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July, 2011: A Story in Perseverance

The theme for July's cases is “perseverance.” I began working on Gerry's case in 2005, and on Daniel's case in 2007. While Gerry's case was initially a favorable decision, you'll see below what can go terribly wrong at times when the Social Security Administration is involved. After a combined ten (10) years of work on both cases, I am happy to say this month both gentlemen received fully favorable decisions in the month of July. While Daniel was able to stay the course with me (and I'm thankful for his trust in my abilities) and live long enough to see the favorable result in his case, unfortunately, Gerry passed away just after receiving the judge's initial favorable decision (never to hear that there would be another 4 year fight to reinstate a favorable decision).

Daniel's case involves that of a gentleman who became disabled in his late 30's as a result of narcolepsy, severe anxiety, depression and agoraphobia, along with migraines. As has been discussed in prior success stories, some of the most difficult cases can be those where there is little objective evidence that supports the claims of disability. While a back condition can, in many circumstances, be proven as severe through objective tests such as MRI or x-rays, circumstances where someone is suffering from subjective problems such as was the case here (sudden attacks of sleepiness causing him to fall asleep with little to no advanced notice, along with anxiety, depression and migraines, all of which must be proven through one's subjective complaints, and relying on the doctors to document and support these complaints) are much more difficult cases to prove. I credit success in Daniel's claim to 2 things: Daniel's willingness to remain in zealous treatment for his conditions and 2) Daniel's willingness to stay the course (even when he had every reason to feel discouraged and consider walking away from the process.

Daniel went through a 2 year initial claim and appeals process only to be denied at the hearing level by one of the Boston administrative law judges (ALJ's) who was assigned to hear his claim in the Portland, Maine ODAR office. This particular judge was not willing to give weight to the opinions of his long term treating neurologist, primary care physician and psychiatrist. It appears to me that the ALJ was somewhat prejudiced and disbelieving of Daniel's narcolepsy condition (notwithstanding the fact that he was in significant and regular treatment over an extended period of time with an area neurologist who was supportive of his condition and undertook a very helpful residual functional capacity assessment on his behalf). Given what was very substantial evidence supporting his claim, and given Daniel had to restart psychiatric treatment with a new psychiatrist at around the time of his initial hearing (who was likewise willing to provide supportive evidence as part of the Appeals Council process), this case was sent back for another hearing before an administrative law judge (after an additional 2 year wait). During this period of time, Daniel stayed the course with his counseling, psychiatric care, neurological care (and all of these providers stayed the course with him): he likewise stayed the course with our office. On this occasion, a new Administrative Law Judge was assigned to hear Daniel's case, and to his credit, the new judge called for 2 medical experts to comment on Daniel's condition (whereas, at the time of the initial hearing, no medical expert was called to comment). Both of these doctors, in reviewing the medical evidence (including the reports obtained on Daniel's behalf) were supportive of the notion that Daniel was suffering from very severe mental health problems in addition to significant effects from the condition of narcolepsy. In turn, the Administrative Law Judge provided a new decision which was fully favorable (and which has provided Daniel and his family more than 6 years of retroactive disability benefits). I remain hopeful that Social Security's ultimate favorable decision in this matter will provide Daniel with a sense of vindication and validation. I feel fortunate that I was able to work with Daniel to ensure he is able to play a significant role in supporting his family.