Summary:  this case involved the PTSD claim by a 60 year old male whose PTSD arose not from combat but from an auto accident that happened near his base in the 1970′s, his subsequent hospitalization in a mental hospital, and from the psychological trauma of seeing a co-worker die in a work accident

Claimant:  60 year old male with college education

Past work:  fiber optic and and copper cable installation, computer technician, network systems engineer, information systems consultant

Hearing background:  my client applied for benefits in February, 2010 alleging an onset date in October, 2004.  His date last insured for Title II benefits is September 30, 2008, meaning that we will have to show that he became disabled on or before that date to qualify for SSDI.  The case was scheduled to be heard in November, 2011 by a judge who is very pleasant but who is slightly less likely to approve cases than the average.

Medical background:  my client’s medical record consists of extensive VA (Veterans Administration hospital) records.   On the positive side these records show on-going and regular treatment for PTSD – including individual and group therapy sessions 2 to 4 times per week.  These records also show that my client has periodically had a substance abuse problem – both with alcohol and with crack cocaine.   If the judge was to find that substance abuse was a material contributing factor to his disability, that would be grounds to deny payments.

The medical record also showed that my client had GERD (gastric distress) and DVT in his right leg – he believes from exposure to Agent Orange when he was maintaining airplanes.   Finally, my client contends that he continues to suffer with back pain from his 1970′s auto accident.

Hearing Strategy:  I felt that there were some positives and negatives about this case.  On the positive side:

• my client is 60 years old – any claimant over the age of 50 has a better chance at winning
• there is also an extensive medical record of treatment
• my client also had a long and extensive work history performing well paying work and there did not seem to be any financial incentive for him to stop working
• my client has been able to obtain a 100% service connected VA disability for PTSD

There were a few negatives as well:

• there was reference to substance abuse (my client asserts that he was “self medicating” during a time when he was temporarily unable to obtain VA medical services)
• the trauma that underlies the PTSD was not combat related
• VA records are difficult to read and VA doctors rarely offer much help in terms of activity limitations.  Further, the VA often tries to avoid findings of PTSD because of VA disability liability.  As such the finding of 100% service connected disability is fairly recent and after the date last insured
• I felt that my client comes across as a person who is somewhat “invested” in his disability.  He is very aware of his diagnosis and the symptoms and he is very quick to discuss his medical status.  This may be a function of his intelligence but as I listened to him, I could see how a judge might find him less than fully credible

I felt that my best strategy would be to focus on his long work history, the consistency of his medical treatment and his description of the PTSD symptoms he suffers with, including sleepless nights, social isolation and distrust of others.

Hearing Report:  the judge opened the hearing by introducing himself, the hearing reporter and the vocational witness.  After accepting the exhibit file into evidence, the judge turned the questioning over to me (I have appeared before this judge many times and this is his protocol with me).

I began by asking my client some simple background questions to make him comfortable then I turned to the PTSD issue.  I asked him about the source of the PTSD and how he was able to deal with it during a long work career.  He explained that as a younger man he was able to compartmentalize his stress, the flashbacks and the outbursts of anger, but he was less able to do so as he got older.   He testified that after he underwent surgery in the early 2000′s to remove a cancerous lung (which he attributes to Agent Orange exposure), his mental state deteriorated to the point where he could not function.

I asked him about the alcohol and drug use and he testified that he was imprisoned for 6 months in 2010 and that during his incarceration he was unable to get mental health treatment or medication and that he “self medicated” during that time.  He also testified that upon his release he immediately checked into a rehab center and has been clean ever since.

At several times during his testimony, my client became tearful, especially when discussing the “triggers” for his flashbacks (loud noises, flashing lights, low planes overhead).

The judge asked a few follow up questions about the alcohol and drug use then he turned to the vocational witness.  The judge first asked the VE to describe the claimant’s past work – all of which was skilled or semi-skilled.  The judge then posed the following hypothetical questions:

Question 1:

Assume an individual the same age as the claimant with the same education and work background.  Assume further:

Q: he is limited to medium work

A: he could preform all of his past work

Question II:

Assume a person who is limited to medium work and

• is limited to simple, 1 or 2 step tasks
• his contact with the public is infrequent and casual

A:  such a person could not perform the claimant’s past work because it is all skilled or semi-skilled

Q:  are there other jobs such a person could do?

A: such a person could perform the jobs of:

• hand assembler
• bundler
• sorter

Question III:

Q: Assume a person who could perform the skills that the claimant would have obtained during his work career (i.e. his transferable skills)

A: such a person could do some detail work at the semi-skilled level.  These skills would be highly marketable and would include reporting and recordkeeping, data entry, clerical tasks, reading blueprints.  Examples of light jobs, low end semi-skilled jobs such a person could do include:

• assembler of wire harnesses
• assembler of electrical components
• inspector of fabric

At this point the judge asked me if I had any questions.  I posed the following question:

Question IV:

Q: Assume an individual limited to light work.  As a result of emotional instability (crying spells, episodes of anger, poor concentration, flashbacks), such a person would not have the emotional stability to perform competitive work for up to 1/3 of a workday.  Could such a person perform the claimant’s past work or any other work?

A: No

Question V:

Q:  Assume an individual limited to light work.  Such a person could sit for up to 30 minutes at a time but no more than 3 hours total sitting during the course of a day.  Such a person could stand and walk for up to 10 minutes at a time but no more than 2 hours during the course of a day.  Could such a person perform the claimant’s past work or any other work?

A: No, because you are not describing full time work

Analysis:  I am not sure how this case will come out.  I was not encouraged by the judge’s hypothetical – normally judges will set out a hypothetical that incorporates the testimony and results in a finding of “no jobs.”   It was not clear to me that the judge made much of a connection with this claimant.  On the other hand, I elicited testimony that, if accepted as credible, would support a favorable decision.