MS is an autoimmune disorder that attacks the central nervous system – the part of your body that controls your ability to walk and think. It causes unpredictable symptoms such as pain, fatigue, impaired balance and walking, issues with memory and cognition, mood changes, blindness and/or paralysis. Although there is no cure for MS, there are therapies and medications available to treat its symptoms, reduce the frequency and severity of attacks, and to slow the progression of the disease.

MS affects everyone differently, and the nature and severity of its symptoms will vary by patient. Many people who have been diagnosed with MS can continue to work for years before their ability to complete their job duties is impacted. We’ve previously shared examples of the types of accommodations that can be requested when that happens. Once symptoms have progressed to a point where accommodations are no longer enough, it may be time to submit a disability claim.

Although our Courts have recognized that MS is a totally disabling disease, it takes more than a diagnosis of MS to succeed on a disability claim. Proving that that your particular MS symptoms, (and the severity of those symptoms) prevent you from working can be harder than you think. Insurance companies will often disregard self-reported MS symptoms and deny claims based on the stability of MRI imaging, the presence of “normal” neurological exams, and/or the treating physician’s failure to fully establish their patient’s impairments during the claims process.

Insurance companies will require a claimant’s treating physician to complete forms documenting their patient’s symptoms and particular restrictions and limitations. These forms were designed by the insurance company, and are not specific to MS. As a result, they often include questions that do not apply to MS claimants and leave out important clinical information. A doctor who is unfamiliar with the disability claims process might incorrectly assume that the insurance company is asking for all of the information that is needed, and might not realize that they are permitted to supplement it with additional reports and/or different forms.

In the face of these pitfalls, having the collaborative support of doctors (and attorneys) who are experienced in navigating MS-based claims can make all the difference.

I was selected to consult on a project with the National Multiple Sclerosis Society to create a comprehensive new form, the Universal Attending Physician Statement, to address these issues and assist MS patients with their private disability claims. This form was specifically created with MS patients in mind, and has been tailored to fit their specific needs. The National MS Society suggests that the Universal APS be utilized instead of the forms designed and sent by the insurance companies.

The Universal APS is just one tool available in the National MS Society’s Guide for People with MS and Their Healthcare Providers. This valuable resource includes an explanation of Key Concepts in Private Disability Insurance, a Glossary of Disability Insurance Terms, Frequently Asked Questions, a Physician’s Checklist, and a MS Symptom Tracker for patients. If you or a loved one is interested in or currently pursuing a disability claim as a result of their MS symptoms, it is important to review this information and discuss it with the doctors who will be involved in the claim. It is up to claimants and their doctors, together, to make sure the insurance company has as much evidence as possible to have their claim approved.

An attorney can help by acting as a liaison between claimants, doctors, and insurance companies. Experienced disability attorneys take the lead in screening and facilitating the exchange of information to protect their client’s rights, ensure that their clinical information is presented in the most compelling way possible, and allow claimants to focus on their much-needed medical care. We at Bonny G. Rafel LLC, provide legal counsel to individuals seeking to obtain (or overcome a denial of) long term disability benefits, and advocate for our clients as the Voice of the Disabled. See our website for video presentations and information on our boutique practice and contact us to discuss your case. www.disabilitycounsel.com

Ms. Leetzow suffered from migraines for 20 years getting more severe, more frequent, (2-5 per week) and more resistant to treatment. Metropolitan Life challenged the viability of the claim, since there was no “objective evidence” of her crippling pain. Another roadblock to recovering disability benefits is if the impairment is based on a claim of chronic pain. The court laid the groundwork for a claim such as this. Since there are no neurological exams for migraines that are likely to be positive, claimant’s personal accounts of her migraine related pain are to be credited, “migraines are an invisible illness and there is often no objective medical evidence to confirm their existence, patients’ personal accounts are the strongest, and often only, evidence of disability in such cases”.

The frequency of medical visits to the doctor was less critical to the Court, since Ms. Leetzow stated that her disability makes it harder for her to initiate and arrange and attend doctors appointments. And she had in the past tried all reasonable treatment for her condition. The court noted,

“It is not uncommon for people with longstanding illnesses that have not responded to aggressive medical treatment to lose hope in the ability of doctors to improve their situations.” “Accordingly, a lack of doctors’ appointments during the elimination period does not mean Plaintiff was not disabled. In fact, it could mean Plaintiff was so disabled she had temporarily given up hope on doctors’ abilities to improve her illness.”

This case provides a helpful roadmap to arguing a claim based on longstanding but progressive illness.

We at Bonny G. Rafel LLC handle disability claims based on chronic illness and know what evidence to gather to improve our chances of successful appeals and litigation. Contact our firm for more information. www.disabilitycounsel.com

Decades ago, disability insurers became aware that a high percentage of their policyholders became disabled by mental health conditions. Instead of lending a helping hand, they turned their back on this population, by incorporating coverage limits for disability caused or contributed to by a mental health condition. This sweeping limitation has been upheld on court challenges even involving the ADA. 42 U.S.C. § 12101 et seq; Fletcher v. Tufts University 2005 U.S. Dist. LEXIS 7237 (D. Mass. April 15, 2005) Illnesses of the body that affect our physical health are far easier to objectify and more accepted within the disability landscape, tending to overshadow emotional health. Physical ailments are often related to or can lead to mental disorders. NBC reported that Robin Williams was battling symptoms of early Parkinson’s disease. The news source noted that in addition to the paralyzing affects on a patient’s body, Parkinson’s often leads to “depression and other disability.” This is well documented.

As disability attorneys, we are always careful to carve out mental health issues from our cases, so that our clients do not fall into the trap of receiving limited disability benefits for their claims that arise from a physical disorder, but understandably impact their psyche. See for example Ayers v. LINA, 2012 U.S. Dist. LEXIS 55814(D. Ore, April 12, 2012) At Bonny Rafel LLC, we review and advocate for patients that have illnesses of both the body and the mind. We understand that mental and emotional health is just as crucial to overall wellness as one’s physical condition.

An estimated 400,000 Americans have this disease. The New York Times recently highlighted several New Yorkers living with Multiple Sclerosis and reported the toll the disease has on their lives in Multiple Sclerosis Takes Toll on Body and Soul.

The story of Denise Muller in particular peaked my interest because it is so similar to the experience of our clients struggling to have their disability claims paid. A significant percentage of the cases we handle at Bonny G. Rafel LLC involve autoimmune disorders, including Multiple Sclerosis.

Denise Muller explains that she worked in banking until she experienced symptoms of vertigo which required hospitalization. She returned to work and was laid off due to a “reduction in force” which she attributes to her illness. At the time, her doctors did not realize that her symptoms were related to MS. Symptoms of pain materialized and interfered with her function, and she eventually was properly diagnosed by a neurologist. Her descent into illness was gradual, and during the process, her financial security was shunted off. The article reports that she fought three years for Long Term Disability. It is not uncommon to have a struggle with insurance companies to establish that you qualify for Long Term Disability. Our firm steps in early, to assist with the collection, development and submission of evidence sufficient to prove the disabling features of MS. There can be many differential diagnoses other than MS at first, if the diagnostic testing, (MRI, Spinal Tap) is negative. However, these tests do not exclude the disease if the lesions do not show up. Read more about Denise at the National MS Society website.

Unfortunately, many insurers do not appreciate the impact this disease brings to the individual, how the muscle spams, nerve pain, the fatigue, progressively interferes with their daily function and eventually their ability to perform their occupation. Of particular interest to us is the impact that this disease has on executive functioning skills and how to prove the effect that cognitive changes have both in and out of the work setting. Realize that there may be a ‘tipping point’ when the disease progressively impacts your ability to work, leading to poor performance evaluations and the potential of discharge before you have the chance to file for disability. We advise our clients to “stay as long as you can function, but not beyond your ability to perform the essential duties of your occupation. “

We are here to help. At Bonny G. Rafel, LLC we advocate for patients with disabling conditions. Contact us for a consultation if Multiple Sclerosis or any other problem, has inhibited your ability to work. We may be able to assist you in getting the benefits you deserve.

Van der Kolk reasons that the most helpful therapies to heal patients suffering from PTSD are not emotional or behavioral, but instead physiological. Van der Kolk calls the patient’s act of remembering a traumatic event, “reactivation,” because the body sends the individual back into fight-or-flight mode. The majority of PTSD patients desire to numb this “reactivation” of pain by “dissociating” in the short-term, and self-numbing (food, exercise, work, alcohol, etc.) in the long-term. While most therapists would normally focus on the mind and how it relates to the traumatic incident, van der Kolk’s techniques shift that focus to the body.

To treat the disconnect between memories and the body’s reaction to them, van der Kolk suggests techniques that give attention to the way the body functions, like yoga, the Emotional Freedom Technique (tapping), or eye movement desensitization and reprocessing (E.M.D.R). With a therapist’s guidance, patients use Emotional Freedom Technique by tapping various acupressure points with their own fingertips while reciting positive phrases. By physiologically tuning into the problem, tapping can calm the sympathetic nervous system and prevent the patient from entering fight-or-flight mode. For patients with isolated traumatic memories, van der Kolk also recommends E.M.D.R., in which “a therapist wiggles fingers back and forth across the patient’s field of vision and the patient tracks the fingers while “holding in mind” the traumatic memory. Van der Kolk now uses this technique routinely because it helps patients process their traumas; the goal is for the negative experience to transform from an existing paranoia into a distant memory. Now, more than 60,000 therapists around the world are certified in E.M.D.R., and van der Kolk calls the therapy a godsend.

Ultimately, the NY Times article draws attention to therapists, like van der Kolk, who practice methods that may improve symptoms in a wider variety of traumatized patients. Even with therapy, however, emotional illness can lead to disability and an inability to work. We are here to help. At Bonny G. Rafel, LLC we advocate for patients with disabling conditions. Contact us for a consultation if PTSD, or any other psychological problem, has inhibited your ability to work. We may be able to assist you in getting the benefits you deserve.

By: Hannah Silverman

Certain jobs come with zero-tolerance for the use of even prescribed controlled substances. The Federal Aviation Administration’s (FAA) Office of Aerospace Medicine has published a lengthy and non-exhaustive list of prohibited medications, and Aviation Medical Examiners have been instructed to refuse issuance of an FAA medical certification to any person who use any drug on this list. In

In the past, patients have had to make the effort to locate well-trained and knowledgeable health professionals that specialize in movement-diseases. The Wall Street Journal reveals that out of 500 patients that completed a Harris Poll survey for the Michael J. Fox Foundation, only 28% of the participants were seeing movement-disorder specialists, and roughly 50% of the them felt “informed” or “very informed” about how to control their symptoms. These statistics point to a lack of education about treatment and access to care in this medical field.

To close this gap between education and care, the Michael J. Fox Foundation has taken an important first step. In collaboration with the International Parkinson and Movement Disorder Society, the foundation has launched their newest initiative called, Partners in Parkinson’s. This program offers an online tool to help patients locate a movement-disorder specialist; it has also implemented patient and family events where specialists in surrounding clinics demonstrate comprehensive evaluations. Beyond the doctor’s office, specialists motivate patients to engage in a regular exercise routine to delay disease progression. Dr. Lawrence Elmer of the University of Toledo’s Gardner-McMaster Parkinson Center affirms that an active lifestyle can help and even reverse the effects of Parkinson’s disease.

Parkinson’s disease is a progressive illness that impairs one’s function tremendously. Protecting your rights to financial security becomes a paramount concern and disability benefits through your employer’s plan or your private policy is critical. We at Bonny G. Rafel, LLC are experienced advocates for the disabled. Contact us for a consultation if your occupational abilities are hindered as a result of Parkinson’s disease. We may be able to help.

By Hannah G. Silverman

For example, the Los Angeles Times recently published an article on post-chemotherapy cognitive impairment, or “chemo brain,” the mental fog often caused by chemotherapy treatments. Los Angeles Times, Feb. 27. 2012. Symptoms of “chemo brain” include impaired cognition, attention, and memory, as well as mental fog, fatigue, and confusion. Mayo Clinic Online. The Times cited a recent study which tested 196 women who had undergone chemotherapy treatment for breast cancer, and which found that women who received the chemotherapy “fared much worse” on cognitive and executive function tests long after (21 years on average) they finished treatment. While it is not clear whether it is chemotherapy alone or complications of the treatment that cause “chemo brain,” the symptoms can be disabling, especially for patients whose pre-disability occupations required extensive cognitive or critical thinking ability. The long-lasting effects of cancer treatment have been acknowledged by the courts. See, e.g., McCauley v. First Unum Life Ins. Co. (finding that the insurer wrongfully denied a cancer survivor disability benefits where chemotherapy had left him both mentally and physically impaired).

Another well known side effect of chemotherapy treatment that can be disabling independent of the cancer itself, is peripheral neuropathy. This condition is often irreversible and can be devastating and painful. Objective testing such as EMGs and Nerve Conduction Studies can be helpful in proving that this condition is severe to the insured.

Insurance companies must take side effects of treatment into consideration when determining whether claimants qualify for disability benefits. They should not terminate your benefits simply because you enter remission. We at Bonny G. Rafel can assist you in overturning a disability carrier’s denial if you are disabled due to the after-effects of cancer treatment.

– By Sara E. Kaplan, Esq.

The Institute of Medicine has stated that “pain is all too often undertreated in the U.S.” The article goes on to explain the difference between acute pain and chronic pain. Acute pain is generally a warning signal to stop doing something that is harmful to your body. Chronic pain is described in the article as an alarm that “keeps sounding and producing pain long after the original cause is gone, probably due to a malfunction in the central nervous system.”

Chronic pain is a terrible condition. Having to wake up each day with no medical improvement is so difficult for our clients to endure. But in order to prove that your pain is severe and restricts and limits you constantly, it is very important to be careful when filling out disability forms and medical forms. Do not overstate your limitations.

Be sure your treating doctor keeps a record of the level of pain that your experience so that if called upon to comment on whether your pain interferes with you ability to work, the doctor can provide this important link between pain and function.

Proving chronic pain remains a challenge in disability matters, but we at Bonny G. Rafel can help.

Craig Partridge, the chief scientist for a high tech research company, describes a migraine as imagining “someone having driven a nail straight through your head.”

The Migraine Research Foundation reported that nearly a quarter of all households are affected by migraines and that migraines are three times more likely to occur with women compared to men. The Foundation also found that more than 10% of adults and children suffer from migraines.

When filing a disability insurance claim citing migraines as the main reason why you cannot perform your normal work duties, it is important to provide your treating physician a list or ledger of the symptoms that affect you and even a migraine journal of the regularity of your migraines and how long they last. When migraines do not respond to medication and cause you to be absent from work on a regular basis, you may be unable to sustain a full time work schedule.

At Bonny G. Rafel LLC, we assist our clients file for disability, and work on appeals to insurance companies to convince them that the restrictions and limitations of migraines can indeed render someone disabled.