Knee Pain Disability Case Study #3
Chronic Knee Pain Following Bi-Lateral Knee Replacements
Claimant: 59 year old female
Past work: registered nurse at local hospital for 34+ years
Education: high school graduate + 2 years college equivalent (nursing school)
Hearing Info: in January, 2005, my client was visiting a seriously ill relative at the hospital when she right knee unexpectedly buckled as she was exiting an elevator. At the time of her fall, she was 54 years old and somewhat overweight, carrying approximately 250 lbs. on a 5’2” frame. Other health problems at the time included non-insulin dependent diabetes and hypertension.
Following her fall, my client was unable to return to her job as a hospital based registered nurse. She sought treatment with an orthopedist who performed arthroscopic surgery on her right knee in March, 2005. The arthroscopic procedure did not result in a return to weight bearing status, so my client underwent right knee replacement surgery in October, 2005. By November, 2006, her left knee had deteriorated (perhaps as a result of the extra pressure on it following the right knee injury). Although both knees had been replaced, my client was not free of pain, nor was she able to walk without a cane.
The claimant filed for benefits in August, 2007, alleging an onset date of February 5, 2005. A hearing was held in Atlanta in January, 2009.
Hearing Strategy: I felt that this was a good case because my client had a long and consistent work history and because her complaints of pain arose from a clearly identifiable orthopedic injury. Working against us were barely readable photocopies of medical records and my client’s “matter of fact” tone when discussing her problems. Because of her medical background, it seemed to me that my client would revert into a very clinical, non-emotional state when discussing her injuries. Knee pain cases usually turn on a pain element and I was a little concerned that my client might not be able to express herself emotionally about her pain level.
My client did herself a real favor by insisting that her treating doctor fill out a functional capacity form. During our pre-hearing meeting, my client explained that her doctor wanted to help but that he was very busy and protected by his staff. Therefore, during our meeting, my client and I actually reviewed and filled out a functional capacity form that she was able to bring to her doctor. My client reports that the doctor was grateful to have a semi-completed form and my client was able to bring this form with her to the hearing. The form was very supportive and most definitely helped.
The judge opened the hearing by introducing himself and by asking a few preliminary questions. He then turned the questioning over to me. I began by asking my client about her work, eliciting testimony that she had been employed for over 30 years as a nurse. I had her explain what happened when her knee gave way and I took her through the three surgical procedures.
I then asked her to describe her pain using a “ten point” scale and to explain what it was like when her pain was severe.
I then turned to the other issues – diabetes complications of peripheral neuropathy in the hands at nighttime, hypertension that caused headaches and medication side effects that included diarrhea and constipation.
I then returned to a discussion of the knee pain and had my client testify that her activities of daily living were severely impaired and that her capacity to stand or sit for more than 15 to 20 minutes was also limited. My client concluded her testimony by telling the judge that she would much rather be working than sitting at home.
The judge then turned to the vocational witness and asked the VE to classify the claimant’s work:
– registered nurse – DOT: 076.364-010 – medium, with SVP 7 (skilled work). There are transferrable skills to medium and light nursing positions. There are no transferrable skills to sedentary work.
The judge then asked one detailed hypothetical question:
Assume an individual who is the same age as the claimant, with the same education and work background. Assume that:
she can lift 10 lbs frequently
she could stand up to 2 hours per day, but no more than 20 minutes standing at a time
she can sit for 4 out of 8 hours during the day, but no more than 30 minutes sitting at time
she could alternate sitting and standing at a job
she can push frequently with her upper extermity
no pushing with lower extremity
no ladders, ropes, scaffolds, stairs, kneeling, climbing, stooping, crouching or crawling
occasional balancing
occasional reaching
occasional fingering
no work around hazardous machinery
no work at unprotected heights
no work around vibrating services
no work involving the driving of a motor vehicle
she would likely be absent 3 or more times per month because of her condition
she experiences a moderate level of pain
Vocational Expert testimony:
The VE testified that this hypothetical person could not return to past work because nursing requires more standing and walking than this hypothetical permits
she could not perform any other job because of the job absences and because there are not a significant enough number of sedentary jobs that permit only occasional reaching
As the VE’s testimony was “no jobs,” I had no questions.
Summary: this case will be decided favorably as the judge’s hypothetical question elicited a “no jobs” response from the VE. Some judges start with less restrictive hypotheticals and add limitations until the VE eliminates all jobs. This judge set out what he was thinking in only one hypothetical question.
I feel that the claimant’s long and consistent work history, the objective nature of her medical problem, her age, and the helpful functional capacity form we had from the treating doctor were the main factors in this favorable decision.