Social Security Disability & SSI Benefits are ALL WE DO!
A 32-year-old male had experienced weakness and clumsiness in his youth but could never determine why. His symptoms progressively worsened where he started experiencing seizures, fatigue, muscle pain, and weakness. He had to stop working because of his poor health. Doctors’ thought he had cerebral palsy. It turns out, after a biopsy was performed, my client had a form of muscular dystrophy. We had a hearing before an Administrative Law Judge and won. This case illustrates that some medical conditions are difficult to diagnose, such as multiple sclerosis, migraines, fibromyalgia, and Parkinson’s disease. We, the social security attorneys and clients, have to be persistent to get the proper diagnosis so treatment can be given. We don’t give up and I know our clients won’t either.
I recently had the opportunity to represent a claimant suffering from a lengthy history of back pain. Unfortunately, it was discovered that he additionally had bone cancer, a likely reason for his pain severity. Due to his illness, he was unable to travel to his social security hearing. I successfully lobbied to allow my client to testify via telephone for his disability hearing, which is unusual. Additionally, I was able to convince the Administrative Law Judge to grant benefits a year prior to his actual cancer diagnosis. Although my client had been suffering from pain for quite some time with no actual diagnosis, the medical evidence eventually revealed a condition capable of producing the symptoms alleged. My client was able to have his case heard with compassion and speed.
Chronic Migraine Headaches
I recently received a Favorable Decision after an Administrative Law Judge hearing awarding benefits to my client, a 35 year old female, who suffers from chronic migraine headaches. These cases are hard to win because the client has to be very credible when testifying about the frequency and severity of the migraine headaches. It was very helpful to have a supportive treating doctor who kept very detailed notes concerning my client’s migraine headaches. This case demonstrates why it is so important to have a believable client and a supportive treating doctor in your corner.
Many times, it can take years of medical testing to discover the cause of physical symptoms. In a recent case I represented a client who for years was thought to have bad feet or ‘plantar fasciitis’. With this diagnosis, his case had been denied at the initial level. As his symptoms progressed to include numbness and burning pain, objective nerve testing finally revealed a diagnosis of progressive, length-dependent polyneuropathy. With this updated medical testing and assessment, combined with testimony regarding his symptoms at the social security hearing, I was able to successfully obtain disability benefits for my client. Although my client had experienced his symptoms for years, it was a difficult condition to diagnosis given his combination of symptoms. Unfortunately, it can take years for medical diagnoses to become clear and confirmed.
I recently had a case where my client suffered from severe depression. I felt that the record of multiple psychiatric hospitalizations and suicide attempts, combined with the treating doctor opinion gave me a great record. My client easily becomes tearful and her outward demeanor does not reflect someone with the capacity to work. When testifying, she had a difficult time remembering dates and presented herself as someone with poor communication skills. I had her testify about her symptoms including her withdrawal, isolation from people and crying spells. The judge asked my client several times about her psychiatric hospitalizations and suicide attempts. I think that these factors were the deciding elements that helped the judge decide that my client’s testimony was credible.
As is the case with many of my fibromyalgia cases, this client fit the profile of a high achiever with an extensive medical record and a type A personality. My client was a nurse for many years, performing multiple nursing duties. She began experiencing extreme fatigue and memory issues on the job. She was seeing her internist for hypertension, fatigue and migraine headaches. She then saw a rheumatologist who diagnosed fibromyalgia and documented her trigger points. I was able to get the rheumatologist to complete a functional capacity form, which identified a number of vocational limiting factors. Social Security sent the claimant to a psychologist for a consultative exam, and the psychologist identified issues with concentration such that the claimant would not be able to adhere to a typical workday schedule or maintain adequate pace at even a simple I felt that this was a strong case. The claimant had extensive and on-going treatment, and she had unconditional support from her treating doctors. She also had objectively observable medical issues, including neck and back problems, a mild heart problem and partially controlled hypertension. Although none of these medical problems was likely to be enough to support her claim for disability, when taken in combination and taken along with her fibromyalgia diagnosis, it was compelling evidence. My client was a good witness and she spoke about each of the areas of her body that were causing problems. The judge noted that her medical history was consistent and long-standing and that she had a solid work history. I think that the factors that helped win the case was my client’s solid work history, regular visits to the doctor, support from two treating doctors, one of which was a specialist who documented her trigger points and a judge who was very familiar with the file and who had no philosophical objection to a fibromyalgia diagnosis.
Although relatively young, my client had a history of degenerative back problems including a prior laminectomy surgery several years ago and later bulging discs and even a small herniation. She continued to be in pain management. Her doctors explained to her given the arthritis in her spine and the degeneration of her discs, she should not expect much in the way of pain relief with further surgery. As a result of her chronic pain, my client had also become severely depressed and a consultative psychological evaluation in the file documenting a number of significant work activity limitations arising from the depression, including problems with attention and concentration, emotional stability at work and reliability The medical record of consistent treatment and surgery really spoke for itself. I pointed out to the judge her efforts at reducing pain with conservative treatment and her resort to surgery. I noted that the surgery had not been successful in eliminating all her pain and numbness. Since the medical evidence in this case was solid and my client came across as sincere and clearly appeared to be in pain, the judge announced that he would be finding my client disabled.
I recently had a case where my client had ulcerative colitis. The main issue I argued was the functional issues with this disease which include frequent, unscheduled bathroom breaks associated. Further, colitis is difficult to treat effectively. I argued to the judge that my client was likely to miss work and would be very uncomfortable because of their condition. Additionally, unscheduled bathroom breaks can make it impossible for a worker to keep a job. I also argued to the judge that affected individuals frequently experience a great deal of pain in the restroom and have a difficult time getting through the workday. Most affected individuals take restroom breaks for 15-30 minutes at a time, thus causing work performance issues because of the time consumed in going to the restroom. Most judges recognize that gastrointestinal irritation can and does cause a great deal of pain and discomfort. In this case, my client’s long work history enhanced his credibility despite a less than extensive medical record. The judge asked a few questions about the frequency of my client’s bathroom issues. The client explained the pain and frequent restroom breaks as well as the embarrassment he experienced from his previous job because of his frequent long visit to the restroom. The judge asked the client about how his medication is helping him. The client testified that he had been on Prednisone for many months and that other medications were given to control the inflammation. However, the prescribed medications only work for a while and would eventually lose effectiveness. The judge granted the case and benefits were paid.
I had a case where a younger person had severe rheumatoid arthritis. It is important in these types of cases to have clear diagnostic test results. Rheumatoid arthritis can be detected in blood levels as well as by x-rays and the tests results which sometimes can be inconclusive. In this case, my client’s doctor had not only performed blood tests that showed a positive Rh factor and elevated sedimentation rates, but the doctor had written down how my client had reported feeling including his impressions as to redness, stiffness, and swelling of the joints. These notes were excellent documentation of my client’s illness and in my opinion is what won the case. As a result of her chronic pain, my client had also become severely depressed and a consultative psychological evaluation in the file documented a number of significant work activity limitations arising from the depression, including problems with attention and concentration, emotional stability at work and reliability. It also helped that my client was very credible when testifying at the hearing. She described her pain and inflammation and constant swelling in her hands and feet and medication side effects (Methotrexate and Plaquinil). Three weeks following our hearing, my client received a favorable decision by a written
Congestive Heart Failure
I recently successfully represented my client who was diagnosed by her cardiologist with congestive heart failure and a serious diastolic dysfunction. I felt that this was a strong case with a well-documented medical issue. She had been seen at the ER for chest pain and shortness of breath several times. She was also admitted to the hospital for chest pain, shortness of breath and swelling. My client underwent surgery to have a pacemaker installed which did give her energy but it also resulted in uncomfortable side effects as she felt “jumping” in her chest when the pacemaker was active. Her doctors turned the pacemaker off, but that resulted in extreme fatigue and shortness of breath. They then turned it back on but at a lower power, providing less benefit. My client testified that even minimal exertional activities caused extreme fatigue. This case is a good example of a case documenting a significant medical problem that is not easily treatable.
I recently had a case where my client suffered from schizophrenia. It was a hard case as most of the treatment records were from a treatment facility that did not document the claimant’s symptoms that well. Additionally, my client did not have extensive medication or psychotherapy. My client testified to his audio and visual hallucinations which have been consistent for several years. He also testified, in great detail, about hearing voices and meeting UFOs (and even writing a non-fiction book on UFOs). My client became very animated in describing his experiences. My client, very matter-of-factly, described bizarre situations as if they were “normal” thoughts. The case was approved despite the reservations expressed by the consultative psychologist and the relative lack of treatment evidence. This was a case that turned on whether or not the judge felt that my client was truthful and credible in his presentation. It was clear that the claimant was experiencing audio and visual hallucinations. The vocational witness explained that a person experiencing the distractions described by my client would not be able to stay on task sufficiently to sustain competitive employment.
I successfully represented an individual who had a stroke. In regards to his complications, my client testified that he continues to suffer from left sided weakness that occurs with exertion or stress two to three times per week. Next, my client stated that he experiences severe headaches three times a week that are a level 7 on a pain scale of 10, lasting 30 minutes to an hour. He testified that he sleeps most of the day when this happens. In general, he rarely leaves his house, that he is afraid to drive and that he lives with his mother who helps him with his activities of daily living such as cooking and laundry.
The medical documentation was limited as the client had participated in rehabilitation for a few months after his stroke but once he received the maximum benefit from it, he did not receive much medical treatment. Although his speech greatly improved after rehab, he continues to suffer from partial paralysis of his left side, memory loss and problems with comprehension.
The judge then asked the VE to consider the impact of these symptoms which would cause an employee to either miss work or need to lie down during the day. The vocational expert testified that daily periods away from the worksite would preclude any type of job. In my opinion, it is hard to convince a judge that you are disabled from a stroke just because you appear to have weakness, poor coordination, or impaired gait because all of these findings are subjective. Thus, your medical history is very important. In this case, an MRI scan was done of the brain which showed the location and severity of brain damage. I was also able to point out to the judge that his deep tendon reflexes in the affected parts of limbs were hyperactive, or faster than normal. Also, I argued that his positive Babinski sign, which means the great toe in the affected lower extremity moves upward when the bottom lateral surface of the foot is stroked, was positive. Hence, I was able to correlate the claimant’s testimony concerning weakness, memory loss and headaches with the objective findings of record.
I had a younger claimant who had worked several years as a social worker and left her job due to her worsening symptoms from fibromyalgia. She also had other medical issues including degenerative disc disease and bilateral knee arthritis but these conditions were not what prevented her from working. My client was a very credible witness with a long career with the same employer, doing something that she loved to do. Fibromyalgia cases can be difficult because of the lack of objective testing. My client had been treated by several doctors, all of whom gave their own spin on her diagnosis. Not every doctor out there believes in fibromyalgia. Thankfully, my client saw a fibromyalgia specialist (a rheumatologist) at the University of Michigan who was very helpful and documented several positive tender points . This was a case that could have easily become confusing to the judge because of the multiple medical diagnoses and the absence of a consistent diagnosis, which is common with fibromyalgia cases. Further, I had no functional capacity forms from her doctors. My client explained that since her fibromyalgia became very symptomatic, she had a great deal of difficulty with concentration and was often fatigued. She had to quit her job even though she would have received a much bigger pension if she had work a few more years. I continued this line of questioning and asked my client to testify about her prior work as well as her most recent work attempts, to show that her capacity for competitive work has become greatly impaired. The claimant ended up winning her claim. In my opinion, the credibility of the claimant with the UofM doctor’s solid diagnosis was the key to prevailing. Now, most Social Security administrative law judges do understand that fibromyalgia exists and is real, but some are still skeptical because it cannot be confirmed radiographically. Even these judges will approve cases where there is unqualified support in the form of a functional capacity evaluation form from a treating rheumatologist or pain doctor along with a solid diagnosis. It is important to use the American College of Rheumatology which defines fibromyalgia as a history of widespread pain lasting longer than 3 months, with pain in at least 11 of 18 tender points, and the pain cannot be attributed to another illness mimicking fibromyalgia. Social Security will accept a diagnosis of fibromyalgia if a physical and neurological exam is taken by a rheumatologist.
This case involved the claim of a 53 year old man with PTSD arising from trauma when he was in the military. My client filed for disability based on unrelenting psychological trauma that arose from multiple incidents of trauma while he was in the Gulf War. In addition to the PTSD, my client had developed a torn rotator cuff of his dominant arm. There were extensive VA records documenting PTSD and he has a 100% service connected VA disability award. My client’s VA psychiatrist wrote a letter stating that he is disabled and unable to be gainfully employed as a result of PTSD, anxiety and depression. He had a successful work history but the jobs he obtained through friends or family would end up being lost due to his PTSD. He was also on 6 different prescribed medications which had significant side effects such as fatigue, drowsiness and mental confusion. My client came across as very credible – his testimony was sad and compelling. He testified that his PTSD symptoms became more and more intrusive as he got older and by the last year or so of his employment, his performance had begun to suffer. My client came across as someone who was fighting the idea of not working – exactly what judges want to hear. He discussed in detail how panic attacks and flashbacks made it so he could not function in the workplace. I received a favorable decision in this case. I think that the judge was persuaded by the fact he was already on disability through the VA, his solid work history and by his very effective testimony.
I had a client who had congestive heart failure with a left ventricular injection fracture of 35%. He had symptoms of profound fatigue and shortness of breath upon exertion. My client, who was very credible, noted that he needed to nap at least twice a day for 30 minutes. He also said that he frequently became lightheaded and that he experienced chest pain two to three times per week. However, my client’s medical records contain a number of subjective comments by the treating cardiologist that most likely reflected the doctor’s desire to emphasize positive results. For example, the doctor noted in his record that the patient denies any chest pain, dyspnea (shortness of breath), edema (swelling or weakness. I believe that the doctor was minimizing my client’s symptoms. Fortunately, our judge was receptive to my client’s testimony. This was a case where I had to help my client by practicing testimony to show the full extent of his limitations. Like many heart patients, my client takes a sublingual nitroglycerin tablet when he experiences chest pain. He testified that he takes the nitroglycerin at least three times per week and that it takes about 20 minutes to go into effect and an hour to fully recover from the episode. I argued to the judge that my client would be “off task” for this amount of time at least three times a week along with just being “slower” due to multiple symptoms. The judge was receptive to the argument and granted benefits. Thankfully, the client’s testimony was effective and outweighed the negative comments made by the cardiologist in his records.
Disclaimer: This story is based on a real case. The names and identifying details have been changed to protect the privacy of individuals involved. Information presented here is general in nature and should not be construed as formal legal advice or as the formation of a lawyer/client relationship. Cases differ and past performance does not guarantee future results.