STD Claim Denial - Self-Reported Fatigue

[az]

ADVICE DESPERATELY NEEDED.

I recently filed for short-term disability with my employer of 18 years. Extreme fatigue and accompanying cognitive issues just got to be too much.

Fatigue is an all day, everyday, event. All activities, whether work related or simple non-physical activities around the home, are limited to 1 - 2 hours max before my body (and frequently my mind) gives out to the point that I am pretty much useless for the next few hours.

My claim was denied primarily due to having "self-reported" symptoms. Although I've been self-reporting these symptoms for 2+ years now, and my neuro has documented such-including worsening over this time period-my employer's STD carrier doesn't seem to care. They want "OBJECTIVE MEDICAL EVIDENCE" to support my claim.

Question for my fellow MSers (disability attorneys also), have you found yourself in this same boat (or for attorneys, have you helped a client with similar problems?)? If so, how did you handle this, and what objective medical evidence did you have/use? Are there any medical tests that would confirm fatigue and its severity?

Being that fatigue is so common and one of the top reasons people who suffer from MS leave their employ, I'm hoping to receive advice to help me through this frustrating and stressful time.

Thanks in advance.

[pennstater]

Sorry to hear AZ.

Fatigue and cognitive issues are my primary work related issue. I am not sure what type of work you do, whether physical or sedentary classification. I had a long history of self reported symptoms that were included with my medical records, as well as what was done to try to alleviated the fatigue. I tried amantadine, and was on Provigil, with the dosage increased over time. With my doctor's support, I also had asked for job accommodations, initially allowing me to come in a little later than normal start, then work a day or two from home, then more from home, and finally, with a long break at lunch. I was fortunate that my job allowed this type of flexibility and my employer supported me. But even with all of that, I could no longer work full time.

One of the things I did based on an attorney's advice was to "quantify" the issue. So I would track how many hours I slept a night and how often I needed to nap during the day. So I could summarize that I slept x% of the time 8- 10 hours, 10-12 hours, and that y% of the time, I took a 1 hour or 2 hour nap. You get the idea. I also kept a log of how long I worked on a computer, attended a meeting, and other key job activities and at after what duration symptoms crept in, as well as how severe the symptoms were.

As for medical tests, you can ask the STD company what type of evidence/tests are needed and do they have a specific form they want your doctor to complete. Have you had cognitive testing, such as neuropshych testing? I had this done a few times, which tended to support the fatiguability impact on cognition. It also drew conclusions that I was not someone "malingering" and trying to get out of work. There are other physical tests that can be done as well to demonstrate physical fatigue (timed walk test, how much you can lift, etc...). Can your neurologist provide any supporting documentation on MS/fatigue. Likewise, do any of your meds contribute to fatigue?

I wish you good luck with this. I didn't have trouble with STD, but LTD and SSDI, I did. Both were eventually reversed, with testing results, especially the neuropsych and my medical records as the reason. Funny, same records, etc... just different outcome. Sometimes, it seems as if you have to challenge. I guess they figure most people go away.

[az]

Thanks for your reply and great feedback, Kathy.

Let me answer some of your questions:

1. Type of work? Sedentary classification.

2. Have you had cognitive testing, such as neuropsych testing? Yes, back in 2014. Showed cognition was normal but decreased with fatigue. Will likely go for updated testing/assessment and use the 2014 results as a baseline.

3. Can your neurologist provide any supporting documentation on MS/fatigue? Medical records support increased fatigue, and the very last visit (Dec 2015) reflected "severe" fatigue. All self-reported, though. I will be asking him to send the STD carrier a letter explaining more about my particular type of MS and situation, as well as clarify some of the points he documented in his progress notes.

4. Do any of your meds contribute to fatigue? No. Also, I've tried all the medications prescribed to help alleviate my fatigue, and none worked. Most just made me extremely anxious.

Similar to your work situation, my employer allowed this same flexibility for the past couple years. But like you, working has become a non-option.

I really appreciate your suggestions and will pursue some of them. Thanks again!