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, known as a lumbosacral transitional vertebra (LSTV), 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 in-depth look at 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.

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

Key Evidence for a Bertolotti’s Syndrome LTD Claim

An LTD claim for Bertolotti’s Syndrome requires a thorough and well-organized presentation of medical evidence to support the disabling nature of the condition. Essential evidence includes:

1. Medical Imaging and Diagnostic Records:
   • X-rays, MRI or CT Scans: These imaging studies are critical to confirming the presence of the structural abnormality (e.g., the fused or malformed vertebra). Imaging studies can verify the presence of LSTV and illustrate any associated degeneration or spinal misalignment caused by the syndrome.
   • Nerve Conduction Studies: If sciatica is present, nerve conduction studies can document nerve irritation or compression, further supporting claims of pain and decreased mobility.
2. Physician’s Statements and Clinical Documentation:
   • Specialist Reports: Reports from orthopedic or neurological specialists describing the nature and extent of your spinal abnormality and related symptoms can support your disability claim.
   • Pain Management Records: Documentation of treatments from pain management clinics, such as steroid injections or nerve blocks, can help prove that your condition is severe enough to require ongoing pain management efforts.
   • Detailed Symptom Descriptions: Medical records should reflect the consistent reporting of disabling symptoms, such as chronic pain, weakness, and functional limitations. Doctors’ notes that specifically describe how these symptoms affect your daily life and ability to work are especially valuable.
3. Residual Functional Capacity (RFC) Assessment:
   • Functional Limitations: An RFC evaluation documents specific functional limitations, such as restrictions on lifting, bending, sitting, and standing. For example, if you cannot stand for more than 10 minutes or must alternate between sitting and standing every 20 minutes, these details will help support your inability to work.
   • Daily Activity Limitations: A well-documented RFC can show how Bertolotti’s Syndrome restricts not only work-related activities but also basic daily activities, adding weight to your claim.
4. Treatment History and Response:
   • Failed Conservative Treatments: Showing that you have tried conservative treatments such as physical therapy, chiropractic care, medications, or injections without long-term relief can demonstrate the severity of your condition.
   • Surgical History (if applicable): Some people with severe Bertolotti’s Syndrome undergo surgery. Records of the surgery, recovery, and any persistent symptoms afterward can further demonstrate that you have exhausted reasonable treatment options.

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

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.

How a Long-Term Disability Attorney Can Help with a Bertolotti’s Syndrome 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 Bertolotti’s Syndrome 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 consultation 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 consultation today.