Chiari Malformation

Chiari Malformation Headaches and Your Long-Term Disability Claim

Chiari malformation is a group of defects affecting the brain and the spinal canal that can cause debilitating headaches, which may qualify you for Long-Term Disability benefits.

The condition is present from birth, and according to the American Association of Neurological Surgeons, 0.1% of the population has a Chiari malformation. Not everyone who has a Chiari malformation experiences symptoms.

If you have been diagnosed with Chiari malformation, there are a number of things you must understand before you stop working and apply for Long-Term Disability benefits, or appeal a wrongful claim denial or termination.

The number one thing you must understand is that you have the burden of proving that you are disabled, as that term is defined by your disability policy. You will have the burden of proving:

• What type of Chiari malformation you have,
• The objective basis for the diagnosis of Chiari malformation,
• Your disabling symptoms,
• What treatment you have had, and
• Your response to the treatment.

That can take teamwork between you, your doctor, and your disability lawyer. These cases can be difficult, and you need the assistance of an experienced disability lawyer to meet your burden of proof.

The Four Types of Chiari Malformation

Disability carriers often don’t understand Chiari malformation or its different types. You should make sure that your doctor makes a clear diagnosis of the type you have:

Type 1

This is the most common form, and people generally experience symptoms in late childhood and adulthood. These include:

• Headache
• Neck pain
• Dizziness
• Balance problems
• Weakness of the muscles
• Tinnitus and hearing problems
• Nausea
• Excessive vomiting or drooling
• Scoliosis
• Coordination problems
• Psychological problems, including depression

Type 2

In Type 2, a larger amount of tissue pushes into the spinal canal, and it is called “classic Chiari malformation.” Symptoms are more severe than Type 1 and often require surgery. They include:

• Difficulty swallowing,
• Breathing changes, and
• Weakness in the extremities.

Type 3

Type 3 is rare and occurs when a lower part of the brain protrudes into the back of the head or neck. This is usually diagnosed at birth and is generally fatal. If a person with Type 3 survives infancy, they may experience:

• Neurological defects,
• Seizures, and
• Developmental delays.

Type 4

This is where the cerebellum is not fully formed, and it is also fatal.

The Objective Basis of the Diagnosis of Chiari Malformation

You most likely have Type 1 or Type 2 Chiari malformation, but it might have been hard to get an accurate diagnosis because the symptoms are generalized and linked to other types of common disorders. Chiari malformation is often misdiagnosed as a different neurological or psychological condition.

The disability carrier will want to see a positive brain MRI.

Your Disabling Symptoms

The disability insurance carrier will get your medical records and have those records reviewed by their medical staff. The carrier will be looking for your medical history, including your symptoms.

The most important thing you can do is create an Excel spreadsheet of your symptoms and document the frequency, nature, and intensity of each one. Just as important as documenting symptoms is explaining how these symptoms impact your functionality both at home and at work. For example, your headaches may occur daily and interfere with your ability to use a computer, complete various job duties, or avoid making mistakes.

Provide this spreadsheet to your doctor at each visit and submit it to the carrier. Be accurate and do not exaggerate – exaggeration will kill your case.

Treatment and Your Response to Treatment

Treatment can range from conservative measures to radical surgery. You might treat with a pain management provider for headaches or neck pain. If conservative treatment does not relieve your symptoms, surgery might be recommended.

Be sure that your medical records document the nature of the conservative treatment and your response to it.

There are two different types of surgery that can be recommended:

• Decompression surgery, which involves opening the base of the skull and removing small pieces of bone from either the skull or the top of the spine. This releases pressure and can help the headaches. However, this is not always successful.
• Hydrocephalus surgery, which involves the placement of a shunt to drain excess fluid into the chest or stomach so the body can absorb it. This relieves the pressure in the skull.

The disability carrier can’t make you have surgery as a condition of paying benefits. If you do have surgery, be sure that your medical records document your post-surgical course, your post-surgical symptoms, and your functionality.

Remember – you have the burden of proof, not the disability carrier. Don’t give the carrier a reason to deny your claim.