Summary: this case involved the disability claim of a 55 year old female with chronic kidney disease, depression and musculoskeletal pain
Client profile: 55 year old female
Education: 10th grade, with no GED, training as certified nursing assistant
Past work: packer at thrift store, baker/clerk at grocery store, nursing assistant, home health care provider
Claim background: my client filed for benefits in May, 2011 alleging an onset of 2006. At the hearing, we decided to amend the onset date to March, 2011 because my client had worked for 7 months in 2010 and 2011and because there was insufficient medical evidence dating back to 2006. This claim was a disabled widow’s benefit claim, based on the earnings record of my client’s late husband.
Medical background: the medical record in this case was not very extensive as my client has no insurance and has very limited access to medical care. There were two psychological consultative evalutions and some hospital notes describing depression and anxiety, and the functional limitations described in these reports included comments such as:
- can structure and execute a daily routine in a marginal manner
- concentration and memory are fair
- she functions at a reduced pace but with adequate energy
- adequate capacity for work but marginal for sustained employment
My sense is that this record describes a person who may have some limited capacity for simple, repetitive, one or two step work but no more.
The record also indicates that my client has chronic kidney disease arising from long standing, minimally treated hypertension. Here, the main symptom my client complains about is urinary incontinence, frequent, unscheduled need to urinate and chronic mild to severe headaches. The medical records do not describe listing level kidney disease and the question of whether my client’s symptoms are consistent with the medical record are matters for the judge.
There was one doctor visit describing overall body pain including back and hip pain but no diagnostic studies or other confirmation of back and hip pain.
Factors in our favor:
- my client is over age 50 and has a less than high school education
- incontinence and urinary frequency is often seen by Social Security judges as significant vocational problems
Factors not in our favor:
- the medical record in this case is very thin and other than one consultative psychological report does not include much in the way of functional limitations
- the judge in this case is much less likely than average to approve cases
- my client has not been proactive in seeking medical treatment, even from emergency rooms
My strategy: I felt that the incontinence and bathroom frequency issues were my strongest argument, followed by depression and the relatively significant functional limitations described by the consultative psychologist. My client comes across as a person who is depressed and has essentially given up on life – the question: will the judge see this as laziness or evidence of less than marginal capacity to work.
Hearing Report: the hearing began almost an hour late and the judge apologized to the claimant and me for the delay. The judge was appearing by video, and there was no vocational witness present. After accepting evidence into the record the judge asked me to identify the severe impairments – I noted the chronic kidney disease and associated symptoms, depression and back and hip pain. The judge then asked me to question my client.
I began by reviewing my client’s past work, and establishing that her past work was entry-level, unskilled type of work. I next asked my client why she felt that she could not return to any job. She replied that her incontinence and need to urinate frequently would make it difficult for her to stay at a work site. She explained that she needed to urinate every 30 to 45 minutes and that several times a week, she had “accidents.”
I asked her if she knew why she had incontinence problems but she did not recognize that I was trying to get her to talk about her kidney issues and high blood pressure problems. I felt that I had no choice but to ask leading questions to get this information on the record, which the judge did not object to, but which made my client’s testimony somewhat less convincing.
We did discuss the kidney issues and high blood pressure and my client testified that medications were not able to control her hypertension and that it has been very high for many years. She noted that she frequently experienced headaches that lasted “as long as it takes for Advil to kick in.”
We then turned to depression and I asked my client how she would describe depression to someone who had never experienced it. Here, too, my client was unable to say more than to assert that she was sad all of the time and did not want to be around people
Finally I turned to the hip and lower back pain. My client testified that she frequently used a walker (borrowed from a friend) and that her low back pain might be coming from her kidney issues. She testified that she experienced severe pain, sometimes so severe that she could not move.
The judge then asked several questions to clarify a few points, then closed the hearing.
Conclusions: as noted above, my client appears to have given up on participating in life. She lives in her ex-husband’s mobile home and lays in bed most days doing nothing. My sense is that a full medical workup would yield more significant diagnoses and that she might benefit from psychotherapy if it was available to her. On the other hand, my client shows little motivation or effort to improve her lot in life. Social Security judges are often not sympathetic to claimants who have given up so my guess is that this case will be denied.