Deep Vein Thrombosis Disability Case Study #1

Deep Vein Thrombosis (DVT) and
Social Security Disability Case Study #1

Claimant: 40 year old male

Occupation: my client had worked as an auto mechanic for the entirety of his working career

Education: 10th grade education + GED, and auto mechanic training

Hearing info: my client applied for benefits in August, 2006 alleging disability beginning in September, 2004 when he last worked.  My client denied any work attempts, although in our pre-hearing meeting he admitted that occasionally he would work on or supervise work on a car for a friend in exchange for a few dollars.  Notes from doctor’s visits after September, 2004 contained references to employment as an auto mechanic.  My client insisted that since his alleged onset date he has not performed any substantial work other than helping friends with their cars on rare occasion.  The hearing was held in Gainesville, Georgia in June, 2009.

Medical summary and case analysis: my client had a variety of medical problems including depression, panic disorder, non-insulin dependent diabetes, degenerative disc disease, and DVT.  The DVT arose in the summer of 2006 following a laminectomy in April of that year.

I chose to classify this case as a vascular disease case because it seemed to me that the April, 2006 back surgery and the subsequent DVT complication have truly left him unable to function physically.  Specifically, my client stated that he had to recline with his leg higher than his heart

 

every two hours at a minimum and that the DVT caused pain as well as a great deal of stress.  DVT patients live with the threat of a clot breaking loose and causing instant death so stress and anxiety are a part of almost every DVT related claim.

My client reports that he left work in 2004 because of mental health issues but I was wary about that onset date because there were no definitive work activity limitation statements from his psychological and psychiatric treatment providers and because there was a history of alcohol abuse (remote history) as well as  prescription medicine (hydrocodone and oxycontin) abuse between 2004 and 2006 prior to the back surgery.

I was concerned that the judge would find the mental health argument not entirely compelling and I was concerned about the impact of the substance abuse complication.

My strategy was to keep the September, 2004 onset date but be prepared to amend to 2005 or even 2006 if the judge indicated a concern with the mental health element of this case.

The hearing:  the judge called the case and went through the preliminary matters.  Prior to the hearing I had submitted a pre-hearing brief setting out my arguments for the mental health elements of this case, the back injury and surgery argument and the DVT complication. 

The judge turned the questioning over to me at the outset and I began by asking about the mental health issues dating back to my client’s teenage years.  We then turned to the back pain issues, the surgery, and the complications arising therefrom.  At each step of my direct examination I elicited testimony about my client’s activity limitations - e.g. standing and sitting limitations, memory issues, concentration problems, etc.

My client was very nervous throughout the hearing but especially so at the beginning.  I tried to loosen him up by asking open-ended questions, such as:

tell me what it is like to have panic disorder

if you were describing DVT and its complications to someone who knew nothing about this condition, what would you say?

tell me about your pain level - when is it at its worst? how frequently does it get to that level and what do you do to reduce the pain?

After taking testimony, the judge followed up with a few questions.  As expected he did ask about the medical reports containing references to jobs, and he asked my client about his substance abuse problems.  I had prepared my client for these questions and he answered them truthfully and clearly.

The judge then turned to the vocational witness and asked him to classify my client’s past work. As discussed above, all of his past work was as an auto mechanic.  The judge then posed the following hypothetical question:

Q: Assume that we have a hypothetical individual who can work at the medium (can stand and walk at least 6 hours in an 8 hour day, and can lift 25 lbs. frequently and 50 lbs. occasionally).  Assume further

  • no job involving climbing ladders, ropes and scaffolds
  • only occasional stooping, balancing, crouching, crawling
  • (limitations sourced from the non-examining psychologist hired by the State Agency to review this file) moderate limitations in
    • remembering and carrying out detailed job instructions
    • maintaining attention and concentration for extended periods
    • maintaining regular attendance
    • the ability to complete a normal workday without interference from psychological symptoms
    • ability to perform work at a workmanlike pace
    • ability to interact with general public
    • ability to respond appropriately to criticism from supervisors
    • ability to get along with co-workers
    • ability to adapt to changes in the work setting

A: After reading the notes from the State Agency psychologist consultant, I believe that the cumulative effect of these limitations would eliminate both past work (as an auto mechanic) as well as any other job.  The notes suggest that the claimant’s work capacity would be affected by all of these limitations at the same time, thereby unacceptably eroding his capacity for work.

The judge then asked if I had any questions.  Normally, when the vocational witness answers “no jobs” to a judge’s question I keep my mouth shut, but in this case I asked one question:

Q: Assume that our hypothetical person’s only limitation was a requirement that approximately every two hours he had a medical need to elevate his left leg above his heart level and keep it so elevated for 1 to 2 hours. 

A: Elevating to heart level is quite high.  He would basically be in a reclining position.  Based on that limitation, there are no jobs that he could perform.

Analysis: My fear that the judge would attempt to move the onset date forward in time were unfounded.  Based on the vocational witness’ testimony this case will be approved.

The testimony by the vocational witness was a little unusual.  Most VE’s do not subscribe to the “cumulative effect” idea.  The hypothetical that the judge posed basically came from the State Agency non-examining physician, and was used to deny this claim. 

I have some concerns that the Appeals Council may review this case because the vocational witness testimony was somewhat out of the mainstream.  This is why I asked my question - the elevated leg question is clearly documented in the record and, as the VE noted, vocationally significant.

 
 
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