A diagnosis of Parkinson’s disease (PD) can be life-changing. Parkinson’s usually begins gradually and worsens over time. It is episodic and unpredictable. Symptoms are both obvious and hidden, and many are often underdiagnosed.
As it often advances into stages of disability and loss of independence, Parkinson’s disease forces many people to stop working. If this is your situation, you may be eligible for vital disability benefits, through the Social Security Administration (SSA), from private insurers, or from the Department of Veterans Affairs (VA).
What many claimants are shocked to learn is that most disability claims based on Parkinson’s disease are initially denied—sometimes in error, sometimes due to insufficient information, sometimes unfairly.
In this post, you will learn why many PD disability claims are denied, and how you can approach your claim most effectively—so you can move forward to protect your rights and secure your rightful benefits.
The Disabling Symptoms of Parkinson’s Disease
PD is generally caused by a deficiency of dopamine, a neurotransmitter in the brain. The lack of dopamine disrupts a person’s movement and coordination.
The main motor symptoms include:
- tremor in the hands, arms, legs, jaw, or head
- muscle rigidity of the limbs and trunk
- bradykinesia (slowness of movement)
- impaired coordination and balance, including posture, gait, and mobility.
Other symptoms—which on their own, severely damage one’s quality of life—include pain, confusion, fatigue, sleep disturbances, depression, anxiety, urinary problems, difficulty swallowing, speech problems, and cognitive changes. Advanced PD can result in severe dementia.
There is no single test that concludes a person has Parkinson’s disease. Diagnosis is based on an ongoing medical history, the patient’s symptoms, neurological and physical exams, and medical tests and scans targeting Parkinsonian Syndrome.
Parkinson’s and Social Security Disability Insurance (SSDI)
An important thing to know about Parkinson’s and SSDI is that you might not qualify for benefits based solely on a diagnosis of Parkinson’s. Most people continue working for years after being diagnosed.
Meeting SSA’s Medical Listing for Parkinsonian Syndrome
With that in mind, the fastest way to win SSDI benefits for Parkinson’s is to qualify under SSA’s medical listing 11.06, Parkinsonian Syndrome. Qualifying under this listing requires detailed medical evidence. In brief, you need a diagnosis of Parkinson’s disease, supported by medical records of symptoms including:
- Significant rigidity
- Bradykinesia (slowness of movement)
- Tremors in two extremities (both legs, both arms, or an arm and a leg)
Your symptoms should also show difficulty with fine motor skills, large motor skills, standing, or walking. In addition to various test results, SSA will require your doctors’ responses to targeted questions concerning your PD, as well as proof of your adherence to prescribed treatment.
If you meet or equal the requirements of the listing, SSA will find you are disabled without considering your age, education, and work experience.
Parkinson’s SSDI Claim Based on a Reduced Residual Functional Capacity (RFC)
If you cannot satisfy the guidelines of the SSA’s medical listing for Parkinsonian, you have another option. You may qualify based on a reduced RFC.
Here you must prove that your condition has made it impossible to work consistently and earn a gainful living. SSA will base its decision on the evidence you provide, which can be very difficult at the initial application stage. You need to prove you cannot do your “past relevant work” and “any other work.” Adjudicators often find the claimant’s reported signs and symptoms of PD are not “severe enough” or are incomplete when filed without attorney representation.
You must be thorough and provide what SSA needs to see:
- A detailed history of your medical condition and functional abilities. This process is critical and involves your medical records, doctors’ statements, and further evidence that evaluates and shows your inability to work consistently.
- Evidence of various forms of limitations, such as postural, exertional, manipulative (reaching, handling, fingering), visual, communicative, mental, and environmental.
- Your case strengthened by documenting all symptoms, carefully tracking worsening symptoms, describing problems with daily activities, including the testimony of family, friends, co-workers, and reporting prescriptions for any assistive devices as a Parkinson’s patient.
Do not be discouraged.
Many SSDI claims for Parkinsonian Syndrome are initially denied. Yet when represented by a disability attorney, denials often go on to be approved at the ALJ hearing before an Administrative Law Judge.
Our attorneys can give you superior support in pursuing your disability benefits and can represent your claim at any level of the appeals process. We also have the resources that can help a borderline claim based on Parkinsonian syndrome be successful.
Parkinson’s Disease and Long Term Disability (LTD) Insurance Claims
You may have group disability insurance coverage as part of an employee benefits plan, or you may have purchased an individual disability policy as protection against loss of income.
In either case, to receive these long term disability benefits, you need to meet your plan or policy’s definition of disability. This generally requires that, due to sickness or injury, you are now unable to perform the duties of your own occupation or another occupation.
Your insurance company may not fully understand the impact that Parkinson’s disease can have on a person over time, both physically and cognitively. Claim examiners may not appreciate how is it that you have been able to work for years with PD and now suddenly you cannot.
Our attorneys do understand. We also know what it takes to submit a strong LTD insurance claim to prove disability for Parkinson’s or file an appeal that will stand up in court.
We prepare for the tactics insurers use to avoid having to pay monthly benefits. Here are a few:
- Most policies have a pre-existing condition exclusion clause. These provisions will exclude coverage if you have had certain medical conditions in the past. This is a preferred tactic used by insurance providers to deny claims based on Parkinson’s disease.
- LTD policies are often worded to limit or deny coverage under a subjective conditions limitation clause. Certain parkinsonian symptoms—like stiffness, slowness, tremors, rigid muscles, cognitive issues, numbness, and balance disorders—will not show up on any “objective” tests, but rather are self-reported or diagnosed by the doctor based on examination and medical history. But the insurer will require objective evidence meaning diagnostic tests like MRIs, X-rays or CSF analysis to prove those symptoms exist.
- Most LTD policies have a 24-month mental health limitation. Insurers attempt to limit benefits to 24 months for impaired memory or other cognitive problems caused by Parkinson’s disease. This is especially effective when the disease is in the early stages and less medically identifiable.
A lawyer experienced in disability insurance laws and Parkinson’s disease can provide the support you need.
Group LTD claims fall under federal ERISA law. When a group claim is denied, the information you present in your appeal to the insurance company will also be the basis for a potential lawsuit against the insurance company. An experienced ERISA lawyer is essential to your case.
In a private disability insurance claim denial based on Parkinson’s, state contract and bad faith laws prevail. In each case, our experienced attorneys are prepared to review your claim, explain your legal options, and help you get the compensation you deserve.
Disability Compensation for Veterans with Parkinson’s
The minimum VA disability rating for Parkinson’s disease is 30%. However, you must consider other important factors that can increase this rating to 100%. While you may be awarded 30%, that rating alone may be incomplete.
The 30% rating is the starting point. It is vital to make sure the VA completes its rating and evaluates each of your symptoms associated with PD. The VA then should calculate your rating using the combined rating for each symptom. These may include:
- Tremors, rigidity, and slowness of movement in both upper and lower extremities
- Cognitive problems
- Difficulty swallowing
- Speech problems
- Bladder and/or bowel problems
- Facial muscle paralysis
Presumptive Service Connection for Parkinson’s:
The VA may presume your PD is connected to your military service. Veterans who develop Parkinson’s disease and were exposed to Agent Orange or other herbicides or contaminants during military service do not have to prove a connection between their disease and service to be eligible to receive VA disability compensation.
UPDATE: As of January 2020, the VA extended the presumption of Agent Orange exposure and other toxic herbicides to Blue Water Navy Vietnam Veterans, and to veterans who served in or near the Korean DMZ (see below). H.R.299 – Blue Water Navy Vietnam Veterans Act of 2019.
Veterans with Parkinson’s disease who served in the following locations and specified times need not prove they were exposed to VA-recognized toxins to get disability compensation:
- Exposure to Agent Orange in Vietnam: Veterans who set foot in Vietnam, and veterans serving aboard ships operating on the close coastal waters and inland waterways of Vietnam, and as of January 2020, Blue Water Veterans for any duration between January 9, 1962 – May 7, 1975, or
- Exposure to Agent Orange in or near the Korean Demilitarized Zone for any duration between April 1, 1968 – August 31, 1971, or
Exposure to Contaminated Water, Marine Base Camp Lejeune, NC for at least 30 days between August 1953 – December 1987 (water contaminated with industrial solvents, benzene, and other chemicals).
We have more information about Blue Water Veterans.
Proving Service Connection for Parkinson’s Disease without a Presumption:
As for any other non-presumptive conditions, veterans with Parkinson’s who did not serve in a location listed above may still qualify for VA compensation. You will need to submit additional evidence to show that your exposure was during military service, and link the exposure to your Parkinson’s.
Because PD is progressive, the VA does not make veterans wait for the disease to slowly evolve. So medical documentation of symptoms should pave the way to service connection. The first thing you need to provide is documentation that you have symptoms of Parkinsonism.
You will need to provide the VA with your
- Military separation records
- Service treatment records
- Medical evidence of diagnosis (if available) and treatment of Parkinson’s
Timing and sufficient evidence of Parkinson’s are critical, as a timely filing for VA compensation properly ensures that you can start receiving benefits from the date VA has your claim in hand.
You will also need your physicians’ opinion saying that your PD was caused by exposure to toxins in service, or by a service-connected traumatic brain injury (TBI). We recommend providing a statement detailing your exposure or event.
Regarding Parkinson’s in particular, various instances exist by which veterans may qualify for service-connected VA compensation, including
- Traumatic brain injury which is a known causative factor in Parkinson’s disease;
- Burn Pit Exposure in Southwest Asia, after 9-11-2001;
- Herbicide exposure in various military theaters and bases regarding Thailand, Vietnam, and Korea that are not part of the presumptive list of the Vietnam Era, and exposure to herbicides associated with Department of Defense projects involving herbicides.
Veterans with Parkinson’s Eligible for TDIU
If your service-connected Parkinson’s keeps you from working, benefits may also be available under a unique rating called Total Disability Based on Individual Unemployability (TDIU). Under this program, the VA pays 100% of total disability compensation to veterans who are unable to earn a living, and whose service-connected disabilities are not rated as 100-percent disabling. You want to be sure to file for TDIU as well.
The right legal guidance can make the difference in your case.
At Marc Whitehead & Associates, we can help you prepare an initial SSDI or LTD application for the best possible outcome. If you’ve already been denied benefits for Parkinson’s, our attorneys will develop and file a solid appeal to rebut a wrongful claim denial.
Our accredited veterans’ claims lawyers help vets across the U.S. get their rightful benefit payments approved in the shortest amount of time possible.
We have helped hundreds of claimants with Parkinson’s, and as we analyze your situation, we identify and fix critical information gaps in any of part of your claim—including missing medical data or incomplete vocational and functional evidence. We work in cooperation with your treating physicians and may enlist the assistance of qualified vocational experts, and much more.You must never give up. Call us toll free at 866-365-7898 or request a Free Legal Consultation to learn how we can help. Parkinson’s is a serious disability, and we are able to assist you wherever you live.