What is Wernicke-Korsakoff Syndrome?
Wernicke encephalopathy (“WE”) and Korsakoff syndrome (“KS”) [the combined disorder is named Wernicke-Korsakoff syndrome (“WKS”)] are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism, but more recently it has been recognized in patients who have undergone bariatric surgery for obesity or who have eating disorders such as anorexia nervosa. Patients at highest risk of developing non-alcoholic WE and WKS have a history of malnutrition, delusions related to food, or vomiting lasting longer than a week. Patients with nutritional deficiencies of any origin are at risk for WKS. [Ref: McCormick LM, et al. “Beyond Alcoholism: Wernicke-Korsakoff Syndrome in Patients with Psychiatric Disorders.” Cogn Behav Neurol. 2011 Dec; 24(4): 209–216.]
The National Institutes of Health (NIH) provides a good description of this condition. To wit: Wernicke's encephalopathy is a degenerative brain disorder caused by the lack of thiamine (vitamin B1). It may result from alcohol abuse, dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. B1 deficiency causes damage to the brain's thalamus and hypothalamus. Symptoms include mental confusion, vision problems, coma, hypothermia, low blood pressure, and lack of muscle coordination (ataxia).
Korsakoff syndrome is a memory disorder that results from vitamin B1 deficiency and is often associated with alcoholism. Korsakoff's syndrome damages nerve cells and supporting cells in the brain and spinal cord, as well as the part of the brain involved with memory. Symptoms include amnesia, tremor, coma, disorientation, and vision problems. The disorder's main features are problems in acquiring new information or establishing new memories, and in retrieving previous memories.
Wernicke-Korsakoff syndrome may be two ends of the same disorder, where the early stage is Wernicke's encephalopathy and the later or "chronic" stage is Korsakoff's amnesic syndrome. [Ref: https://www.ninds.nih.gov/Disorders/All-Disorders/Wernicke-Korsakoff-Syndrome-Information-Page]
Wernicke-Korsakoff syndrome is diagnosed by a neurologist based on a careful medical history and physical examination, laboratory tests that include liver function tests, and tests that measure thiamine and erythrocyte transketolase activity (both which are reduced in Wernicke-Korsakoff syndrome). Imaging of the brain by CT or MRI scans are performed to rule-out other diagnoses that may result in dementia or encephalopathy. Brain scans may also show specific findings that are indicative of Wernicke-Korsakoff syndrome, such as atrophy of the mammillary structures (which affect emotions and formation of memory) in the limbic system on both sides of the thalamus.
Thiamine deficiency (“TD”) appears to be a critical factor in the development of Wernicke-Korsakoff. Thiamine is vitamin B1. It is found in foods such as cereals, whole grains, meat, nuts, beans, and peas. Thiamine is important in the breakdown of carbohydrates from foods into products needed by the body.
Treatment requires prompt thiamine replacement, together with nutritional support, hydration, and other supportive measures. Stopping alcohol consumption, if that has been a problem, may help prevent further neurological damage. [Ref: “Korsakoff's syndrome: a critical review.” Nicolaas JM, et al. Neuropsychiatr Dis Treat., 2017; 13: 2875–2890.]
The earlier treatment with thiamine is instituted, the better the chance of some improvement in brain function. However, the prognosis is guarded in advanced cases, where the disorder may be permanently disabling.
Disability Benefits for Wernicke-Korsakoff
Although disability benefits for alcoholism, which has been one of the more common causes in the United States of Wernicke-Korsakoff syndrome, are not paid by SSDI, persons who have developed advanced symptoms of an alcohol-related condition, including Wernicke-Korsakoff, are eligible for disability benefits under the Social Security Disability (SSDI) program and/or a long-term disability plan through their employer (ERISA), when they are unable to work because of symptoms of encephalopathy or dementia, such as mental confusion, memory loss, amnesia, ataxia, vision impairment, or disorientation.
Wernicke-Korsakoff may be evaluated by the Social Security Administration under listing 11.00 Neurological (see: 11.17), although there may be an evaluation of findings under 12.00 Mental Disorders.
Neurodegenerative disorders of the central nervous system under section 11.17, such as Wernicke-Korsakoff, also include conditions such as Huntington's disease, Friedreich's ataxia, and spinocerebellar degeneration. LTD benefits awarded under category usually require meeting the criteria set forth in A or B, as follows.
- Disorganization of motor function in two extremities (see 11.00D1), resulting in an extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
- Marked limitation (see 11.00G2) in physical functioning (see 11.00G3a), and in one of the following:
- Understanding, remembering, or applying information (see 11.00G3b(i)); or
- Interacting with others (see 11.00G3b(ii)); or
- Concentrating, persisting, or maintaining pace (see 11.00G3b(iii)); or
- Adapting or managing oneself (see 11.00G3b(iv)).
Whether you qualify for long-term disability (LTD) benefits under SSDI or ERISA will depend on the documentation in your medical records of your diagnosis, your symptoms, physical findings, laboratory tests, x-rays, imaging studies, and other diagnostic studies, and the functional limitations that are the result of your condition. It's important to remember that LTD benefits are not usually awarded for just having a diagnosis, but instead will depend on the functional restrictions and limitations (R&L) from your condition that are documented by your doctors in your medical records.
If you have Wernicke-Korsakoff syndrome and if your restrictions and limitations equal or match the above limitations, then you may qualify for benefits. However, if your symptoms and findings do not match-up with the criteria under Section 11.17, you can still qualify for benefits, especially if your medical record show that you are unable to even perform a desk job (“sedentary work”).
At Law Med, we have knowledge and experience in obtaining LTD benefits under both SSDI and ERISA, and we will work with your doctor to get you the benefits that you deserve.