October, 2017 Anita’s Fully Favorable Social Security Decision out of Augusta, Maine and the Lawrence, MA OHO
As an attorney handling Social Security disability claims and appeals in Maine, Massachusetts and New Hampshire for going on 30 years, one thing is clear to me: one size does not fit all when it comes to evaluating the validity of a particular claim. One cannot generalize that certain types of cases (whether they be a specific type of illness or injury), or a specific type of individual (whether that means being a certain age or having a certain work background) are likely to result in a favorable decision. Anita’s case is a good example for this proposition.
Anita is a relatively younger individual, in her late 30’s, who over time developed a number of medical problems, including problems with her lower back that, while thought to be potentially lumbar disk related, did not show definitive objective proof that disk pathology was the cause of her low back problems. Over time, her back problems caused her to become more and more sedentary, gain weight and to have difficulty performing the counter position she had worked for many years. As time passed, she developed a more body-wide pain that her rheumatologist diagnosed as Fibromyalgia, and ultimately she did develop carpal tunnel syndrome. Not unexpectedly, these various physical difficulties caused Anita to spiral downwards emotionally (from both anxiety and depression) resulting in the need for mental health medication management and counseling.
Anita was of the mindset when she initially applied for benefits that because she had a strong work history she should not require the assistance of a Social Security disability lawyer. Unfortunately, given the nature of her conditions (not to mention her age), Anita found herself denied at the initial level (following an application at the Augusta, Maine SSA District Office), and then denied on reconsideration. She contacted our office after the point in time she undertook her Request for Hearing before an Administrative Law Judge (ALJ) and was awaiting hearing. Anita had likewise been receiving both short and long term disability (LTD) benefits through insurance plans she had through her employment. Even though her LTD policy provided that she simply needed to prove that her conditions did disable her from performing the usual and customary duties of her ordinary occupation (versus the more difficult standard presented by the Social Security regulations, that is, that she cannot perform any of the work she had performed in the 15 years prior to becoming disabled, deemed her past relevant work, or any work for which she’s reasonably suited by age, education and experience), she was likewise denied on her LTD claim.
Ultimately, though, the substance is found in the details when it comes to Anita’s story: and that’s the story of persistence. During Anita’s attempts to remain employed, she was able to push for and receive accommodations from her employer for a stool so she could sit when she needed to (although company policy was against sitting during the course of a shift). When she started missing time from work, it was not Anita that is pushing to leave, but her managers, who had to convince her of the need to go on disability. When it comes to her treatment, Anita was equally as persistent. When a new issue would arise, she not only followed through with the treatment available, she sought out specialists and second opinions. Upon leaving work, her consistently expressed goals to her providers were to return to work, part-time, and then full-time when able. All of these facts were spelled out in her treatment records and became arguments by her counsel at hearing.
Unfortunately, however, Anita never found herself in the position of being able to return to any manner of employment. Her medical providers, however, became more than willing advocates for her application for disability benefits in light of the fighting spirit they routinely saw in their patient to 1) address her medical conditions head on and 2) return to work if at all possible.
As her legal advocates, we were able to obtain helpful medical questionnaires which spelled out the nature and severity of her medical conditions and the extent to which she was physically and, from a mental health standpoint, limited in terms of her ability to undertake work functions. Just as importantly, we were able to locate what were thought to be lost records from her prior treating rheumatologist who had definitely diagnosed her years earlier with Fibromyalgia (and whose records helped show the struggle to continue working).
At hearing, while suffering from medical conditions that may not objectively form the basis for a strong claim, the presiding ALJ was obviously quite convinced as to the appropriateness of her claim and did grant a fully favorable decision within three (3) days of her hearing. While providing little solace to Anita insofar as the decision did not grant her wish to recover from her conditions such that she could return to work, the decision did serve to return to Anita a sense of independence she had since lost.
If you are finding, like Anita, that your Social Security disability claim is simply going nowhere and you can’t understand why, contact the Law Offices of Russell J. at 1-800-773-8622 for a no-cost evaluation of your circumstances. It may change both the course of your life and your case, as was the case for Anita.