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    Fatigue and Disability Tests

    Hi All,

    I am going thru the process of filing for disability. My primary issue is fatigue, which neuro and I think is caused more from mental exertion and not the other away around. I had neuropsych test.

    Has anyone else filed for LTD and/or SSDI primarily for fatigue and associated increased symptoms? If so, what tests did your neuro do to support fatiguability?

    Appreciate any help during this emotional time.
    Kathy
    DX 01/06, currently on Tysabri

    #2
    First of all, I am sorry you are so fatigued. It is a challenge isn't it?

    But I do not think a Neuropsych test will pick up much or any of fatigue. It just isn't designed for that. They may pick up depression which could cause fatigue via the test results. You may not be having depression, but they will be testing for mood disorders, psychosis and cognitive symptoms.

    Know that social security disability tends not to approve cases if you are under 50 unless you have severe, or terminal illnesses. Also you do not get much $ if you get SSDI/SSI under 50. It is based on a formula on how long you have worked and put INTO the system. Keep that in mind. Attorney will not get any $ unless you win and they do not take cases unless you have been denied. Most attorneys know if a case is worth pursuing or not.

    Also any disorder/illness that is treatable is also denied, unless the doctor will write you cannot work ANY job, full or part time. Most docs will not say that trust me.

    Don't mean to discourage you , but filing for disability is not an easy process.

    Keep a journal of your symptoms, and how they affect your daily living, like cleaning, hygiene, finances, thinking, job functioning. Things like that.

    Good luck hon and let us know how you are doing.

    Warmly, Jan
    I believe in miracles~!
    2004 Benign MS 2008 NOT MS
    Finally DX: RR MS 02.24.10

    Comment


      #3
      Thanks Jan. I appreciate the caution, but have no choice but to proceed. Even with employer accommodation to work from home and split day, I could not recover for next day at work and could not lift arms.

      Neuropsych was repeated multiple times over years. IQ remained within one point, but results as far as strengths/ weaknesses were all different. They seem to think this is evidence of inability to maintain/persist. And with latest developments, neuro seems to think further evidence that MS is causing mental fatigue.

      I do have a strong work history but am just 50, and last few years, problems and first time had to use STD. I have decent symptom and medical records as I always took symptom log to neuro so he could include in medical record.
      Kathy
      DX 01/06, currently on Tysabri

      Comment


        #4
        Binder & Binder

        I used Binder & Binder as I was so sick I couldn't focus on the process. They are not all attorneys but they are well established and know the red-tape and ways to word things clearly to optimize chances of approval. They do not get paid unless you are approved, and federal law protects the client from having reasonable charges. I did much of the work filling out the original forms then sent it to them for review. They called to clarify things and/or suggest edits before submitting to SSDI. Although it seemed like a long time because I had lost income, the whole process only took about 3-4 months and only cost me about $300 deducted from $ SSDI paid out at approval. Well worth it to me, but obviously every case is different. I had really good documentation of ongoing lupus and MS diagnosis plus I was 56 years old which I think definitely helped it to be expedited. Good luck to you.

        Comment


          #5
          Kathy, glad you are on your way toward getting some help. You sounded like a "kid" to me..sorry. Hope this all works out.

          Just wanted to mention ALLSUP agency. I am not sure, but if you are already going to get LTD from your job, (off work completely) then they WANT you to apply for SSDI.
          But ALLSUP is known for getting answers within 4 months and that is exactly how long it took for me.

          Just wanted to pass that along.. for what its worth.

          Let us know how you are doing ok?

          Warmly, Jan
          I believe in miracles~!
          2004 Benign MS 2008 NOT MS
          Finally DX: RR MS 02.24.10

          Comment


            #6
            pennstater, I read your post on the SSDI thread too. There is a subjective element to the SSDI review for approval process.

            Fatigue as a medical manifistation of MS is more a subjective versus clinical/lab based medical 'condition'. Fatigue is also in the 50%-60% rate for dibilating sx's for MS'r. If attempts to treat fatigue have been unsuccessful, there's that in your favor.

            A high lesion load, plus documentation of MS sx's going back years before offical dx, poor cognitive evaluation, cumulative effect of all your sx's, age, and the support of your MS doc would seem to support a rather compelling? case in your favor.

            If you are having DMD side effects, then there's that in your favor, along with MS sx's, with support from your MS doc.

            I agree with the other poster's comments about having an attorney who can build your case and present it effectively to SSDI may make a difference. In addition to having a MS doc who is supportative of dxing disability, based on your document history pre MS dx and current cumalutive MS sx's that limit your ability to perform your job.

            Comment


              #7
              Thanks Jan and MSW. I do have the support of neuro who thinks I should have no trouble with SSDI. But it is mostly subjective and everything I read talks about having objective tests. So I was wondering how/if others were tested. I was trying to stay away from Atty as I have one for LTD employer denial. I was hoping to try SSDI on own for now and avoid additional expense.

              Thanks again.
              Kathy
              DX 01/06, currently on Tysabri

              Comment


                #8
                Kathy, what's this about your LTD denied? Geez...

                Like I said, I got SSDI in 4 months, somehow ended up with ALLSUP who took over, never needing an Atty.

                Got LTD but when SSDI checks started they subtracted that amt from the LTD amt. Because I was getting LTD at 61 I was entitled to receive it till 65 as long as I remained disabled. Well all of a sudden they cut me off just less than the first 2 years. Most only get 2 years, I was to get 4 years.

                I won the first appeal allowing me to get LTD benefit to the remainder of first two years. Now I am fighting the last 2 years and have not been approved. Oh, they said I could no longer work my job, but I could still work. I cannot. MS neuro and others will not write any letters for me, they just don't get involved beyond their records.

                My primary knows me well and writes great letters stating why I can no longer work, but to no avail. She is upset as she knows I can no longer work, mostly due to "black out" type moments and memory issues. Then there is the fatigue, and spasticity which I deal with on a daily basis. So far.. not sure if I'll ever get that benefit back. I turn 65 in March this year.

                Hope your appeal works and you get SSDI. Keep us informed ok?

                Jan
                I believe in miracles~!
                2004 Benign MS 2008 NOT MS
                Finally DX: RR MS 02.24.10

                Comment


                  #9
                  Originally posted by pennstater View Post
                  But it is mostly subjective and everything I read talks about having objective tests.
                  Objective tests are always better, but even the Social Security Disability Evaluation criteria are vague when it comes to MS fatigue. This is what the section says:

                  "Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the multiple sclerosis process."

                  If I'm remembering correctly, the neuro-psych evaluation has at least one test that involves a motor component. That might help to establish fatigue. I'm not aware of any other standardized objective tests that are used to measure physical fatigue. I'm guessing that there aren't any or the Social Security evaluation criteria would have included them, like the way they include standardized tests of vision.

                  -The only specific test mentioned as an example is:
                  11.09C: "Clarification of the evidence regarding central nervous system dysfunction responsible for the symptoms may require supporting technical evidence of functional impairment such as evoked response tests during exercise."

                  So if your claim is about the decrease in muscle function as part of physical fatigue, an SSEP during activity might be a test to include.

                  The evaluation criteria do discuss that, if muscle weakness doesn't exist at rest, it must be documented that it does exist after physical exertion and is a result of physical fatigue. At that point, the same tests that demonstrate muscle weakness and physical impairment at rest can be used.

                  11.09A: "Disorganization of motor function as described in 11.04B"

                  11.04B: "Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C)."

                  11.00C: "Persistent disorganization of motor function in the form of paresis or paralysis, tremor or other involuntary movements, ataxia and sensory disturbances (any or all of which may be due to cerebral, cerebellar, brain stem, spinal cord, or peripheral nerve dysfunction) which occur singly or in various combinations, frequently provides the sole or partial basis for decision in cases of neurological impairment. The assessment of impairment depends on the degree of interference with locomotion and/or interference with the use of fingers, hands and arms."

                  From all of that it sounds like your neurologist can choose his own description of how you demonstrate "significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination".

                  This is just my idea, but perhaps he can document how your walking slows significantly on each successive try (maybe by doing an unofficial timed 25 foot walk over and over) or how many times you can lift your arms in a certain amount of time before you can't lift them anymore or how many times you can perform some manual dexterity task before you can't physically do it anymore.

                  From what the evaluation criteria say, to establish fatigue as the basis of your claim, your neurologist has to note that the deficiencies are not present at rest but do wax an wane with physical activity.

                  Comment


                    #10
                    Jan - thanks again. I basically was played by LTD carrier. I told them I didn't have appt until 1/22 with neuro, they said it was OK. I also released hipaa to them, but didn't get other forms and medical records as I was sick with bronchitis and sinus infection. Against , they said fine. What they didn't tell me was they were going to make decision and call of this would need to be submitted in appeal window. Lawyer actually says that worked in my favor as that should have been treated as if I had asked for extension

                    Good luck with your appeal. It will be awhile but will let you know how I make out.

                    mser102 - thanks. I did read all that. I guess at this point I am going to have to rely on neuro, my medical history, and neuropsych tests. I do computer work and it is the mental exertion that seems to wipe me out more than physical effort. I have numerous brain and cervical lesions so for once, that may help
                    Kathy
                    DX 01/06, currently on Tysabri

                    Comment


                      #11
                      Originally posted by pennstater View Post
                      I guess at this point I am going to have to rely on neuro, my medical history, and neuropsych tests. I do computer work and it is the mental exertion that seems to wipe me out more than physical effort.
                      Yes, it does sound like you'll have to rely on the neuro-psych tests. Two of the three evaluation criteria apply only to motor dysfunction. The fatigue section under MS is very specific that it applies to "motor function with substantial muscle weakness".

                      Without significant motor dysfunction, the only thing left under the criteria for MS is section 12.02 Organic mental disorders. The word "fatigue" doesn't appear in them anywhere and the criteria are very tough.

                      You've got your work cut out for you. Good luck.

                      Comment


                        #12
                        All I can say is that I remember how exhausted those tests made me when I took them 12 years ago. By the end I couldn't answer anything. I'd hate to try to take that test now!
                        Marti




                        The only cure for insomnia is to get more sleep.

                        Comment


                          #13
                          functional capacity exam

                          In order for me to get my LTD and it did play a role in my SSDI, I had to have a functional capacity exam.

                          It is a series of PT and OT tests that lasts all day long. Now, number one. I did a water workout before I went to the functional capacity exam.

                          The examiner watches your fatigue. Will see your muscular fatigue as the tests are done. My LTD company paid and chose who did this exam.

                          Towards the end of the day. There was no way that I could do some of the tests. One of the tests for my work (I am a nurse) was kneeling. I told them, I can not physically do that with my religion, I am certainly not going to be able to do it for this test either.

                          I would call your LTD company and ask if that would help with the decision. This then may also help with the SSDI claim.

                          Also, have you looked at Rich's website? Or, has he posted on your thread in the disability section?
                          God Bless and have a good day, Mary

                          Comment


                            #14
                            Thanks Marti. I have the 3hr neuropsych test again at the end of Feb. We will see how it goes.

                            Mary - thanks. I will discuss with my neuro but most of these tests are physically oriented. I had a sedentary job, working with computer systems and project planning. The mental exertion seems to wear me out, more than physical. I think a multi day neuro psych would show it more. The functional could help with the keyboard though. Thanks for the suggestion. Sounds like you were successful in your claim. Glad to hear.
                            Kathy
                            DX 01/06, currently on Tysabri

                            Comment

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