Can Lyme Disease qualify me for Disability Benefits?

Summary: Can I get disability benefits if I am suffering from the effects of Lyme Disease?

Though we may not hear about it often, Lyme disease is becoming more common and a serious public health concern in Texas. Most cases of Lyme disease appear in the upper Midwest and northeastern states, but Texas A&M University’s Lyme Lab has noted a significant increase in the number of cases in Texas and along the Texas/Mexico border. Lyme disease is caused by borrelia bacteria transmitted through the bite of a tick. While ticks live throughout the United States, a person is more at risk if they spend time in grassy, brushy or wooded areas. Left undiagnosed and untreated, Lyme disease can become debilitating, spreading to the heart, joints and the nervous system. If you are suffering from the effects of Lyme disease you may qualify for disability benefits.

---

If you are suffering from Lyme disease and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are.

Lyme disease progresses in three stages.

In Stage 1 (3 – 30 days after a tick bite), the most common symptom is a rash that appears as a small circle that spreads, like a bull’s eye or target. Some individuals will not notice they’ve been bitten at all. Other early symptoms include:

•    Fever
•   Headache
•   Muscle aches and pains
•   Swollen lymph nodes
•   Joint stiffness

Stage 2 (3-10 weeks after a tick bite) symptoms include:

•    Neck pain and stiffness
•   Muscle weakness on one or both sides of the face
•   Rashes on other parts of the body
•   Pain in the back, hips, and legs
•   Muscle weakness on one or both sides of the face
•   Pain, numbness or weakness in hands or feet
•   Heart problems

In Stage 3 (2-12 months after a tick bite), patients experience symptoms from the earlier stages of Lyme disease, but the most common is arthritis in large joints, particularly knees.

Pain, swelling and stiffness may continue a long time.These or a combination of these symptoms can cause you to miss work and jeopardize your ability to maintain employment.

Treatment is limited to antibiotics, either by pills or IV in more serious cases.

It should be noted here that patients with Lyme disease are often untreated for various reasons. Doctors may not recognize the symptoms or misdiagnose the patient due to a lack of definitive testing procedures. This is compounded by the CDC’s rigid reporting requirements and that some insurance companies may not recognize Lyme disease as a chronic disorder. However, the Texas Lyme Disease Association states “Lyme disease is not a rare illness that is easy to avoid, difficult to acquire, and simple to diagnose; nor is it easily treated and cured. The longer the time elapsed between a tick bite causing infection and the diagnosis and treatment of Lyme disease, the more likely the illness will be serious and long lasting, and the cost of treatment very high.”

Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.

Can I qualify for SSDI if I have Lyme Disease?

The Social Security Administration has created a manual called the Blue Book which lists impairments Social Security considers disabling and may automatically qualify for benefits.

Lyme disease is not included as a specific listing, but that does not change the fact that without proper medical treatment, Lyme disease may develop into carditis, arthritis and other neurological conditions which disable a person. One way you may qualify is by meeting the requirements of a medical condition that is listed in the Blue Book, for example:

•    Section 1.00 (Musculoskeletal System), if you have significant limitations in your ability to walk or use your arms;
•   Section 4.00 (cardiovascular system), if Lyme disease causes damage to your heart;
•   Section 12.00 (Mental Disorders), if you have cognitive problems or anxiety caused by Lyme Disease; or
•   Section 14.00 (Inflammatory Arthritis), if you have arthritis in your knees or other weight-bearing joint that is severe.

Even if your symptoms don’t match the criteria of a listed impairment, your limitations may still prevent you from working.

The effects of Lyme disease such as pain in muscles and joints, numbness and tingling in hands and feet, swelling, and weakness in the legs can make walking, standing, lifting or any physical activity impossible. Additionally, problems with fatigue, memory and other mental limitations may also severely inhibit any type of work. Social Security will conduct a Residual Functional Capacity (RFC) assessment to evaluate your physical and mental capabilities and determine if you can perform your old job or any job, taking into consideration your age, education and whether or not you can drive. If you can’t even perform a sedentary job, it’s likely you will be approved for disability benefits

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you are 55 or older and can’t return to your old job, yet you don’t have the skills to learn a new job, Social Security might grant you disability benefits.

You may also be eligible for Social Security Disability benefits if you have another medical condition.

Lyme disease often has long-lasting aftereffects such as arthritis, body aches, constant fatigue, and memory problems. One disorder by itself may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined together limit your ability to hold a job and perform necessary daily tasks.

Social Security also has basic financial requirements.

You must satisfy some basic financial requirements before you are eligible for Social Security Disability Income.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.

What if I don’t qualify for SSDI?

If you earn too much income or you haven’t worked long enough to earn enough work credits, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a federal program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. Do not quit your job before you file a claim because LTD coverage is good only as long as you are employed, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

If you are suffering from Lyme disease and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged – most are – and you will have the opportunity to appeal. There are four steps to the Social Security appeal process:

1.   File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.   If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.   If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.   Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI

If you have Lyme disease and cannot work, you may be eligible for Social Security Disability benefits, but qualifying may be challenging and applying for SSDI is a lengthy process that may take several months to years.

Your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an experienced disability attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner, and they can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

We had a client who suffered from medical conditions Northwestern Mutual had previously found to be disabling.

Those conditions included chronic fatigue with severe fatigue, widespread muscle/joint pain, recurrent infections, insomnia, irritable bowel syndrome, headaches, sore throat, cognitive dysfunction, and tender points (fibromyalgia).
She had also been diagnosed with Lyme disease. NW Mutual Life denied her claim, saying there was no medical support for a disabling condition that did not fall under the Mental Disorder provision contained in the group policy. The medical, as opposed to psychological, nature of the client’s condition was well supported by her treating physicians, and she had been awarded SSDI benefits.

Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.