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October, 2015: Daniel’s Case: Overcoming a Problem with a Date Last Insured in Maine

Daniel’s case shows the importance of having an attentive attorney from the very beginning of their involvement in your case. Daniel is a 49 year old gentleman with an 11th grade education who had been unemployed for a number of years prior to becoming disabled from working as a result of a car accident occurring in Portland, Maine (in which he was involved as a pedestrian), which caused him injuries that resulted in longer term problems with migraines, neck pain, left hip pain and knee pain. Because Daniel had not worked in a number of years, he remained insured for disability insurance benefits for only a short period of time following the accident.

Following the accident, Daniel was noted to be having problems/pain with his upper and mid back, his neck, his left shoulder blade and chest. Within weeks of the accident, he is likewise noted to be having left hip and knee difficulties. Diagnostic tests did not evidence any objective findings that would suggest anything other than muscular in nature. During the weeks that follow, his neck pain only increases and ultimately results in what are considered to be muscle tension type headaches resulting from injuries to his neck muscles (and what is deemed to be a whiplash type injury). Ultimately, when the headaches, neck pain, hip and knee problems do not resolve completely, he is referred for additional evaluation and treatment with an osteopathic specialist and is likewise referred for physical therapy evaluation and treatment. When these treatment options do not prove helpful, Daniel is referred for evaluation and treatment with an orthopedic surgeon for his knee and hip, and additional testing does reveal an aggravation of a pre-existing lesion of the hip. Daniel is likewise referred for a neurological evaluation with a specialist (neurologist) who undertakes a detailed assessment and history at the time fo the initial evaluation and provides a basis for what he believes are post-traumatic headaches.

Within months of the initial evaluation, Daniel’s insured status under the Social Security disability insurance program ran out as he had remained unemployed for a number of years prior to this date. Daniel continued to treatment with this neurologist for an additional 2 years, at which point the treating neurologist retired from practice. While the other conditions did remain severe, and he did continue to receive treatment, the headaches appeared to be the most significant disabling condition.

Fortunately, upon getting involved in Daniel’s case and prior to the doctor’s retirement, we sought out a Headaches RFC Questionnaire from the treating neurologist so as to address the nature and severity of this condition at all points in time since the accident (and which would address his condition prior to his date last insured).

Shortly after obtaining the questionnaire, the treating neurologist retired and Daniel was left with having to initiate treatment with a different neurologist. It would take an additional 2 years to get to a hearing. Fortunately, we did not wait until the scheduling of a hearing to obtain the evidence that would turn out to be essential to his case: we see that many attorneys do wait until they are on the heels of hearing, only to discover that the neurologist treating Daniel prior to his date last insured had retired. Daniel’s case is another example as to how having a zealous, attentive attorney from the very beginning can prove essential to prevailing in one’s claim. The presiding Administrative Law Judge at the Portland, Maine Office of Disability Adjudication and Review ended up relying on the initial treating neurologist’s opinion as the basis for deciding that Daniel had remained totally disabled from all forms of gainful employment since prior to his date last insured (and since the date of his accident).