Depression and Anxiety
Social Security Disability Case Study #3
Claimant: 32 year old female
Occupation: Claimant had worked as a nurse’s assistant at an assisted living facility, a photo lab technician and a customer service rep for a retail store
Education: high school graduate
Hearing info: Claimant applied for benefits in April, 2006, alleging an onset date in February, 2004. The hearing was held in October, 2008 at the Atlanta downtown ODAR.
Background: My client’s disability arises from her very traumatic childhood in which she suffered sexual, emotional and physical abuse from her father and other male relatives. As an adult, my client has been experiencing flashbacks, anxiety attacks and depression and her condition worsened significantly after the birth of her two children. She experiences significant separation anxiety whenever her children are out of her sight and seeing her young children brings back memories of her own childhood.
Analysis: The judge in our case was a regular judge at the downtown Atlanta ODAR. This judge is very polite and professional but I have found her to be somewhat conservative, especially in cases involving younger claimants. On the other hand, we had several very supportive forms from the treating psychiatrist and assuming that the judge found agreed that the claimant was being truthful, I felt that we had a strong case.
In speaking to my client prior to the hearing, I found her to be somewhat childlike in presentation. She came across as being somewhat passive and dependent on her husband for most decisions. She clearly perceived herself to be a disabled person and I was a little concerned that our judge might sense an “attitude of entitlement” that could hurt this case.
Hearing Report: Prior to the hearing I explained to my client that I might need to call her husband to testify as claimants with mental health issues sometimes have a hard time objectively describing their condition. My client became very tearful and she made it clear that she would be very uncomfortable without her husband nearby for moral support. I explained to the judge’s hearing assistant that I did need the husband available to testify but that my client wanted him here. The judge agreed to make an exception to her normal rule sequestering witnesses during claimant testimony.
The judge opened the hearing by accepting into evidence all of the medical records in the file. The judge asked me to present an opening statement and I summarized the source of my client’s depression and anxiety and I noted a variety of work activity limitations arising from her condition.
The judge then asked the claimant a number of questions about her mental health condition and some of the issues she was facing. The claimant frequently became tearful in describing the issues she had when trying to work as well as her social isolation and problems interacting with others.
The judge then turned the questioning over to me. At that point, nothing had been discussed about the claimant’s history of being abused, but I was concerned that the claimant would not be able to keep herself together when I brought it up. Therefore, I decided to focus initially on the claimant’s behavior during her daily activities and her anxiety when she was separated from her husband and children. I elicited testimony about crying spells, lack of energy and sleep problems.
As my questioning drew to a close, I told my client that I needed to put into the record something about her childhood abuse. I stated that I was not going to ask for details but that I needed to know if, in fact, she had been a victim of sexual, emotional and physical abuse as a child. I also asked her if she experienced any flashbacks from these experiences and if this history had affected her in any way. She did become tearful but I did need to make sure that this information was on the record.
After taking testimony from the claimant, I put her husband on the stand and asked him to describe what he had observed about his wife’s behavior and emotional state. He described a person who was very anxious emotionally unstable.
The judge then turned to the vocational witness to ask him hypothetical questions. The judge began her questioning by setting out some definitions:
“fair” means limited but not precluded
“poor” means seriously limited but not precluded
The judge then set out the following hypothetical, describing a person of the same education, work background and education as the claimant with the following limitations:
Fair ability to:
- remember work procedures
- understand and carry out simple work instructions
- maintain attention and concentration for greater than 2 hours
- perform within a work schedule
- maintain attendance at a job
- sustain a routine without interference from psychological symptoms
- ask simple questions or request assistance from a co-worker or supervisor
- interact appropriately with the general public, supervisors and co-workers
- adjust to changes in a work setting
- handle the normal stress of a workday
- exercise reasonable judgment
The vocational witness testified that a person with these limitations would not be able to perform past work but could do a variety of simple, unskilled jobs such as working as a cleaner, housekeeper, or garment bagger.
Next, the judge asked the vocational witness if his answer would be different if the hypothetical person’s abilities in these categories was “poor.” The vocational witness testified that such a person could not perform any job.
The judge then turned the questioning over to me.
I asked the vocational witness to return to hypothetical #1, but to assume that any one of the factors set out by the judge was “poor” instead of “fair.” The VE responded that it depends on which ones were “poor.” I then identified:
- maintain attendance – answer: no jobs
- handle normal stress of a workday – answer: no jobs
- perform within a work schedule – answer: no jobs
- sustain a routine without interference – answer: no jobs
I then advised the judge that I had no more questions. (In retrospect, I would not have asked my first question about “any poors;” instead I would have gone directly into identifying the factors most relevant to reliability).
The judge then announced that she would be finding in favor of my client and would be issuing a bench decision (an expedited decision that would not recite all of the facts).
I think that the horrifying history associated with my client’s case (as set out in detail in the record) and the very supportive forms from treating doctors made this case a good one. Our judge made a very thorough inquiry which is certainly appropriate, and protective against a sua sponte reversal by the Appeals Council. I do know other judges who would have approved this case on the record or with much less testimony and stress for my client.