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Maine state Bar

April, 2012: Many to Choose From

This month's success stories (and I am happy to say that there have been a number to choose from this month) remind me (and I hope will point out to those reading) the importance of maintaining treatment (and not just with their primary care physician). From my experience, the Administrative Law Judges at the Offices of Disability Adjudication and Review pay much greater attention to the opinions of specialists (and expect that if a condition is severe, that the individual is being followed by a specialist in the area in which they have a severe condition). Linda is a prime example of the above. She is presently 55 years old and became disabled 3 years ago as a result of difficulties involving rheumatoid arthritis, fibromyalgia (along with liver disease, anxiety, depression, high blood pressure, bursitis of the left hip and osteoporosis ). Linda has a four year college degree and a child care certification (having worked for many years as a child care director, as well as various other positions working with children, including work as a camp counselor and a preschool and elementary school teacher). She continued to be followed for these conditions by an orthopedic specialist and a rheumatologist , both of whom supplied significant objective findings in their treatment records and exhausted medication trials (and treatment protocols, including even the use of a TENS unit to attempt to address the pain component of her problems) that would be appropriate for her conditions. As I've mentioned previously in cases involving Fibromyalgia , it is extremely important that evaluation and treatment has been addressed by a specialist (that is to say, a rheumatologist) and that objective findings have been made by the rheumatologist concerning the condition. The diagnostic criteria for Fibromyalgia has been set forth by the American College of Rheumatology , and past experience has shown me that objective diagnosis by a rheumatologist carries much more weight with the Social Security Administration and the Administrative Law Judges . Not only was Linda able to show the Social Security Administration that she was “ disabled from all forms of gainful employment despite prescribed treatment ,” but also her doctors evidenced through their records and the medical questionnaires that there were objective findings supporting her diagnoses that likewise would support the notion that she indeed remained significantly limited from a functional perspective. These functional limitations were likewise spelled out by her providers. By way of an argument brief, I was able to show the Administrative Law Judge (out of the Portland, Maine Office of Disability Adjudication and Review ) how the state agency physician at the prior agency level of decision (reconsideration) had failed to provide appropriate consideration to the medical questionnaires that had been provided by these specialists (and to the findings within those questionnaires). I am happy to say that we were able to avoid Linda's need to attend an administrative law hearing given the fully favorable decision we were able to obtain for her. Mark's circumstances are a variation on this same theme. He is a fifty (50) year old gentleman who has been suffering from longstanding problems with Diabetes Mellitus, Type II and corresponding problems with diabetic neuropathy (involving his feet), diabetic gastroparesis, diabetic retinopathy, anxiety and hypertension . In Mark's case, he was continuing to be followed by an endocrinologist for his significant Diabetes concerns. Upon getting involved in his claim, we were able to prevail upon his long-term treating endocrinologist to address a Diabetes Mellitus Residual Functional Capacity Questionnaire that addressed in detail the severity of his condition (noting both significant objective clinical findings supporting his opinions) and significant corresponding functional limitations that would impair his ability to undertake any form of work. I am happy to say that this additional evidence and an argument brief on Mark's behalf served to make all the difference in his case (and, again, kept the client from having to attend a hearing). The presiding Administrative Law Judge out of the Lawrence, Massachusetts Office of Disability Adjudication and Review granted a fully favorable decision based on the new evidence provided and by doing so allowed substantial retroactive benefits to be awarded to Mark and his family.