LTD / ERISA Disability Lawyers: OC, Riverside and San Bernardino

Meniere's Disease and Long-Term Disability Benefits

Definition

Ménière's disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. It is named after a French physician, Prosper Menière, who in the 1800's discovered that the inner ear was responsible for these symptoms, and the condition has since been known as Ménière's disease. Ménière's disease usually affects only one ear but may progress to both ears. The cause is not known, and there is no cure. However, what is known about the pathogenesis of this disorder is that there is a buildup of fluid (“endolymph”) in the cochlea (which controls hearing) and the semicircular canals (which control balance) of the inner ear (“labyrinth”) that interferes with the normal functioning between the inner ear and the brain.

Symptoms

Symptoms include periodic “attacks” of dizziness (“room spinning”), disequilibrium (balance problems), nausea, tinnitus, and/or hearing loss. It is classified as a vestibular disorder, and some individuals may have severe vertigo to the point that they fall (“drop attacks”). It typically affects adults between 40 and 60 years of age. There are an estimated 615,000 individuals in the United States that have been diagnosed with Ménière's and 45,500 new cases each year. It is a relatively rare disorder and the symptoms can come and go.

Attacks of extreme dizziness (vertigo) can occur suddenly, without warning. There may be fluctuations in hearing. Attacks of Meniere's can severely disrupt activities of daily living.

Attacks of Ménière can last for hours and may sometimes be triggered by stress, fatigue, and emotional issues. Symptoms may come in clusters over several days or weeks, and then they may resolve spontaneously for a while. Some people with Ménière disease have no symptoms of the disorder between episodes, particularly in the early stages of the disease. Over time, however, many affected individuals develop ongoing problems with unsteadiness, tinnitus, and a feeling of fullness in the ears. Additionally, permanent hearing loss eventually develops in many people with this disorder.

[Ref: https://www.nidcd.nih.gov/health/menieres-disease]

Diagnosis

There is no definitive diagnostic test for Meniere's. The diagnosis is typically established by an ENT doctor based on the following four criteria: (a) two or more episodes of vertigo lasting at least 20 minutes each, (b) tinnitus, (c) temporary (or permanent) hearing loss, and (d) a feeling of fullness in the affected ear.

An MRI brain scan is usually performed in order to rule out other conditions (e.g., an acoustic brain tumor or multiple sclerosis). The MRI is usually normal in Meniere's.

Tests for the Inner Ear

There are several diagnostic procedures that may be performed in assessing inner ear function. They include positional and caloric testing (electronystagmography), tests that evaluate balance and eye movement (videonystagmography or VNG), computerized rotary-chair testing, vestibular evoked myogenic potentials (VEMP) testing, video head impulse test (vHIT), and electrocochleography (ECoG), which can assess abnormal fluid build-up in the inner ear.

In most cases, these tests are nor performed. They are used mostly in research.

Causation

While it is not known what causes Meniere's disease, research has focused on viral infections, trauma to the inner ear, noise pollution, allergies, immunological factors, migraines, and genetics.

Treatment

There are medications that can improve the vertigo symptoms of Meniere's, including antihistamines such as Antivert. If nausea and vomiting are present, anti-nausea medications, such as promethazine may be helpful. Diuretics and reducing sodium intake in the diet may decrease the fluid build-up in the inner ear and help decrease the severity and frequency of symptoms.

Physical therapy and balance training can help. Hearing aids for hearing loss are prescribed by an ENT doctor or an audiologist.

Positive pressure therapy, using a pulse generator that applies pulses of pressure to the ear canal through a ventilation tube, is sometimes used to treat extreme cases of vertigo that are refractory to other treatments, but the results are mixed.

ENT doctors sometimes inject corticosteroids into the inner ear, through a puncture in the ear drum, which can improve symptoms.

There are also surgical procedures that include decompression of the endolymphatic sac in the inner ear and vestibular nerve section.

Treatments to help restore hearing loss are unfortunately not available.

Lifestyle modification includes limiting salt intake, caffeine, alcohol, and smoking. The Vestibular Disorders Association (VeDA) has useful information and access to support groups. [Ref: https://vestibular.org/?gclid=EAIaIQobChMIp6LEz_X05gIVkONkCh3DRgOMEAAYASAAEgKUCPD_BwE

Long-Term Disability (LTD) Benefits for Meniere's

What's important is careful and consistent documentation in the medical records from your treating doctors that (a) you have an established diagnosis of Meniere's disease, (b) a longitudinal and chronological record of the frequency and severity of your symptoms, and (c) a detailed description of how your Meniere's affects your ability to function, not only in your job, but also in your activities of daily living (ADL).

It is important that you be proactive with your treating doctors and that they take the time to document your symptoms and functional impairments, including the duration, frequency and intensity of your symptoms, factors that aggravate or precipitate the symptoms, the type, dosage, effectiveness, and side effects of any medications you take to alleviate your symptoms, treatment, other than medications, that you use for the relief of symptoms, and any measures other than treatment you use (such as having to lie down flat on your back and not moving) and how often you have to do that.

If all of your medical records from your treating doctor(s) and other medical providers contain reliable clinical findings and consistent documentation of your symptoms and the presence of a demonstrable functional impairment, your chances of obtaining a successful LTD award under SSDI or under an employer-provided group disability plan (ERISA) will be greatly enhanced, even if you have a disability based on subjective symptoms. Chronister v. Baptist Health, 442 F.3d 648 (5th Cir. 2006) (clinical findings are as “objective as x-rays or blood tests.”)