Depression, PTSD and Fibromyalgia
Social Security Disability Case Study #4
Claimant: 38 year old female
Occupation: Claimant had worked as a cashier at a convenience store, a circuit board assembler, a fabricating machine operator, and a crill operator at a carpet mill
Education: 11th grade education + GED
Hearing info: Claimant applied for benefits in April, 2006, alleging an onset date in December, 2002. The hearing was held in December, 2008 at the Rome, Georgia ODAR. This was a video hearing with a judge from the Chattanooga ODAR
Background: This case arises from my client’s very traumatic childhood in which she was molested by her biological father from the age of 9 to 14. In addition to mental health issues related to her childhood, my client has neck and back issues relating to a childhood diagnosis of scoliosis. In addition to the pain associated with her physical back problems, my client also complains of pain, fatigue and discomfort that has been identified as fibromyalgia. a
Analysis: The judge in our case is an experienced judge at the Chattanooga ODAR. I have appeared before him previously and I find him to be very professional, even-tempered and well prepared.
In speaking to my client prior to the hearing, I found her to have what is known as a “flat affect” in presentation. For example she spoke about a very traumatic event in her life – the unexpected appearance of her father – in very unemotional, matter of fact terms. In fact, seeing her father resulted in a breakdown of sorts, resulting in my client being admitted to an inpatient psychiatric hospital and triggering a long term PTSD episode.
My concern, therefore, was that my client would not present as a very effective witness, which, as it turned out, was an prescient observation.
I was convinced, however, that the medical record in our case was good. My client has been consistent about seeking medical and mental health treatment, although most of that treatment came after June of 2006, when her father moved back into town.
Hearing Report: 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 post traumatic stress disorder (PTSD), depression and anxiety as well as her low back and hip pain.
The judge then asked the claimant a number of questions about her mental health condition and some of the issues she was facing. As I feared, the claimant testified in a very flat, unemotional tone (by contrast I have represented other claimants who are recovering from childhood sexual abuse and they frequently become tearful and very emotional).
The judge then turned to me and stated that he was comfortable accepting the claimant’s allegations as of June, 2006, at the time she was admitted into an inpatient mental health facility, but that he did not see that the record supported disability from 2002 through June, 2006. He invited me to present evidence in the form of testimony.
I attempted to do this by asking the claimant questions about her mental health status prior to the in-patient hospitalization. My client did testify that she did not have much treatment during this 3 year period because of insurance issues. She also asserted that during this time period her physical problems (fibromyalgia and back pain) was a bigger problem than her depression, PTSD and anxiety. Since there was not much record for this period of time and because my client was not a compelling witness I did not feel that there was much point belaboring the 2002 – May,2006 time period.
I asked the judge for a brief recess to discuss a possible amendment to our onset date, and after discussing with my client the issues relating to the pre-2006 time period, we decided to amend our onset date to June, 2006. The judge strongly suggested that he could accept that date as an appropriate onset for a fully favorable decision.
Summary: this case illustrates the importance of an on-going and consistent medical record. It is certainly possible that my client was not able to work from 2002 through May, 2006 due to PTSD issues and/or the fibromyalgia. Without a treatment record, however, a disability argument for that time period was not going to go anywhere.
This case also demonstrates why it is so difficult to win a case based on claimant testimony only. Administrative Law Judges generally do not decide cases based on a hunch. They want to see evidence to back up their rulings. In this case, the judge locked in on an onset date because there was medical evidence consistent with that date.