Archives for July 2019

Veterans Disability For Autoimmune Diseases In Houston, TX

Autoimmune diseases encompass a number of different conditions that share one common trait: they attack the body’s tissues as if it were a pathogen by producing specific antibodies to attack the healthy cells.

Doctors aren’t sure what triggers this biological mistake, but some people are more likely to have it than others. Science has identified 81 different autoimmune diseases. These illnesses can develop at any age, but most commonly between 40 and 50.

Discussing Veterans Disability benefits For Autoimmune Diseases In Houston, TX with a disability benefits attorney

Types Of Autoimmune Disease

Of the 81 identified, the most common of these autoimmune conditions include:

  • Rheumatoid Arthritis
  • Multiple Sclerosis
  • Type 1 diabetes
  • Lupus
  • Inflammatory bowel disease (IBD)
  • Hashimoto’s Thyroiditis
  • Grave’s Disease
  • Vasculitis
  • Myasthenia gravis
  • Psoriasis
  • Chronic inflammatory demyelinating polyneuropathy
  • Guillain-Barre Syndrome
  • Human Immunodeficiency virus (HIV)

If left untreated, an autoimmune condition could lead to damage to different parts of the body, including joints, skin, nerves, and muscles.

Causes Of AD

While science doesn’t offer a direct cause, researchers suspect:

  • Genetics, since some conditions run in families (i.e., lupus and MS)
  • Increased exposure to chemicals and other environmental toxins
  • The “standard Western diet” (sometimes called SAD or Standard American Diet), consisting of highly processed foods, including a large amount of sugar and synthetic fats
  • The “hygiene hypothesis”—children use antiseptics frequently are now vaccinated for such a wide range of things that they aren’t exposed to the bacteria and other substances that they used to. Without the exposure to “everyday germs,” immune systems don’t develop properly, and tend to over-react to harmless substances.

PTSD And The Service Connection

Part of applying for VA benefits includes establishing a service connection, and proving that your condition or injury occurred during the time you were in the service. But with many conditions, that’s not as easy as it sounds, although PTSD is a common service-connected cause for VA benefits.

A study conducted at the San Francisco VA Medical Center demonstrates a strong link between PTSD and the onset of autoimmune diseases. With 666,000 Iraq and Afghanistan veterans as study subjects, those diagnosed with PTSD had a 51% higher chance of developing an autoimmune condition.

The research team cited a number of reasons for this correlation, including:

  • Immunity and/or hormonal changes that are brought on by PTSD
  • Habits that are prevalent in PTSD patients, such as smoking, drinking, a less-than-ideal diet, and insufficient sleep
  • Genetic and/or pre-existing genetic risk factors may lay the ground work for both conditions

It’s important to note that PTSD does not directly cause an autoimmune deficiency, only that there is a strong correlation. However, to prove a VA claim for compensation, one only has to establish a 50% probability of causation for the autoimmune condition. Therefore, the aforementioned VA study may be one part of your overall strategy.

Autoimmune As A Secondary Condition

If you already have a claim for PTSD, seeking a secondary service connection between the PTSD and the autoimmune condition may be your best bet for getting benefits for it.

Because no primary causes are established, it may be difficult to pinpoint where and when your autoimmune condition began. But proving that your autoimmune disease as a “side effect” of PTSD as a secondary service connection is a different matter.

You will have to prove your primary service connection first, which will require evidence including:

  • Medical records and diagnosis
  • Treatments
  • Psychological exams
  • Vocational reports
  • Other related, relevant documentation

Additionally, you’ll need to prove a connection to your primary condition in order to prove your secondary condition. This will require a letter from a medical professional demonstrating the connection between the two conditions. The VA offers some information here.

Getting help with your VA disability application is the best way to get a head start on what may be a long, difficult process. An attorney experienced in VA applications can help you get started. He or she understands the process, and will ensure that your application is done correctly.

Helping Houston’s Veterans

William Herren is a veterans’ disability attorney who has worked with veterans in the Houston area for more than 30 years to help them get the benefits they deserve. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges. We don’t charge you a fee until we win your case.

What Is ERISA And What’s The Connection To Houston Disability Benefits

If your employer covers your benefits package, it’s likely governed by ERISA. Most employer-sponsored plans are ERISA-regulated, except for privately-purchased policies or those provided by governmental agencies, churches or church-owned hospitals.

What Is ERISA And What's The Connection To Disability Benefits In Houston, TX

Despite the title and description, getting disability benefits isn’t always as simple as filling out forms and waiting for a check. Although ERISA was created to protect employees’ benefits and rights, its complex requirements can sink your claim right after you file it. If you file a claim and don’t follow the ERISA guidelines exactly, you claim may be denied without the right to appeal. Missing a deadline for appeal can prohibit you from filing a future claim.

ERISA Basics

Employer-sponsored benefits plans are regulated by ERISA, or Employee Retirement Income Security Act, established in 1974.This federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  If you apply for disability and are denied, ERISA gives you the right to sue the insurer in federal court.

ERISA requires that employers provide their employees with basic information that includes:

  • Details of what’s covered and not covered under the plan
  • Instructions on filing a claim if an employee becomes disabled
  • Details of the company’s appeal process if the company denies an employee’s claim

ERISA sets a limit on the insurer’s timeframe to accept or deny a claim once it’s filed. The insurer has 45 days to render a decision, but can add an additional 30 days, and must notify the employee in writing.

If the insurer denies the claim, it must provide the reasons in writing within 45 days. ERISA controls not only the employee’s time frame for appeal, it also controls the deadlines for insurers to approve or deny the appeal.

Providing Documentation

It’s important to have a wealth of documentation in your claim file at the outset. This includes medical records, test results, doctor’s notes, and other instruments that will prove your claim for disability. Your attorney can advise you on the ERISA requirements, what information you need, and what you’ll need to request.

Note that if your claim is denied on appeal and you decide to move forward with a lawsuit, you will not be able to add additional evidence or information as you would with a civil or criminal trial or appeal. Everything that is already in your file is all that the judge will see. That’s why it’s important to have as much documentation to support your claim as you can obtain as soon as you can.

Discretionary Clauses In Texas Are Denied

You may have heard the term “discretionary clause” when discussing your policy with your employer or with the insurer. This is language written into the policy and allows the insurer plenty of “wiggle room” to limit or deny their claims. The clauses also prevent a court decision from reversing the insurer’s claim decisions.

In 2012, the state of Texas passed a law prohibiting any insurance company from using “discretionary clauses.” That is, any policy written or renewed after January 1, 2012 in Texas cannot contain a discretionary clause.

Deadlines Count

Insurers have specific deadlines for filing claims for disability benefits as well as appeals. Don’t miss a deadline, and make sure your claim adheres to ERISA’s very complicated rules. Let an experienced Houston disability benefits attorney take care of your claim and make sure everything is taken care of.

The Herren Law Firm can help you with your ERISA application, appeals and help you get the long-term disability benefits you need. Contact us in Houston today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

 

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