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Sjogren’s Syndrome and Your Long Term Disability Claim

Sjogren’s (SHOW-grins) syndrome is no stranger to some of our Bay Area ERISA clients.  Attorneys not familiar with this condition or with ERISA law often find themselves way in over their heads when their client is disabled by Sjogren’s syndrome and is seeking long term disability benefits from his or her employer’s disability plan.  Sjogren’s symptoms may interfere with one’s ability to maintain the persistence and pace of regular full-time employment.  If you find yourself in the situation of being disabled by Sjogren’s syndrome, knowing your rights to disability benefits is crucial.

For starters, it’s important to understand the illness and how its symptoms can impact one’s ability to work.  According to the Mayo Clinic, Sjogren’s syndrome is a disorder of your immune system identified by dry eyes and a dry mouth.  Specifically, with dry eyes, you might experience burning, itching, or feeling like there is sand in your eyes.  With dry mouth, you might experience the sensation that your mouth is full of cotton, with difficulty swallowing or speaking.  Other related symptoms include:  joint pain, swelling and stiffness, swollen salivary glands, skin rashes or dry skin, vaginal dryness, persistent dry cough, and prolonged fatigue.

Patients with Sjogren’s may also have other immune system disorders such as rheumatoid arthritis and lupus.  This condition is most common in women who are older than 40 years of age.  Treatment is focused on relieving symptoms rather than completely curing the condition.  Sjogren’s syndrome can also damage other parts of your body, such as:  joints; thyroid; kidneys; liver; lungs; skin and nerves.

Symptoms from Sjogren’s and other related immune disorders may cause disability from work.  In Okuno v. Reliance Standard Life Ins. Co., 836 F.3d 600 (6th Cir. 2016), where the plaintiff was successful against Reliance Standard, the court noted that Okuno had been diagnosed with Sjogren’s syndrome, an autoimmune disease that often accompanies other immune system disorders. “This combination resulted in ‘a battle of fatigue from medication, potential interaction with other medication interventions, disruption of sleep from many symptoms (back pain, anxiety, etc.) and a general sense of loss of vitality.’” Id. at 605.

But, a diagnosis of Sjogren’s syndrome is not enough to establish disability.  For example, in Bauer v. Metro. Life Ins. Co., 397 F. Supp. 2d 856 (E.D. Mich. 2005), the court noted that although Bauer was objectively diagnosed with Sjogren’s syndrome (via a lip biopsy), MetLife did not abuse its discretion in finding that she did not show that the syndrome prevents her from working.  Objective evidence of functionality may include a statement from a doctor that ties this condition to the plaintiff’s subjective complaints.  It may also include a functional capacity evaluation.  There are many ways one can establish evidence of disability but every person’s medical condition is unique.  There is no one fool-proof way to establish disability.

If you are disabled by Sjogren’s syndrome and are seeking to apply for disability benefits from your employer’s short or long term disability plan, don’t go at it alone.  It is recommended that you consult with an experienced disability attorney who knows how to navigate the intricacies of an ERISA disability benefit claim.

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