What is Lyme Disease?
Lyme disease is an extremely controversial illness that effects thousands of individuals around the country. According to the Center for Disease Control:
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well.
How do I know if I have Lyme disease?
CDC currently recommends a two-step process when testing blood for evidence of antibodies against the Lyme disease bacteria. Both steps can be done using the same blood sample.
The first step uses a testing procedure called “EIA” (enzyme immunoassay) or rarely, an “IFA” (indirect immunofluorescence assay). If this first step is negative, no further testing of the specimen is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The second step uses a test called an immunoblot test, commonly, a “Western blot” test. Results are considered positive only if the EIA/IFA and the immunoblot are both positive.
The two steps of Lyme disease testing are designed to be done together. CDC does not recommend skipping the first test and just doing the Western blot. Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment.
New tests may be developed as alternatives to one or both steps of the two-step process. Before CDC will recommend new tests, their performance must be demonstrated to be equal to or better than the results of the existing procedure, and they must be FDA approved. For more details, see: Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease.
In a recent case out of the Western District of Tennessee, Brown v. Federal Express Corporation et. al., the Court held that in an ERISA case for LTD benefits, the Court may take judicial notice of CDC Standards for diagnosing Lyme disease when considering whether the Defendant properly denied benefits to the Plaintiff. This case is important since the Court looked outside the administrative records when making a determination as to whether the Defendant was arbitrary and capricious in denying Plaintiff’s claim.
In the Brown case, the Court held that the administrative record showed no evidence that the Plaintiff had undergone the first test, the “EIA” or “IFA” test. The Plaintiff did undergo the second test, the Western Blot Test, on a number of occasions. The first 2 times the test came back negative under the lab and CDC standards. The test results did indicate the presence of some, but not all, of the indicative antibodies in Plaintiff’s blood. The third time she was tested, the test came back positive under the lab’s standards, but not under CDC standards. The Plaintiff argued that the court was not permitted to consider CDC standards as they were not contained within the administrative record. The Court disagreed citing to Rule 201(b) of the Federal Rules of Evidence which permits the Court to take judicial notice of the background information on Lyme disease, its diagnosis, treatment from the CDC website since the “facts set forth… are not subject to reasonable dispute and are capable of accurate and ready determination by visiting the CDC’s website.” Therefore, the Court determined that Defendant’s physicians were not arbitrary and capricious in their determination that the Plaintiff did not suffer from Lyme and was not disabled from performing her occupation.
If you suffer from Lyme or believe that you do, it is very important to ensure that your physician performs the proper tests to make this determination. Many physicians do not agree with CDC criteria for testing and treating Lyme as it is the CDC’s position that once you are treated with antibiotics, you no longer suffer from the disease. Many Lyme experts around the country disagree with the CDC as they believe that chronic Lyme does exist even after one has received the antibiotic treatment as recommended by the CDC. The Lyme debate is ongoing, but it is crucial to treat with doctors that are well versed in Lyme who will order all tests suggested by the CDC and ensure you receive the proper diagnosis and treatment for the disease. This is of the utmost importance if you have a disability claim as you want to ensure that a Court of law will determine that the diagnosis and treatment you received conforms with CDC standards.