Sjogren's Syndrome May Qualify For LTD Benefits

What is Sjögren’s Syndrome?

Sjögren’s Syndrome is an often misdiagnosed autoimmune disease that affects the entirety of the body. Several symptoms include fatigue, painful joints, and dry eyes and/or mouth. In addition to those symptoms, patients with Sjögren’s can have problems with major organs, including the lungs, kidneys, liver, pancreas, gastrointestinal system, central nervous system, and blood vessels. A patient’s symptoms may remain consistent, increase in intensity, or occasionally go into a state of remission. Similarly, symptoms may be severe for some patients, while they may be minimal in others.

Over 4,000,000 Americans suffer from this disease, and nine out of ten of those sufferers are women. However, the disease has been found to be present in almost every race or ethnicity. As the symptoms of the disease are similar to other health conditions, it is easy to misdiagnose Sjögren’s Syndrome. In fact, the average diagnosis of Sjögren’s takes almost three years to be made. Several examples of similar diseases include chronic fatigue syndrome (CFS), multiple sclerosis, lupus, fibromyalgia, and rheumatoid arthritis. It is also not uncommon for a patient who has Sjögren’s Syndrome to have another autoimmune disorder. Additionally, certain side effects of medicine (i.e., allergy medication, antidepressants) can create symptoms that are similar to those of Sjögren’s.

Diagnosis of Sjögren’s Syndrome

Generally, a rheumatologist is the primary physician who diagnoses and treats Sjögren’s. While there is not one test alone that he or she can perform that will indicate whether a patient has Sjögren’s Syndrome, the more positive indicators of Sjögren’s, the more likely that Sjögren’s is the proper diagnosis. There are three main categories of tests that can indicate Sjögren’s: blood tests, eye tests, and dental tests. The blood tests primarily involve identification of certain antibodies in the patient’s blood, inflammation, and/or the presence of certain amounts of blood proteins. Eye tests, on the other hand, involve an analysis of tear production and dry spots on the eyes. For dental tests, saliva amounts or salivary gland function may be measured.

Treatment of Sjögren’s Syndrome

While there is no cure for Sjögren’s Syndrome yet, there are a number of treatments that can assist with symptoms. For dry eyes and dry mouth, there are over the counter (OTC) medicines that may help. Depending on the severity of the symptoms, a patient may also be prescribed immunosuppressive treatments by his or her physician. As each patient’s symptoms are unique, the best plan of action is to meet with a physician to personalize a treatment plan to match exactly what the patient needs.

Ways to Determine Whether One Qualifies for Long Term Disability Insurance Benefits

For a determination of possible long term disability insurance benefits due to symptoms of Sjögren’s Syndrome, a claimant must prove that their symptoms are so debilitating that they are unable to work as a result.

What the Insurance Company Needs from You and/or Your Medical Providers

When an insurance company or other agency evaluates an application for disability benefits, they will want to know what the limitations of the patient are. To provide this information, a patient should gather any relevant records and/or medical history related to Sjögren’s Syndrome. This can include hospitalizations, treatment dates, physician reports and findings, as well as any test results that might indicate or be related to the disease. It is also important to include any physician opinions on what the patient may or may not be able to do as it relates to the symptoms exhibited. Specifically, an insurance company will need to know the intensity or severity and frequency of the symptoms and how those symptoms could inhibit a person in a working environment.

Evaluating Disability for Persons with Sjögren’s Syndrome

The evaluation process will take further analysis by an insurance company or other agency in order to determine what benefits a patient qualifies for. For example, if symptoms include fatigue and a job requirement is to be highly alert at all times, there may be limitations on what activities a patient can do. Further, if a patient has painful joints, he or she may be limited from lifting amounts heavier than 25 pounds. Depending on the evaluation of how debilitating a patient’s symptoms are and whether that person may be completely unable to work as a result, he or she may qualify for disability benefits.

How the Insurance Company Assesses Your RFC

In light of your documented symptoms, the insurance company may develop a Residual Functional Capacity (RFC) evaluation for you that states, for example, that due to persistent pain and/or fatigue you need to take frequent breaks throughout the day to rest as needed. Because most employers would not accommodate more than one or two rest breaks at scheduled times, it would be difficult for you to obtain and maintain most jobs.

If you suffer from documented fatigue as well as muscle pain and weakness, your RFC may include limitations on certain work-related physical (or exertional) activities. For example, the RFC may state that you cannot lift or carry objects that weigh more than 10-15 pounds. This limitation would prevent you from doing jobs that required extended physical exertion, such as factory work, warehouse work, and most janitorial positions.

Mental illnesses such as anxiety and depression may also be associated with Sjogren’s Syndrome. If you are seeing a therapist or psychologist for treatment of a mental illness, you should report this to the long term disability insurance company and provide it with the treatment notes from your provider. The adjuster assigned to your claim will use the behavioral health records to prepare a mental RFC that addresses your ability to perform the mental tasks required for different types of work activity. For example, if you suffer from severe anxiety or depression, you may have difficulty maintaining attention or concentration required for your work, or even exhibit difficulty showing up for work on a regular basis. Anxiety and depression can also interfere with your ability to interact with coworkers. The insurance company will consider the severity of these symptoms when determining their limiting effect on your ability to work.

If you are receiving physical (or mental) health treatment, you should ask your treating physician (your psychiatrist or psychologist), to fill out an RFC form that details his or her opinions of your work-related limitations. Keep in mind that the insurance company they will assign them weight only they are supported by objective medical evidence.