Claimant: 37 year old female
Past work: veterinary technician, bank teller, retail sales clerk, receptionist, fast food cashier
Education: college graduate
Hearing info: the claimant applied for benefits in the winter of 2006 alleging an onset date in the summer of 2006. The case was called for a hearing before an administrative law judge in April, 2009. The judge in our case is a warm, thoughtful person who always prepares himself thoroughly for disability hearings.
Hearing strategy: in reviewing the file, I felt that this case was a winner. Alagille Syndrome is a genetic disorder that causes a paucity (reduced number) of bile ducts in the liver. Alagille patients also have smaller than normal artery near the heart, resulting in high blood pressure, spinal bone malformation and kidney issues.
In my client’s case, she had apparently been diagnosed with Alagille Syndrome as an infant because she did undergo surgery on her liver to improve bile flow, but she contends that no one ever told her about this diagnosis or the genetic implications until 2006 when she sought medical treatment because of extreme fatigue and pain in her kidney region.
The medical records indicate that my client’s kidney function is greatly reduced to the point where she has a borderline need for dialysis, and as of 2006 her treating physicians have suggested that she may need a kidney and liver transplant.
My client has not had insurance since 2007 and has not been able to afford specialized medical treatment, but she continues to experience a great deal of fatigue and low energy such that she need to sleep 3 to 4 hours during the day in addition to her rest at night.
Hearing Report: the judge opened the hearing by introducing himself, the hearing reporter and the vocational witness. He explained that the hearing would be conducted informally and that both he and I (Jonathan) would be asking questions.
The judge then asked me to make an opening statement. I briefly explained that this case involved an individual with Alagille Syndrome, which was a genetic disorder that resulted in extreme fatigue. I also advised the judge that the claimant had been attempting to perform volunteer work, but was having difficulty doing that even part time. As I spoke the judge was nodding his head in agreement and it was apparent to me that he had read the file and understood the issues.
The judge then asked a few preliminary questions about where the claimant lived (house or apartment), confirmed the address and then asked her about the volunteer work she had been attempting. My client testified that she was trying to perform volunteer work 3 days a week and that over the course of the past month, there were only two days in which she was able to put in 6 hours – the rest of the time she had to go home after 3 hours because of fatigue.
The judge then asked me to take over the questioning and I asked my client to explain what Alagille Syndrome was and how it affected her. I elicited testimony about fatigue and her need to sleep three to four hours every day. I also prompted her to testify that she would likely need a liver and kidney transplant in the near future and that despite her desire to work she simply did not have the energy to do so.
The judge then followed up with a question about what the claimant did in an average day. My client testified that she got up at around 7, ate a small breakfast, then went back to bed until 9. She then spent her day watching TV or performing volunteer work until about 1. She then took a nap until 4, then spent time with her father before bathing and going back to sleep by 10pm.
Examination of Vocational Expert
The judge then turned to the vocational witness and asked him to classify the claimant’s past work. Several of the jobs were skilled or semi-skilled and ranged from sedentary to medium.
The judge then posed the following hypothetical question:
Assume that we have an individual limited to sedentary work with the following limitations:
- she can stand and walk for no more than 30 minutes at a time during a work day
- her standing and walking is limited to 2 hours or less during the course of the day
- she needs to take a 2 hours rest break away from the work site every day
The vocational witness testified that my client could not perform past work, and that she would not be able to perform any other work in the regional or national economy.
Favorable Bench Decision Announced
At that point the judge turned to my client and announced that he would be awarding benefits. He then read a “bench decision” setting out the reasons for his decision. In the bench decision the judge stated that the evidence indicated that the claimant had a genetic disorder that caused impairment to kidney, liver and heart function and that the claimant’s testimony was consistent with the symptomology of her condition and that it was credible.
Analysis: Because my client’s medical condition is a genetic disorder that results in compromise to the functioning of such essential organs as the liver, kidneys and heart, I think that the judge was predisposed to finding in favor of my client. She came across as a credible witness and followed my instructions in that she focused on the fatigue and low energy symptoms. This is really a case that should have been approved several years ago at the administrative level but most likely was not because the State Agency adjudicator who reviewed the file most likely has never heard of Alagille Syndrome. Fortunately we were assigned a good judge who did not waste much time in awarding benefits