Understanding Bertolotti’s Syndrome And Long-Term Disability Claims

Bertolotti’s Syndrome is a spinal condition that results from a congenital malformation of the lumbosacral spine, typically resulting in an abnormal connection (or fusion) between the fifth lumbar vertebra (L5) and the sacrum. This fusion can cause problems with the alignment and structure of the spine, resulting in chronic pain, limited mobility, and other debilitating symptoms that make it difficult to function and work.

People with Bertolotti’s Syndrome often experience severe limitations, and in some cases, may qualify for long-term disability (LTD) benefits if they can demonstrate how their symptoms affect their ability to perform work-related activities. Here is an overview of Bertolotti’s Syndrome and how it relates to long-term disability insurance claims.

Symptoms and Complications of Bertolotti’s Syndrome

Symptoms of Bertolotti’s Syndrome vary depending on the degree of vertebral malformation and the extent of nerve involvement. While some individuals with an LSTV may be asymptomatic, others experience severe, chronic symptoms that interfere with daily activities and work responsibilities. The most common symptoms include:

• Chronic Lower Back Pain: Persistent, often severe pain in the lower back is a hallmark symptom of Bertolotti’s syndrome. The pain is typically aggravated by physical activities that place stress on the lower back, such as lifting, twisting, bending, or prolonged standing.
• Sciatica or Radicular Pain: This occurs when the abnormal bone structures compress or irritate the sciatic nerve, causing pain that radiates from the lower back down one or both legs. The pain associated with sciatica can be sharp, shooting, or feel like an electric shock.
• Limited Mobility: Many people with Bertolotti’s Syndrome have difficulty with movements that involve the lumbar spine. Actions such as bending, stretching, or even sitting for prolonged periods can be extremely painful.
• Muscle Weakness and Fatigue: Constant stress on the lower back muscles and the sciatic nerve can lead to reduced lower body strength and endurance. This can affect balance, gait, and the ability to stand or walk for long periods.
• Frequent Need to Rest and Change Positions: Pain and discomfort often force people with Bertolotti’s Syndrome to change positions frequently, take breaks, or rest, which can make it difficult to meet job requirements that require prolonged standing, sitting, or uninterrupted concentration.

The severity and persistence of these symptoms often limit a person’s ability to hold a regular job, especially one that requires physical labor. Even sedentary jobs can become challenging due to the need for frequent position changes and rest breaks. Given how debilitating these symptoms can be, many people wonder whether they qualify for long-term disability benefits.

Does Bertolotti’s Syndrome Qualify for Long-Term Disability?

Eligibility for long-term disability benefits due to Bertolotti’s Syndrome depends on the specific terms and definitions outlined in the individual’s LTD insurance policy. Disability insurance policies generally define disability in one of two ways:

• Own Occupation: The policyholder is considered disabled if they cannot perform the specific duties of their current job.
• Any Occupation: The policyholder must prove that they cannot perform any job for which they are qualified based on their education, training, and experience.

To qualify for LTD benefits under either definition, claimants must provide substantial evidence of how Bertolotti’s Syndrome impairs their ability to work. This evidence may include medical documentation, functional evaluations, and records of ongoing treatment that demonstrate the severity and persistence of their symptoms.

RELATED POST: Own Occupation vs Any Occupation In Long-Term Disability Insurance Claims

What Evidence Do You Need for a Bertolotti’s Syndrome Long-Term Disability Claim?

If you’re preparing a long-term disability (LTD) claim for Bertolotti’s Syndrome, you’ll need more than just a diagnosis. Insurance companies want clear, detailed evidence that shows how your condition limits your ability to work and function day to day.

Below is a breakdown of the types of evidence that can help support a strong LTD claim for Bertolotti’s Syndrome:

Key Evidence for a Bertolotti’s Syndrome LTD Claim

Evidence Type	Examples
Medical Imaging	X-rays, MRI, CT scans
Nerve Studies	Nerve conduction tests
Specialist Reports	Orthopedic or neurological evaluations
Pain Management Documentation	Injections, nerve blocks, treatment logs
Doctor’s Symptom Notes	Notes on chronic pain, weakness, limited mobility
RFC Assessment	Physician-completed form with physical work limitations
Daily Activity Limitations	Notes on difficulties with cooking, cleaning, walking, standing, etc.
Conservative Treatment History	Physical therapy, medications, chiropractic care
Surgical Records (if applicable)	Surgical notes, follow-ups, persistent symptoms after procedure

Now let’s take a closer look at each type of evidence and why it matters.

1. Medical Imaging and Diagnostic Testing

Objective medical evidence is crucial to proving the existence and severity of your condition.

• X-rays, MRI, or CT Scans: These tests can confirm the presence of structural abnormalities—such as lumbosacral transitional vertebrae (LSTV)—as well as any resulting degeneration or spinal misalignment. Imaging helps show the connection between your condition and your symptoms.
• Nerve Conduction Studies: If you’re experiencing sciatica, nerve conduction studies may reveal nerve compression or irritation, further supporting your complaints of pain and limited mobility.

---

2. Physician’s Reports and Clinical Notes

Detailed documentation from your doctors provides a narrative that connects your diagnosis with your limitations.

• Specialist Reports: Orthopedic and neurological specialists can describe how your spinal abnormalities and symptoms affect your ability to function and work.
• Pain Management Records: Records of treatments like steroid injections or nerve blocks help demonstrate that your pain is severe enough to require ongoing care.
• Doctor’s Notes Describing Symptoms: Your medical records should include specific descriptions of your symptoms—chronic pain, muscle weakness, and limited range of motion—and explain how they interfere with daily life and work.

---

3. Residual Functional Capacity (RFC) Evaluation

An RFC form, completed by your treating provider, outlines the physical and functional limitations caused by your condition. This form gives the insurance company a clearer picture of how your symptoms limit your ability to perform work and daily activities on a consistent basis.

Here are some of the types of limitations that may be documented on an RFC form:

• Workplace Limitations: These might include restrictions on sitting, standing, walking, lifting, bending, or maintaining posture throughout the day. For example, your provider might note that you can only sit for 10 minutes at a time or that you require frequent breaks to lie down.
• Daily Activity Limitations: Your RFC may also describe how Bertolotti’s Syndrome affects your ability to perform everyday tasks like cooking, cleaning, bathing, or dressing. These details help reinforce that your condition impacts more than just job-related duties—it affects your overall functional capacity.

---

4. Treatment History and Response

Insurance companies want to see that you’ve tried to manage your condition.

• Failed Conservative Treatments: If you’ve tried physical therapy, medications, chiropractic care, or injections without long-term relief, this supports the seriousness of your symptoms.
• Surgical Intervention (if applicable): If you’ve had surgery due to Bertolotti’s Syndrome, records of the procedure and any ongoing symptoms afterward can further support your claim and show you’ve exhausted reasonable treatment options.

---

Challenges in Proving Disability for Bertolotti’s Syndrome

Bertolotti’s Syndrome can be difficult to prove as a disability due to its often variable and subjective symptoms. Some insurance companies may argue that because Bertolotti’s Syndrome does not always produce clear objective functional limitations, claimants could theoretically perform sedentary work. In addition, insurers may suggest that conservative treatments should be effective, even if a patient’s experience suggests otherwise. Accurate documentation of your symptoms and functional limitations is critical.

Legal Help Can Strengthen Your Claim

Building a successful long-term disability claim for Bertolotti’s Syndrome takes more than a stack of medical records. You need to present the right evidence, in the right way. At the Ortiz Law Firm, we help claimants gather the strongest possible documentation, work with their doctors to complete detailed RFC forms, and fight back against unfair denials.

If your claim has been denied or you need help building your case, contact us today for a free consultation.

RELATED POST: Residual Functional Capacity Forms [Download A Free RFC Form]

How Can a Long-Term Disability Attorney Help with My Claim?

An experienced long-term disability attorney can be invaluable in helping you organize and present the strongest claim possible. Here is how a lawyer can help:

1. Gather and Present Medical Evidence: An attorney can help you obtain detailed medical records, physician statements, and necessary imaging results to substantiate your condition.
2. Securing a Robust RFC Evaluation: Your attorney can work with your healthcare providers to ensure that your RFC assessment fully reflects your limitations and how they prevent you from working. This is especially useful because RFCs can address factors that insurers may overlook in standard medical records, such as the need for frequent breaks or the inability to sit or stand for extended periods.
3. Prepare and File an Appeal: Insurance companies often deny initial claims, especially for musculoskeletal conditions such as Bertolotti’s Syndrome, which relies on subjective symptom reporting. An attorney can file an appeal and present new evidence or a more detailed analysis of your limitations to strengthen your case.
4. Navigate Complex Policy Language: Disability insurance policies can have complex language, especially when it comes to defining what qualifies as a “disability.” Your attorney can interpret the policy language to ensure that your claim meets all the necessary definitions and standards for approval.
5. Provide Guidance Through the Process: The appeal process can be lengthy and overwhelming, especially if you are dealing with chronic pain. An experienced attorney can manage the administrative burden, allowing you to focus on your health while they manage communications with the insurance company.

Get Help with Your Long-Term Disability Claim

If you are having trouble working due to the symptoms of Bertolotti’s Syndrome, you may be eligible for long-term disability benefits. Unfortunately, proving disability for conditions like Bertolotti’s Syndrome can be complex. An experienced attorney can make a difference by helping you gather the necessary evidence, presenting your claim in a clear, organized manner, and advocating on your behalf if the insurance company denies your claim.

At the Ortiz Law Firm, we understand the impact that chronic spinal conditions can have on your ability to work and live comfortably. Contact us for a free case evaluation to discuss your case and let us help you take the next steps toward securing the benefits you need. Call (888) 321-8131 to schedule a free case evaluation today.