Earlier this week I appeared with a client at a hearing who had a very extensive and complicated medical history. Her complaints included pain and discomfort in her lower extremities – from the hips to the feet, chest pain, breathing problems and low back pain.
In reviewing her record, I noted ten (10) diagnoses, including:
- unspecified autoimmune disease
- unspecified neurological disorder
- bulging disc (without impact on spinal cord)
- mild congestive heart failure
- shortness of breath of unspecified cause
- post traumatic stress
My client did not want to come in to the office for her pre-hearing conference so we spoke on the phone. When I spoke to her, it was clear to me that she saw herself as being disabled – she was able to talk at length about all of her medical issues. My client was living with an adult child and relied totally on support from her children and relatives. Her sense of self and identity was tied to her medical issues and she had given up any sense of financial or personal independence.
Usually when someone is this invested in her medical problems, it is very difficult to win because judges usually don’t find such people credible. During the pre-hearing conversation I tried to explain to my client that she needed to avoid coming to court with an attitude of entitlement, but after a few minutes on the phone, it was clear to me that my client did not understand what I was getting at or she was so invested in being disabled that she was unable to back off this self-image.
Usually when I have a client like this I prepare my case to minimize the damage that my client would do to her case by speaking too much, while at the same time giving my client her day in court by putting all of the medical issues on the record for the judge.
This case was a little different for two reasons. First, my client had a very skilled work background involving positions of significant financial and managerial responsibility. Secondly, there was a consultative psychological evaluation in the file from my client’s one-time visit with a Social Security evaluating psychologist who normally issues very conservative reports. This report, however, described significant psychological issues and included language to suggest that my client would have not be able to sustain competitive work. Interestingly the evaluating psychologist stated that my client had undergone severe emotional and physical trauma but he specifically declined to describe these traumas although the suggestion was that they were quite bad.
What I had here, therefore, was a client who had created for herself an aura of disability by seeking medical attention for a variety of medical issues that could not be documented by objective testing or showed up as mild impairments in objective testing. The mental health record contained an unusually supportive consultative exam that was short on details, and there was minimal on-going treatment other than psychotropic medications.
I made the decision to go with the mental health angle even though my client most likely was not introspective enough to recognize that depression and PTSD were the issues that left her unable to work. In my opening statement I argued to the judge that the multiple physical complaints were likely the physical manifestations of underlying depression and PTSD and I referred specifically to the conclusions set out in the consultative exam as well as the inconsistency between my client’s past work and her current mental state.
I have not yet received the decision in this case but I think I made the right choice. My client cried throughout the hearing and she came across as credible when describing her fear of leaving the house and poor concentration. She also testified about being hit and kicked in the head by her now deceased husband. I did ask her about the other physical issues but I kept that testimony at a minimum to keep the focus on the mental health issues.
The hypothetical question asked by the judge included a limitation whereby the hypothetical person would miss up to one-third of the workday due to poor concentration and inability to behave in an emotionally stable manner. This evaluation of capacity, if used by the judge, would result in a favorable decision.
Most of the time, disability claimants who are thoroughly invested in their alleged disabilities will find their cases denied because these claimants are simply not credible. Occasionally, however, a truly disabling condition lurks below the surface waiting to be highlighted.