Multiple Sclerosis and Social Security
Disability – Case Study #4
Claimant: 52 year old female
Occupation: medical office manager, secretary, legal secretary
Education: high school graduate with 1 year of college but no degree
Hearing info: my client applied for benefits in early 2009, alleging an onset date in the summer of 2006. I noted that she had last worked in late 2003 – when I asked her about this, she explained that she had stopped work because her employer had laid her off and that she was planning to look for another job, but before she could do this, she lost a close family member unexpectedly. She chose the summer 2006 onset date because that corresponded with an MRI report showing a progression of her disease.
Background: my client was first diagnosed with multiple sclerosis in 1988. MS is a disease that can result in periods of active disease and periods of remission. My client explained that when the disease was active, she experiences symptoms including numbness in her hands and feet, double vision, balance issues, fatigue, incontinence (she cannot feel when her bladder is full), headaches and slurred speech. During her remissions, the symptoms subside but her baseline functioning decreases. In 2004, my client lost a close family member, which was a severe emotional trauma. She states that this trauma brought on an active phase of her disease, which was consistent with an MRI in June, 2006 that showed new lesions on her brain.
Analysis: In reviewing this file, I thought that we had a good case. My client had a long and productive work history and her onset date was tied to a specific objective medical record (an MRI report showing new lesions on her brain). I also felt that the symptoms she was reporting would likely cause interference with her capacity to function. My client and I met the week before the hearing and we identified the following specific limitations that we wanted to bring out in testimony:
need to use the restroom every 45 minutes
blurred vision
need to use a cane for balance
fatigue, especially in hot weather
limited exertional capacity – no more than 2 hours of even sedentary activity at a time before needing to rest
problems with fine motor movement (i.e. difficulty with buttons)
lifiting capacity of 5 pounds occasionally
Hearing Report: the judge in this case works at the video hearing office in Falls Church, Virginia. I have appeared before him several times and I have always found him reasonable and pleasant.
The judge opened the hearing by introducing the vocational witness and hearing assistant and reviewing a few preliminary matters. He then asked me to offer an opening statement and then move right into testimony. I began by identifying my client’s impairment – her multiple sclerosis and I stated that I expected my client to testify about the specific functional limitations noted above.
I then moved into my direct examination of my client. I asked her about her past work and I elicited testimony to explain why there was a 2 1/2 year gap between her last work and her alleged onset date. I then asked her to explain the multiple sclerosis disease process and how the disease progresses. We then moved into the symptoms and she testified as we had prepared.
After my direct examination the judge asked my client the following:
Q: how long can you walk or stand at a time
A: 30 to 40 minutes, then I need to rest
Q: if you had a job that required standing and walking and you could rest after 30 to 40 minutes, how much total standing and walking could you do during an 8 hour day?
A: no more than 2 hours total
Q: how long can you sit at any one time?
A: about 45 minutes
Q: how much total sitting can you do during an 8 hour day?
A: no more than 4 hours total
Q: how much can you lift?
A: about 5 lbs.
Q: how much can you lift frequently – if you had to do it regularly throughout the day?
A: no more than 2 1/2 lbs.
Q: did you say earlier that you had trouble getting dressed?
A: I said that I have trouble with buttons and zippers so I try to avoid clothes that have buttons and zippers
The judge then turned to the Vocational Expert and asked the following:
Q: Assume we have an individual who is “closely approaching advanced age” with a high school education and the same work background as the claimant. She has the capacity to perform “light” work with the following limitations:
must have a sit/stand option
any standing and walking beyond 10 to 12 feet would necessitate the use of a cane
she can walk or stand for 2 hours total, but not consecutively
she can sit for 6 hours total but not consecutively
she can use her hands occasionally for fine or gross movement
she needs to be able to take bathroom breaks at will
she cannot climb ladders, ropes, scaffolds
she cannot climb stairs
she can only occasionally stoop, bend, crouch or crawl
Based on these limitations could this hypothetical person return to past work?
A: No
Q: Could she perform other work in the regional or national economy?
A: No, because there are no light jobs that allow for both a sit/stand option and only occasional use of the hands. Further, the need to take unscheduled bathroom breaks every 45 minutes would not be consistent with competitive work.
At that point the judge turned to my client and announced that he would be issuing a favorable “bench decision.”
Summary: I believe that the factors that worked in my client’s favor included:
the objective nature of her medical problem
her credibility and precision in describing her symptoms
her long and consistent work history