Summary: 51 yr. old female with congestive heart failure
Client profile: 51 year old female
Education: college educated
Past work: pension consultant/401(k) specialist for insurance companies
Claim background: my client filed for benefits in August, 2011 alleging onset in November, 2011. A hearing was held in Atlanta in April, 2012
Medical background: my client has been significantly overweight for many years. She is 5’3″ & weighed over 300 lbs. In 2007 she was diagnosed with sleep apnea and non-insulin dependent diabetes. In 2010 she began experiencing periods of shortness of breath and chest palpitations. In mid-2010, she was seen at a local emergency room with shortness of breath and swelling. Her cardiologist at the time diagnosed congestive heart failure and a serious diastolic dysfunction. Over the next few months, she was seen at the ER for chest pain and shortness of breath several times. In November, 2010, she was admitted to the hospital for chest pain, shortness of breath and swelling. A cardiac catheterization was performed but it did not show any significant blockage. Since that time my client has lost her insurance but continues to see a cardiologist at a local charity clinic. She continues to experience shortness of breath, chest pain and the need to take frequent restroom breaks because of medications.
Factors in our favor:
- my client has a long and solid work history
- the medical record documents an ongoing cardiac problem
- my client takes a medication to reduce fluid buildup that causes her to need to urinate hourly
- my client has made a concerted effort to lose weight and has lost 70 lbs.
- the judge assigned to our case is a very compassionate person and more likely than average to approve cases
Factors not in our favor:
- while my client has heart issues, there is no blockage or obvious damage to the heart muscle
- we do not have a functional capacity form in the file
My strategy: I felt that the strongest factors I had with this case were my client’s long and consistent work history, her well documented heart disease and the vocationally significant medication side effect of frequent urination.
Hearing Report: my client and entered the hearing room and were greeted by the judge, who is very friendly and welcoming. After swearing in the claimant and the vocational witness and accepting the medical exhibits into the record, the hearing took a bit of an odd turn.
The judge had some questions about the original alleged onset date, which was about a month and a half prior to the date my client stopped working. There were also some work attempts after the alleged onset date.
This discussion evolved into a somewhat free-flowing conversation between the judge, my client and to a lesser extent me about her various medical problems. Generally Social Security judges are most concerned about specific work limitations but in this case the judge’s questions were more open ended and my client focused mostly on her medical problems as opposed to the limitations that arise from those problems.
Normally, this judge asks me to question my client but in this case she did not. At times, I was concerned that the conversation was getting a little out of control. Fortunately, my client is very well spoken and came across as being very credible and unrehearsed. She did a good job describing her pain and was very matter of fact about her need to urinate hourly (and at one point she asked to be excused to use the restroom during the hearing).
After conversing with my client for about 45 minutes, the judge asked me if I had any questions. I just asked a few follow-up questions as I felt that by this time either the judge was going to find my client believable or not.
The judge then turned to the vocational expert and asked him to identify the claimant’s past work, which was a pension consultant – sedentary, skilled work.
The judge then posed her hypotheticals:
I. Assume an individual who is the same age as the claimant with the same work history and education.
- She can lift 20 lbs. occasionally and 10 lbs. frequently
- she can sit for up to 6 hours during an 8 hour day or stand for 6 hours out of 8
- she can engage in frequent pushing and pulling
- occasional use of ladders, ropes or scaffolds
- occasional kneeling or crawling
- no concentrated exposure to heat or cold
- no work around hazardous machinery
Q: Could such a person perform the claimant’s past work?
II. If I accept as true the claimant’s testimony that she needs to take a restroom break of at least 5 minutes where she would be away from the work station, could such a person perform the claimant’s past work or any other work?
A: No, that is an excessive number of breaks.
Conclusions: the medical record in this case did document a significant heart problem but there was no firm linkage of this medical issue to any specific work limitations. Because my client no longer has insurance we did not have a doctor who could complete a functional capacity form for us. The question is whether the judge will take a logical leap to conclude that a person with a significant but not life-threatening heart problem can be fully believed with regard to her testimony about excessive bathroom breaks, chest pain and fatigue.