Summary: 47 year old female with long work history asserting disability based on gastroparesis and depression
Client profile: 47 year old female with high school education. My client has a long, continuous work history as school bus driver.
Claim background: my client applied for benefits in December, 2012. Her hearing was held in an Atlanta area hearing office in January, 2015.
Factors in our favor:
- my client has a long, consistent work history going back well over 15 years
- my client has an extensive treatment record that includes many painful tests and some minor surgical procedures
- more than one of my client’s treating physicians support her claim for disability
Factors not in our favor:
- my client complains of symptoms associated with gastroparesis (paralysis of muscles in the gut necessary to move food through the intestines) but objective testing does not show significant weakness or dysfunction of those muscles
- the judge in our case has a slightly below average approval rate of cases
My strategy: None of my client’s treating doctors suggested that my client was faking her symptoms so I felt that my client was sincere and truthful in describing her discomfort and pain. My sense was that there was a significant mental health component associated with this case and, to her credit, my client did seek psychiatric care. The treating psychiatrist did diagnose a significant level of depression and provided us with a functional capacity form that contained a number of significant work limitations. My plan was to have my client describe her symptoms in detail for the judge then argue that the impairments were real, whether caused by an organic gastrointestinal problem or a mental health problem.
Hearing Report: my client and I entered the hearing room and were greeted by the judge. After accepting the medical record into evidence the judge asked me for a brief opening, during which I set out my assertions that my client’s symptoms were real, whether caused by actual issues with her abdominal muscles or caused in whole or in part by her depression.
The judge then turned the questioning over to me. I began by asking my client about her past work – she testified that she had been a school bus driver for over 20 years. I had noted that she left her last bus driving job at the beginning of the school year and my client acknowledged that this was the case because her abdominal pain symptoms did not allow her to complete even a month of the new school year.
My client went on to testify about regular bouts of severe abdominal pain, constant constipation, vomiting and bloating. She explained that she sought treatment with various doctors but that no one had been able to offer her relief.
She explained that her current gastroenterologist had performed surgery to install an electrical stimulator in her colon to trigger muscle contractions but that this device had not helped much.
I then turned to the depression issue. My client testified that her depression was a byproduct of her physical problems – the constant pain, nausea and bloating. She testified to crying spells, angry outbursts and even occasional episodes of self-mutilation (pulling out her hair).
I completed my direct examination by taking my client through a typical day, eliciting testimony that even with a bland diet she could not perform any activity for more than 30 minutes without severe pain or extensive time in the bathroom.
The judge asked a few followup questions then turned to the vocational expert.
The vocational expert testified that my client’s past work as a bus driver was semi-skilled, medium exertional level work. The judge then posed the following hypothetical question:
1. Assume a hypothetical person who is the same age as our claimant, with the same level of education and work background. Assume further:
- she is limited to medium level work
- she can frequently climb stairs
- she can frequently kneel, stoop and crawl
- she should avoid unprotected heights or work around hazardous equipment
- she needs to lie down or recline between 4 and 5 hours per day because of abdominal pain and nausea
- she experiences moderate to moderately severe pain on a chronic basis
Could such a person perform the claimant’s past work or any other competitive work?
A: No. Not with these limitations.
The judge then asked me if I had any questions for the vocational witness – I did not. The judge then closed the hearing.
Conclusions: the judge is going to approve this case. It appears that he accepts my argument that whether my client’s abdominal pain is caused by dysfunction of abdominal muscles or is a by-product of depression, her functioning is significantly impaired.