Depression Associated With HIV Diagnosis and Stress
Social Security Disability Case Study #7
Claimant: 42 year old male
Occupation: instructor at private vocational training school, IT operations manager for real estate manager, customer service manager for startup business
Education: college degree and some post-grad work
Hearing info: Claimant applied for benefits in spring of 2009, alleging an onset date of spring, 2008 when he last worked. Hearing was held in spring of 2010 in Atlanta.
Background: my client was diagnosed with HIV approximately 15 year ago. He has been compliant with his medications. He contends that he has experienced anxiety and panic attacks since early childhood and that other family members suffer from anxiety and depression as well. He contends that the HIV medications make him nauseous and fatigued and that he has no control of his life. The medications sometimes result in explosive diarrhea and he rarely ventures far from home. He feels depressed that he has contracted a terminal disease that will eventually cause unpleasant symptoms and will eventually take his life. He asserts that he suffers panic attacks and severe depression, that he has isolated from friends and family and that there is no hope. My client has attempted suicide 4 times during the past five years, although he contends that the suicide attempts may reflect side effects from medications. My client also has chronic neck pain arising from cervical disc problems that have been exacerbated by several car accidents.
Analysis: In reviewing the file, it appeared to me that the HIV diagnosis would not support a finding of disability. Although my client has been HIV+ for close to 15 years and he is nearing the final stages of drug cocktail combinations currently available, his viral counts remain low and his main medical complications have been colds and infections that last longer than normal. He has not developed full blown AIDS.
Instead, the better argument here was based on depression, especially given the suicide attempts and chronic migraine headaches and neck pain. In my experience judges take suicide attempts very seriously, and they take multiple suicide attempts as compelling evidence of a significant depression problem.
My client did not have ongoing psychiatric or psychological care, but both his HIV doctor and his general physician noted his depression and migraines. Further there was a helpful consultative psychological evaluation that identified significant work limitations, including problems adhering to a work schedule and pace of work.
Hearing Report: the judge in our case uses different procedures than most other judges. His hearings often last no more than 5 minutes – my sense is that he reviews the record and if he finds the evidence compelling, he will not waste his time with testimony. This judge handles more cases than every other judge in the local hearing office and he expects attorneys to be prepared and to limit our comments to the issues at hand. I have found that a strong opening statement that clearly spells out a strong theory of disability and references to the most compelling evidence are appreciated by this judge, although in the end, he tends to focus primarily on the evidence as opposed to the claimant’s hearing testimony.
When the case was called to order, the judge asked me for my opening. I explained that this claimant had a longstanding HIV diagnosis but that HIV complications were not the basis of our claim. Instead, the severe depression, migraine headaches and multiple suicide attempts were the most compelling evidence of severe depression.
Not surprisingly the judge seemed interested in knowing more about the suicide attempts – he swore the claimant in and asked him for dates and to confirm my assertions. After taking this testimony the judge turned to me and said “I think I have heard enough – is there anything else you want to put on the record.” I said “no” and we closed the hearing.
Summary: Based on the judge’s body language and his statements, I expect that this will be a favorable decision. Because I know this judge and what he prefers, I was able to keep the hearing short and not waste his time with what he considers unnecessary testimony and procedure.