Patients with Chiari malformation may be unable to work because of their disorder and its related complications. Patients who find themselves unable to work because of their Chiari malformation may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
What Is Chiari Malformation?
People who have brain tissue that extends into their spinal canal due to a small or misshapen skull have a condition known as Chiari malformation. The skull presses on the brain and forces the tonsils of the cerebellum into the upper spinal canal. This can interfere with the flow of cerebrospinal fluid that’s protecting your spinal cord and brain, leading to a buildup of spinal fluid in those areas, or neurological symptoms. While Chiari malformation is uncommon, it is being more frequently diagnosed with the increased use of imaging tests.
There are two main types of Chiari malformation. The type you have depends on whether there are developmental abnormalities of the spine and brain and on the anatomy of the brain tissue that has been displaced into the spinal canal. Chiari malformation type I develops as the brain and skull are growing, so it may not be discovered until adulthood or late childhood. Chari malformation type II is a pediatric form that is present at birth.
Chiari malformation can lead to several serious complications including:
- Tethered cord syndrome – when the spinal cord attaches to your spine and stretches leading to muscle and nerve damage in your lower body;
- Syringomyelia – a cyst or cavity that appears within the spinal column;
- Spina bifida – when your spinal cord or cord covering isn’t fully developed, leaving a portion exposed and leaving you susceptible to paralysis. A common form of spina bifida in people with Chiari malformation type II is myelomeningocele; and
- Hydrocephalus – when you accumulate excess fluid in your brain. You may need a flexible tube, or shunt, placed in the problem area to drain and divert the cerebrospinal fluid to another part of your body.
Disability Evaluation of Chiari Malformation
Insurance companies who handle long-term disability claims refer most often to the Center for Disease Control, or CDC, to evaluate Chiari malformation types I and II. The CDC defines Chiari malformation as a brain and spinal cord disorder with neurological or physical issues that: interfere with personal, social, school, or work activities; have no other physical or mental cause; and appear in imaging tests. To qualify for disability benefits, you should be able to demonstrate that you experience many – if not all – of the following symptoms:
Chiari Malformation Type I
- Hoarseness or other speech problems;
- Blurry or double vision, as well as other vision issues;
- Trouble swallowing that is sometimes accompanied by choking, gagging, or vomiting;
- Being lightheaded or dizzy;
- Tingling or numbness in the feet or hands;
- A lack of fine motor skills, such as poor hand coordination;
- Balance problems such as an unsteady gait; and
- Neck pain.
Chiari Malformation Type II
- Arm weakness;
- Quick downward eye movements;
- Problems swallowing, including gagging; and
- Breathing pattern changes.
Less frequently, those with Chiari malformation may suffer from the following:
- Central sleep apnea or other abnormal breathing;
- Scoliosis (curvature of the spine) related to spinal cord impairment;
- Decreased heart rhythm;
- Body weakness; and
- Tinnitus (buzzing or ringing in the ears).
To qualify for a diagnosis of Chiari malformation, your medical records should document the above criteria.
Disability Definition
Most LTD policies consider you disabled if you are: (1) unable to perform the job duties of your own occupation for the first two years of the policy, and (2) unable to perform the duties of any viable occupation after the first two years of the policy are up. Every long-term disability policy is different, so be sure to review your specific policy to see how the terms “disability” and “totally disabled” are defined.
Evaluating Disability for Persons With Chiari Malformation
The insurance company will assign an adjuster to your claim who may have a psychologist, physician, or other medical disability examiner review your file and determine your level of impairment. You may also be required to complete a functional capacity evaluation or a compulsory medical examination. Your adjuster should consider every bit of evidence including treatment from the onset of the illness and the impact of the illness on affected body systems.
If there is not enough evidence available to make a decision, the insurance adjuster may contact you for more information. If you don’t have what they need, they may ask you or another medical source to find it and report back.
All medical documentation should be clinical or laboratory findings, not simply symptomatology or diagnosis. It is essential that your doctors include all objective findings about your condition, even if they might relate to another disorder.
Work With an Experienced Long Term Disability Attorney
If you suffer from the effects of Chiari malformation type I or II, or another physical or mental disorder that keeps you from sufficiently performing your job duties, you may be eligible for long-term disability benefits. Because these benefits can be difficult to obtain, it’s important to speak to legal counsel. If you’ve been denied for LTD despite a genuine disability, Ortiz Law Firm can help. Contact us today at (888) 321-8131 and find out how we can get you the benefits you deserve.