Summary: 46 year old female claiming disability based on chronic back pain following multiple spinal surgeries, plus pain medication side effects
Client profile: 46 year old female
Education: high school graduate + some vocational training
Past work: license clerk for city government
Claim background: my client filed for disability in early 2012. Her hearing was held in an Atlanta hearing office in July, 2014.
Medical background: my client has early onset degenerative disc disease. Although she has had no trauma such as a fall or car accident, her vertebrae have deteriorated causing multiple herniations. Within the past 10 year she has had five surgeries. She has fused vertebrae at the thoracic level, the lumbar level and the cervical level. She has also been diagnosed with rheumatoid arthritis (although the record was not clear about this) and osteoarthritis. Due to pain and stiffness following her surgeries she is on long term pain management which includes morphone. She also experiences significant depression because of her limited activities.
Factors in our favor:
- significant surgical history
- morphine is a very powerful narcotic pain medication that is rarely prescribed
- the claimant comes across as very credible
- the judge in our case has a higher than average approval rate
Factors not in our favor:
- evidence of a rheumatoid arthritis diagnosis was limited in the record
- my client does not look especially disabled
My strategy: I felt that the record in this case – especially the morphine prescription – spoke for itself. I prepared my client to testify about the side effects of her morphine prescription – the fatigue, cognitive loss, digestive upset and need to rest. I also wanted my client to explain how these multiple surgeries have impacted her life, limited her activities and left her with marginal functioning.
Hearing Report: my client and I entered the hearing room and were greeted by the judge. The judge introduced the vocational witness and hearing assistant then proceeded through a brief opening, swearing in the witnesses, and acceptance of the case file into the record. The judge then asked me to present my case.
I started by asking my client about her morphine prescription – why had she been prescribed such a potent painkiller and how did it effect her. She testified that without morphine the pain was intolerable and that it “took the edge off” the pain. She explained that the morphine made her fatigued, and that it interfered with her concentration and focus. She also testified that she could only sit for about 20 minutes at a time and for no more than 2 hours total during the day. Standing was similarly limited. She explained that she did not sleep well at night because of discomfort and that she frequently napped during the day.
My client also testified that she was quite depressed about her physical condition and that she rarely left her house.
The judge asked a few follow up questions and then turned to the vocational witness.
Hypothetical 1: Assume an individual limited to light work, but with the following additional limitations:
- no climbing ladders, ropes or scaffolds
- occasional crawling, stooping, kneeling or crouching
- no exposure to extremes of heat or cold
- no exposure to hazardous equipment
Could such a person return to the claimant’s past work?
Hypothetical 2: Add to hypothetical #1 that this due to pain, stiffness and medication side effects, this individual could perform competitive work for 4 hours out of an 8 hour day, but not consecutive hours.
A: such a person could not perform the claimant’s past work or any other work
Conclusions: like any pain case, this case will come down to where the judge draws his line. Given that hypothetical #1 did not include any pain or medication side effects limitations, I think it is likely that the judge will use the limitations set forth in hypothetical #2 as his assessment of my client’s functional capacity for work and will issue a favorable decision.