Sjögren’s disease, also known as Sjögren’s syndrome, is an autoimmune disorder in which your immune system attacks the moisture-producing glands in the eyes and mouth, leading to chronic dryness in these areas. Sjögren’s disease can also affect other parts of the body, including the joints, skin, and organs such as the lungs, kidneys, and nervous system.
The exact cause of Sjögren’s disease is not known, but it is believed to be related to genetic and environmental factors. It is more commonly found in women and typically occurs in middle-aged or older individuals.
If you suffer from Sjögren’s disease, you may be experiencing intense symptoms that interfere with your ability to carry out daily activities, including work. In this article, we’ll discuss how Sjögren’s causes disability, whether you can receive disability benefits for Sjögren’s disease, how insurance companies evaluate Sjögren’s disease disability claims, and how The Maddox Firm can help prove your Sjögren’s short or long term disability claim.
How Does Sjögren’s Disease Cause Disability?
Common symptoms of Sjögren’s disease include:
Dry eyes
Dry mouth
Fatigue
Joint pain and stiffness
Swollen salivary glands
Skin rashes and/or dryness
Oral and eye infections
Peripheral neuropathy
Difficulty concentrating and/or impaired memory
Treatment for Sjögren’s disease focuses on relieving the symptoms of dryness, such as using artificial tears or saliva substitutes, as well as treating any underlying medical conditions that may be contributing to the disease. Immunosuppressive drugs may also be used in some cases to help reduce inflammation and slow the progression of the disease, though they may also cause their own side effects that contribute to disability.
Some people afflicted with Sjögren’s disease are able to function normally, but others may experience more intense and frequent symptoms that prevent them from working. For example, your job may require constant phone communication, and the chronic mouth dryness caused by Sjögren’s can make it difficult to speak. Sjögren’s disease may also cause joint pain and stiffness, which make it difficult for you to sit, stand, or walk for extended periods. You may also suffer from significant fatigue due to your Sjögren’s disease which interferes with your ability to complete a normal workweek. Or you may notice that your ability to concentrate or remember certain details has decreased, which could also be caused by Sjögren’s.
Sjögren’s disease can cause a wide range of symptoms that significantly impact your ability to perform daily activities, thus leading to disability.
Can I Receive Disability Benefits for Sjögren’s Disease?
Yes, it is possible to receive disability benefits for Sjögren’s disease. However, it will depend on the nature of your condition and the associated physical and cognitive symptoms.
Your disability insurance policy will lay out what criteria you must meet to receive short or long term disability benefits due to your Sjögren’s disease. One important term to look for is your policy’s definition of disability. Generally speaking, most disability policies define disability as the inability to perform the “substantial and material” duties of your own occupation. This means your Sjögren’s disease need not impair you from performing all activities of daily living, but if it impairs your ability to perform one or more of your essential job functions, you may qualify for disability benefits from your insurance company. Of course, you should always refer to your policy to verify the definition of disability.
Some other general criteria for receiving disability benefits for your Sjögren’s disease include:
You must be treating regularly with an appropriate doctor (and following that doctor’s treatment recommendations).
If your policy has a pre-existing clause, you must be in compliance with it.
If approved for benefits, you must also file for Social Security Disability (“SSDI”) benefits.
How Do Insurance Companies Evaluate Sjögren’s Disease Disability Claims?
To receive disability benefits, you will need to prove to your insurance company that your Sjögren’s disease impedes your ability to work. Your insurance company will not approve you for benefits at face value. You must provide them with compelling and objective evidence demonstrating your Sjögren’s disease symptoms and how they prevent you from working. Should you fail to do so, your insurance company will likely deny your claim due to lack of evidence.
The two general components to your Sjögren’s disease disability claim are your medical disability and your inability to work. Below we’ll explain the different types of evidence you may submit to support each of these components.
Medical Disability Due to Sjögren’s Disease
One of the most important types of evidence your insurance company will consider is objective medical evidence of your Sjögren’s disease diagnosis and symptoms. Objective medical evidence includes office visit notes from your treating providers, diagnostic testing, medical testing results, imaging, and any other medical records.
Diagnostic Testing
Sjögren’s disease is typically diagnosed via a combination of medical history, physical examination, and laboratory tests. An immunologist and/or rheumatologist are appropriate specialists to diagnose and treat Sjögren’s disease.
During a physical examination, your doctor will look for signs and symptoms of Sjögren’s disease, such as dry eyes and mouth, swollen salivary glands, and joint pain. Your doctor may also check for evidence of other autoimmune disorders, such as rheumatoid arthritis and lupus, which may occur along with Sjögren’s disease.
Blood tests are often used to detect antibodies that are commonly present in people with Sjögren’s disease. These antibodies include:
Anti-SSA/Ro antibodies
Anti-SSB/La antibodies
Rheumatoid factor (RF)
Antinuclear antibodies (ANA)
In addition to blood tests, your doctor may also perform a biopsy of the salivary gland to check for signs of inflammation and damage.
Diagnostic imaging tests, such as magnetic resonance imaging (MRI) or ultrasound, may also be used to evaluate the salivary glands for signs of inflammation and damage.
Objective Medical Evidence of Sjögren’s Disease Symptoms
Evidence of your Sjögren’s disease diagnosis is only one part of proving your medical disability to your insurance company. More important will be proving the presence, severity, and frequency of your symptoms that stop you from working.
Some types of objective medical evidence of your Sjögren’s disease physical symptoms may include:
Schirmer’s test: This test measures number of tears produced by the eyes. A small piece of filter paper is placed inside the lower eyelid, and after five minutes, the amount of wetting is measured. Reduced wetting indicates dry eyes, which is a common symptom of Sjögren's disease.
Ophthalmologic exam: An ophthalmologist can perform an exam to look for evidence of dry eyes, including measuring tear production and examining the cornea.
Imaging tests: Imaging tests such as MRI or ultrasound can show inflammation and damage to the salivary glands, which is a hallmark of Sjögren's disease.
Dental exam: A dentist can examine the teeth and mouth for signs of dryness, such as cavities or gum disease.
Your medical records from your treating doctors may not fully reflect the scope of your physical limitations and experiences due to your Sjögren’s disease. In this case, you may want to undergo a Functional Capacity Evaluation (“FCE”). The FCE measures a wide range of your physical functioning, including your ability to sit, stand, walk, lift, squat, gross motor skills, hand dexterity, and endurance. The results of an FCE may provide your insurance company with more comprehensive, detailed evidence of your limitations and restrictions that prevent you from working.
Studies have also shown that up to 60% of people with Sjögren’s disease experience cognitive symptoms such as fatigue, difficulty concentrating, and impaired short-term memory. The cognitive symptoms of Sjögren’s disease are believed to be caused by inflammation in the brain and nervous system, as well as the effects of chronic illness and fatigue.
These cognitive symptoms are often harder to prove to your insurance company. They may be considered “self-reported” and therefore unreliable by your insurance company if not backed by any objective evidence.
If you experience serious cognitive symptoms due to your Sjögren’s disease, you may consider undergoing a neuropsychological evaluation. A neuropsychological evaluation involves assessing your cognitive abilities including attention and concentration, memory recall, language, visual-spatial skills, and executive functions. The results from a neuropsychological evaluation can provide objective evidence of any cognitive impairment you experience as a result of your Sjögren’s disease.
Inability to Work Due to Sjögren’s Disease
The second piece of your Sjögren’s disease disability claim is explaining how these symptoms prevent you from working. Vocational evidence you may submit in support of your claim includes:
Your resume
Your official job description
A personal affidavit outlining your job functions, responsibilities, and day-to-day duties
A witness statement from your employer or co-worker detailing your job responsibilities and your performance decline due to your Sjögren’s disease symptoms
A vocational expert’s assessment of your occupation
Your insurance company may have a poor understanding of your occupation and what it entails. It’s important to provide vocational evidence explaining your occupation and essential job functions, and how your Sjögren’s disease symptoms prevent you from performing these duties. Make sure to cover the physical and cognitive demands of your job role.
How Can The Maddox Firm Prove My Sjögren’s Disease Disability Claim?
Before filing a short or long term disability claim due to Sjögren’s disease, it’s always recommended that you speak with an ERISA attorney. The experienced team at The Maddox Firm has helped countless clients win their short or long term disability benefits due to similar autoimmune diseases. We understand what your insurance company requires to approve your benefits and how to avoid common mistakes claimants make when going through the process on their own.
Here are a few ways The Maddox Firm can help prove your Sjögren’s disease disability claim:
The Maddox Firm examines your policy. As discussed earlier, your disability insurance policy outlines the necessary criteria you must meet to qualify for benefits. The policy language is often complex, confusing, and easily misunderstood. The Maddox Firm will study your policy and explain the terms to you so you understand the definition of disability, any change in definition after approval, the elimination period you must meet, any pre-existing condition clauses, and any other conditions to consider.
The Maddox Firm handles all communications with your insurance company. Once retained, The Maddox Firm will take over all communications with your insurance company immediately. This prevents your insurance company from blindsiding you with any attempts to undermine your disability claim with misleading questions. We ensure all claim forms are received in a timely manner and that your insurance company does not drag its feet with your claim. If your insurance company tries to request an interview with you, we will push back on your behalf. Should an interview proceed, we attend the interview with you to make sure your insurance company doesn’t overstep and your rights are protected.
The Maddox Firm gathers and evaluates your evidence. The Maddox Firm will request and obtain your medical records from your treating doctors. We review the records for any “red flags” to get ahead of your insurance company’s questions. Oftentimes these medical records do not fully detail your restrictions and limitations caused by your Sjögren’s disease symptoms. We will coordinate with your treating doctors to procure supplemental statements in support of your Sjögren’s disease disability. If needed, we will refer you to trusted professionals for additional testing, such as a Functional Capacity Evaluation or a neuropsychological evaluation. We then review these reports for completeness and accuracy.
The Maddox Firm will handle an appeal or litigation on your behalf. If your Sjögren’s disease disability claim has already been denied or your benefits are terminated, The Maddox Firm can handle your appeal or litigation with your insurance company.
We always recommend speaking with a trusted attorney before filing or appealing a Sjögren’s disease short or long term disability claim. Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.