Summary: 45 year old male with neurocardiogenic syncope
Client profile: 45 year old male
Education: high school graduate with some college but no degree
Past work: long and consistent work career as warehouse manager and worker
Claim background: my client filed for benefits in March, 2012. He requested a hearing in November, 2012. Our hearing was scheduled in June, 2014.
Medical background: my client’s main problem involves on-going episodes of passing out – often as frequently as 3 to 4 times per week. This issue began around 15 years ago, but only happened once or twice a year. In February, 2012, the frequency suddenly increased to several times a week. Without warning, my client will begin to feel lightheaded and he will suddenly lose consciousness. After waking up he will be exhausted and weak for several hours. My client has seen several doctors and there is no firm diagnosis or recommended treatment. His passing out episodes are not seizures (no abnormal brain wave activity) and they do involve a sudden slowing of his heart rate.
Factors in our favor:
- my client’s long and consistent work history
- medical reports document an on-going problem with passing out, although there is no firm diagnosis.
- My client has been compliant with treatment although treatment has not been effective
Factors not in our favor:
- the judge in our case is slightly less likely than average to approve claims
- because of financial considerations my client has not had extensive testing and currently treats with a low cost clinic
there is no firm diagnosis
My strategy: I felt that this was a good case in that the medical record documented an on-going problem with sudden passing out episodes. I also felt that my client would be deemed credible because of his long work history.
Hearing Report: prior to the hearing I submitted a pre-hearing brief detailing my argument for disability. When we entered the hearing room the judge greeted us and began the hearing. After going through preliminary matters he turned to me and said “Mr. Ginsberg, please present your case.”
I started by asking my client about his most recent job, then proceeded backwards to have him describe prior jobs. I did this to highlight for the judge my client’s long and consistent work history. My client also testified that in every past work experience he started with one set of responsibilities and was quickly promoted to assume more duties. My experience has been that a solid work history usually leads to a finding of credibility by Social Security judges and we had a very strong work history in this case.
Next, I turned to the medical issues. My client and I had spoken extensively the week prior to the hearing where I had emphasized to him the importance of being very specific when discussing his passing out episodes. My client did a nice job explaining that 3 to 4 times per week he would simply pass out without warning and that he would wake up 20 minutes later feeling like he was “in a daze.”
We established that medications had not helped the passing out episode frequency although it did help him recover more quickly.
I asked my client about his medical treatment and he spoke about his financial problems and the limitations he had on getting brain scans or other diagnostic testing. I had him talk about the frustration of not being able to support his family and his desire to return to work.
After finishing my questions the judge had a few follow up questions that focused mainly on establishing that there was no firm diagnosis.
The judge then turned to the vocational witness, who described my client’s past work as including light and medium jobs at the semi-skilled and skilled levels.
The judge then asked the following hypothetical question:
Assume an individual limited to the medium exertional level. He would not be able to perform work involving the use of ladders, ropes or scaffolds. He should avoid hazardous machinery and unprotected heights. Two to four times per week, at unpredictable interludes, this hypothetical person would experience episodes of syncope (passing out) followed by a recovery period of 1 to 2 hours. This problem exists on a chronic basis.
Based on these limitations could our hypothetical person return to the claimant’s past work or any other work?
The VE, as I expected, replied “no.”
The judge then turned to my client and announced that he would be approving this claim. He wished my client well then closed the hearing.
Conclusions: This case turned primarily on my client’s strong credibility. The medical evidence was sufficient but not overwhelming. The judge clearly recognized that my client would work if he could but that a person who passes out at random times would not be able to function effectively in a work environment.