One of the most frustrating moments in a Long COVID disability claim happens when a claimant finally gets an MRI of their brain, hoping it will objectively confirm what they know from lived experience. Most of the time with long COVID, a traditional MRI radiology report comes back ”unremarkable.” .
Insurance companies love that word. “Unremarkable MRI” gets quoted in denial letters as if it settles the question. But the fact is, while an abnormal MRI tels us something major is wrong, an unremarkable MRI is close to meaningless.
If you’ve been told your brain scan looks fine while your memory, focus, and processing speed clearly are not, it’s worth understanding why that disconnect happens, and why it doesn’t mean your injury isn’t real or provable.
Why a Standard MRI Often Looks “Normal” After Long COVID
A conventional brain MRI is read the way a radiologist has always read one: looking for visible lesions, tumors, bleeding, or obvious structural damage. It’s an excellent tool for what it’s designed to detect. But the changes associated with post-COVID cognitive impairment tend to be microscopically small and/or more subtle than that. Research into how SARS-CoV-2 affects the brain points to diffuse, small-scale changes in brain structure volume, in the integrity of white matter connections, and in the microstructure of specific regions that simply aren’t visible to the naked eye on a standard scan read at a glance.
In other words, the absence of a visible lesion is not the same thing as the absence of a real, physical injury. It just means you need a more sensitive tool to see it.
What Quantitative Volumetric Analysis and DTI Actually Measure
Two more advanced imaging techniques have become increasingly important in Long COVID cases, and both detect aspects of the brain that are often affected in measurable ways.
Quantitative volumetric analysis measures the size of dozens of specific brain regions and compares them against expected norms, flagging any regions that show statistically significant shrinkage or asymmetry. In post-COVID cases, this kind of analysis has identified reduced volume in regions tied directly to memory (the hippocampus), language and verbal processing (the angular gyrus), attention and executive function (the thalamus), and even the olfactory system, consistent with research suggesting the virus can affect the brain via the olfactory pathway. When these structural findings line up anatomically with the specific cognitive deficits a person is experiencing, memory problems correspond to hippocampal volume loss, and attention problems correspond to thalamic changes. That is objective corroboration.
Sometimes these volumetric changes in the brain take months or years to take place after brain fog sets in. Exercise caution in expecting measurable changes too early in your long COVID journey. When these tests do reveal abnormalities, it is powerful proof.
Diffusion tensor imaging (DTI) looks at something different: the integrity of the brain’s white matter, the “wiring” that connects different regions and allows them to communicate quickly and efficiently. DTI can detect microstructural disruption in specific fiber tracts, the pathways responsible for sustained attention, working memory, and integrating information across brain networks, even when the overall shape and size of the brain look unremarkable. Abnormalities in these networks have been directly linked in the medical literature to the exact profile of slowed processing, executive dysfunction, and attention difficulty that so many Long COVID patients report.
Together, these tools don’t diagnose Long COVID on their own; no single scan does that. But when a radiologist’s imaging findings are anatomically consistent with a person’s documented neuropsychological test results, and both are consistent with the known science on how COVID-19 affects the brain, you have something insurance companies find much harder to dismiss: objective, measurable evidence that lines up with subjective symptoms, rather than symptoms floating on their own with nothing to anchor them.
Why This Matters So Much for a Disability Claim
Long-term disability insurers are, understandably, skeptical of claims based purely on self-report. “I can’t concentrate anymore” and “I get exhausted after a few hours of work” are true and devastating experiences, but they’re hard to independently verify, and insurers know it. That skepticism is exactly why cognitive impairment claims, as opposed to claims involving a broken bone or a tumor on a scan, face so much more resistance and so many more independent medical exams.
Advanced neuroimaging changes that dynamic. It gives a claim three things that self-report and even standard neuropsychological testing alone sometimes struggle to provide:
Objectivity. A measurement of hippocampal volume or white matter integrity doesn’t depend on how well someone performed on a test on a given day or how convincingly they can describe their symptoms. It’s a physical measurement. It is also not as susceptible to conflicting interpretations as neuropsychological test results.
Anatomical correlation. When memory testing shows a weakness and imaging shows volume loss in the exact brain region responsible for that function, the two pieces of evidence reinforce each other in a way that’s difficult for an insurance consultant to explain away as unrelated or coincidental.
Rebuttal of alternative explanations. Insurers often try to attribute cognitive complaints to depression, anxiety, aging, or “functional” causes rather than the illness itself. A distinct, lateralized, and anatomically coherent pattern of structural change, one that doesn’t match the profile typically seen in primary mood disorders or normal aging, makes that alternative explanation much harder to sustain.
How to Use This Evidence Effectively
Getting an MRI, volumetric analysis, or DTI study isn’t, by itself, enough to win a disability claim. The real value comes from how that imaging is interpreted and how it is connected to the rest of your medical and vocational record. A few things matter a great deal here.
The imaging needs to be read and explained by someone qualified to connect the dots, ideally a specialist who understands both the neuroradiology and the clinical significance of the specific findings, and who can explain, in terms a claims examiner or a court can understand, why a given pattern of structural change is consistent with the type of illness you have and inconsistent with alternative explanations.
The imaging findings should be integrated with your neuropsychological testing, not treated as a separate, standalone piece of paper. The strongest disability claims tell one coherent story: here’s what my cognitive testing shows, here’s what my brain imaging shows, and here’s how they confirm each other.
And timing matters. Advanced imaging performed years after the original injury, showing a pattern of stable or worsening structural findings alongside stable or worsening cognitive test results, tends to be more persuasive than a single early scan, because it speaks directly to permanence, one of the central questions insurers fixate on when deciding whether to pay a claim long-term.
What to Do If Your Claim Was Denied Despite a “Normal” MRI
If your long-term disability insurer denied or is threatening to deny your claim partly because a standard MRI came back “normal,” don’t assume that’s the end of the road. It often isn’t. There are more sensitive imaging tools available, there is a growing body of peer-reviewed research on exactly this issue, and there are attorneys who know how to build a claim file that connects imaging, neuropsychological testing, and treating physician opinions into a case an insurer can’t simply wave away.
Robinson & Warncke represents long-term disability claimants throughout Georgia in exactly these kinds of complex medical disputes, including cases involving Long COVID and other conditions where the injury is real but hard to see on a standard scan. If your claim has been denied or delayed, or you’re being told that “normal” imaging means there’s nothing wrong, contact us to talk through your options and what additional evidence might strengthen your case.
