Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) are often under-diagnosed. They are serious, but preventable medical conditions.
Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein. These clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm.
It is important to know about DVT because it can happen to anybody and can cause serious illness, disability, and in some cases, death. The good news is that DVT is preventable and treatable if discovered early.
Pulmonary Embolus (PE)
The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs and is fatal.
For some people, DVT and PE can become a chronic illness; about 30% of people who have had a DVT or PE are at risk for another episode and they may be required to take life-long anticoagulation.
Risk Factors for DVT
Almost anyone can have a DVT. However, certain factors can increase the chance of having this condition. The chance increases even more for someone who has more than one of these factors at the same time.
DVT can occur following an injury, fracture, surgery, prolonged bed confinement, sitting for a long time with legs crossed, taking estrogens (e.g., birth control pills), heart disease, lung disease, inflammatory bowel disease, cancer (especially cancer of the pancreas), clotting disorders, age, obesity, and other factors.
Symptoms of DVT
About half of people with DVT may have no symptoms at all. When symptoms do occur, they typically include swelling of a limb (usually the calf), pain, tenderness, and redness of the skin (erythema).
Symptoms of a PE
If part of a blood clot breaks away, it can travel through the circulation up to the lungs and cause a pulmonary embolism (PE). It is important to know and recognize the symptoms of a PE, because a PE can be life-threatening.
These symptoms can include chest pain (which usually is "pleuritic" and worsens when taking a deep breath), shortness of breath, fast heart rate, coughing up blood (hemoptysis), lightheadedness, and a drop in blood pressure.
Blood Clots in the Vein or in the Artery
DVT does not cause heart attack or stroke.
A blood clot in a deep vein of the leg, pelvis, and sometimes arm, is called deep vein thrombosis (DVT). This type of blood clot does not cause heart attack or stroke. If the clot breaks off, it will travel to the lungs and cause a pulmonary embolus.
A blood clot in an artery, usually in the heart or brain, is called arterial thrombosis. This type of blood clot can cause heart attack or stroke.
Acute DVT Can Lead to Chronic Post-Thrombotic Syndrome (PTS)
While most cases of DVT (60%) resolve with anticoagulation therapy, there are a number of patients (40%) who develop some degree of a chronic and very painful condition called "Post-Thrombotic Syndrome."
In approximately 4% of patients, the chronic pain, swelling, impaired circulation, and recurrent skin ulcerations can become severe.
These complications are often disabling because they can make it impossible to perform even a sedentary ("desk job") occupation. That's because sitting aggravates the pain and swelling in the affected leg, and often makes it necessary to keep the leg elevated.
Getting Long-Term Disability Benefits with DVT/PTS
DVT is usually a self-limited condition that will not give rise to long-term disability. Treatment with anticoagulation typically resolves the DVT (or PE) and following a period of convalescence, a patient is typically able to return to work.
However, patients who develop varying degrees of PTS following a DVT may qualify for long-term disability benefits under either the Social Security Act (SSDI) and/or a long-term disability plan provided by their employer (ERISA).
One of the most important points to clarify right from the outset of filing a disability claim, either with the insurance carrier or the judge hearing the case, is that PTS is much more complicated and disabling condition than DVT, and it's not the same thing.
Insurance carriers and judges are familiar with DVT and know it to be a self-limited condition, which typically gets better with anticoagulation and which does not result in long-term disability. They may not be as familiar with PTS, which is a serious complication of DVT and which can be completely disabling.
The treating doctor must make this distinction clear in the medical records and must document with specificity what a claimant cannot functionally do (e.g., sit for 6 hours or more in an 8 hour day) as a result of the PTS.