What is Small Fiber Neuropathy?
Small fiber nerves are found throughout the body. In the skin, they control sensations such as pain and temperature. In the organs, they control involuntary automatic processes such as breathing. Small fiber neuropathy is a type of peripheral neuropathy that involves the destruction of these small fiber nerves. Typically, these nerves are first damaged at the feet and then damage spreads throughout the body in a “stocking and glove” pattern.
One of the most distressing symptoms of small fiber neuropathy is chronic pain, which can range from a burning or stinging sensation to feelings of electric shocks. Patients may experience phantom sensations, such as insects crawling on their skin or water dripping on them. Pain is usually variable in both the intensity and expression, sometimes disappearing entirely for periods before reoccurring. As the condition progresses, patients may experience a loss of sensation in parts of the body to the point of feeling completely numb.
In more severe cases, the autonomic functions are also affected. Patients that have impaired autonomic functions can experience a disruption in any of the tasks the body automatically regulates. Symptoms include dizziness, fainting, dry eyes, dry mouth, constipation, diarrhea, urinary or fecal incontinence, sexual dysfunction, inability to regulate body temperature, sleeping, and difficulty digesting food. In rare cases, severe damage to the autonomic nervous system can cause life-threatening autonomic failure.
Diagnosing Small Fiber Neuropathy
Diagnosis of small fiber neuropathy is conducted through a punch biopsy. During a punch biopsy, a doctor takes a small sample of tissue from the skin and examines the nerves by microscope. The biopsy usually includes taking several samples at the ankle, knee, and thigh. An electromyography and nerve conduction test are often ordered to rule out large fiber neuropathy, which can cause similar symptoms. Autonomic nervous system testing assesses the functional state of the autonomic nervous system.
Typically, additional testing is required to determine what may be causing the neuropathy. Blood tests are used to screen conditions such as diabetes, autoimmune diseases, and genetic disorders.
Treating Small Fiber Neuropathy
If doctors can discover what is causing the neuropathy, addressing the cause is critical to adequately treating and stopping the progression of the condition. With the leading cause of small fiber neuropathy being diabetes, this includes managing blood sugar levels in patients with diagnosed diabetes. Since most other cases of small fiber neuropathy are idiopathic, doctors generally must focus on treating the symptoms.
Medications to treat neuropathic pain include anti-convulsants, antidepressants, anti-anxiety drugs, and opiates. A doctor may also prescribe a topical cream to relieve pain. Often patients take a combination of medications. Over-the-counter treatments such as Epsom salt, magnesium oil, and hot compresses can also help the pain.
For patients with autonomic involvement, treatments that support the function of the affected organs are necessary. That may include special diets, physical therapy, medications, or surgical interventions.
Disability Evaluation of Small Fiber Neuropathy
Small fiber neuropathy may prevent someone from working. People who cannot work must apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
Definition of Disability
Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their current job for the first two years of the policy and 2) be unable to work in any other position for the years following the initial 2-year period. Every plan is different, so look over your policy to see how it determines disability.
Evaluating Disability for People with Small Fiber Neuropathy
Since small fiber neuropathy is usually a chronic and progressive condition, it is easier to prove that it will prevent the person from working for at least the first two years. Not all cases of small fiber neuropathy are considered disabling, but many people find that they eventually cannot work.
Neuropathic pain can be debilitating and may prevent a person from completing basic tasks. Even sitting in a chair or wearing specific clothing can be excruciating. Chronic pain may leave a person with issues focusing on and completing tasks. Side effects from pain management treatments can leave a person fatigued and with even more problems concentrating on work assignments.
Autonomic involvement can cause any organ to malfunction. Some patients experience a loss of consciousness if their heart rate is not regulated, which will prevent them from working almost any job. Patients that experience breathing difficulties may not be able to exert themselves enough to work in a difficult position or in an environment that includes dust or exhaust. If autonomic failure occurs, a person may need intensive care to replace the loss of bodily functions.
A person may still be eligible for long-term disability benefits even if their small fiber neuropathy is not severe enough to qualify on its merits alone. Evaluators look at a person’s overall health when making a consideration, so it is essential to list all relevant medical conditions when applying for benefits.
What the Insurance Company Needs From You and Your Medical Providers
Your insurance company will need to know which doctors have treated you for your small fiber neuropathy. They will need to get your medical records from those doctors when they are evaluating your claim. You may need to send those records yourself if your insurance company cannot get them from your doctors.
The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how those symptoms affect your life. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete a correct RFC for you.
Working with a Disability Attorney
You do not have to fight the insurance companies alone. An experienced disability attorney will guide you through the process and give you the best chance of getting the benefits you deserve for your small fiber neuropathy.
An experienced disability attorney at the Ortiz Law Firm can help you through every step of the process, from initial application to potential appeals. We only get paid if you win. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.
The Ortiz Law Firm has successfully represented people in long-term disability cases across the United States. To see how we can help you win your long-term disability case, call us at (888) 321-8131.