Vestibular Disorders - Dizziness, Meniere's Disease, and Benign Paroxysmal Positional Vertigo

Welcome to Season 4, Episode 33 of Winning Isn't Easy.  In this episode, we'll dive into the complicated topic of "Vestibular Disorders."

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses vestibular disorders, which are disorders impacting the vestibular system (responsible for balance). Join Nancy as she covers the basics of vestibular disorders, and walks through three in particular: dizziness, Meniere's Disease, and benign paroxysmal positional vertigo (known as BPPV). Even if you don't have a vestibular disorder, this episode will provide valuable insight into how disability carriers react to and handle claims based on subjective complaints.

In this episode, we'll cover the following topics:

1 -  What You Need to Know about How Disability Carriers View Vestibular Disorder Disability Claims

2 - What Are the 21 Things Your Doctor Should Address in Your Medical Records in Your ERISA Disability Claim for Dizziness?

3 - What Medical Testing Will a Disability Carrier Expect in My Meniere’s Disease Long-Term Disability Claim?

4 - Benign Paroxysmal Positional Vertigo (BPPV) and an ERISA Disability Insurance Claim

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

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


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Transcript

Nancy Cavey [00:00:15]:
 Hey, I'm Nancy Cavey, national Erisa and Idi, disability attorney. Welcome to winning isn't easy before we get started, I've got to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I've got to tell you that. But now that I've said it, nothing will ever prevent me from giving you an 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. Vestibular disorders are disorders that impact the vestibular system that controls balance. These disorders can be highly disabling, but they can be difficult to objectively prove and convince the disability carrier that you're entitled to the disability benefits you deserve.
 
 Nancy Cavey [00:01:03]:
 Now, I will tell you that disability carriers hate these claims, and you need to be educated before you stop work and apply for benefits because of vestibular disorders. I'm going to take a deep dive into three vestibular dizziness, Meniere's disease, and BPPV. Specifically, I'm going to talk about four things today. First, what you need to know about how disability carriers view vestibular disorder disability claims. Secondly, the 21 things that your doctor should address in your medical records in your ERISA disability claim for dizziness. Thirdly, what medical testing a disability carrier will expect to see in your meniere's disease long term disability claim. And lastly, BPPV and your ERiSa disability insurance claim. Let's take a break before we get started.
 
 Nancy Cavey [00:02:07]:
 Welcome back to winning isn't easy. What you need to know about how disability carriers view vestibular disorder disability claims the vestibular system is your gyroscope. It works with your eyes, the visual system, and your bones and joints, your skeletal system to maintain the position of your body at rest or in motion. It does this by detecting mechanical forces, including gravity, that act on your vestibular organs when you move. Now, vestibular disorders can cause problems with loss of balance, dizziness, vertigo, fainting, problems with vision, hearing, and can even impair your cognitive abilities. Most vestibular disorder cases are denied simply because disability carriers hate these cases because, in part, they are based on your subjective complaints. After all, anybody can say that they have a poor memory, they have difficulty concentrating, they can't hear, and of course, they can't work. Now let's talk more specifically.
 
 Nancy Cavey [00:03:05]:
 Because disability carriers have position papers on vestibular disorder claims, they will have internal policy statements that guide the claims adjuster, their peer review physicians, and the vocational evaluator on how to evaluate a vestibular disorder claim. I think there are three disturbing patterns in these policy statements. Number one, vestibular disorder cases without objective evidence should be denied. Two, don't give a lot of weight to subjective complaints if there's no objective basis for the diagnosis or causation. And number three, anybody who's got a vestibular disorder, regardless of the severity, can work. Remember, these are three principles that are going to guide disability carriers or plans in evaluating your claim. Once you've filed your initial claim for disability benefits, the disability carrier is going to get a copy of your medical records. They're going to have those records and your physician's attending physician statement form reviewed by its medical team.
 
 Nancy Cavey [00:04:05]:
 Many vestibular disorders can initially be accepted by the disability care, but then denied once there has been a plateau or once there are no complications. In other words, once they think you're quote unquote stable, they'll see that as a reason to potentially deny the claim if they haven't denied the claim sooner. So let's talk more about the denial of benefits after your vestibular disorder has stabilized. The carriers will wrongly assume that once your vestibular system disorder becomes stable with medication, that you can immediately return to work or they can refuse to acknowledge the progression of your vestibular disorder and its complications. On the other side of this unfortunately, not all disability claims adjusters are familiar with the stages and progressions of vestibular disorder. The symptoms, the treatment, the side effects of the medication that in and of themselves can result in disability. That's why it's so important that I think in your medical records that you are documenting your symptoms, document the objective medical testing that supports your claim and that your physician properly completes an AP's form. Now, I also do Social Security disability work, and I often will supplement the disability insurance carrier plans AP's form with a residual functional capacity form for vestibulare disorders that we use in our Social Security cases.
 
 Nancy Cavey [00:05:33]:
 I think that's important because those AP's forms purposely don't ask the right questions and we want to provide the disability carrier with all the necessary information they need to understand the extent of your disability and why you qualify for your benefits. So let's talk about an analysis of those medical records by the disability carrier or plan. What's going to happen is that the disability carrier or the plan is going to ask that a staff nurse or a physician evaluate your records to determine first if there are any objective basis for the diagnosis. Next, they're going to ask, is there an objective basis for the restrictions and limitations assigned? Now, it's not uncommon for disability carriers to hire what I call liar for hire peer review medical companies, who in turn will hire a liar for hire medical gun to review your file and create reasons to deny your claim. By the way, these liar for hire physicians are not always experts in vestibular disorders, but what they're going to be looking for and what things you should make sure are in your medical records are the following how long have you had the vestibular disorder symptoms? What are the nature of those symptoms? Have you undergone a tilt table test and what's the result of that? Have your symptoms progressed or changed over time? And if so, how? What have you reported to your physicians about how your vestibular disorder symptoms impact your ability to do activities of daily living and compare that to what you reported on your activity of daily living forms? So they're looking for inconsistency. They, of course, want to know the nature of the treatment and your response to that treatment. They do want to know the side effects of medication. They also want to understand what other physicians have diagnosed a vestibular disorder and what other complications you might have.
 
 Nancy Cavey [00:07:23]:
 They always want to know what your physicians have to say about your physical exam, diagnostic studies and laboratory findings. And they expect that you will be seen by a specialist for the treatment of your symptoms, such as a neurologist, a neurosurgeon, an EnT, a balanced specialist, a psychiatrist, and maybe even a psychologist. So what else is the claims examiner going to review? They're going to have a review of the attending physician statement form that your physician completed and any objective testing. Of course, they're going to pick it apart and they may even have their physicians contact your physicians. And in order to persuade your physician that you can work in at least a sedentary capacity doing routine, repetitive tasks, you should be asking your physician to do the following if they have any contact from the carrier, particularly if it's by phone, you want to ask that your physician suggest that the carrier put all of those questions in writing so that there's no chance that that liar fryer peer review or will misrepresent what your physician might have said during the call. Don't be surprised if disability carrier physicians or plan physicians lie about those conversations. You do want to have your physician send me a copy of their response and the letter that the carrier sent before it's submitted to the disability carrier so I can review it and make sure that it is correct. Guess what your policy may have given the disability carrier the right to have you examined by a physician of their choice.
 
 Nancy Cavey [00:08:59]:
 This is called an independent medical examination and I will tell you it is anything but independent. These liar for hires are paid to give the disability carriers a reason or reasons to deny your claim. If the disability carrier's physician or claims adjuster questions your restrictions and limitations, you most likely are going to be scheduled for that ime. That ImE is going to take from a history from you about the severity and duration of your symptoms, your responses to treatment and side effects of medication. And guess what? They are going to compare that to what you put on your activity of daily living forms and what you told your physician. Why? Because they're going to ultimately suggest that you might be exaggerating the extent and nature of your symptoms and the impact those symptoms have on your ability to function. Now, I will generally prepare my clients for that examination and if possible, I want to try to videotape that examination. If it's not possible, we want to have a third party witness to audio tape the examination and take notes.
 
 Nancy Cavey [00:09:59]:
 So if the carrier contacts you directly and wants to set up an IME, it's time for you to hire an experienced ERISA disability attorney. I also want you to understand that claims are won and lost with attending physician or residual functional capacity forms and neuropsychological testing. The vestibular disorder claim and any complications are won and lost. I think based on the history that you give to your physician, the exam findings, and these AP's or RFC forms, they're also going to be making a decision in part based on your credibility. So I want you to understand that all of this comes into play that may even result in them doing a review of your social media to look for you doing things that seem to be inconsistent with a vestibular disorder. I once represented a physician's assistant who had Meniere's disease, and they had film of him golfing on a boat and attending his son's football games. They argued all of those activities were inconsistent with his complaints of vestibular disorder. Ultimately, we were able to overcome that.
 
 Nancy Cavey [00:11:07]:
 But I want you to understand that social media postings are also a weapon that disability carriers will use in meniere disease cases and other vestibular disorder claims. Got it? Let's take a break.
 
 Speaker B [00:11:19]:
 Robbed of your peace of mind by your disability insurance carrier, you owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com. today.
 
 Nancy Cavey [00:12:04]:
 Welcome back to winning isn't easy so what are the 21 things that your doctor should address in your medical records in your ERISA disability claim for dizziness? Once again, ERISA disability carriers or plans often deny claims for dizziness because of the lack of an objective basis for the diagnosis. After all, anybody can claim that they're disabled because of dizziness. And in the view of disability carriers or plans, subjective complaints are easy to dismiss. There is no gold standard test to prove that you have dizziness. What they want to understand is the cause or source of your dizziness. It can be related to a number of diseases such as Meniere's disease, neurological disorders, tumors, metabolic disorders, vestibular dysfunction, even the side effects of medication. So when you're filing an ERISA disability claim for dizziness, I assure you that the disability carrier plan is going to have your medical records reviewed and you need to understand what it is they're looking for so that you make sure your medical records are accurate and complete. So what are those? Well, what is the diagnosis of your dizziness related to? What's the average frequency of your dizziness episodes per week and per month? How long does an episode last? Do you have any warning of impending dizziness attacks? How long is it between the warning and the episodes of dizziness? Can you take safety precautions when you feel an episode is coming on? Are there precipitating factors such as stress or exertion? What are the symptoms associated with the dizziness episodes after the episode ends? Are there any after effects? How long after an episode do these after effects last? To what degree does your dizziness episodes interfere with your activities of daily living? Have you ever injured yourself in the course of an episode? What type of medication are you taking, and what is your response to that medication? Do you require more supervision at work than an unimpaired worker? Are there safety concerns working at heights with power machines, operating a motor vehicle, or using other equipment? Do you have any mental problems associated with your dizziness? Do you have good days and bad days, and what do they look like? What would cause you to be off task or take unscheduled breaks because of your episodes of dizziness? Are your impairments demonstrated by signs, clinical findings and laboratory testing reasonably consistent with your symptoms and functional limitations? And what are those functional limitations that would affect your ability to work on a regular, sustained basis? And lastly, is there any additional testing that would help clarify the severity of your dizziness impairment or limitations? Now I know that's a heck of a lot of information for your doctor to put in your medical records.
 
 Nancy Cavey [00:14:57]:
 The carrier's AP's forms will generally not ask those kinds of questions, which is why I supplement them with a Social Security disability residual functional capacity form for dizziness or balance issues or Meniere's disease. I use that because I think it's a better way to supplement the AP's form and to get your doctor to really address the relevant issues in a dizziness ERISA disability claim. If you suffer from dizziness and are applying for ERISA disability, I would suggest that you not go it alone because disability carriers are going to be looking closely for the basis of the diagnosis, physical exam findings, functional, physical and psychological restrictions, limitations in order to decide whether they're going to pay or deny an ERISA disability claim. And don't forget that they can terminate benefits if in your disability policy, there is a subjective medical condition limitation. And normally what will happen is the benefits will be limited to just two years because of that subjective medical condition limitation. And guess what? They think dizziness is a subjective medical condition. So you need to know that. Heading in.
 
 Nancy Cavey [00:16:06]:
 Got it? All right, let's take a break. Welcome back to winning isn't easy. What medical testing will a disability carrier expect in my meniere's disease? ERISA long term disability claim Meniere's disease, known as MD, is a disorder of the inner ear that can make it difficult, if not impossible, to work. Your physician will diagnose Meniere's disease if you have two or more episodes of vertigo, which is the feeling of spinning or moving while you're still. That lasts 20 minutes or so to 24 hours. Your vestibular system, which includes your inner ear, your eyes and the nerves connected to the brain, help us with the balance, coordination and posture. Vertigo happens when your vestibular system isn't working correctly. There are, however, some other common symptoms of Meniere's disease, along with a vertigo that the carrier is expecting to see.
 
 Nancy Cavey [00:17:34]:
 There could be hearing loss that changes from better to worse, known as fluctuating hearing loss. There could be a sensation of air pressure where your ear feels like it's full or plugged, or there could be a ringing or buzzing or other noise in your ear known as tinnitus or tinnitus. Any one of the combination of these symptoms can be the basis of a long term disability claim. Now, the reality is that disability carriers or plans hate these claims because they're based on subjective complaints. The vertigo, the sensation of ear pressure, the ringing or buzzing or other noise in your ears. Now, those symptoms obviously can make you feel sick, tired, or make it difficult for you to pay attention. And the disability carriers tend to discount those complaints, too, because there's no objective basis for the diagnosis or those symptoms. But what they will want to see, of course, is a history of your symptoms in terms of the frequency of your symptoms, the nature of your symptoms, how long they last, what problems you have, performing your occupational duties when you have those symptoms.
 
 Nancy Cavey [00:18:38]:
 And they're also going to be looking for hard medical evidence. They're going to be looking for audiograms, the results of VNG or eng testing. They're looking for other testing, including an MRI of the brain and testing known as EcochG, where they're testing the cochlear portion of your ear. Now, I will tell you that the lack of medical testing can doom your disability claim. And if you have the testing and it's negative, that certainly is helpful. If you have the testing and it's normal, that also can be a problem. And it's a problem that needs to be addressed in your medical records before you stop work and apply for benefits. What you really should be doing is having an experienced risked disability attorney review your policy, review your medical records and give you recommendations for the documentation of your symptoms, your functionality, and how to deal with negative medical testing.
 
 Nancy Cavey [00:19:39]:
 Got it? Please don't make a mistake that can destroy your meniere's disability insurance claim. Let's take a break.
 
 Speaker B [00:19:46]:
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 Nancy Cavey [00:20:46]:
 Welcome back to winning isn't easy benign paroxysmal positional vertigo, BPPV and your ERiSa disability insurance claim now, you may have purchased a disability insurance policy through your employer or covered under an employer sponsored disability plan, or you might have bought your own individual disability insurance policy. You probably never thought you would have to file a claim for your disability benefits, but if you've been diagnosed with BPPV, you may be entitled to your disability benefits. So what is BPPV? Well, it's characterized by brief, recurrent bouts of vertigo, which is a sensation of spinning or moving or whirling. It's often triggered by changes in your head position and is thought to be caused by a displacement of small calcium carbonate crystals within your inner ear. The severity and progression of BPPV varies from person to person. It can cause mild symptoms, severe symptoms, and even debilitating and disabling symptoms that can reoccur even after treatment. So what are the symptoms that disability carriers or plans looking for in your medical records? They are looking for severe or recurrent symptoms that don't respond to treatment. They are likely to deny BPPV claims where the symptoms are infrequent and really don't interfere with your work activities.
 
 Nancy Cavey [00:22:08]:
 Unfortunately, though, disability carriers or plans tend to treat everybody the same way. Sort of a cookie cutter approach. And that can be problematic because the severity of symptoms and the impact those symptoms have on functionality vary from person to person. So what are they looking for in your medical records? Well, they're looking for things like the frequency of the episodes, the type of changes in your head position that might trigger an episode, the volume of calcium crystals that are moved, your symptoms such as vertigo, lightheadedness, dizziness, nauseousness, vomiting, blurred vision, and those sorts of symptoms. It's really crucial that you're giving a complete and accurate history of your symptoms, how those symptoms impact your ability to do your own occupation, how long those symptoms last, and how you feel after you have those symptoms. I will tell you that after they review your medical records, they're next gonna look at the diagnostic studies that your doctor used to make the diagnosis of BPPV. So, what is the diagnosis? How is it made? Well, it's made based on your history, including your symptoms and clinical testing and workup. The key diagnostic test is the Dick hall pike test, where you sit down on an examination table with your legs extended.
 
 Nancy Cavey [00:23:27]:
 Your physician rotates your head 45 degrees and then has you quickly on your back. If you have BPPV, you should have an episode of Vertigo. Or you might have an issue with eye movement disorder characterized by rapid, involuntary movement of the eye. Your eyes may jump or twitch in certain directions. The timing and appearance of this will help your physician decide what part of your inner eye is involved and differentiate vertigo caused by a brain disorder. The response obviously is subjective in nature. It relies on your report of symptoms, and disability carriers don't necessarily like to solely rely on that. They're looking for you to have undergone an MRI of the brain or a VNG test.
 
 Nancy Cavey [00:24:16]:
 After they decide whether there is an objective basis of the diagnosis and that your symptoms are consistent with that diagnosis, they're next going to look at your medical records for your treatment. Under the terms of disability policies and plans, you're required to undergo medical treatment that's reasonable and necessary and appropriate based on your medical condition. So they're going to expect that the treatment will include vestibular rehabilitation therapy, vestibular suppressant medication, maneuvers like the Epley maneuver, surgery, including things like canal plugging. Your medical records should document the nature of the treatment you got, your response to the treatment, and if for some reason you didn't undergo the surgery, why it was not performed and the medical acceptable reasons for you not to undergo that testing or treatment that are still consistent with the diagnosis. Let's talk about how the disability carriers or plans are going to look at this claim. It's safe to assume that they don't really understand the diagnosis and symptoms and how they impact your ability to perform your own or any occupation. Now, the symptoms of BPPV are similar to some other medical conditions, and sometimes the disability carrier wants to have a definitive diagnosis and a rule out. So one of the things that they were looking out at for a rule out is Meniere's disease, which is characterized by recurrent vertigo, unilateral hearing loss and ringing in the ears.
 
 Nancy Cavey [00:25:55]:
 They're looking for a rule out of labyrinthus, which is an inflammation and swelling of the inner ear, which can lead to vertigo caused by head movements. They're also looking for a rule out for migraines, head trauma, vestibular neuritis, and that's the result of a viral infection of the vestibular nerve of the ear that can lead to imbalance in vertigo. And they're also looking for reduced blood flow secondary to a stroke or a hemorrhage. And they're also looking for a rollout of maldemarkment syndrome. So obviously what they're going to be looking at is what's the diagnosis? What's the objective basis of the diagnosis? Are your subjective complaints consistent with the diagnosis? What's your response to the treatment that's been recommended? And what are your functional restrictions and limitations? Notwithstanding all that, you really have to tie it together, ultimately to show that you're unable to perform the material and substantial duties of your own occupation or any occupation, and simply saying that you have problems with dizziness or other issues with your balance or coordination isn't going to do it. It comes down to proof. I hope that you have enjoyed this week's episode of winning isn't easy. If you've enjoyed this episode, please like it the page, leave a review, share it with others and please subscribe to our podcast.
 
 Nancy Cavey [00:27:20]:
 That way, you're going to get notification of every time a new episode comes out. Please tune in next week for another insightful episode of winning isn't easy.