Multiple Sclerosis Disability Case Study #1
Debbie W. is a 42 year old female, married with a 13 year old daughter. Three years ago, her husband, who works for a large corporation, was given a work assignment that kept him out of town for weeks at a time. At this same time, Debbie’s daughter was attacked at school and her mother became ill with a terminal disease. Debbie and her family were living in California at this time.
Debbie is convinced that her MS was brought on by intense stress – the stress of dealing with her daughter’s school and social issues; the stress of her mother’s illness and the stress of having to deal with these problems alone. In any case, Debbie reports that about three months into this stressful period, she woke up one morning with a painful “pins and needles” sensation in both her legs. By the end of that week, she was bedridden, completely unable to walk.
Debbie’s primary care physician ran a number of lab tests, sent her for diagnostic tests and referred her to various specialists. Within two months, she was diagnosed with MS.
At the time Debbie fell ill, her husband returned home and eventually requested a transfer – which brought the family to Atlanta. Debbie’s condition stabilized to the point where she was able to move around with large metal braces. When she arrived in Atlanta, Debbie obtained a job as a staff coordinator at a temporary staffing service.
Debbie worked for about a year. Although she was no longer under intense and direct stress, she had at least three MS “episodes” that were characterized by the onset of new symptoms. Each of these episodes lasted approximately three weeks before subsiding, although each left her with residual symptoms from that episode. Debbie left her job because of frequent absences and increasing visual problems.
Debbie applied for benefits shortly after leaving her job. In her application she reported symptoms that included difficulty standing and walking, loss of muscle strength in her left ((non-dominant) arm, problems sleeping because of shallow breathing, and periodic episodes of blurred vision.
After applying, the State Agency adjudicator scheduled Debbie for a consultative exam with an internist. On the day that Debbie went to her appointment, she was having a good day – she still needed to use her braces to walk, but her vision was fine and her left arm was not bothering her much.
For more information about the State Agency adjudication process, read our discussion about the initial and reconsideration appeal process. Click here to go to that part of our web site.
The consultative physician, who is employed by a clinic that derives most of its income from independent medical reviews (for worker’s comp and auto accident insurance carriers) wrote that Debbie’s MS was “mild” and that she could perform simple or complex tasks. He further wrote that her vision test was “normal” and that while he did not doubt that Debbie experienced her claimed symptoms occasionally, he did not see these problems as inconsistent with work activity. He also noted that Debbie could sit for an unlimited time although she should avoid heights, ladders and scaffolds because of her leg braces.
In the meantime, the State Agency adjudicator requested copies of Debbie’s medical records from both her California doctor as well as the primary care physician she had found in Atlanta. Both of these doctors mailed copies of their largely handwritten notes to the adjudicator.
Upon receipt of the doctors’ notes and the report from the consultative physician, the State Agency Adjudicator sent the file to a staff physician employed by the State Agency. This staff physician, who has never actually met Debbie, reviewed the records then completed a physical functional capacity form in which he determined that Debbie’s symptoms were mild and would not cause any significant limitations in the performance of various work activity functions.
The file was then returned to the Adjudicator, who issued a form denial to Debbie stating that the Social Security Agency had determined that Debbie’s condition was not severe enough to prevent her from returning to her previous job as a “receptionist/secretary.”
Upon receipt of the denial, Debbie retained our law firm to assist her with her case. During our initial interview, I discussed with Debbie and her husband all of the symptoms she had had. We pulled up the web site for the National Multiple Sclerosis Society and reviewed a discussion of other symptoms common to the disease.
During our discussion, Debbie described symptoms of depression including crying spells and occasional thoughts of suicide. Although she had never received any specific psychological treatment, her primary care doctor had prescribed Paxil, a psychotropic medicine. Debbie and her husband also noted that Debbie seemed to be suffering some cognitive loss, including such problems as memory loss, difficulty adding in her head and mood swings.
Following our interview, my paralegal and I completed the request for reconsideration and the reconsideration disability report. We included in this report allegations of disability arising from depression, cognitive loss as well as other MS symptoms described by Debbie.
The State Agency adjudicator assigned to the reconsideration file did send Debbie out for a neuropsychological evaluation that was not entirely conclusive but that did note cognitive dysfunction. The examining psychologist concluded by stating that Debbie should be more thoroughly evaluated by a treating physician.
As is the case in most reconsideration appeals, Debbie was denied. We then filed for a hearing.
At the time I received the neuropsychologist’s report, I copied it and sent it to Debbie’s primary care physician. I also sent him a functional capacity evaluation I had drafted. Thereafter, the primary care doctor referred Debbie to a neurologist and to a psychologist, both of whom began treatment.
By the time the hearing was scheduled, I was able to provide to the Judge treatment records from three doctors – the primary care physician, the neurologist and the psychologist. I also had three functional capacity evaluations all of which identified limitations I knew to be significant. One of the treating physicians was kind enough to state on the form that in his opinion Debbie’s condition was at a significant level of severity prior to the date she last worked. Debbie subsequently testified that during the last three months of her employment, she missed more time than she was there.
The Judge permitted us to amend out “onset date” and Debbie was awarded benefits as of our amended onset date. The hearing lasted about ten minutes – the only real issue was the onset date question. After taking Debbie’s testimony about her last few weeks of employment, he turned to the Vocational Expert and asked the following:
Judge: “Ms. ___, have you reviewed the functional capacity forms completed by the claimant’s treating physicians?
Judge: If I accept any one of these evaluations as an accurate representation of this claimant’s condition, could she return to past work or any work?
VE: I do not believe so, Judge.
Judge: Why not?
VE: Well, Judge, let’s take Exhibit 17F, which is the functional capacity form completed by Dr. _______. In it he says that this claimant would have to take unscheduled 15 minute breaks every 60 to 90 minutes. In my view, this is not consistent with competitive employment.
Judge: Thank you. Mr. Ginsberg, do you have any questions?
Ginsberg (knowing that this is a good time to keep my mouth shut): No, your Honor.
This case is only an example – not every case involves cooperative doctors and extensive records, but I hope you get the idea – medical records alone are not enough – they have to be translated into a language understood by Social Security and the case has to be prepared for the Judge. If we make the Judge’s life easier, your results will be better.