Listing 11.22 Motor Neuron Disorders Other Than ALS in 2026: Primary Lateral Sclerosis, Progressive Muscular Atrophy, Kennedy Disease
ALS gets Listing 11.10 and a Compassionate Allowance. Every other motor neuron disorder goes through Listing 11.22. And 11.22 is a very different animal. Where 11.10 grants disability on diagnosis alone, 11.22 makes you prove functional limitation. That difference matters a lot to patients with primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), progressive bulbar palsy (PBP), spinal muscular atrophy (SMA) adult onset, Kennedy disease (spinobulbar muscular atrophy), and other rare motor neuron conditions.
This article walks through the exact text of 11.22, defines each of the three paths (A, B, C), explains what "extreme limitation" and "marked limitation" mean in SSA language per 11.00D and 11.00G, covers what bulbar and neuromuscular dysfunction means per 11.00F, and shows how each of the major motor neuron disorders typically routes through the listing. Two worked cases show the mechanics.
The path to SSDI approval runs through Listing 11.22. Understanding the three routes gets you there faster.
See If You QualifyThe exact text of Listing 11.22
11.22 Motor neuron disorders other than ALS, characterized by A, B, or C:
A. Disorganization of motor function in two extremities (see 11.00D1), resulting in an extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
OR
B. Bulbar and neuromuscular dysfunction (see 11.00F), resulting in:
1. Acute respiratory failure requiring invasive mechanical ventilation; or
2. Need for supplemental enteral nutrition via a gastrostomy or parenteral nutrition via a central venous catheter.
OR
C. Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following:
1. Understanding, remembering, or applying information; or
2. Interacting with others; or
3. Concentrating, persisting, or maintaining pace; or
4. Adapting or managing oneself.
Three paths. Any one of them wins the case if documented.
Which motor neuron disorders qualify under 11.22
ALS is excluded because it goes to 11.10 with a Compassionate Allowance flag. Everything else in the motor neuron family goes here.
- Primary lateral sclerosis (PLS). Upper motor neuron degeneration only. Slower progression than ALS. Spasticity, hyperreflexia, and gait disturbance dominate. Life expectancy is typically near normal but function declines progressively.
- Progressive muscular atrophy (PMA). Lower motor neuron degeneration only. Weakness, atrophy, fasciculations without upper motor neuron signs. Faster progression than PLS but slower than ALS.
- Progressive bulbar palsy (PBP). Predominantly bulbar involvement with swallowing and speech difficulties. Often eventually classified as ALS but can persist as isolated bulbar disease for a period.
- Spinal muscular atrophy (SMA) adult onset. SMN1 or SMN2 gene mutations. Type III (Kugelberg-Welander) and Type IV are the adult-onset forms. Slow progression of proximal weakness. Nusinersen, risdiplam, and onasemnogene abeparvovec have changed the disease course but many adults have significant residual weakness.
- Kennedy disease (spinobulbar muscular atrophy, SBMA). X-linked, AR gene CAG repeat expansion. Male patients present in middle age with proximal weakness, bulbar signs, and androgen insensitivity features (gynecomastia, testicular atrophy).
- Post-polio syndrome is a separate listing (11.11) and has its own criteria.
Path A: Disorganization of motor function in two extremities
Section 11.00D1 defines disorganization of motor function:
Disorganization of motor function means interference, due to your neurological disorder, with movement of two extremities; i.e., the lower extremities, or upper extremities (including fingers, wrists, hands, arms, and shoulders). By two extremities we mean both lower extremities, or both upper extremities, or one upper extremity and one lower extremity.
So "two extremities" is either both legs, both arms, or one arm and one leg. Not one alone.
Section 11.00D2 then defines the extreme limitation required:
- Inability to stand up from a seated position means once seated, you cannot stand and maintain an upright position without another person's help or an assistive device such as a walker, two crutches, or two canes.
- Inability to maintain balance means you cannot maintain an upright position while standing or walking without another person's help or an assistive device such as a walker, two crutches, or two canes.
- Inability to use your upper extremities means loss of function of both upper extremities that very seriously limits work-related fine and gross motor movements. This includes not being able to pinch, manipulate, or use fingers; or not being able to use hands, arms, and shoulders for handling, gripping, grasping, holding, turning, and reaching; or not being able to lift, carry, push, or pull.
One cane does not satisfy the standard. The SSA definition requires two canes, two crutches, or a walker. That is a specific and deliberate threshold. If you use one cane, you do not meet the assistive device criterion. You may still meet the criterion via inability to stand up from seated or inability to use upper extremities, but the ambulation-with-two-devices bar is important.
PLS patients with severe spasticity often reach this criterion in the moderate-to-advanced stages. PMA patients with severe proximal weakness meet it earlier. Kennedy disease patients typically progress slowly and may take years to hit Path A.
Path B: Bulbar and neuromuscular dysfunction with vent or PEG
Section 11.00F defines bulbar and neuromuscular dysfunction:
The bulbar region of the brain is responsible for controlling the bulbar muscles in the throat, tongue, jaw, and face. Bulbar and neuromuscular dysfunction refers to weakness in these muscles, resulting in breathing, swallowing, and speaking impairments.
Path B does not just require bulbar involvement. It requires that the bulbar involvement has progressed to either:
- Acute respiratory failure requiring invasive mechanical ventilation. This means intubation or tracheostomy with ventilator support. Not BiPAP. Not non-invasive ventilation used at night. Invasive means through the airway.
- Need for supplemental enteral nutrition via gastrostomy (PEG or G-tube) or parenteral nutrition via central venous catheter. This means feeding tubes or IV nutrition. The wording says "need for," so intermittent supplemental use or short-term post-op tubes do not qualify. There needs to be a durable need documented.
Progressive bulbar palsy patients often reach Path B faster than any other MND. PLS almost never reaches Path B because upper motor neuron disease alone does not usually cause the kind of bulbar weakness that leads to respiratory failure or PEG placement.
Path C: Marked physical limitation plus marked limitation in one area of mental functioning
Path C is the equivalent of the "hybrid" path in many neuro listings. It requires marked limitation in physical functioning AND marked limitation in one of the four areas of mental functioning.
Section 11.00G2 defines marked:
Marked would be the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate limitation, marked limitation, and extreme limitation. We consider the nature and overall degree of interference with your functioning. The term marked does not require that you must be confined to bed, hospitalized, or in a nursing home.
Marked limitation in physical functioning per Section 11.00G3a means you are seriously limited in your ability to independently initiate, sustain, and complete work-related physical activities. These include standing, balancing, walking, using both upper extremities for fine and gross movements, or limitations in one upper and one lower extremity. Persistent or intermittent symptoms have to cause serious limitation on a sustained basis.
Marked limitation in one of the four mental functioning areas. The four areas are:
- Understanding, remembering, or applying information
- Interacting with others
- Concentrating, persisting, or maintaining pace
- Adapting or managing oneself
Motor neuron diseases often cause the mental limitations indirectly. Cognitive-behavioral changes are common in ALS (frontotemporal features), less common but present in PLS. Anxiety and depression are common across MND. Chronic pain, sleep disruption, and medication side effects (baclofen, tizanidine, gabapentin) can also cause marked limitation in concentration, persistence, and pace.
Path C is where a good treating source statement matters enormously. A neurologist who documents both the physical decline and the cognitive or emotional impact of the disease can build a Path C case in a patient who does not yet meet the strict Path A or Path B thresholds.
Worked example: David, 58, Phoenix, AZ, primary lateral sclerosis
Facts: David is a 58-year-old former electrician. Diagnosed with PLS in 2022 at Mayo Clinic Phoenix after 3 years of progressive gait difficulty and hyperreflexia. UMN signs prominent, LMN signs absent on serial EMG. By 2025, he was using a walker at home and a wheelchair for community distance.
Exam findings: Bilateral spasticity in both legs, 4/5 strength but severely limited by tone. Positive Babinski bilaterally. Sustained clonus. He could stand from a seated position only with the walker and a lot of effort. He could walk 25 feet with the walker before needing to sit. No bulbar symptoms.
SSDI filing: May 2025 with alleged onset October 1, 2024.
SSA analysis: Path A met.
Two lower extremities affected: yes.
Extreme limitation in balance while standing or walking: he required a walker (an assistive device that qualifies under 11.00D2). His walker use was documented in PT notes and neurology exams over 6 months.
Outcome: Initial approval September 2025 under 11.22A. EOD October 1, 2024. Five-month waiting period. First payment March 2025 covered as back pay.
Takeaway: PLS is a classic Path A case. Documented walker use plus severe spasticity puts the patient in the extreme limitation category.
Worked example: Maria, 46, Milwaukee, WI, Kennedy disease (SBMA)
Facts: Maria was diagnosed with Kennedy disease at 42 after genetic testing showed a CAG repeat expansion of 48 in the AR gene. Note: Kennedy disease is X-linked and typically only affects males, but rare cases exist in female carriers with skewed X-inactivation. She had proximal weakness, mild bulbar involvement (tongue fasciculations, mild dysarthria), and hormonal features (androgen insensitivity was not applicable given female sex, but she had similar muscle involvement).
Progression: By 2025, she had proximal weakness with 4/5 hip flexors, 4-/5 shoulder abductors, and difficulty rising from a chair. She used a single cane. No PEG. No vent. Mild swallowing dysfunction but eating orally with modified diet.
SSDI filing: February 2025 with alleged onset August 1, 2024.
SSA analysis at initial:
Path A: NOT met. Single cane use does not meet the two-cane/walker/two-crutch standard under 11.00D2.
Path B: NOT met. No vent, no PEG.
Path C: Physical limitation is marked. Mental limitation? Not documented at initial. Denial.
Reconsideration: Attorney arranged for neuropsychological testing and referred her to a psychiatrist. Both provided reports documenting marked limitation in concentrating, persisting, or maintaining pace. She had chronic fatigue from her disease, sleep-disordered breathing (documented on polysomnogram in Wisconsin sleep clinic), and clinical depression secondary to progressive disability with a PHQ-9 of 19. Concentration was measurably impaired on standardized cognitive testing.
Outcome: Recon approval December 2025 under 11.22C.
Marked physical limitation: documented via cane use, proximal weakness, and inability to sustain work-related activity.
Marked mental limitation in concentrating, persisting, or maintaining pace: documented via neuropsych testing and psychiatry evaluation.
Takeaway: Path C requires evidence in both physical and mental domains. When the physical alone does not clear the extreme threshold of Path A, the mental piece becomes the difference. Do not skip the psychiatric evaluation.
Common mistakes with 11.22 claims
- Using one cane and expecting Path A to work. Section 11.00D2 explicitly requires two canes, two crutches, or a walker. One cane does not meet the standard.
- Treating BiPAP as invasive ventilation. Path B requires invasive ventilation via tube or tracheostomy. BiPAP through a mask, even used all night, is non-invasive and does not meet the criterion.
- Missing the mental functioning piece for Path C. Chronic disease patients often have depression, anxiety, or cognitive changes that are undocumented because no one has referred them for evaluation. Ask for referral.
- Assuming diagnosis alone qualifies. Unlike 11.10 ALS, 11.22 requires functional evidence. A Kennedy disease diagnosis does not automatically approve. Neither does PLS.
- Not filing early enough. Most non-ALS MND is slowly progressive. File as soon as you meet the functional criteria. Do not wait for maximal decline.
- Confusing 11.22 with 11.10. If your diagnosis is ALS, use 11.10 with the CAL flag. If your diagnosis is anything else in the MND family, use 11.22.
What to bring to the initial claim
- Neurology consultation notes with specific diagnosis (PLS, PMA, PBP, SMA, Kennedy disease, or other named MND).
- EMG and nerve conduction studies showing upper or lower motor neuron pattern.
- Genetic testing results if applicable (SMN1/SMN2 for SMA, AR CAG repeat for Kennedy, SOD1/C9orf72 if ALS was ruled out).
- MRI of brain and spine to rule out structural causes.
- Physical exam documentation including strength testing, tone, reflexes, gait, and assistive device use.
- Physical therapy notes with functional assessments (timed up-and-go, 10 meter walk test, gait speed).
- Occupational therapy evaluation of upper extremity function if arms are involved.
- Speech-language pathology evaluation if bulbar signs are present.
- Pulmonology consultation with pulmonary function tests if respiratory symptoms are present.
- Psychiatric or neuropsychological evaluation for Path C mental functioning.
- Treating neurologist RFC form.
How 11.22 interacts with other listings
Section 11.00 explicitly says that if your MND has caused a breathing disorder, SSA may evaluate that condition under the respiratory listings in 3.00 as well. That opens up dual evaluation under 11.22 and:
- Listing 3.02 chronic respiratory disorders for progressive respiratory failure with FEV1 or DLCO criteria.
- Listing 3.09 chronic pulmonary hypertension for MND with cardiopulmonary involvement.
- Listing 5.08 for weight loss due to any digestive disorder including bulbar dysphagia leading to severe malnutrition (BMI less than 17.50 documented on at least two occasions at least 60 days apart within a 6-month period).
Compassionate Allowances for MND
The SSA CAL list does not include most non-ALS MND. Adult SMA Type I and Kennedy disease with rapid progression and specific presentations may be considered for expedited processing. Standard PLS, PMA, and PBP go through regular processing. See our Compassionate Allowances guide for the current list.
Three separate paths to approval. Line up your evidence early.
See If You QualifyFrequently Asked Questions
Does PLS or PMA qualify as ALS for SSDI purposes?
No. Only ALS itself qualifies for Listing 11.10 and the Compassionate Allowance flag. PLS, PMA, PBP, and other MND go through 11.22, which requires functional evidence.
Can I qualify under 11.22 if I only need one cane?
Path A requires two canes, two crutches, or a walker per Section 11.00D2. One cane does not meet the assistive device criterion. You might still qualify under Path C if you have marked physical and marked mental limitations, or via a Residual Functional Capacity argument.
Does BiPAP count as invasive ventilation under Path B?
No. Path B requires invasive mechanical ventilation, which means intubation or tracheostomy. BiPAP through a mask is non-invasive and does not meet the criterion.
What if my diagnosis is uncertain and I might have ALS?
If ALS is not yet ruled out and your neurologist has diagnosed possible or probable ALS, you may qualify under 11.10 with a Compassionate Allowance. If ALS has been formally ruled out and another MND is diagnosed, you go through 11.22.
Do I need genetic testing?
Not for the listing itself, but genetic testing strengthens the diagnosis and supports the case. SMN1/SMN2 testing for SMA, AR gene CAG repeat testing for Kennedy disease, and SOD1/C9orf72/other panels to help rule in or out ALS are commonly used.
Does Kennedy disease automatically qualify?
No. Kennedy disease is not on the CAL list and does not automatically meet a listing. Functional evidence under Path A, B, or C is required.
How often should I be seen by a neurologist to build the case?
At least every 3 to 6 months. Serial exam documentation of progression is what supports the case. Isolated single visits with severe findings do not paint the same picture as a documented trajectory of decline over 12 to 24 months.
Bottom line
Listing 11.22 has three paths for motor neuron disorders other than ALS. Path A is extreme limitation in two extremities requiring specific assistive devices (two canes, two crutches, or a walker). Path B is invasive ventilation or feeding tube. Path C is marked physical plus marked mental in one of four domains. Any one path wins the case.
Do not confuse this with the ALS listing. Do not accept one-cane documentation on Path A. Do not assume BiPAP counts as invasive on Path B. And do not skip the mental functioning workup on Path C. Motor neuron diseases can look catastrophic on paper without meeting the strict definitions the listings require. Get the documentation right and the case wins.