Diabetes and Socal Security Disability - Case Study #1

Diabetes and Social Security Disability
- Case Study #1

Claimant: 52 year old female

Past work: certified nursing assistant (CNA) for approx. 6 years, and short stints as cashier, sewing machine operator and factory worker

Education: high school graduate + CNA certificate.  My client advised me, however, that she had very limited reading and writing skills and that she was “socially promoted” in school.  Her reading and writing skills are less than what a high school graduate would otherwise be assumed to possess.

Background: my client’s claim for disability arises from diabetes.  She was first diagnosed in December, 2005, although it appears that she had been suffering from diabetic complications for several years previously.  As far back as the late 1990’s she stopped driving because of vision problems and she quit both a factory job and a sewing job, each after only 2 months on the job, because of problems with numbness in her hands, difficulty sitting for more than 30 minutes or difficulty standing for more than 10 to 15 minutes.

My client stands 5’5” and weighs close to 320 lbs.  She reports that she experiences pain in both knees, in her back and in her hips.  She says that she has been unable to lose weight because she cannot exercise and because she cannot afford regular medical care that might assist her in a weight loss program.

My client applied for disability benefits in August, 2007 alleging an onset of her disability in September, 2004.  Her date last insured for Title II benefits is September 30, 2008.

 

The medical record in this case was not extensive.  My client has sought regular medical treatment but given her dire financial situation, this means that she visits a doctor only two to four times a year.  There were no x-rays in the file and her medical treatment consists mainly of medication management.

Hearing info and case strategy: the hearing in this case was scheduled for March, 2010.  We had requested a hearing in September, 2008 (18 months previously) and as of the hearing date, the case had been active for 31 months (2 years, six months).  During this time, my client has been living with her adult daughter.

In reviewing this file, I felt that my best argument was to argue that my client’s functional capacity for work had been so eroded by her diabetes that she would not be a reliable worker.  Consider the following activity limitations that my client and I discussed prior to the hearing:

  • diabetic retinopathy resulting in blurry vision - she sees black spots moving in her field of vision; she cannot see clearly enough to read more than headline size type
  • diabetic neuropathy - both big toes are numb, resulting in poor balance and pain when standing.  The tips of all fingers in both hands are numb - she would be unable to pick up a dime from a tabletop.  Both her hands and feet stay cold most of the time, regardless of the weather.  She experiences tingling and pinprick pain in her extremities
  • sitting limited to 15 minutes because of back, knee and hip pain
  • standing limited to 5 minutes because of back, knee and hip pain
  • frequent urination due to diabetes - difficulty with urine flow - resulting in a need to use the restroom hourly, but needing up to 15 minutes per visit
  • pain in both knees arising from arthritis, obesity and diabetes, especially if in one position for more than 10 to 15 minutes
  • pain in achilles tendon
  • fatigue arising from uncontrolled blood sugar levels - regularly over 300

My guess is that her diabetic condition would meet the listing at 9.08, but in the absence of regular medical care or written support from a treating physician, we are unable to prove that she meets the listing.

As a backup argument, I felt that we had a grid argument at 201.14 based on my client’s education and limited skills, although as it turned out, her CNA skills were transferrable from medium to light.

Course of Hearing:  the judge in our case is a good judge who is always prepared and who is reasonable.  This judge is less likely than other judges to base a decision on a claimant’s testimony in the absence of objective medical evidence, which, as noted, was not in abundance here.

The judge opened the hearing by greeting the claimant and proceeding through several introductory matters.  He asked me for an opening statement which I offered, essentially setting out a functional capacity argument based on the activity limitations noted above.  He then turned the questioning over to me.  I started by reviewing my client’s past work, with an emphasis on why she had left each job.

I then turned to the diabetes and elicited testimony about each of the activity and functional limitations applicable.  My client did a nice job and came across as a simple, but honest woman and credible in her statements. 

The judge asked a few followup questions about my client’s medical treatment. Many of his questions had to do with when my client’s medical problems became apparent - my client truthfully dated her complaints back to well before her alleged onset date.  The judge also asked about X-rays or MRI’s and was concerned that there were none in the file.

The judge then turned to the vocational expert to ask for a description of past relevant work.  The VE testified that there was only one past job of more than 3 months - the Certified Nursing Assistant, which he classified as medium and semi-skilled (with an SVP of 4).  He noted that a light job of a companion or sitter transferred from this job and that transferrable skills included patient management and monitoring vital signs.

The judge then posed a hypothetical question that he drew from the non-examining state agency physician, which described a light job with some postural and exertional limitations.  The VE testified that such a hypothetical person could not perform past work but that there were other light unskilled jobs that such a person could do, including a laundry sorter, a cashier and a ticket seller.

The judge then asked the VE if a hypothetical person could perform either the claimant’s past work or any job if the claimant’s testimony was deemed credible - the VE answered “no.”

I then asked the VE his opinion about available jobs if we took the state agency profile and added to it the visual and fine motor hand limitations described in testimony.  The VE responded that the finger manipulation issue would not preclude the light, unskilled work and that the visual limitations could eliminate all jobs if it was severe enough to preclude vision.

The judge then restated his concern about the absence of an x-ray.  He stated that while he believed the claimant, he felt that he needed proof of the claimed arthritis before he could fully accept her testimony. He asked me if I had any objections to sending the claimant out for a consultative examination that included x-rays.  Presumably when the consultative exam report comes back, the judge will be in a position to issue a favorable decision.

Summary: this is an example of a good case that has been delayed by the claimant’s marginally adequate medical treatment.  Another judge might have approved this case based on the claimant’s credible testimony, but many judges would have taken the same approach as this judge by insisting on some objective medical evidence.  Unfortunately, as free or low cost medical resources dry up, more and more deserving claimants will find themselves having to proceed with less than complete medical records.

 
 
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