.
📝 How to navigate the complexities of the claims process, from diagnosis to benefits.
Dr. Moreo brings invaluable insights from the medical perspective, shedding light on the medical intricacies that can significantly impact disability claims related to MS.
Tune in to Season 3, Episode 31 of "Winning Isn't Easy" for a comprehensive discussion on MS claims, as we aim to provide you with the knowledge and guidance needed to pursue your disability benefits effectively. 📻🧡
Please remember that the information shared is based on general knowledge and should not replace personalized advice from a qualified attorney or medical professional.
Welcome to Season 3, Episode 31 of "Winning Isn't Easy"! 🎙️
In this episode, we delve into an important topic: "MS Claims" with a special guest, Dr. Natalie Moreo from USF Health. Join your host, Nancy L. Cavey, a seasoned ERISA Disability Attorney, and Dr. Moreo, an expert in the field of MS (Multiple Sclerosis), as they explore the intricacies of MS claims and how they impact individuals seeking disability benefits.
We'll cover:
🧠 An overview of Multiple Sclerosis and its various manifestations.
📄 The crucial medical evidence required for a successful MS disability claim.
📝 How to navigate the complexities of the claims process, from diagnosis to benefits.
Dr. Moreo brings invaluable insights from the medical perspective, shedding light on the medical intricacies that can significantly impact disability claims related to MS.
Tune in to Season 3, Episode 31 of "Winning Isn't Easy" for a comprehensive discussion on MS claims, as we aim to provide you with the knowledge and guidance needed to pursue your disability benefits effectively. 📻🧡
Please remember that the information shared is based on general knowledge and should not replace personalized advice from a qualified attorney or medical professional.
<silence> Hey, welcome to this week's episode of A Winning Isn't Easy. We've got a special guest, Dr. Moreo . Dr. Moreo is with the Department of Neurology at U SS F, and , uh, she specializes in ms. In fact, she's the associate program director for the MS Fellowship. So, welcome, doctor.
USF MS Dr. Natalie Moreo :Thank you. I appreciate, I'm happy to be here this morning.
Disability Attorney Nancy Cavey:I wanna know what made you specialize in neurology and in particular, ms.
USF MS Dr. Natalie Moreo :Yeah, so neurology is a booming field. Um, and so there have been , uh, the past couple decades, especially so much research going into understanding why disease occurs in neurology and all the subies of neurology and what to do about it. Um, so as physicians, we are considered lifelong learners. And so I guess I was attracted to the idea that I would never get bored, <laugh> , um, uh, in particular , uh, so I specialize in multiple sclerosis and , uh, neuroimmunology. Um, and what attracted me to that field, not only the research, but also the fact that you , uh, establish lifelong relationships with your patients , uh, and that you can't just know your neurology training. You have to remember all of your medical training , uh, because it is such a complex disease.
Disability Attorney Nancy Cavey:That's neat. And , uh, for those of you who don't have the pleasure of working with the doctor, she's fantastic, and she is very empathetic , uh, and very supportive of , uh, of her patients. And I will tell you, that can be rare to find these days. So thank you for your specialty in ms.
USF MS Dr. Natalie Moreo :Thank you, Nancy <laugh> ,
Disability Attorney Nancy Cavey:Can you tell me what are the symptoms of MS and how does the disease progress?
USF MS Dr. Natalie Moreo :Yeah, so , uh, MS has a highly variable presentation. Uh, so it can range from very mild disease with virtually no symptoms , uh, to, on the other end of the spectrum, a very staggeringly disabling disease , um, where , which can affect the entire body , uh, and the mind. Um, and so on one end of the spectrum, you can have somebody who's , uh, 22 and they can barely get across the room without their walker. And on the other end of the spectrum, you can have somebody who's in their eighties and they're playing pickleball and they've never been on MS treatment in their entire life . So it's, it's highly variable. Um, the disease course, as you can imagine, is just as variable, and that's why it's such a difficult , um, disease to, to wrap your head around and , and , and to deal with on a day-to-day basis.
Disability Attorney Nancy Cavey:Doctor, I'm curious why there's a variability, because as you said, you'll see people who are , um, 23 and tremendously disabled, and you'll see 80 year olds playing pickleball. Um, why is this variability , uh, in patients? What, what's the medical cause?
USF MS Dr. Natalie Moreo :Yeah, so that's a great question, and that's one that we are trying to strive to answer worldwide. And so when I said that the, the field was booming with research, that is one of the questions that we are really aiming to, to find the answer to. Um , we know in general it has to do with , um, the physiology of the disease , um, the neuro immunology behind it. Uh, genetic factors may, may come into play , uh, risk factors such as smoking and, and diet and , uh, activity level, they may all interplay. Um, but behind the scenes, what is the, the main reason, the core of it for why people experience some aggressive disease and other people don't. We don't have the answer for that yet. So , uh, stay tuned. Hopefully we'll have an answer for you
Disability Attorney Nancy Cavey:In
USF MS Dr. Natalie Moreo :A few years down the road.
Disability Attorney Nancy Cavey:So how is MS diagnosed? What are you looking for clinically and on diagnostic studies to arrive at the diagnosis?
USF MS Dr. Natalie Moreo :Yeah, so ms. MS is a very difficult disease to diagnose. Uh, so some of the leading sources actually think that , um, there's up to 20% of people who have been diagnosed with MS don't actually have the disease. And part of the reason is for that is because we do not have what we call in medicine a gold standard test, right ? So a gold standard test where you can get that one thing done and it can tell you with pretty good accuracy whether disease is present or not. Um, so really the diagnosis , um, uh, comes from putting the pieces of the puzzle together, the, the history and the symptoms, the neurological exam findings, the laboratory data, the M r I data , um, and trying your best using your expertise, your experience , uh, and pattern recognition to recognize that the disease is present. And so you may get a couple different opinions if you go to a couple different specialists as to whether or not you actually have the diagnosis. And we run into that problem a lot.
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Disability Attorney Nancy Cavey:So I've experienced that in my own practice where , uh, patients or or clients will come to me and they're not sure that they have the diagnosis and then they're not sure about treatment. Can you explain how MS is treated , uh, and what relationship, if there is any, between the diagnosis and the nature of the treatment? In other words, we know the people have like relapsing remitting mm-hmm. <affirmative> , uh, ms, they have progressive ms. So can you explain the treatment , uh, modalities for us?
USF MS Dr. Natalie Moreo :Absolutely. Um, and, and thank you by the way, for touching on the different categories of ms. Uh, I want everyone as, as much as you're able to try to do away with those categories in your mind. Um, so what we're learning more and more about MS is that is it is a spectrum of disease. It's a continuum, and you can fall anywhere along that continuum in terms of how relapsing and how remitting versus how progressive. Um, and so they're not strict categories anymore. We're trying to move away from that in general , um, in the medical field and in the research side of things. Um, depending on where you fall along that, that continuum, the treatment does certainly matter. So somebody with what we call benign ms, and this is very, very few people, maybe only 5% or less of people with benign ms , uh, may only have one or two relapses, and they completely remit , uh, and then they are perfectly back to normal. And then the, the rest of their lives are fine. Uh, versus on the other end of the spectrum, again, we see that, you know, complete opposite , um, where somebody just has progression from the very beginning. They don't really have these clear attacks , um, called relapses that other people experience. And very quickly in , in fact, within a few years, it can get to the point where they're extremely disabled and and confined to a wheelchair. Um, so that's again, how variable the disease is. And so depending on where along the spectrum your Ms. May land, the treatment will be very different. Um, so in general , uh, and I I try to tell , uh, people that there are essentially two pillars of treatment for the disease. The first is the , uh, symptomatic treatment. And so that's all the medications that we use to try to , uh, fix the symptoms that MS already caused to your body. Um, so, and you can be on six different of these at ones of these at , uh, at once . So you can be on , uh, amantadine for your fatigue metric for your bladder. Um, you can be on gabapentin for your pain and impure for your walking, and that might be the first pillar of the symptomatic treatment. Um, in parallel with that, we have to have a second pillar because if not the , the structure crumbles. Um , and that second pillar is the disease modifying therapy. So that's , um, really depends on where you are on that spectrum of, of , uh, uh, disease severity , um, with respect to what we use. But there's only one at a time. You use one at a time disease modifying therapy. Um, and that is to change the course of the disease and to prevent more disease from happening. So if you don't use both pillars in, in parallel with each other, you , you can't , uh, you know, fix what's currently going on and prevent more things from happening.
Disability Attorney Nancy Cavey:Well, that's a great way to explain it. I like the , the concept of the pillars. That's neat. Thank you. Um, what are the three most common questions that you get from your patients?
USF MS Dr. Natalie Moreo :Right. So , uh, certainly the one that comes up the most often, and this is regardless of , uh, you know, the phenotype of the MS that someone might be experiencing , uh, people are worried about how disabled they will be. Um, and , you know, and this , uh, speaks back to what we traditionally know about ms , uh, that is unpredictable and that it can lead to severe severe disease . Um, and so whether somebody is newly diagnosed or whether someone's had MS for 30 years, they still wanna know what their future is going to look like and what their functional capacity will be. So a lot of discussion centers around that. Um, and then other than that , uh, I guess the second most question would be, second most common question would be , uh, is the treatment gonna be worse than the disease? I dunno if that's a very fair question. 'cause some of these medications are scary, but in general, the answer is no. Um, so that there's your answer for that. The treatment is not worse than the disease, please get on a treatment. Uh , and then the, the third common one probably being , um, you know, what can I do about the most common symptoms usually being fatigue and cognitive dysfunction. So those are two of the ones that come up the most often. Um, and they wanna know what they can do about those. Um, 'cause if you can reverse, those people can really get their quality of life back.
Disability Attorney Nancy Cavey:And so what's the answer to that? Third question?
USF MS Dr. Natalie Moreo :Medications? No, I'm just kidding. Um, we do have a couple , uh, uh, medications that can help. Um, but , uh, uh, one thing that I wish people would ask me more often is , um, you know , what else can I do besides medicines to help with my fatigue? What else can I do? Um, besides medications to help with my cognitive function? There's, there's quite a bit actually , um, uh, the most important ones being , uh, diet , uh, and exercise. So it sounds very , uh, run of the mill when you're talking to any physician in any field field, but it's actually true. So there's a been a lot of research going into a gut microbiome and how your diet influences your immune system, and therefore the course of your MS and the degree of cognitive and , and physical disability that somebody might accumulate. So the diet's very important as is exercise. So.
Disability Attorney Nancy Cavey:Well, that leads me to my next question, and that is, what are the three questions that you wish a patient would ask you but they don't ask you?
USF MS Dr. Natalie Moreo :Yeah, I, I really , um, wish that when we were having a discussion , um, you know, usually it has to do with symptoms or about treatment, but what often gets overlooked is their disability application. Um, oftentimes somebody won't even mention to me that they're applying for disability, and then we might just get forms all of a sudden to fill out. And if I had known that you were applying for disability , um, or that you are , you already had , um, an application open , uh, then I would've been able to have a , a much better , um, discussion with you during your visit to be able to fill these forms out in a way that can help your, your claim. Um, so I, I wish , uh, patients would bring that up to me more often. You know, I'm thinking about applying for disability. Um, what, what can you do to help me with that? Uh, so please ask me that <laugh> .
Disability Attorney Nancy Cavey:So how about the other two questions that you wish people would ask ? Oh , <laugh> ,
USF MS Dr. Natalie Moreo :I don't know . Patients ask a lot of questions, <laugh> , so I'm not sure that there are any others that , uh, really come up. Uh, patients with MS are usually very, very well read . Um, they do a lot of their own research. They're online all the time. They're on blogs, and so they're usually the ones coming to me with the questions. Uh, I can't think of too many others that , uh, I wish would
Disability Attorney Nancy Cavey:Be ,
USF MS Dr. Natalie Moreo :Uh, tied in to the, to the conversation. I think they already have been .
Disability Attorney Nancy Cavey:Uh , I'm gonna throw you a , a hardball question. Uh, and that is , um, there are a number of support groups out in the community we're , as you know, very active in the MS support , uh, groups and their walks. Um, to what extent , uh, do you think that patients should be involved in support groups like , uh, the MS society or the local support groups that , uh, and chat lines that you'll see
USF MS Dr. Natalie Moreo :100% across the board? Um, it, it will not only help , um, you know, your your fellow person with ms , um, but it'll help you in so many ways that you can't even understand. The, the knowledge that a physician can impart to you during a visit is, is limited , uh, by our medical background. When you're part of a support group , uh, you can talk with other people with MS, who go through similar experiences as you, and they have often so many solutions to the very problems that you have been trying to combat and things that we can't even think of. Uh, and, and , uh, it could be as simple as, you know, how to go about doing something during your daily routine, where of course, we've never had to do that before with, with ms. And so how could we possibly come up with a solution for you? Um, so support groups are incredibly important. Not only that , uh, in terms of, you know, finding little tips and tricks for yourself. They're , they're healthy , um, mentally and emotionally to be able to connect with other people , um, that are going through what you're going through versus, you know, your friends and your family who don't have ms. They empathize with you and they want to help you, but they really just don't know how. Um, so support groups are , um, tremendously helpful for, for, for various reasons.
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Disability Attorney Nancy Cavey:Alright , doctor, how does somebody find a doctor like you? Because as you know, I think the world of , of you and what you do for your patients, how do they find somebody just like you?
USF MS Dr. Natalie Moreo :Well, thank you. I'm flattered, but I, but I , I think what you're trying to ask me is how, how can someone find an MS specialist , um, somebody who has the experience , um, who sees MS on a, a daily basis and not just once in a while walking through their clinic? Um, you know, as part of , uh, a general neurology clinic, I highly encourage anybody with MS or a related disease, N M O , MOG disease, any other neuroinflammatory disease to get plugged in with a neuroimmunologist. So an MS specialist or a NEUROIMMUNOLOGIST who has the experience level. We are so honed in on the, the advancements in the field and the research going into it and, and everything out there. Um, that if you're not plugged in with an MS specialist , um, you may be missing out on , um, all the, the updates in the field and , and what can be best done for you. Um, a classic example is somebody who's been following with the general neurologist for a long time. Um, they might be on a very old medicine that's been out since the nineties , um, like the interferons or Copaxone. And sometimes these medicines are appropriate depending on the case. Uh, but one , a vast majority of patients coming from the community and from general neurology are on these medicines. It tells me that maybe the, the physician is not comfortable with , uh, prescribing the, the newer therapies that have come out, especially in the past five years. The field has been booming, as I said. So to get plugged in with an MS specialist and just at least to be seen by one on a once a year basis, just to check in and see how things are going. Um, look for somebody who's at an academic center, that's always a good place to start, or at least try to find someone who has , um, dedicated fellowship training in your immunology or the field of multiple sclerosis. Um, so it's not, not too hard, just Google.
Disability Attorney Nancy Cavey:So , uh, for those of us who , um, just heard that word, neuroimmunologist mm-hmm. <affirmative> , uh, can you explain what that is? Or, or , and what's the difference between that and a neurologist who specializes in ms? If there's a difference,
USF MS Dr. Natalie Moreo :They're the same. Uh, so an MS specialist is a neuroimmunologist. So , um, somebody who understands the immune system basis for the disease, the autoimmune aspects of the disease for why the disease behaves the way it does, and why the treatments for MS work the way they do. Um, so , uh, there's synonyms , um, so sorry to get all medically technical on you, but neuroimmunology , um, is a much larger umbrella term to encompass all the diseases that are related to ms. Um, that can affect the central nervous system because of an autoimmune driven process. Now
Disability Attorney Nancy Cavey:You're the associate director of U s s fellowship program . Yes . So , uh, can you explain what is it that a physician learns in that fellowship program that makes them a specialist in ms?
USF MS Dr. Natalie Moreo :It, it really has to do primarily with the exposure. Um, so because that's essentially all we do in our clinic, we don't see Parkinson's. We don't see Alzheimer's, we don't see diabetic neuropathy or any other common neurological disease process. We really hyperfocus on MS related diseases. So , and so because of that, we follow a patient base of , uh, I think 2,500 , uh, patients with MS in the, in the central West Florida. Um, and so just the sheer volume and , um, that experience that , you know , a , a fellow just in one year of training can build to seeing all those patients over the course of a year , um, is really what , um, gives 'em that, that level of exposure to be able to get comfortable with treating the disease, recognizing the disease, and knowing what to do about the disease. Um, but of course, it's not just sheer volume. Um, we also , um, uh, embed into their training didactics and, and other , um, uh, academic resources to be able to help them learn the immunological basis for the disease. Uh, they're very , um, well integrated into the clinical research on our research side. We are actively involved in more than 30 clinical research trials at , at any one time studying the pipeline drugs and what's coming out for ms. And so that's really , um, what we try to do at U S F with our fellows and, and get them ready to be able to treat people with multiple sclerosis.
Disability Attorney Nancy Cavey:Uh, which leads me to the , uh, a next , uh, another interesting question that I just thought of. Um, how does a patient become part of these research studies that you've mentioned?
USF MS Dr. Natalie Moreo :Yeah, very good question. I really do, from the bottom of my heart, wish that they were more openly accessible. Um, so the clinical trials, just by the nature of having to study , um, a certain question, are very guarded with , um, their enrollment criteria for who can be enrolled , um, you know, by age dis disease type. Um, even though we were trying to get away with those categories, relapsing remitting, primary progressive, they still categorize it by type. Um, how recently was the , was their relapse relapse? What are they currently on for their MS for treatment? All these criteria get , get rolled into it. And so it actually becomes quite , quite tricky to find a clinical trial that works for your particular circumstances. But I wish that there were , was a clinical trial available to everybody out there, because that is really the best way to get the earliest access to the treatments that are becoming , um, the most fine tuned target ms. Uh, if you're interested in getting in a clinical trial , um, it's a good idea. Um, and , um, the best way to go about it , um, is to ask for your neurologist or your primary , uh, to , for a referral to an academic center where clinical trials are typically conducted. Of course, private , uh, clinics do them as well. Um, uh, but there is where you'll, you're going to be evaluated , um, during your regular visit for , um, enrollment criteria to be able to see if you can qualify for anything that's, that's offered.
Disability Attorney Nancy Cavey:Great. What a fantastic answer. Um , so how can a patient help you support their disability claim? 'cause you already mentioned that you like to know early on if someone is thinking about or has applied for mm-hmm . <affirmative> , what else can they do to help you support , uh, their disability claim?
USF MS Dr. Natalie Moreo :Yeah, so please communicate with your physician, me or whoever you're seeing as early and often as possible. So number one is just letting us know that you're doing it. Um, we know the questions to ask you to be able to , um, help support your claim as much as possible when it , uh, you know, even from sim questions as simple as, you know, hand function , um, you'd be amazed how important that can be for a disability claim or cognitive dysfunction. We can help you , um, get , um, into the right referrals. Um, so neuropsychological testing when it comes to evaluating your cognitive status. Um, so that'll be important for your disability claim. Um, so if you just communicate with us and let it , let us know , uh, what you're applying for , uh, what the status is, who's helping you , um, uh, and what forms you're gonna be sending in. Aside from that, let us know. Communicate with us about what are your symptoms. Uh, don't wait for us to ask you, does MS affect your bladder? Does MS affect your , uh, your fingers? So, you know, do you have trouble typing? Don't, don't wait for us to ask. I need you to, to tell us and be proactive about it, doctor, this is how my MS affects my everyday functioning and this is why I can't do the things that other people can do. 'cause we can put all that into the notes. We can try to document that as well as possible. And then when it comes time to fill out forms or to, to send records back to your disability lawyer, that'll all be clearly written out for you, and that can really help your case. So communication is key.
Disability Attorney Nancy Cavey:Well, as you know, I'm a big proponent of symptoms and functionality worksheets and great interval histories that the patient should be giving you. What is your thoughts about the patient coming in with something like a symptoms and functionality sheet? This sort of gives you the overview of the symptoms and how it impacts their ability to function and give that to you between each visit. Would that be helpful?
USF MS Dr. Natalie Moreo :Absolutely. Um, so we, we try our best to already have , um, measures like that sort of incorporated into the visit. Um, but as, as everyone watching this knows , if you have ms , um, there's usually quite a bit to, to go over at each visit and there's only so much time to do it. And so the most important thing to you at a certain visit may be addressing your bladder function or address addressing your fatigue level or, or going over what happened with your last MS treatment and why didn't it work out. We gotta get you back on treatment quickly. So there's always gonna be one or two things that really take priority for that visit. But if we, I mean, applying for disability is a long-term process. It does take a long time for these claims to go through. And if we can incorporate a little bit at a time through each visit , uh, and have a discussion, a piece of the discussion over a long period that not only tells the story and , and how it evolves over time for the claim , um, but we can actually get to the bottom of it in a much more effective manner. So coming with , um, uh, symptom questionnaires like that already fill out ahead of time, that would be fantastic. And then we can focus in on not only what's important to document for your claim, but also what is the most , um, bothersome to you in reality. Um, and , and often the two line up , of course , um, so that we can help you with those things at the same time.
Disability Attorney Nancy Cavey:Great. Now just one more question, <laugh> , um, people will have side effects , uh, from treatment that can impact a person's , uh, function. And many disability insurance carriers or even the Social Security Administration expects that those complaints be made to the doctor and that those are addressed in the medical records with different attempts at , uh, medication trials. Can you just briefly address the kind of side effects that are common in some of the , uh, treatment modalities and how you and , and your , uh, colleagues go about addressing those , um, functionally and within the medical records?
USF MS Dr. Natalie Moreo :Yeah, and interesting question. Thank you for asking that. So , um, there's more than 20 currently f d a approved medications on the market for ms. And again, when it comes to those two pillars of treatment, I'm just talking about the disease modifying therapies, the ones that can change the course of the ms, all the symptomatic medications are not specific to ms. They can be used across any of the neurological or even just medical field in general, like Gabapentin, for example. Um, uh, and so those come with their own side effects. So we're just focusing in on, on the MS disease modifying therapies and the side effects that those can produce. Um, each one all more than 20 of them comes with their own set, obviously, but there are some common themes. Um, so there's basically three routes of treatment, that's oral pills, injectable medicines that you can inject under the skin or into the muscle, and then infusion therapies, ones that you get through an iv. Um, and so in general you can expect the oral medicines because they're going through the GI to maybe have some GI side effects. You can expect the IV medicines to maybe have some, what we call infusion related reactions. And those can include blood pressure spikes, headache , um, hives , uh, scratchy throat. So those are very common themes that we see with any infusion , uh, related therapy. And then in the injectables, of course, you're given the injection at a very local site in your body, and so you may have a reaction at that site. So injection site reactions or ISRs , uh, include swelling, redness, pain at the injection site. So these are just the common threads. Of course, you can get more detail depending on which one you're talking about exactly. Um, but we have ways to combat all of that. So yes, please tell us if you're having a problem with your medicine. 'cause there's probably something we can do about it. For example , um, one of the most common , uh, side effects from Tecfidera or any of the related medicines , uh, like vum, er, em , uh, is flushing. Flushing is where your skin gets really, really red after taking the medicine. Um, aspirin can treat that. Um, so we usually just tell people to take a baby aspirin with their Tecfidera and then usually problems solved. Not all the time, but that's a good example.
Disability Attorney Nancy Cavey:Well, this was fantastic. I wanna thank you for taking time from your practice to speak with us today. If someone would be interested in , uh, being seen at uh , u the U S F M S clinic, how would they get ahold of the clinic?
USF MS Dr. Natalie Moreo :Yeah, thank you. We'd love to see you and , and again, even if it's just, just for a once a year check-in just to kind of see how things are going and see if your doctor's treating you well, which I hope they are. Um, but if you would like to, to get in with us, we've got a , a very big team at U S F . Um, we have a , a handful of physicians who are MS specialized. We have apps , we have a whole team of nurses , uh, and not to mention our entire research staff . So big team ready to help you. Uh, you can give us a call. That's the easiest way to do it. 8 1 3 3 9 6 9 4 7 8. I think it's on the bottom of the screen there for you.
Disability Attorney Nancy Cavey:Well, again , thank you. And , uh, I will attest that the , uh, patients and clients that I have , uh, that are treated there. Love everybody, love you, and thank you for what you do.
USF MS Dr. Natalie Moreo :Thank , thank you so much , Nancy . The feeling's mutual by the way, from the patients . So thank you for all you do.
Disability Attorney Nancy Cavey:Thank you.