An Illinois court rules in favor of Prudential and finds that the claimant failed to provide objective evidence confirming the existence of his alleged vestibular disorder. The court also gave greater weight to the opinions of the claimant’s treating specialists, and dismissed the contention of the primary care doctor that the claimant was disabled from working.
The claimant in this case, Mr. K, had 3 major flaws with his case which led the court to determine that Prudential was correct in denying the claimant short-term and long-term disability benefits: 1) the claimant was not credible; 2) his claim lacked objective evidence of his alleged illness; and 3) none of his specialists supported that he was disabled from performing his job.
The Court finds, based on the evidence, that the claimant is not credible
In his lawsuit, Mr. K contends to the court that the automobile accident which prompted him to stop working due to his alleged disability was caused by his “symptoms associated with vertigo, ear aches, severe migraine headaches, chronic imbalance, and persistent episodes of lightheadedness, as well as hearing and vision limitations; in addition to the side effects of his prescribed medications.” However, the court notes that Mr. K was charged with driving under the influence as a result of the accident. Mr. K pled guilty to the DUI charge but a conviction was not entered as it was ordered that if Mr. K was compliant with the terms of his supervised release, and paid a fine, after 2 years the charges would be dismissed without an adjudication of guilt. The Illinois court took offense to Mr. K’s misstatement regarding the cause of his automobile accident and found that the accident was not caused by Mr. K’s alleged illness, but rather by his drunk driving. The court also stated that, “[t]he fact that [Mr. K] would falsely blame his alleged symptoms for the accident undermines the credibility of his claim, and the self-reporting to his physicians, to have suffered from those symptoms in the first place.” Further, the court noted that the records from the date of the accident reflected that he told the fire rescue personnel that transported him from the scene of the accident to the hospital that he “drank 3 jagermeister shots”, and that he did not have any medical history, was not taking any medications and did not have any allergies. In fact, Mr. K has a medical history which includes anxiety and panic attacks, and he was taking medications for those conditions (Alprazolam and Xanax). In the ER, the doctor that examined Mr. K noted that he was not a “terribly reliable historian”, and that he complained of some mild upper back and neck pain. The ER doctor diagnosed Mr. K with “motor vehicle accident, possible cervical and thoracic strain with belligerent behavior.” He was released to police custody that same night.
No Objective Evidence
Following the accident, Mr. K began treating with his primary care physician (PCP) due to complaints of ringing in his ears, headaches, sleeping problems, vertigo, memory problems, loss of feeling in the fingers of his left hand, occasional left elbow and shoulder pain, and balance problems which led to multiple falls. Mr. K’s PCP diagnosed him with continuing anxiety, malaise, fatigue, tinnitus, neck pain, vertigo, Post Traumatic Stress Disorder (PTSD), hearing loss, disorder of labyrinth, and possible Ménière’s disease. It was suggested that Mr. K suffered from a “vestibular disorder”. It was due to these disorders that Mr. K’s PCP determined he was disabled and unable to work. It is well-established that a claimant does not need to “prove” his condition with objective evidence “where no definitive objective test exists for the condition or its severity.” Though this is the case with conditions such as fibromyalgia and chronic fatigue syndrome, a vestibular disorder can be verified with objective testing. The court in this case recognized the Social Security regulations which require that impaired vestibular function be “demonstrated by caloric or other vestibular tests” and that “[h]earing loss [be] established by audiometry” to meet the disability listing for a vestibular disorder. It goes on to state that “the diagnosis of a vestibular disorder requires a comprehensive neuro-otolaryngologic examination with a detailed description of the vertiginous episodes, including notation of frequency, severity, and duration of the attacks. Pure tone and speech audiometry with the appropriate special examinations, such as Bekesy audiometry, are necessary. Vestibular function is assessed by position and caloric testing, preferably by [ENG].” The court went on to identify other tests used for diagnosis of a vestibular disorder which it obtained from the Vestibular Disorders Association website. Those tests include vestibulo-ocular reflex, which measures eye movements; ENG, which measures involuntary eye movements; VEMP testing; CDP to test postural stability; audiometry; and MRI or CT scans to locate structural problems. Mr. K’s PCP sent him to numerous specialists who, in fact, performed most, if not all, of these objective tests to confirm or rule out vestibular disorder as the cause of Mr. K’s reported symptoms: MRI and EcoG were normal; one specialist’s audiology tests found mild hearing loss but another specialist found the hearing loss did not rise to the level expected for a vestibular disorder, and a third specialist determined the test results were a mistake because he was not able to repeat the findings of hearing loss; one VEMP test was performed which was found to have a “pathological result”, but 2 other specialists repeated the VEMP tests with normal results; one CDP test was performed which was within normal limits; one specialist confirmed a diagnosis of involuntary eye movement, but ENG testing produced normal results.
None of the claimant’s treating specialists support that his was disabled from working due to his alleged illness
As stated previously, Mr. K’s PCP diagnosed him with continuing anxiety, malaise, fatigue, “tinnitus unspecified”, neck pain, vertigo, Post Traumatic Stress Disorder (PTSD), hearing loss, disorder of labyrinth, and possible Ménière’s disease. It was due to these conditions, and his reported symptoms, that the PCP determined that Mr. K was disabled and could not work. Additionally, the PCP referred Mr. K to multiple specialists perform further evaluations of Mr. K’s reported symptoms. A dizziness and balance disorder specialist concluded that the diagnosis of Ménière’s disease was “dubious”. A doctor of audiology concluded, based on inconsistent results of audiology tests, that “some amount of non-organic hearing loss versus possible psychological hearing loss [was] suspected”, and that “at minimum, [Mr. K’s symptoms were] being exacerbated by his anxiety, if not being a major contributing factor.” An ENT specialist opined that Mr. K was suffering from a “psychosomatic more than a structural” disorder, and that Mr. K was “bringing his problems upon himself.” Mr. K saw 2 different psychiatrists who concluded that Mr. K did not suffer from PTSD, as was diagnosed by his PCP. One psychiatrist determined that Mr. K’s vestibular symptoms were not related to mood changes or to anxiety/panic.
Further, Mr. K, himself, denied that his alleged impairments were caused by “mental illness.” Only Mr. K’s primary care physician was of the opinion that Mr. K should not work and that his symptoms were disabling. The court noted that the PCP’s opinion held less weight than that of Mr. K’s specialists and that courts have long recognized that opinions of primary care physicians regarding patients’ disabilities are often biased in the patient’s favor. Further, Mr. K’s PCP is not a specialist and did not perform any of the objective tests for vestibular dysfunction. Rather, the specialists that examined Mr. K and performed the objective tests relative to his reported symptoms did not place any restrictions or limitations on Mr. K’s ability to perform his job or return to work. The court ultimately determined that Prudential was correct in denying Mr. K’s claims for short-term and long-term disability benefits based on the fact that Mr. K was unable to present any objective test data to confirm a diagnosis of vestibular dysfunction, and that none of Mr. K’s specialists placed any work restrictions or limitations on Mr. K – combined with the fact that Mr. K was not credible with regards to his self-reported symptoms. Mr. K did not show that he met the plan’s definition of disability and that he was prevented by his illness from performing the duties of his occupation.
Attorneys Dell & Schaefer did not represent Mr. K in his disability claim, appeal or lawsuit. If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.