Summary: 58 year old female with 20+ years past work as a teacher, alleging disability based on chronic back pain not resolved by lumbar surgery.
Client profile: my client is a 58 year old female with a high school education and 20+ years of past work as a teacher. In mid-2017 she began experiencing numbness and pain radiating into her right leg, and weakness and poor balance. She was forced to leave her job two months into the 2017 school year because she could not stand or walk.
Claim background: my client filed for benefits in the winter of 2018. Her case came before an Atlanta area administrative law judge in June, 2019.
Factors in our favor:
- my client has a long and consistent work history as a teacher
- the medical record in this case includes an MRI report showing a significant lumbar disc herniation, conservative treatment prior to surgery, and a lumbar fusion. The records post surgery show abnormal neurological test and on-going complaints of pain, weakness and numbness
- my client uses a walker and has an external spinal stimulator panel, which was noted by the judge
Factors not in our favor:
My strategy: I saw this case as fairly straightforward “failed back” case where my client underwent lumbar surgery but 18 months later continues to have pain and weakness and limited function.
Hearing report: my client entered the hearing room using her walker and sat on the built in seat. After swearing in my client and the vocational expert the judge asked me for a brief opening statement, which I provided.
The judge asked my client about her past work, which my client described as serving as 3 different types of teaching roles – elementary school, middle school, and special education.
The judge did have a question about the earnings record, which showed earnings post-onset date. My client explained that she was receiving long term disability benefits and the judge asked me to provide documentation of this post-hearing.
The judge then asked me to present our case. I began by asking my client to describe in detail what happened in the summer and fall of 2017 that caused her to quit her teaching job at the beginning of the school year.
My client testified that she began noticing pain radiating from her lower back into her right leg, then increasing weakness and increasing pain. She went to her family doctor who referred her to an orthopedist. She stated that during her first orthopedist visit her weakness and pain were such that she literally could not stand up. The (non-surgical) orthopedist gave her pain medications and eventually epidural spinal injections which provided partial temporary relief but after only a few weeks, the non-surgical orthopedist referred her to a surgeon.
My client testified that her orthopedic surgeon reviewed her MRI and pointed out significant disc herniations at L2/3 and L3/4 and recommended surgery. In January, 2018, my client underwent a lumbar laminectomy and fusion.
I noted that the record indicated that she had post-surgical complications. My client testified that when she woke up following surgery, she was short of breath and that her voice sounded “weird.” She testified that she remained hospitalized for 3 weeks (normal post-surgical hospitalization is 3 days) and that she developed a blood clot in her lungs.
My client testified that following surgery, she continued and continues to have low back pain and numbness radiating into her leg and that her pain level is not significantly different than it was prior to surgery. She testified that she has to use a walker because of poor balance and weakness.
My client testified that she uses a “grabber” to put on her socks and that she cannot bend over to tie her shoes. She stated that she needs to use a shower chair to bathe and that she depends on her adult children to take her places, cook and clean.
She testified that two to three times per week, her pain level increases to the point where she needs to take a Oxycontin and that this powerful pain medication puts her to sleep. She stated that she avoids using this medication because it can be addictive but has to use it when her pain level becomes unbearable.
My client testified that she spends several hours a day in her recliner and that when she sits in a regular chair she keeps her legs extended to avoid blot clotting issues. She is on a blood thinner for this problem as well.
After I concluded my direct examination the judge had no follow-up questions and she turned to the vocational expert witness (VE). After the VE identified my client’s past work as a teacher as “light” and skilled, the VE noted that there were no transferrable skills to any sedentary occupation.
The judge then posed one hypothetical question: assume a hypothetical person who is the same age as our claimant, with the same work history. Assume further that this individual is limited to sedentary work but with the following additional limitations:
- occasional use of ramps and stairs
- no use of ladders, ropes or scaffolds
- occasional stooping
- no kneeling, crouching or crawling
- no proximity to hazardous work environments, or vibrating equipment
Could such a person perform the claimant’s past work?
Assume our hypothetical person from question #1 would be off task for 15% of the workday due to pain, medication side effects and other complications from her medical issues. Would she be able to perform the claimant’s past work or any other work?
The judge had no additional questions, nor did I so the judge closed the hearing.
Conclusion: the judge will approve this case using a functional capacity analysis. My client fits the profile for a failed back case. Her orthopedic problem was imaged using an MRI, conservative treatment failed, she underwent surgery and surgery was not successful in restoring enough function to allow for any type of work.
Further, my client presented as a credible claimant because of her long work history and her full compliance with treatment.