Long-term disability and coronary artery disease.

Mrs. C, who suffered from hypertension, hyper-lipidemia, COPT, cerebrovascular disease, coronary artery disease, and emphysema, underwent an angiogram that showed a high-grade stenosis for which she had stenting on three occasions and a subsequent venous graft.

Her treating physician opined that she was permanently restricted from her job as a vocational rehabilitation counselor and, as a result, she was initially granted long-term disability benefits based on her inability to perform her job.

She was entitled to continue disability benefits if she was unable to perform her own occupation, which was defined as “usual and customary employment, business trade or profession or vocation employee performed as generally recognized in the national economy… it is not limited to the job or position the employee performed for the employer….”

Mrs. C’s employer was unable to offer her her prior position based on a review of her job andher physician’s opinions. Her employment was terminated.

The long-term disability carrier began the payment of long-term disability benefits. Unfortunately, Mrs. C underwent a cardiac catherization that showed a 50-percent stenosis consistent with a right coronary artery disease for which she underwent stenting and grafting. She was placed in a Class 3 cardiac function with severe limitations of functional capacity, indicating she was incapable of minimal or sedentary activity.

In December of 2002 Dr. H conducted a paper review for the long-term disability carrier, concluding that she was “capable of sedentary to light activities.” The long-term disability carrier also chose to exercise its rights to an IME with Dr. A because it “felt the restrictions and limitations placed upon her… by her treating physician were based on her self-supported symptoms consisting of subjective chest pain which she claimed would come on with minimal exertion even at rest.”

Dr. A concluded that Mrs. C was capable of doing sedentary light duty work but was unable to exert herself for any tremendous amount of distance.

He opined that she was “capable of engaging in sedentary or light duty work.”

The peer review physician also reviewed the medical records and opined that Mrs. C “may be unable to withstand the stresses of her occupation” after reviewing a detailed job description. He concluded that it was “highly unlikely she would return to her previous capacity as a vocational counselor…” but felt that it was “possible she was able to utilize her skills from this occupation in a less stressful condition and in one that was not fast paced or emotionally demanding.”

The long-term disability carrier had a vocational analysis performed and the counselor erroneously assumed that Mrs. C was capable of engaging in sedentary to light duty employment, which was inconsistent with the opinions of her treating physicians. The vocational rehabilitation report did not address the temperament factors, as outlined in the DOT, of any of the sedentary or light duty jobs the vocational counselor Mrs. C was capableof performing.

Based on Dr. A’s report and that of the vocational rehabilitation counselor, Mrs. C’s long-term disability benefits were terminated as of May 31, 2003.

The long-term disability carrier had a further paper review done by Dr. P who concluded that Mrs. C could do sedentary work, which in his opinion, “should not present any significant increase in risk of a cardiovascular event.” Dr. P did not address stress factors.

At Nancy Cavey’s suggestion, Mrs. C came under the care of a physician who was familiar with cardiovascular claims and stress. Dr. P recommended that Mrs. C avoid high-stress jobs and indicated that she was capable of only performing light-stress jobs. From a cardiac standpoint, he opined that “Mrs. C should not perform jobs for which she would experience stress or perceive as stressful.”

Nancy Cavey presented to Dr. P the Department of Labor Dictionary of Occupational Titles for the temperament factors for the specific positions identified by the long-term disabilitycarrier’s vocational rehabilitation counselor. Dr. P opined that he did not believe, from a cardiac standpoint, that these were appropriate jobs and suggested that she avoid specific work environments where she would have potential sources of conflict, working under tight deadlines, or be caught in conflicting supervisory demands.

Nancy Cavey also secured the services of an independent vocational rehabilitation counselor who opined that Mrs. C couldn’t go back to her past work as a vocational rehabilitation counselor. He also completed a vocational analysis of the jobs that fell within the capabilities with a range of sedentary, low-stress jobs and opined that Mrs. C was not capable of performing any of the jobs that have been identified by the vocational rehabilitation counselor for the insurance company.

In reviewing Mrs. C’s claim, Nancy Cavey noted an adjuster’s note indicating that “to be perfectly honest, this is a very tricky claim in many respects.”

In preparing this appeal, Mrs. Cavey pointed out to the long-term disability carrier the erroneous assumptions made by the long-term disability carrier’s peer review and IME provider and their failure to address the impact of temperament and stress factors.

Ms. Cavey also pointed out the “risk of disability issue.” There was a significant issue as to whether Mrs. C would be disabled due to the risk of being in an environment that would result in adverse health consequences. The stress of working could aggravate the health condition and Ms. Cavey pointed out that Mrs. C didn’t have to prove a mathematical percentage, so long as there was “medically unacceptable risk of future heart attack or death.”

Ms. Cavey also pointed out that the long-term disability carrier had improperly failed to consider the combined effects of all of her physical conditions, including pulmonary and gastrointestinal problems.

As a result of Ms. Cavey’s work with Dr. P, her Independent Vocational Counselor and appeal letter, Mrs. C’s long-term disability benefits, based on her cardiac disability, were reinstated.

Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-477-3263.