Summary: 48 year old male claiming disability based on significant heart damage following heart attack
Client profile: 48 year old male
Education: college degree + masters degree
Past work: 25+ years in military, followed by two work attempts after his heart attack – one managing contracts for a vendor who works with the military, and the second as an ROTC teacher at a local high school. He had to leave both of these post-heart attack jobs because of fatigue
Claim background: my client filed for benefits in December, 2011 alleging an onset in December, 2011 (after he left his teaching job). A hearing was held in a north Georgia hearing office in December, 2013 with a judge appearing by video from a neighboring state.
Medical background: in June, 2010, while working as an air traffic controller for the military, my client began experiencing chest pain and shortness of breath. His wife took him to the hospital where he went into full cardiac arrest due to a severe myocardial infarction (heart attack). The heart attack caused significant scarring to his heart muscle, leaving his with an ejection fraction of 30% (normal is 55 to 60%). In November, 2010, he underwent surgery to insert a pacemaker. Since that time, his ejection fraction has decreased to 28%. He is relatively stable with his medications, but experiences chest pain and tightening two to three times per week, requiring him to use a nitroglycerin pill. He also asserts that because of fatigue he must nap between 30 to 90 minutes per day, and sometimes twice per day. Even moderate exertion leaves him exhausted and he is basically homebound.
In addition to his cardiac issue, my client has longstanding back pain and in June, 2013 he underwent a laminectomy. He contends that he cannot sit or stand for more than 15 to 20 minutes at a time and he frequently must change positions.
My client also experiences symptoms of PTSD arising from his experience in the military while deployed overseas.
Factors in our favor:
- the judge in our case is reasonable and fair
- the primary medical issue – severe heart disease – was well documented by objective testing
- my client had a long, productive work history and he comes across as sincere and truthful
- my client attempted to work after his heart attack – these two unsuccessful work attempts enhanced his credibility
Factors not in our favor:
- the treating cardiologist’s notes suggest that my client’s chest pain and tightness are well controlled by medication
- my client has a very high tolerance for pain and does not complain about many of the symptoms he experiences
My strategy: I felt that the heart disease was our primary medical issue and that it alone was strong enough to win this case. My client and I spoke extensively about the need to describe his symptoms fully and accurately and to associate these symptoms with specific measurements (time, distance, etc.).
I also worked with my client to draw out certain symptoms that he was experiencing but did not offer originally in our talks. For example, I asked my client how often he experienced chest pain and what he did as a result. He stated that two or three times a week he felt a tightness and sharp pain in his chest and that he took a nitoglycerin under his tongue, which usually reduced his pain in 20 minutes or so.
With further questioning, we established that the nitroglycerin caused severe heartburn and usually diarrhea within an hour. So, rather than saying that he chest pain resolved in 20 minutes, we established that the entire episode – starting with the chest pain, the waiting for the nitro to take effect, the resulting heartburn and gastric upset – would likely require at least an hour from start to finish.
Hearing Report: my client and I entered the hearing room and were greeted by the judge. I had previously submitted a pre-hearing brief so the judge did not ask for an opening statement.
After swearing in my client the judge asked him to explain what happened with his heart attack. My client testified that he initially did not realize that he was having a heart attack and he delayed going to the emergency room. When he got there, he went into full cardiac arrest and had to be shocked several times.
He did a good job explaining the nitroglycerin issue and he did well in explaining his limitations using measurements of time and distance.
After listening to my client’s testimony the judge asked the vocational witness to describe my client’s past work.
The judge then asked me if I had any questions – I firmed up the testimony about the frequency of naps and the total amount of time associated with the nitroglycerin use. I also asked him briefly about his back issues (to get this into the record).
The judge had no questions for the vocational witness and he closed the hearing saying that he would get a decision out soon.
Conclusions: the judge will issue a favorable decision in this case as it was apparent to me that he found my client credible and the medical issues severe.