Early Onset Alzheimer’s Disease & Social Security Disability

November 2014 is national Alzheimer’s Disease Awareness/Family Caregiver Month. In keeping with my habit of matching my Texas social security disability blog posts to disease awareness months, I would like to focus on Early-Onset Alzheimer’s Disease and Social Security Disability. Alzheimer’s Disease, we all know, is a degenerative brain condition associated with aging. It is a form of dementia: all Alzheimer’s is dementia, but not all dementia is Alzheimer’s. Since social security disability benefits are not available to those under full benefit social security retirement age (i.e, age 66), I confine this post to Early-Onset Alzheimer’s Disease, which affects people younger than age 65.  It is estimated that up to 5 percent of the more than 5 million Americans with Alzheimer’s have early onset Alzheimer’s. Actress Julianne Moore portrayal of an Early-Onset Alzheimer’s Disease victim in the coming movie “Still Alice” will be released in January 2015 and is already generating “Oscar buzz”.

Early-Onset Alzheimer’s Disease is on the list of medical conditions under the Social Security compassionate allowance program (CAL). This program is designed to cut claim processing times for conditions that typically are disabling. It is unclear whether the CAL program is truely cutting approval wait times for Early-Onset Alzheimer’s in Texas and throughout the nation, but its mere existence provides me as a Texas social security disability attorney with a good “club” to push for an early approval.

The Social Security Administration service manual for social security personnel use in handling disability claims, the Program Operations Manual System (POMS), provides specific instructions on considering Early-Onset Alzheimer’s Disease which are helpful to me as a Dallas social security disablity attorney representing Early-Onset Alzheimer’s Disease clients. Among those important points from POM DI 23022.385 “Early-Onset Alzheimer’s Disease”:

• Recognition that there is no specific lab or diagnostic testing for an Early-Onset Alzheimer’s Disease diagnosis. The POM states: “Currently, there is no specific clinical or laboratory diagnostic test for early-onset (or late-onset) AD and at present, the diagnosis can only be confirmed by brain biopsy or postmortem examination of the brain”. This important because social security disability assessment emphasizes the need for diagnostic support for a condition in order to qualify for social security disability benefits. For example, a Texas social security disability claim based upon back pain cannot be successful without radiographic lumbar spine studies, preferrably an MRI, that documents specific and severe abnormalities. A brain MRI, however, is not dispositive proof of Early-Onset Alzheimer’s Disease though the POM notes as follows: “Neuroimaging, such as computerized tomography (CT) or magnetic resonance imaging (MRI) is useful to demonstrate changes in the brain and to exclude other causes of dementia.”

• Diagnosis of Early Onset Alzheimer’s Disease from a specialist, most likely a neurologist, is best.

• Documentation of dementia via neurocognitive testing. The POM indicates that a “Clinical Dementia Rating (CDR) scale with a score of = 1” and/or am “MMSE [Mini Mental Status Examination] with a score of = 24, or equivalent test is helpful but not required.”

• Recognition of limited treatment options. The POM reads as follows: “Currently there is no treatment to cure or slow the progression of early-onset AD. Treatment for the symptoms of early-onset AD may include drugs such as cholinesterase inhibitors (galantamine, rivastigmine, or donepezil) and an N-methyl D-aspartate (NMDA) antagonist (memantine).” Donepezil is well know Aricept, and memantine is best know as Namenda. Contrasting again to a back impairment, consider the wide treatment options available to those suffering from back pain: surgery, pain medications, physical therapy, steroid injections and spinal cord stimulator implant. So if I have a Dallas social security disability client alleging disabling back pain with MRI-documented spinal abnormalities who is pursing no medical treatment for her back pain I have little chance of winning her disability case here in Texas. With the limited treatment options for Early-Onset Alzheimer’s disease, non-treatment is less of a problem.

The Dallas Fort and the North Texas area is blessed with great resources for those with Early Onset Alzheimer’s Disease. Among the most prominent Dallas area Alzheimer’s Disease treatment centers are the Texas Alzheimer’s and Memory Disorders Center at Presbyterian Hospital Dallas, and The University of Texas Southwestern Alzheimer’s Disease Center (the “ADC”) which is currently enrolling in a number of studies for Early-Onset Alzheimer’s disease patients. The ADC is pursuing a number exciting Alzheimer research project, including one to deliver insulin via a nasal spray (researchers have found that Alzheimer’s Disease patients have abnormally low brain insulin levels), and there are several ongoing studies on Early-Onset Alzheimer’s Disease still open to enrollment. Being in a clinical study can be a great way to avoid the isolation of Early Onset Alzheimer’s Disease and  increase one’s sense of purpose. The Greater Dallas Chapter of the Alzheimer’s Association provides a number of support resources, including an upcoming Alzheimer’s Association Caregiver Conference on November 5, 2014 focusing on the oft-neglected Alzheimer’s victim family members.

If you or a loved one is unable to work due to Early-Onset Alzheimer’s Disease in the North Texas, Dallas-Fort Worth area, give me a call for a free consultation.