January, 2015: A Tale of Two Claimants at Hearing

This month’s entries involve two (2) very different cases at the Office of Disability Adjudication and Review. One involves that of Terry, a sixty (60) year old medical professional with an extensive work history and the other involves that of Kathy, a twenty-five (25) year old woman whose medical conditions have kept her from launching her career.

Terry had become disabled as a result of orthopedic conditions involving his neck and back which required him to attempt both medication and injection management. Terry’s chosen profession, for which he had gone to graduate school, required him to spend a great deal of time on his feet, either standing or walking. However, Terry’s case was complicated by the fact that his employment had not come to an end because of his disabling condition. Instead, ethical concerns involving his employer caused Terry to discontinue working his last position. Shortly after discontinuing his employment, it became apparent to Terry that there was simply no way he could continue to undertake the physical requirements of his prior position or for that matter any position for which he was trained. Likewise, his ability to stand for lengths of time was simply too impaired for him to consider any manner of light exertional employment (and he did not have any training or education that would allow for a transition to a skilled sit down position). Given this fact, in speak with Terry, we agreed to assist him with his claim.

Additional MRI studies had indicated that epidural steroid injections might provide Terry with some relief. However, Terry had a poor response to injection therapy. Terry followed up for a neurosurgical evaluation only to learn that his condition could not be addressed surgically.

At the time of the initial decision, we worked with Terry to obtain a medical questionnaire from his primary care physician addressing both the severity of his condition and how it impacted his ability to function. Unfortunately, Disability Determination Services (the state agency responsible for make a medical determination in Terry’s claim) gave little weight to this opinion suggesting wrongly that the opinions of the treating source as to Terry’s functional limitations were issues reserved for the Social Security Administration. This could not have been further from the truth.

Given Terry had sought out additional treatment from an orthopedic specialist who was willing to comment as well on his condition (both in terms of the severity of his condition and the extent of his residual functional capacity), we were able to obtain additional evidence in support of his claim that we could submit at the hearing level with our appeal brief. In every case, as you’ve noticed from my many years of success stories, I undertake an appeal brief to the presiding judge in every case, well in advance of the hearing, in an attempt to win the case prior to the need to proceed to hearing. And so we did in Terry’s case, arguing successfully that improper consideration had been given to Terry’s primary care physician, who had provided rather compelling evidence concerning Terry’s medical condition. These medical questionnaires, along with the argument brief, served to convince the presiding Administrative Law Judge that a hearing in Terry’s case was not necessary. Terry was awarded a fully favorable decision in his case and is breathing a heavy sigh of relief now that he’s able to provide a measure of financial relief to his household.

Kathy’s disability stemmed from an inflammatory medical condition that can cause growths, in her case, in the sinus region, causing the need for surgery to remove abscess material. Kathy began developing difficulties in 2012 that continued into 2013 that caused her to require multiple surgical procedures and IV antibiotic treatment following the procedures, so as to bring her condition to a stable point. Unfortunately, by the time she contacted our office she had already faced a denial of her claim for benefits. Part of the problem with her case stemmed from the fact that no doctor had addressed the extent to which her IV antibiotic treatment caused side effects and resulting limitations in terms of Kathy’s ability to function during the day. This is not to mention the fact that the sinus surgeries themselves caused her to be down for the count for some period of time following each procedure.

Upon getting involved in her case, we were able to work with Kathy to obtain helpful documentation from her infectious disease specialist which laid out in detail the extent to which she was experiencing headaches, fatigue, occasional loss of balance, nausea and decreased appetite which symptoms were being contributed to by both the surgery and the antibiotics she required following each procedure. This additional documentation proved extremely helpful when it came time to the drafting of an argument brief in support of her claim. Likewise, it was extremely helpful to Kathy’s case that she had improved to the point of being able to return to work prior to her hearing date. Thus, the Administrative Law Judge was able to see that Kathy was not waiting around for benefits: she was only requesting them for the period of time it took her to recover and return to some manner of employment. Given this, Kathy was not only awarded a fully favorable decision with both retroactive benefits up through the date of the decision, she was also awarded an ongoing check until such time as she had used up what is called a trial work period (which allows one to attempt a return to work without fear that by doing so they will adversely impact their right to ongoing checks should they need to go back out of work). Needless to say, I have a very happy client who has had the best of all possible results with not only the security of her retroactive benefits for the time she has been out of work, but also the security of an ongoing check as she tests the waters with a return to work (receiving during this trial work period not only a check from the Social Security Administration but also a paycheck). Many clients are not aware until we speak with them about the incentives that exist for a return to work, and such advice to Kathy proved invaluable.