Heart Disease and Social Security Disability
Ventricular Tachycardia Resulting in Recurrent Arrhythmias, Vascular Complications and Medication Side Effects
Claimant: 42 year old male
Past work: heavy equipment maintenance operator, machine operator
Education: completed 8th grade – has basic reading, writing and math skills
Hearing info: this was a June, 2010 hearing for SSDI benefits on a claim filed in April, 2008. My client had a long, consistent work history performing heavy physical work. In 2005 he had undergone a cardiac catheterization because of blockages and had also begun experiencing arrhythmias (skipped beats). By the end of 2007, he had developed ventricular tachycardia, a condition in which the lower chamber of the heart begins beating rapidly and stops effectively pumping blood. My client experiences frequent mild episodes during the day which cause dizziness, and more sustained episodes several times a month which cause him to pass out. In addition to the VT episodes, my client developed vascular problems, requiring the placement of stents (to keep the veins open) in his major leg veins as well as in his heart.
Among his medications are diuretic pills to stop fluid buildup, which cause him to urinate every 30 to 40 minutes. In addition to these cardiac and vascular problems, my client also has degenerative disc disease arising from lifting heavy equipment and materials.
The medical record in this case was complete although we did not have any functional capacity form or statement on the listing. Also, my client lost his insurance about a year prior to the hearing so there were no new treatment records within the past 12 months.
Hearing strategy: I thought this was a good case for several reasons. First, my client had a long, consistent work history. During our pre-hearing conference, he told me that when he was working, he rarely missed work, even when he had a broken wrist or underwent hemorrhoid surgery. My client also has several children and I made a note to be sure and ask him about the economic impact of his not being able to work.
I felt that this might be a listing level case at 4.05, and prior to the hearing I had written the judge to request that he call a medical expert to testify about a possible listing level impairment.
If not listing level, I felt that we had a variety of functional capacity problems that would preclude even entry level type of work, including:
unpredictable episodes of passing out
frequent (every 30 minute) bathroom breaks
fatigue (from meds, obstructive sleep apnea, and after effect of VT)
standing and walking of less than 50 yards (this was in medical record)
sitting for less than 45 minutes because of back pain and numbness in legs
I also felt that my client would be a credible and believeable witness.
Finally, I have had many hearings with the judge in this case, and his approval ratio per the ALJ disposition database is about at the average – just under 2/3 of the cases he hears, he approves. This judge is also a very nice person and reasonable and I saw no reason for concern about the judge.
Hearing Report: the judge opened the hearing by introducing himself and the vocational witness. He confirmed my client’s identity and accepted the exhibit file into evidence, then he turned the questioning over to me.
I started my direct examination by reviewing my client’s past work and his long work history. I also asked him about his work attendance and elicited testimony about his willingness to work when hurt. I had him explain that he quit his last job because attendance problems were about to get him fired and as he had never been fired from a job, he did not want that on his record.
I then asked him about his education and elicited testimony that he had quit school in the 9th grade because he came from a poor family and that he needed to work, and has been working ever since. He further stated that not being able to work has created a huge financial hardship for his family and that he would have tried to do something if his health permitted it.
We then moved to the medical issues – I had him describe ventricular tachyardia – how it felt and what brought on episodes. He testified that several times a day, he experienced dizziness and several times a month he passed out. He also stated that his passing out increased if he exerted himself only slightly or if he was under stress.
I asked about medication side effects and elicited testimony that the diuretic pills resulted in his need to urinate at least every 30 to 45 minutes (side note: my client had used the restroom twice during the time we were waiting for the hearing to be called and immediately thereafter as well). He also testified that he slept at least one to two hours per day because of fatigue brought on by his medications.
We then turned to his back pain and its effects – limited sitting, standing and walking.
I finished by asking my client if he had any other comments and he looked at the judge and explained that he has been working since he was 14 years old, that he has sold everything he can sell and that if he could work he would.
The judge asked a couple of questions about the sleep apnea – which caused fatigue and poor rest at night, but thereafter ended his questioning.
The judge then turned to the vocational witness and asked about past work. The VE testified that the vehicle maintenance job was heavy and semi-skilled (SVP3) and the punch press operator job was medium and semi-skilled (SVP3). Neither of these jobs produce transferrable skills:
Question 1 – reflected the State agency functional capacity form but limited the claimant to light work with:
occasional use of ropes and scaffolds
no use of ramps
frequent – balancing, stooping, crouching, crawling
The VE testified that the claimant could not return to past work, but that there were other light, unskilled jobs that he could perform. The purpose of this question, by the way, was to eliminate from consideration all past work, thereby shifting the burden of proof to SSA to show that there were other jobs in the regional or national economy that the claimant could perform.
Question 2 – consider the following limitations:
frequent (4 to 8 times per week) episodes of dizziness caused by the ventricular tachycardia
episodes of syncope (passing out) at least 3 to 4 times per month
The VE responded that these limitations would eliminate all jobs
The judge then asked me if I had any questions. I had one:
Consider an individual limited to light work but who would need to take unscheduled restroom breaks every 30 to 45 minutes to urinate as a result of medications.
The VE responded that such a limitation would preclude all jobs
The judge then ended the hearing.
Summary: the judge will approve this case. My client came across as credible because of his work history and because he has a clearly diagnosed, serious medical problem. After the claimant left the room the judge asked me to stay and he told me that he had considered by written request for a medical expert but that he felt that was not needed because my client had such a strong case.