Muscular Atrophy

What is Muscular Atrophy?

Muscular atrophy is muscle wasting from being physically inactive. Most commonly, muscle wasting is a result of loss of function as a result of physical injury or disease. If a person is unable to be physically active, the muscle loses mass and sometimes the ability to function correctly. This can happen in people who have had bad accidents, women on bed-rest for pregnancy complications, or elderly people who have difficulty exercising. It can also happen as a result of genetic conditions like spinal muscular atrophy.

In some cases, returning to normal activities can reverse muscular atrophy. For cases that are a result of an underlying disorder, this may not be possible. The focus for those conditions is on delaying the progression of symptoms for as long as possible.

Diagnosing Muscular Atrophy

In muscular atrophy the muscle looks smaller, though not any shorter. A clinical assessment and patient history can diagnose loss of muscular function.

In cases of injury, a physician may not conduct further tests to find the cause of muscular atrophy. If the cause is not known, it is important to try and find out what may be causing the muscles to waste away. Some tests include:

  • MRIs or CAT scans of the affected area, brain, and spinal column
  • Blood enzyme tests, usually for creatinine kinase (an enzyme that is released when muscles breakdown)
  • Genetic testing for genetic conditions like spinal muscular atrophy
  • Muscle biopsy
  • Electromyogram (EMG)

Treating Muscular Atrophy

Keeping as physically active as possible can keep symptoms of muscular atrophy from progressing as quickly. Physical therapy is a primary treatment. Patients should also be encouraged to be physically active, even if it is difficult to do so. Choosing a rollator, a walker with wheels and a seat, can encourage a person to walk when possible but also take breaks if needed. Braces or splints can help the affected area. Often patients find that stopping their physical activity causes symptoms to quickly progress.

People with muscular atrophy may have a difficult time with everyday activities. For people with severe muscular atrophy, even simple activities like sitting up or turning over in bed may be physically impossible. Pressure sores, commonly called bedsores, are painful sores that develop when a person is in the same position for a long period of time. Basic self-care like dressing or using the bathroom may also be difficult. Home health aides or personal care aides may be required.

If muscular atrophy has affected other muscle groups, like in the throat or chest, simple body functions like swallowing or breathing may be difficult. Medical interventions may be necessary.

Disability Evaluation of Muscular Atrophy

Muscular atrophy is not considered to be disabling in all people. Some people can reverse the atrophy with physical therapy or lifestyle changes. Others on the more severe side of the scale find that their muscular atrophy prevents them from working or taking care of basic life functions. People who cannot work because of their muscular atrophy must apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the specific 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 work duties for the first two years of the policy and 2) be unable to work in almost any job for the following years. Each LTD plan defines disability as slightly different, so look over your plan policy to see how your plan determines “disabled.”

Evaluating Disability for People with Muscular Atrophy

Muscular atrophy is not a condition that is automatically considered to be disabling. You must prove that your muscular atrophy prevents you from doing your old job or any job that you could be trained to work and that the condition will last for at least a year. The insurance company will look to see if your symptoms match closely with another condition in the Blue Book, the document the Social Security Administration (SSA) uses to list conditions that are recognized as disabling. The most similar condition to muscular atrophy in the Blue Book is Muscular Dystrophy. In order to qualify for disability with muscular dystrophy, an individual must have difficulties with standing up, balancing while walking or standing, or have loss of the use of their arms.

The primary qualifier for many patients seeking disability benefits for muscular atrophy will be the Residual Functional Capacity (RFC) assessment that indicates how the condition affects and limits their life activities. For people who are unable to use their arms, jobs that require them to lift heavy objects or even small objects like phones or pencils may be impossible. Physically demanding jobs may be out of the question, even for people that do not have severe muscular atrophy.

If your muscular atrophy caused by another condition, you may be meet disability requirements for that condition. You may be eligible for benefits even if your muscular atrophy is not severe enough to qualify. It is in your best interest to list any conditions that affect your function.

What the Insurance Company Needs From You and Your Medical Providers

You should tell the insurance company about any doctor that has treated you for your muscular atrophy or related conditions. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself. Important records to include are:

  • Physician notes
  • Bloodwork
  • Physical therapy notes
  • Diagnostic test results

You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. 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.

Working with a Disability Attorney

An experienced disability attorney will give you the best chance of getting the disability benefits you have earned. Even if you have been denied disability benefits, that does not mean your case is over. It is not unusual to be denied the first time you apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be intimidating, your expert disability attorney will be able to guide you through the process. Since they receive their payment from awarded funds, they do not get paid unless you win your case. You can seek help without worrying about upfront costs or unexpected bills.

The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your muscular atrophy and its impact on your ability to work, call us at (888)321-8131. We would be happy to evaluate your case and to discuss how to help you through the appeal process.


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The Field Interview in Long Term Disability Insurance Claims