July, 2014: A Study in Contrast

Jonathan and Karen’s success stories represent two individuals who, while suffering from very similar medical conditions, come from very different life circumstances. Because of their very different backgrounds, it is interesting to note how very differently their claims were viewed (and handled) by the Social Security Administration. I’m happy to note that in the end both individuals received fully favorable decisions.

Jonathan is a fifty-four (54) year old gentleman who has a consistent work history that goes back to the age of 18. Jonathan had undergone a series of back surgeries in the 1990’s (3 laminectomies) and ultimately a fusion of his low back in 2000. Jon continued to work following the fusion, receiving epidural steroid injections and medications when his back flared up. He worked a variety of sales and attendant type positions over the years that showed Jon’s strong will to continue working despite his back difficulties. Unfortunately, in 2012, Jon’s condition took a turn for the worse once again and injection therapy (and narcotic medication) did not serve to calm down the acute pain he was experiencing in his low back and down his leg. Physical therapy is undertaken and a referral is made for nerve block injections. Ultimately, when these procedures fail, Jon is referred for a potential spinal cord stimulator. What becomes evident once again is that Jonathan is willing to go through whatever steps are necessary in terms of his treatment in an attempt to lead a full and productive life. Unfortunately, given the poor response Jon receives with the trial spinal cord stimulator, the surgeon does not recommend that Jon undergo placement of a permanent spinal cord stimulator.

By gathering the additional medical records, along with helpful medical questionnaires from a number of his doctors, we were able to present a brief to the presiding Administrative Law Judge handling his claim and make evident the fact that a fully favorable on the record decision was warranted. What became evident through our brief was the picture of a gentleman who had persevered for many years, despite his bad back, so that he could provide for his family. Thus, Jonathan was able to avoid the need to attend a hearing and was provided with the benefits he so deserves. I am happy to see that he has been able to enjoy a somewhat more relaxing summer knowing that many of his financial difficulties have been addressed by way of the retroactive benefits he has been awarded.

Karen’s case, while similar insofar as she has been dealing with severe back problems, is different insofar as she is a woman in her mid-20’s who began experiencing back problems while still a teenager. Unfortunately, in her late teens her condition became more unmanageable for her, notwithstanding conservative treatment measures such as physical therapy and narcotics. In 2010, it became necessary for her to apply for Social Security benefits as it became impossible for her to continue working at that time. However, when she found that her condition became once again more manageable with treatment (and when she was initially denied on her first claim for benefits), Karen decided to give work another shot. She was able to find an easier position, which she was able to work for a period of about 7 months before such time as her condition worsened once again and caused her to go out of work.

Given the frustration that Karen was experiencing with her condition, and given she was not experiencing relief from epidural steroid injections, she sought out multiple additional opinions. Some of the doctors suggested that there was nothing surgical that could be attempted, while neurosurgeons she consulted with in Boston recommended that she undergo a low back spinal fusion with hardware. Desperate for answers (and desperate to maintain an active lifestyle), Karen opted to undergo the fusion procedure. Unfortunately, as Karen attempted to become more functional following the surgery, she continued to suffer from setbacks. While the radiology reports suggested that she had good healing from her fusion, she remained quite limited in terms of her ability to function and remained in debilitating pain. She sought additional treatment by way of osteopathic manipulative therapy, injection therapy, physical therapy, along with medications.

Karen made evident her strong resolve to remain in treatment and to attempt a return to work. To her credit, Karen was able to make sufficient gains with her condition that she was able to consider a part-time return to work this past year with a company that she was referred to by a family member. The company was willing to accommodate Karen’s condition such that if she needed to return come in late or leave early, she was able to do so. Others in the business would assist her if she needed to undertake lifting beyond her abilities. Likewise, she was given the flexibility to shift positions at will from sitting to standing to walking. She initially undertook 20 hours per week, and, by the time she made it to hearing, had been able to increase her hours to 30 hours per week.

Unlike Jonathan’s circumstances, Karen did need to go to a hearing before an Administrative Law Judge. Given her young age, and the potential for being on disability benefits for the remainder of her life, it is not surprising that the Administrative Law Judge responsible for Karen’s case wanted to meet her in person and hear her story. It became obvious during the course of the hearing that Karen was continuing to undergo significant treatment. While she was making efforts to work, she would not have been able to maintain the job if it wasn’t for a very understanding employer who was making extraordinary accommodations so as to allow her to succeed. Given these facts, the Administrative Law Judge saw fit to provide Karen with a fully favorable decision, providing her as well with what is called a trial work period (which allows her to attempt a return to work while still collecting a check for what can be up to a year period of time).

Needless to say, Karen is thrilled to see that her attempts at treatment and with work have brought about a win-win situation for her. Not only has she been provided with a fully favorable decision following the hearing, but also she has been provided with an opportunity to work towards establishing a career and self-sufficiency. I am happy to see that things are moving forward in such a positive direction for someone who has worked so hard with both her treatment and her efforts at returning to work.

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