Winning Isn't Easy Season 3 Episode 37: Moyamoya Disease & ERISA Disability Claims

Welcome to Season 3, Episode 37 of "Winning Isn't Easy"! 🎙️

In this enlightening episode, your host, Nancy L. Cavey, explores the intricate world of "Moyamoya Disease & ERISA Disability Claims." Moyamoya Disease is a rare and complex condition that can have a profound impact on an individual's life, making it essential to understand the intricacies of pursuing disability claims under ERISA (Employee Retirement Income Security Act).

In this episode, you'll gain insights into:

🧠 What Moyamoya Disease is and how it affects individuals.
📄 The importance of medical documentation and evidence in ERISA disability claims related to this condition.
🤝 Tips and strategies for building a compelling disability case when dealing with Moyamoya Disease.

Nancy will leverage her extensive expertise in disability law to provide valuable guidance for individuals and their representatives who are navigating the challenges of ERISA disability claims associated with this rare condition.

Whether you or someone you know is affected by Moyamoya Disease or you're a professional assisting clients in similar situations, this episode offers crucial information to help you advocate effectively.

Tune in to Season 3, Episode 37 of "Winning Isn't Easy" to gain a deeper understanding of Moyamoya Disease and its implications on ERISA disability claims. 📻🧠

Resources Mentioned In This Episode:

LINK TO ROBBED: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO PROFESSIONAL BOOK: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/

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Please remember that the content shared is for informational purposes and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Disability Attorney Nancy Cavey: 0:14

Hey, I'm Nancy Cavey , national ERISA and Individual Disability Attorney. Welcome to this week's episode of Winning Isn't Easy. Before we get started, I've gotta give you that legal disclaimer. The podcast is not legal advice. The Florida Bar Association says, I've gotta say it and I've said it, but nothing will prevent me from giving you easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So, off we go. Now, today, I'm gonna devote this episode to one very specific and rare disease called Moyamoya disease. I've never heard of it until recently when I was retained by a client who has MoyaMoya disease. Um, even if you don't have a disease, I think you should stick around because there are many rare diseases , uh, that , uh, can be the cause of an ERISA disability claim. And the games that disability carriers play are really the same, but a little more , um, nuanced, if you will, in the case of a rare disease. So, I'm gonna talk about getting your ERISA disability benefits from Moyamoya disease, the types of treatment that the carrier expects that you get , uh, and strokes moyamoya disease, and the complications of , uh, moyamoya disease and your ERISA disability claim. Now, I said, please stick around. And one of the reasons, again, that you should stick around is that many medical conditions will have secondary complications such as a stroke in a myo may disease , uh, uh, case or other complications. Those complications or secondary medical conditions can in and of themselves be the basis of a disability claim. So, while you may not have moyamoya disease, the complications of your medical conditions can be the basis of a claim, and that's a reason why you should continue to listen to this podcast. Let's take a break. First,

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Disability Attorney Nancy Cavey: 2:35

Welcome back to Winning Isn't Easy. Let's talk about getting your ERISA disability benefits for Moya Moya Disease. But think about this, about getting your ERISA disability benefits for progressive and ongoing medical conditions. Now, Moya y disease is a rare but chronic progressive condition of the arteries of the brain that can lead to disability. The narrowing of the blood vessels can lead to blockages that can cause ischemic strokes, hemorrhagic strokes, and seizures. Any one of these complications can result in a disability insurance claim. So if you have suffer, for example, from MS or Parkinson's, think about the complications that you might have as the disease progresses. The underlying MS in and of itself, or the underlying PD may not be disabling, but it's the complications of the disease process, particularly as it progresses that can result in a disability claim. Disability carriers are always going to be , uh, looking at your medical records and using their medical record toolbox of claim, denial and termination tools to effectuate a denial or termination of a claim. One of the common things that we see, regardless of the nature of the disease, is the game they play by cherry picking your medical records. Now, what's important here, regardless of the nature of your medical condition, is that you're developing those symptoms and that those symptoms are reflected in your medical records. So let's take on my Mya Disease and Moyamoya disease. The disability carrier is gonna be first looking for a diagnosis based on objective medical testing, such as M mri , CT scans , uh, PET pets or spec imaging. Um , and in that case, they're looking for this puff of smoke or tangle of tiny blood vessels that's confirms the diagnosis. So, for example, if you have ms, they're gonna be looking at a brain scan , uh, or a spinal , uh, uh, um, testing that documents white matter lesions or other changes. In the case of moyamoya , they're gonna be looking for an EEG. They're gonna look for a history of mini strokes, seizures, visual problems, cognitive decline, and of course, they're gonna be looking at the diagnostic studies to confirm that. So let's go back to the ms. They're going to be looking for, for example, the symptoms that you have , uh, with problems with balance and coordination problems , uh, with , uh, visual issues, problems with cognition, problems with , uh, tremors. Um, they're gonna be looking for the typical symptoms that one would see in ms, and then they're gonna look at the diagnostic studies to confirm in fact, that you really have those particular problems. So they might want to see visual testing. What's crucial in your medical records is the documentation not only of the diagnosis and the objective basis of the diagnosis, but the symptoms that prevent you from performing your own or any occupation in view of your education training experience, and whatever your restrictions and limitations. So in the case of Moya Moya , you might have had a stroke that left you with paralysis, weakness, impaired vision, speech balance , uh, and , and other issues. The nature of those problems and the restrictions and limitations caused by each of these symptoms should be developed in your medical records. Same way. For example, in the case of of uh , pd, you wanted to document what in fact the problems are that you're having by body system, if you will, and then the restrictions and limitations assigned based on those particular problems based on the body system and document how that is objectively based. 'cause you gotta tie this together, the diagnosis, the symptoms, and the restrictions. Limitations. You can see even in the case of Moya Moya , which is a rare disease, that carriers don't always understand these claims, they don't necessarily see a lot of them. And even if they do, they don't understand the disabling impact , uh, they they can have on a policy holder. Now, again, I think that not only is the diagnosis important, but more important is the complications that you will see from the , uh, ongoing disease process. Uh, that should be documented objectively in the medical records based on the , uh, objective findings correlated with your symptoms, and then mixed together, if you will, with , uh, winning , um, attending physician statement form, documenting your restrictions or functional capacity testing or cognitive testing. This all can be enhanced, of course , uh, by statements from family members and friends, your employer. But again, even in the case of a rare disease like Moya Moya, the process is the same. The game is a little different depending on the nature of , uh, the disease, but the process is the same. Hope you get this, let's take a break. All right , welcome back to winning Isn't Easy. Let's talk about the three types of treatment in a ERISA disability , uh, claim that you're expected to get if you have Moya Moya , uh, disease. Now, this holds true regardless of the nature of your medical condition, but I think even so more with chronic , uh, conditions, particularly if the carrier has accepted the claim, they're paying benefits, and then they decide to stop paying benefits. I mean, I've seen and had cases where clients have been on claim for 10, 15 years, and all of a sudden, based on a peer review , uh, the carrier says, you've improved Heavens know how, and you can go back to , uh, doing a , uh, any type of , uh, occupation based on your education, your training, and whatever restrictions, limitations we think are applicable. So this is a game, a game generally played in chronic medical conditions. Now, the diagnosis of any chronic medical condition, be it moyamoya pd , um, Parkinson's , uh, dementia, you name it, they can be devastating. And it's the progression of the disease and the complications that can lead to the ERISA disability claim. Disability policies or plans require that you get reasonable and appropriate medical treatment , uh, and that's a requirement to continue to get your disability benefits if you don't get appropriate care by a specialist. If you don't get reasonable care based on the level of severity, if you don't, if you're not compliant with the medical care, that failure in and of itself can be the reason for denial of the claim without them even getting to the issue of whether or not you're disabled. And a Moya Moya claim is no different. So in the case of a Moya Moya , uh, claim, the carrier is going to expect medication. Uh , for example, if you've had seizure because of moyamoya , they're gonna expect that you're taking anti-convulsant medication to prevent further seizures. If you had a stroke, they're gonna expect that you would've gotten blood thinners to decrease the risk of your stroke. Um, if you have a medical condition that's , uh, can be treated by surgery, the disability carrier will expect that you either had that or there's a darn good reason why you haven't had it. So let's say for example, you have cluster headaches, which is a progressive condition. One of the recommendations for treatment is deep brain stimulation surgery. They can't make you have that surgery, but they wanna understand why you didn't have the surgery. So in the case of Moya Moya , you'll be expected to have undergone revascularization surgery if your brain scan shows low blood flow. Uh, if you're at risk for a brain aneurysm, the carrier might review your records to see whether you've gotten surgery to prevent or treat the ruptured aneurysm and the results of that surgery. The third thing that we'll generally look for in medical records is therapy. Now, that could be physical therapy, occupational therapy, speech therapy , um, and if you've had cognitive complications, the carrier's gonna expect that you'll have had neurocognitive testing to corroborate your complaints, for example, of memory loss or problems with executive functioning and cognitive behavioral therapy. So you can see , uh, at every level of the progression of , uh, a disease or disabling condition, they're gonna expect a certain level of treatment, they're gonna expect compliance, and they're going to expect that that treatment , uh, rises to a level, if you will, that correlates with your severity , uh, of your claimed medical condition . Uh , many times that's one of their favorite defenses is, you know, you can't be in as much pain as you say you are. You can't have , uh, as many cognitive problems as you say you have, or you can't have this or that because you're not getting a level of care now, a level of care, by the way, that's commensurate with what you're claiming that you're disabled. So in other words, you can't be in as much pain 'cause you're not getting a lot of treatment. That's not true. Um, and disciplinary carriers will still seize on that. Now, you may have a situation where you don't react well to medication. Uh , the disciplinary carrier's gonna expect that you have tried different types of medication or treatments or therapies with a report of your response to that and why it's necessary to try a different kinds of , uh, therapeutic treatment. And then your response to that, the other game that you have to really be aware of in terms of this medical treatment issue is the game of the mental nervous limitation. Well , what do I mean by that? Because your physical, your medical condition is organic. There's a scan that shows you have PD or Parkinson's, or you've got Moya Moya based on scans. What the disability carriers will do is they will apply one of two , uh, conditions or terms in a disability policy to this case. You might have a subjective medical condition limitation that says if your , uh, medical condition is characterized by pain limited range of motion or list conditions like migraines or fibromyalgia. And so laundry, laundry list benefits are limited to just two years. So the disability carrier will try to seize on subjective symptoms even though you have an objective diagnosis, and they'll do that to limit benefits to just two years. The other thing that they will do is to apply a mental nervous limitation, particularly if the mental nerve , mental nervous policy limitation says, Hey, benefits are limited to just two years. If a psychiatric condition like depression or anxiety has caused or contributed to your disability, it's that contributed to what I call the Monty Python Wafer Thin contribution. That can limit benefits to just two years, because legitimately you're depressed. It doesn't matter if you've got a back injury, Moya, Moya , Ms . PD , fibromyalgia, you name it, you probably are depressed. And if you have a disability policy that limits benefits to just two years based on that contribution language, there's a potential problem, a problem that potentially also can be addressed and solved. But you need to know that now because that goes to the carrier toolbox of reasons, if you will, that a claim can be denied. You haven't gotten appropriate treatment by an appropriate person , uh, at a level that is consistent with your complaints, and by the way, you're depressed. And so we're going to sneak in as a defense that mental nervous condition or say, Hey, it's all subjective. We're limiting benefits to just two years. So I hope you understand the games that can be played just based on the expectation that you get treatment. Let's take a break.

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Disability Attorney Nancy Cavey: 15:43

Welcome back to Winning Isn't Easy. Let's talk about strokes and moyamoya disease and a ERISA disability claim. Now remember, I think that this is applicable regardless of the nature of your disease, but particularly applicable to chronic diseases, progressive diseases or rare diseases, Moyamoya diseases, a rare blood vessel disorder. It will cause blockage of the carotid artery. That in turn is going to block blood flow into the tiny blood vessels that are developed at the base of the brain. And obviously that's how your , um, body supplies your brain , uh, with oxygen and , and , um, nutrients. Now, the tiny blood vessels , uh, that are impacted can result in moyamoya disease. And moyamoya is a Japanese term that refers to a hazy puff of smoke or clout . And that's what the blood vessels will look like on a scan. Similarly, you might have pd, you might have ms. So the disability carrier is gonna be looking at those scans to see what they would expect to see. That is the basis of the diagnosis. But many times carriers then forget the rest of the picture, if you will, and that's the complications of the disease. Now, in , in moyamoya disease, you can have transient ischemic attacks or strokes. Any one of those can result in impairment. So, for example, a stroke can result in visual impairment, can result in cognitive impairment, can result in physical impairment , uh, and it's often the complications of the underlying disease that can result in an ERISA disability claim. Um , so let's take it an example of, of of a person who has , uh, moyamoya disease and has a stroke , or a person who , uh, has epilepsy and has , um, a stroke complication or a cardiac disease with a stroke complication. Remember, there are all sorts of complications that can occur with acute medical conditions and chronic conditions. But let's, for the sake of this discussion, talk about stroke comp complications. So your medical records need to document the diagnosis, be it moyamoya disease , um, heart disease, ms, you name it, it should be documented. Then what you have to do is document the stroke, IE the complications. Um, it could be it because of the stroke you have vis visual issues or cognitive issues. So the carrier's gonna want to see, as I've said, visual uh , testing , uh, visual acuity testing. They're gonna want to see neurocognitive testing. Um, as again, I said in the case of a stroke, for example, the carrier's gonna look for symptoms of weakness, numbness, paralysis , um, visual problems, trouble speaking, known as aphasia, headaches, involuntary movements, cognitive issues. And it is those complications that are going to win , I view, I think rather your disability claim. So I think, and I recommend to my clients that they give a really good interval history between each visit about their symptoms and their functionality because you want the doctor to document that. Now, I recently had a case where my client who has cognitive impairment came in with a very, very detailed history , uh, uh, interval history, and the doctor questioned how my cognitively impaired client could write all this down, remember it, do it in such an orderly fashion and questioned the disability. And of course, we had to explain that it wasn't the client who was keeping this diary, it was the spouse that was keeping this diary. Uh, so we gotta , we have to be careful about these diaries, if you will. These, these , um, interval histories. We want to be , uh, explaining what's going on, but not in so much detail that one questions whether you can actually , you actually have these complications, whether there's exaggeration and who's documenting this. So there not needs to be a nice balance, if you will, because ultimately the physician is gonna be relying on your report of your symptoms and complications, their observations and rendering opinions about your functional restrictions and limitations. Obviously, your , your in the case, for example, of a stroke, the doctor's going to be taking an interval history of your symptoms, doing a physical examination, commenting on your restrictions and limitations, commenting on your treatment and your response to treatment. So the medical records shouldn't tell an incomplete history just about symptoms, just about treatment, just about your response to treatment, but should tell a story like a book chapter by chapter by chapter with a beginning, a middle, and an end. I know that people , uh, tend to answer questions of doctors, perhaps glibly like the doctor says, how are you doing? And you say, you're fine. And the doctor thinks, well, hmm , they said they were fine, but what about all these laundry list of problems? So don't be glib about this. Take this very seriously because well-developed medical records can make all the difference in getting and keeping your ERISA disability benefits. I hope you've enjoyed this week's episode of Winning Isn't Easy and Learn lessons , uh, from a Moyamoya claim, and you wonder why on Earth is she talking about that? And have learned today that these kinds of issues that are , you see in moyamoya diseases claims arise in all sorts of chronic and , uh, progressive medical condition claims. It's the same game, unfortunately, just a different disease. If you've enjoyed this episode, please like this page, leave a review, share it with your family and friends, and of course, subscribe to this podcast. That way you'll be notified each time a new episode comes out. I look forward to talking with you in next week's episode of Winning Isn't Easy.