Medical conditions that cause problems with memory, concentration, attention, speed of processing information, etc. can be particularly disturbing. Not only can these symptoms make it difficult for you to successfully perform your job duties, but in severe cases, they can disrupt your activities of daily living. Nonetheless, disabilities due to cognitive impairments are often difficult to prove.
Take the following example: You’re having problems concentrating and focusing on conversations. You’ve been forgetting to do things. Your boss has to remind you – sometimes two or three times – to give her your research on an important project. Tasks that used to take you half an hour are now taking between one and two hours. You’re struggling to get your work done.
As a result, you go to a neurologist who orders an MRI of your brain and conducts a mental status examination. The MRI is normal, and there are no glaring problems on the examination. You are able to tell the neurologist the date, month, year, your location, and the name of the president and vice president. You have no issues recalling three words after a three minute delay, and you are able to count backwards by 7’s and spell the word “World” backwards. Despite the seemingly normal findings, you know something is wrong. You are making mistakes at work, and simply can no longer adequately perform your job duties. But, in light of the “normal” results of the examination, you’re worried that an insurance company won’t believe your complaints if you apply for Long Term Disability benefits without sufficient proof.
While insurance companies must consider your subjective complaints involving your problems with memory, difficulty focusing, inability to quickly process information, etc., they also typically require objective evidence to corroborate your symptoms. One way to objectively prove the existence of your symptoms is through a Neuropsychological Evaluation. The following may answer some of your questions regarding Neuropsychological Evaluations:
What is a Neuropsychological Evaluation?
A Neuropsychological Evaluation is a series of detailed, objective tests designed to assess your level of cognitive functioning. A full battery of testing will measure your functioning in the following areas:
- Intelligence (e.g., an IQ test);
- Memory; both short-term and long-term;
- Processing speed;
- Executive functioning;
- Visual and spatial perception;
- Problem solving;
- Academic skills (e.g., reading speed and math); and
The Neuropsychological Evaluation is administered by a clinical neuropsychologist; that is, a psychologist with special training in the relationship between the brain and behavior. It generally consists of an in-depth interview (e.g., discussing, without limitation, your birth, upbringing, education, work history, medical conditions, symptoms, treatment, and your perceived cognitive deficits), followed by the administration of the actual testing, which is typically done on both paper and a computer. The testing lasts for six to eight hours (which can be broken up over the course of two or more days), and is conducted in a quiet environment to minimize distractions.
Can a Neuropsychological Evaluation Help Prove Your Disability?
Yes. While generally used to help figure out a diagnosis and/or determine a treatment plan, a Neuropsychological Evaluation can help to prove your disability. Neuropsychological testing will document, without limitation, your cognitive strengths and weaknesses and show how your cognitive deficits prevent you from working. For example, the results of your assessment may show:
- deficits in concentration and focus that would prevent you from paying attention at long meetings or during an important phone call;
- slow processing speed that makes it impossible to keep up with your work load and analyze information;
- declines in executive functioning that make it difficult to organize your thoughts and make quick decisions in your stressful and fast-paced work environment;
- problems with short-term memory, such that you have difficulty remembering your “to do” list and retaining/learning new information; and/or
- difficulties expressing your thoughts, which would make it difficult to give a presentation and think on your feet.
In addition, unlike a simple mental status examination, a comprehensive, full battery of neuropsychological testing can pick up on subtle problems with your cognitive functioning. This is very important in the disability arena because even minor deficits or scores in the “average” range can be helpful to your disability claim.
In addition, based on prior neuropsychological testing (if available) and/or based on your education and work history, the neuropsychologist will estimate your pre-disability level of functioning. If, prior to your disability, you were functioning at an “above average” or “superior” level, testing scores in the “average” range can still be considered significant deficits, and supportive of your disability claim. For example, an emergency room doctor with a superior level of pre-morbid cognitive abilities suffers a traumatic brain injury. Neuropsychological testing reveals “average” short-term memory and “average” executive functioning. Inasmuch as the doctor’s job required the ability to remember patient details and make quick decisions, the “average” findings are deficits that would likely render him disabled – especially given that he was often required to make life and death decisions.
Will the Insurance Company Accept the Results of the Neuropsychological Evaluation?
Yes – assuming the Neuropsychological Evaluation contains, and you pass, certain “Validity Tests.” Validity Testing is used to ensure that you: are giving your maximum effort; responding honestly and consistently across the interview and testing and not malingering or exaggerating your symptoms.
Validity Testing measures typically consist of both stand-alone tests and specific scores or indicators embedded within other standardized neuropsychological tests. Generally speaking, if you try your hardest during the testing, you should pass the Validity Tests without a problem. The worst thing you could do is try to “trick” the test in an attempt to make your cognitive deficits seem worse than they actually are.
Which Disabilities Lend Themselves to Neuropsychological Testing?
Neuropsychological Testing can be helpful in proving a disability for any medical condition that causes a decrease in cognitive functioning. Common examples include:
- Traumatic brain injuries;
- Multiple Sclerosis;
- Parkinson’s Disease;
- Sleep Apnea;
- Brain Tumor;
- Lyme Disease;
- Chronic Fatigue Syndrome/Myalgic Encephalomyelitis;
- Psychological disorders;
- Epilepsy or seizures; and
- Dementia or Alzheimer’s Disease.
Contact a Disability Lawyer to Help with Your Cognitive Disability
Navigating a disability insurance claim or disability insurance appeal can be confusing and extremely stressful, especially when you are suffering from disabling symptoms that interfere with your cognition. Hiring an experienced attorney to help with your claim can alleviate some of your stress and allow you to focus on your health condition(s). If you suffer from a disability that impairs your cognitive functioning, we can help in the following ways (among others):
- We will determine if neuropsychological testing is necessary given the nature of extent of your disability and symptoms.
- We will work with your medical providers and gather your medical records and provide them to the neuropsychologist to review prior to your evaluation.
- We will review the results of your Neuropsychological Evaluation to ensure all of the information is accurate, and request an addendum, if necessary.
- We will make suggestions as to which cognitive tests may best demonstrate your disability.