Summary: This case involves the claim of a 48 year old female with chronic pain, depression and congestive heart failure. The judge issued a favorable decision primarily on the mental health limitations set out in the record.
Claimant: 48 year old female
Past work: nursing
Hearing Background: this case was a remand from an unfavorable hearing decision issued in February, 2010. My client had originally applied for benefits in the summer of 2007 and appeared at a hearing in the winter of 2009. The judge in the prior case approves fewer cases than average and the claimant appealed the unfavorable decision. The Appeals Council remanded the case back to the hearing office with instructions for the judge to more carefully consider then claimant’s functional capacity. Fortunately, the judge in the prior case no longer works at the hearing office associated with this claim and a new judge was assigned to hearing this case. This second hearing was held in January, 2012.
Medical Background: my client has an extensive and complicated medical background that documents numerous medical issues including:
- right upper arm pain (which she injured moving a patient at work)
- bulging and herniated discs in her cervical spine
- severe headaches
- suspected congestive heart failure
- episodes of fainting
- swelling in her lower extremities
- abdominal hernia
- myofascial pain
- Ehlers-Danos syndrome
- depression and anxiety
Factors in our favor included:
- the medical record in this case was extensive and voluminous
- my client had a long and solid work career before her medical condition deteriorated
- there was a very helpful consultative psychological evaluation that identified relevant work limitations including slow pace of work and trouble maintaining a work schedule
- strong support from a long time treating family doctor who stated clearly that he did not believe my client could work
Factors not in our favor included:
- some of the objective testing did not show a severe impairment, meaning that we would need the judge to accept my client’s assertions of pain and discomfort
- the previous judge in the first hearing did not find my client fully credible
Hearing strategy: I felt that we needed to focus on two or perhaps three medical issues in this hearing. In my experience, when a claimant identifies more than 3 impairments, judges tend to discount the severity of any one of them and the judge might conclude that the clamant is not credible. In this case, I felt that our strongest impairments were:
- herniated discs in neck and associated pain
- swelling in legs (most likely associated with diabetes) that required my client to sit with her legs raised
- depression and anxiety as documented by the consultative evaluation report
Hearing report: my client and I appeared in a remote hearing location with the judge and vocational witness based in Atlanta and appearing by video. I have appeared before the judge in this case several times and I find her to be very organized, intelligent and prepared. She also tends to approve fewer cases than average but she does give claimants a fair hearing.
In this case, the judge started the proceedings by noting that her file was not properly numbered and that she could not refer to specific exhibit numbers. I got the sense that the judge had not reviewed the materials in this case as closely as she does typically, and I suspected that she would rely on me to better organize the materials.
As she was trying to organize her file, she made specific note of the psychological consultative evaluation and the impairments identified therein. I made note of this and I decided to make the psychological issues our primary disabling impairment for purposes of organizing my questions.
The judge then asked me for an opening statement which I provided. I made specific note of the psychological issues as well as the neck problems and swollen feet. I did touch on the other areas but I emphasized that the mental, the neck and the feet were our main problems.
The judge then asked my client about her past work and about her living arrangements. The judge then asked about the various physical problems and my client testified about her neck issues, her myofascial pain and her chest pain. I got the sense that the judge had already decided to approve this case and that her questions were primarily intended to complete the record.
After completing her questioning the judge asked me to continue. I asked a number of questions about my client’s depression and how it impacted her (crying spells, problems with focus and concentration). I also asked her about her neck pain and headaches, and about the swelling in her feet and her need to keep her feet raised.
After I completed my direct examination the judge turned to the vocational expert and asked him to identify the claimant’s past work. He testified that the claimant had worked as a licensed practical nurse, which is a medium job that is skilled. He also testified that this job would produce skills transferrable to lighter work, including receptionist duty, scheduling, office management, clerical skills, ability to take vital signs, and ability to respond to emergency situations.
The judge then posed the following hypothetical question:
Q: Assume a hypothetical person of the same age, education and work background as the claimant and assume she is limited to light work. Assume further that she can
- lift 5 lbs. frequently
- lift 10 lbs. occasionally
- she can stand for up to 2 hours in an 8 hour day
- she can sit for up to 6 hours in an 8 hour day
- when standing her gait would occasionally be unsteady because of her physical condition
- her capacity for postural movements is occasional
- she cannot climb ladders, ropes or scaffolds
- her capacity to stoop is occasional
- her capacity to climb ramps and stairs is occasional
- her capacity to balance, kneel, crouch, crawl is occasional
- her capacity to reach in all directions including overhead is occasional
- her capacity for handling, fingering and feeling is occaisional
- she has no visual limitations
Could such a person perform the claimant’s past work?
Q: Let me add to this hypothetical question the following non-exertional limitations:
consider the limitations set out in the psychological consultative evaluation – namely that this person would work at a low pace and would have trouble maintaining a work schedule. Could such a person perform the claimant’s past work?
Q: Could such a person perform any other work?
The judge then asked me if I had any questions and I replied “no.” The judge then ended the hearing
Summary: as noted this case was a remand by the Appeals Council from an unfavorable hearing decision issued by another judge. The remand instructed the hearing judge to consider the claimant’s full functional capacity limitations and to consider the primary care doctor’s conclusions about the claimant’s work capacity.
My sense was that the judge in my hearing felt that the Appeals Council remand was suggesting that the medical record was compelling. I also felt that the psychological consultative evalution was compelling evidence.