Rheumatoid Arthritis And The Cognitive Dysfunction Connection In Disability Insurance Claims
Author: Attorney Stephen Jessup
When most people think of Rheumatoid Arthritis (RA) the first thing that comes to mind is severe pain and swelling of the joints. More often than not, when a claim is made for disability insurance benefits due to RA, it is based on these complaints of pain. However, as noted in an Arthritis Today article titled “Brain Fog” there does exist a growing body of evidence to support cognitive limitations stemming from RA. Much like the better known “fibro fog” associated with fibromyalgia a person suffering from RA experiences pain and fatigue that can make it difficult to think clearly or concentrate. These difficulties can be especially problematic for those with occupations that require a high level of cognitive functioning. However, just like pain, it is often argued by disability insurance carriers that cognitive complaints are merely subjective and thus unverifiable. In turn, disability insurance carriers will often argue a lack of objective evidence of restrictions and limitations to support a claim for disability.
Although there may not be a large body of clinical medical evidence in support of cognitive limitations due to RA, there are enough correlations with other medical conditions that allow a skilled disability insurance attorney to properly present an insured’s claim for disability benefits based not on the physical effects of RA, but rather the cognitive effects. In some instances formalized testing, such as neuropsychological testing, can provide objective evidence of impairment to supports one’s “subjective” complaints of memory/cognitive problems. Often the testing reveals subtle changes in cognitive abilities that can be overlooked or even passed off as being within normal limits of cognitive functioning. However, with proper presentation of the results in the context of the duties of one’s prior occupational demands, what could be passed off as normal is in fact proof of cognitive limitations impeding one’s ability to work.
Potentially compounding this issue is the fact that often with any diagnosis related to a chronic pain condition there is secondary depression related to and on account of the physical medical condition. Insurance carriers will often try to argue that any complaints related to memory and/or cognitive functioning are a product of the mental health diagnosis. This in turn would subject the claim to a potential 24 month limitation for mental health conditions, which is often found in employer provided disability policies. As such it is crucial that any testing performed be focused on cognitive limitations due to a physical medical condition as opposed to a mental health condition.
I recently submitted an appeal with Hartford on behalf of a client who was facing this very reality. A former high level executive who could deal with the pain his RA caused, but fell victim to the fatigue and lack of mental clarity that came with the condition. Hartford had ignored all of his complaints of cognitive difficulties and instead only focused on the lack of physical pain complaints in his medical records. Neuropsychological testing performed by the SSA and as well as by an independent medical examiner during the course of the appeal both indicated deficits that would not only prevent him from performing his previous occupation, but any occupation similar in nature. We are awaiting Hartford’s decision on the appeal.
If you are suffering from Rheumatoid Arthritis and are experiencing cognitive difficulties on account of same and have questions about a short or long term disability insurance policies please feel free to contact our office for a free consultation.