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June, 2015, Part I: Ellen’s fully favorable On the Record Decision at the Boston, MA Office of Disability Adjudication and Review

June’s stories revolve around the decisions of two favorable decisions received by way of argument briefs, prior to the need to proceed to hearing. As these cases make clear, zealous representation by an attorney familiar with knowledge of the rules and regulations and whose office has prepared the cases well in advance of hearing may succeed in obtaining a favorable decision at the hearing level without the need to appear in front of an Administrative Law Judge.

Ellen’s case involves that of a woman in her mid forty’s who had been suffering from a variety of medical ailments, including that of heart disease (including a heart attack and unstable angina), diabetes, high blood pressure, sleep apnea, bipolar disorder, major depression, restless leg syndrome and fibromyalgia. While Ellen had experienced a heart attack which had caused her to go out of work, she did recover sufficiently to attempt a part-time return to work. Because this work did not amount to Substantial Gainful Activity and because it ended in less than 3 months, we were able to argue successfully that this attempt at returning to work should not change the onset date of disability provided to her.

Ultimately, Ellen experienced additional hospitalizations related to chest pain associated with her heart disease, while at the same time, her additional blood work continued to show less than controlled Diabetes. Likewise making matters worse for Ellen were the mental health problems she had experienced in the past, but which problems only worsened following the onset of her physical problems. Fortunately, Ellen chose to follow-up with a psychiatrist for evaluation and follow-up of her mental health which showed that these problems were additionally impacting her ability to function.

Ellen continued to follow-up with her cardiologist on a regular basis, and after she had been unable to return to work on a gainful level for longer than a year, her cardiologist was kind enough to address a Cardiac Residual Functional Capacity Questionnaire on her behalf, which detailed the severity of her condition and the symptoms and functional limitations resulting from it. A questionnaire from her specialist concerning the extent of her cardiac condition and how it was impacting her ultimately carried quite a bit of weight with the hearing office. Moreover, Ellen’s primary care physician (who had been treating Ellen for many years, including for her Diabetes condition) was kind enough to address a Diabetes Mellitus Residual Functional Capacity Questionnaire that similarly made clear that Ellen had been experiencing severe symptomatology which was impacting her ability to function in a meaningful manner with any consistency.

These questionnaires were not available at the time of the initial agency determinations and made clear to the hearing office, along with the updated treatment records, that Ellen had continued to remain totally disabled from all forms of gainful employment since her initial heart attack. Given the consistent treatment she had been maintaining, along with her attempt at returning to even part time employment, the hearing office (by way of counsel’s argument brief) was convinced that a hearing would not be necessary in Ellen’s case and that a fully favorable decision was warranted at this time.