browser life

After agonizing about it for two weeks, and then slaving over it for another week, I have finally finished documenting my arguments against my long term disability insurance company's recent cessation of benefits on the basis of "somatoform disorder" and "self-reported symptoms". During the process, I had nightmares of homelessness and other dark concerns. Every time I would read through the denial letter, I would be flooded with feelings of hopelessness, and every time I would try to compose myself and put my appeal into words, I would become discouraged, but I forced myself to work through it.

What follows is the basic text of what I sent my lawyer, with identifying names removed and replaced with a generic term in parentheses. I am posting it to provide some examples of how a long term disability insurance company can exaggerate, mislead or even flat out lie in order to justify termination of benefits. Maybe this will serve to make the public more aware of the difficulties the disabled face in obtaining benefits and retaining them once they've begun:


Rebuttal of (LTD company's) Termination of Benefits Letter Dated 10/25/2007

For ease of reference, I will list the applicable page number and quote the paragraph I am disputing.

Page 3: "A formal Functional Capacities Evaluation was completed on January 31, 2006 by (a physical therapist). After her evaluation, (physical therapist) determined that (I) would be able to perform sedentary work.....it was additionally determined that she would be able to keyboard occasionally."

(Physical therapist) did nothing but a brief physical exam. Her assistant did all the rest of the FCE, and he is not a licensed physical therapist. So how reliable is this "evaluation"? A single afternoon exam does not equate to a 40 hour workweek. I was not even able to complete the exam, so how does that translate to full time work? (Denver primary care doctor) documented very well the adverse affect the FCE had on me the next day as she saw me in her office. Her notes for 2/1/2006 include the following statement: "She has significant myofascial hypertension in her masseter muscles, her trapezius, and all the way down the paraspinal muscles." This is NOT a "self-reported" symptom as she palpated the muscles herself, and as no such muscular tension was noted the previous day by (physical therapist), it occurred as a result of the test, and indeed would occur again should I be subjected to repetitive motion such as the type required for sedentary work.

Page 3: "On February 28, 2006, a comprehensive neurological evaluation was completed by (psychologist)....There was evidence of variable effort on (my) part...."

What (LTD company's) letter fails to mention is that this "variable effort" was likely due to the fact that I kept dozing off during the exam while at a computer terminal. The evaluator does not mention this in her report even though she was aware of it. If my fatigue were merely a somatic complaint, I would not be actually falling asleep during a test. The "personality" exam had many questions about physical symptoms which I answered in the affirmative. These questions were true due to physical illness, not mental, the but the test does not make that distinction, and neither did the evaluator.

Page 4: "(Denver rheumatologist #1) stated that (my) last office visit was on November 6, 2006."

Actually, my most recent visit was June 20, 2007.

Page 4: "On January 11, 2007, (Sioux Falls rheumatologist) sent a letter to (Denver rheumatologist #2)....(Sioux Falls rheumatologist) stated that he had reviewed (my) medical records and asked (Denver rheumatologist #2) if he felt she really had Sjogren's syndrome.....he stated that he was unable to make a diagnosis...."

Before (Sioux Falls rheumatologist) looked a single page of the medical records I brought to my appointment, he stated the following: that one cannot have Sjogren's with negative antibodies, that Sjogren's does not cause arthritis, that it is just dry eyes and mouth, and that Sjogren's is never disabling. This is contrary to what (Denver rheumatologist #2) told me in my appointments with him. I also mentioned these statements to (Denver rheumatologist #1) when I saw him on June 20, 2007. (Denver rheumatologist #1) confirmed that all of these statements are untrue and that there is medical evidence to support that. (Sioux Falls rheumatologist) is not a reliable medical source because he is not knowledgeable about Sjogren's syndrome.

(Denver rheumatologist #2) wrote back to (Sioux Falls rheumatologist) and stated that he felt I had Sjogren's syndrome, particularly since I had a positive lip biopsy. (Sioux Falls rheumatologist) then sent me a letter that stated that even though he conceded that I probably did have Sjogren's, he felt it would not cause extraglandular activity. This is despite the medical records I gave him documenting arthritis, skin dryness and rashes, peripheral neuropathy, Raynaud's phenomenon, reflux, gastroparesis, carpal tunnel and lymphadenopathy, all of which are extraglandular manifestations of Sjogren's. This is further evidence that (Sioux Falls rheumatologist) is not a reliable medical source.

(LTD company) is taking the word of a rheumatologist I saw just once over that of a rheumatologist I saw four times a year for seven years and a rheumatologist with extensive expertise regarding Sjogren's syndrome. Surely (Denver rheumatologist #2) extensive documentation of the progression of my illness is worthy of more consideration? (LTD company) cannot even get (Sioux Falls rheumatologist's) office staff to talk to them since (Sioux Falls rheumatologist) left medical practice in April. How much weight is (Sioux Falls rheumatologist's) opinion going to have without his office's cooperation?

Page 5: "On March 13, 2007, (I) had another office visit with (Sioux Falls primary care doctor).....(Sioux Falls primary care doctor) had a report from (my) Colorado doctor regarding the lip biopsy and that both her rheumatologists have recommended repeat lip biopsy."

This is untrue. Neither (Denver rheumatologist #2) nor (Denver rheumatologist #1) have indicated that a repeat lip biopsy is recommended. (Denver rheumatologist #1) in fact told me in June that he believed it was unnecessary as this test does not produce false positives.

Page 5: "On May 29, 2007, (I) had another office visit with (Sioux Falls primary care doctor)....He noted that (I) was a well woman..."

I was there for an annual gynecological exam, which is called a well woman exam by most medical insurance companies. This does not indicate absence of any of my chronic ailments. This exam could not be completed due to severe dryness from Sjogren's.

Page 5: "Our on-site physician, whose specialty is Internal Medicine reviewed (my) medical records...."

The review of an internal medicine specialist regarding a connective tissue disorder is not superior to that of a board-certified rheumatologist. What qualifications does (LTD company's) on-site doctor have?

Page 6: "In regards to (my) central nervous system illness....Prior neurological opinion in 1998 indicated that physiologic basis was not proven and recommended psychological evaluation for possible conversion disorder or functional disorder."

The neurologist did in fact refer me to a psychiatrist to evaluate my mental health. He concluded that there was no conversion disorder present and could not make a diagnosis of functional disorder.

Page 6: "In regards to (my) gastrointestinal disorders with her history of gastroparesis, reflux disease and constipation, these conditions can be treated with small meals, lifestyle changes and oral medications."

As documented in medical records by (gastroenterologist), oral medications for the gastroparesis were all either ineffective or caused bodywide uncontrollable muscle twitching or other intolerable side effects. The small meals and lifestyle changes have been followed since 2003, and they have not caused significant improvement in the condition. I still have daily nausea and unexpected bouts of vomiting. This and the necessity for eating every two hours would interfere with light work where I am expected to remain at my post performing my duties for the better part of eight hours per day and not snacking or making unscheduled bathroom breaks.

Page 6: "in October 2003, (I) has a gastric emptying study with significant delay noted. Etiology was not established and may be a medication side effect."

What medication would be causing gastroparesis? (LTD company's) "expert" does not specify. (Gastroenterologist) reviewed my medications and did not indicate that any of them could be causing this or that I should discontinue any of them. Gastroparesis is most commonly caused by disease, and (gastroenterologist) felt that this was the case with me.

Page 6: "In regards to (my) history of peripheral neuropathy which is presumed associated with Sjogren's syndrome, her condition would not preclude her from sedentary to light work activities."

A mildly abnormal result on an EMG does not necessarily correlate with a mild course of disease. People with such severe neuropathy that they are confined to wheelchairs can have normal EMGs. My neuropathy is aggravated with prolonged sitting at an office chair as one would do at a sedentary job. The carpal tunnel flares up with just a few minutes of typing.

Page 6: "The neuropathy diagnosis is inconsistently reported....There was no mention of neuropathy by the new primary care physician or rheumatologist or prior endocrinologist."

The reason (Sioux Falls primary care doctor) did not mention neuropathy until September is that she is not a neurologist, and I was going to her for routine things such as bronchial infections, hemorrhoids and annual physical. When I did go to her for a referral to a neurologist, she did note the problems I was having. (Sioux Falls rheumatologist) did mention my neuropathy in his notes during that single office visit, and it is mentioned in pages 7 and 8 of (LTD company's) own letter. (Endocrinologist) does mention neuropathy in her notes for December 9, 2004. She does not mention it in subsequent visits because she is not a neurologist.

Page 6: "As noted by the Social Security Disability Insurance doctor, (some dude) on January 5, 2006....."

I am unclear as to who this is, as I have no record of a doctor by this name. If this is the state agency medical consultant referred to by the Administrative Law Judge in his ruling, the consultant's opinion was weighed as that of a nonexamining expert source. (Administrative Law Judge) stated: "because the opinion is markedly inconsistent with the opinions of examining and treating physicians and the other medical evidence, the undersigned finds it unpersuasive."

Page 6: "In regards to (my) periodic limb movement disorder, her condition would not preclude her from light work activities with treatment running concurrent with work."

The polysomnography done on 12/19/2004 showed SEVERE periodic limb movement disorder with 98 periodic limb movements per hour of sleep resulting in 44 arousals per hour. Also the mean sleep latency was borderline for excessive daytime sleepiness. This is a measurable, not self-reported, cause of extreme fatigue. As a result, I could not be reliably alert and productive during an eight hour work day.

As for treatment, I tried various with a neurologist specializing in sleep disorders whom I saw from June 2005 to June 2006. To sum up, Provigil for daytime drowsiness increased stomach problems, Klonopin caused severe next day sedation, Baclofen causes next day sedation and stomach upset, Rozerem was ineffective. My current sleep medication, Zolpidem, does not reduce the limb movements. So no treatment has gotten rid of the limb movements without sedation that would further hamper my ability to stay alert and productive at a sedentary job.

Page 8: "On May 3, 2007, (I) met with (Sioux Falls rheumatologist's) physician assistant.....(physician assistant) indicated that (I) does have very good saliva present on exam....She noted that on exam there were positive tender points, no synovitis, rash or significant range of motion abnormalities noted."

(Physician assistant) is not a rheumatologist. Furthermore, she did NOT do ANY sort of physical exam on me, and she did not look in my mouth. She merely read the comments (Sioux Falls rheumatologist) had made during my single visit to him in January and used them to produce her report. Her comments to me were exactly the same as (Sioux Falls rheumatologist's), which are noted above. As (Sioux Falls rheumatologist) is not a reliable treating source, neither is his assistant.

Page 8: "In order to complete a comprehensive evaluation, we decided to send her medical records to a designated medical officer (DMO)"

Who is the DMO? (LTD company) doesn't provide a name. Since (LTD company) selected this person, he or she could hardly be considered an impartial source.

Page 9: "He noted that if (I) has Sjogren's syndrome, it is mild. He stated that this conclusion was based on the lack of significant dryness on exams, the normal serologic tests, the normal sedimentation rates, and the lack of need for aggressive treatment."

(ENT's) medical records indicate consistent signs and symptoms of dryness in the sinus, mouth and throat. My c-reactive protein levels, a blood test for inflammation, have been elevated for the majority of the time since 2000. Normal sedimentation rates do not preclude one having Sjogren's syndrome. Normal sed rates do not indicate a mild course of disease either, particularly if one has extraglandular activity. As for treatment, I have been on immunosuppressants for four years. I have had to go on prednisone, which is an aggressive treatment, for edema and for peripheral neuropathy, neither of which are self-reported symptoms. I discussed the possibility of trying Humira, Embrel or Remicade with (Denver rheumatologist #1) and (Denver rheumatologist #2), but they both confirmed that they are contraindicated in Sjogren's patients with neurological complications as these medications often worsen those problems. Also, both (Denver rheumatologist #2) and (Denver rheumatologist #1) told me that medications for rheumatoid arthritis are usually not effective for primary Sjogren's syndrome.

Page 9: "As part of our claim review, we referred (my) file to a vocational consultant for evaluation."

Who is this vocational consultant? (LTD company) doesn't name this person. It is unlikely that he or she is impartial since (LTD company) selected them.

Pages 10 and 11: "However, the administrative law judge's determination did not consider (my) formal functional capacities evaluation on January 31, 2006 which supported her ability for at least sedentary work capacity. The administrative law judge also did not consider the Neuropyschological Independent Medical Exam on February 28, 2006 which indicated support for ongoing psychological impairment for the Somatoform Disorder, without any reliable objective findings of cognitive restrictions and limitations."

Those two tests did not "support" anything except (LTD company's) intention to deny a valid claim. Even if the administrative law judge had had those tests in my file, it is doubtful his ruling would have been different as the opinion of the treating medical specialist carries more weight than the opinion of individuals hired by a private insurance company. While SSDI does grant disability for mental illness, this was not applicable in my case. I was granted disability based on the SUM TOTAL of medically determinable impairments, none of which are mental. (LTD company) went to a great deal of trouble to state that the Sjogren's was not disabling, the gastroparesis was not disabling, the arthritis was not disabling, the neuropathy was not disabling, the periodic limb movement disorder was not disabling, etc. But they did not consider the effect of having multiple chronic ailments concurrently.

And (LTD company) does not mention one thing that the administrative law judge DID consider: (Social Security doctor) as an independent medical source. (Social Security doctor) was hired by Social Security, not me, to do a consultative exam on December 29, 2005. It was (Social Security doctor's) professional opinion that my fatigue, insomnia and chronic pain were the result of autoimmune disease, endocrine disease and neurologic disease, all of which were verified with testing by proper medical specialists and so are not merely self-reported.

(LTD company) contends that my disability is limited to psychological and self-reported complaints. SSDI found me disabled on the basis of neither of those. (LTD company's) decision is indeed inconsistent with that of the Social Security Administration.

In conclusion, (LTD company's) denial is based upon their desire to limit financial obligation to their claimants, no matter what the nature of their disability. Their "self-reported symptoms" clause is a convenient cop out as they can apply it to nearly every medical illness. Their 24 month limitation on mental illness is also extremely convenient for them as all they have to do is hire a psychologist who is willing to label a claimant with somatoform disorder. Their disregard for documentation from reputable medical specialists such as (Denver rheumatologist #1) and (ENT), both of whom have treated me for at least seven years, suggests that they have no interest in the truth. Their tactics to deny my claim have been unethical and must be challenged.