Summary: this case involved the PTSD claim by a 57 year old female whose PTSD arose following a work accident when she was thrown into a dirt berm following a blast at a work site. As a result of this injury, she suffered a concussion, torn shoulder muscles, lower back issues and PTSD. The PTSD takes the form of panic attacks, social isolation, memory and concentration problems.
Claimant: 57 year old female
Past work: site inspector for construction company, small parts assembler, quality control technician, sales attendant, cotton machine operator, warehouse worker
Hearing background: my client applied for benefits in July, 2009 alleging an onset date in October, 2005 (the date of the work accident). Because she waited almost 5 years to apply, this claim was a Title XVI SSI only. The case was scheduled for a hearing in November, 2011 before a judge new to the hearing office where we were appearing. Based on the ALJ disposition data online, I noted that this judge denied a higher percentage of cases than average.
Medical background: my client has a long and extensive medical record. The records related to her shoulder injury were generated by workers’ compensation physicians and the slant to these records was very much to minimize the seriousness of her injuries. One workers’ compensation orthopedist included in his notes a statement that “the patient’s dramatic visable and audible manifestations of pain response during physical exam suggest symptom magnification behavior” and he released her to light duty. Interestingly my client ended up undergoing surgery just a few months after this.
Obviously, I was not present for this exam but this type of report – which minimizes the severity of the injury and which questions the veracity of the patient’s reports of pain – is somewhat typical of workers’ compensation reports and can negatively impact a Social Security disability claim.
Similarly the physical consultative evaluation report did not reveal much in the way of activity limitations. I would note that there were 2 MRI reports in the file which showed only very mild back issues and my client does complain of excruciating back pain.
The mental health records were also not especially helpful. Until recently my client lived many miles from Atlanta and her treatment was sporadic. The more recent records reflect treatment but no definitive diagnosis.
Hearing Strategy: I felt that my client needed to testify effectively since the medical records were not especially helpful. This is a less desirable strategy than one where I have compelling medical records and even a moderately compelling witness, but I will work with what I have.
Hearing Report: the judge opened the hearing by introducing himself and the vocational witness. He accepted the evidence into the record and asked me for an opening statement. I explained that I was arguing that my client’s functional capacity for work had been significantly eroded by both physical issues (the left shoulder, lower back) and mental health issues (PTSD). The judge then turned the direct examination over to me.
I started by asking my client to describe her work injury in detail and then to talk about her medical treatment and the residual limitations that remain on her left upper extremity. Prior to the hearing I had discussed with her the importance of testifying with specificity regarding her capacity to sit, stand, walk and lift, but during the hearing her testimony did tend to wander. My client is intelligent and well spoken, but I got the sense that she was having a difficult time concentrating and focusing – hopefully the judge picked up on that as well.
After discussing her physical issues, I asked her to describe what it was like to have PTSD and to experience panic attacks. Here, too, she had a difficult time expressing herself clearly, which I think may be a manifestation of her medical issue.
My sense was that her testimony was helpful in showing a person who has difficulty concentrating and following a clear train of thought, but it was somewhat short on detail about specific impairments.
After listening to her testimony, the judge told the claimant that he had no questions as my direct exam had been thorough, and he turned to the vocational witness.
The vocational witness described the claimant’s past work – it was light or medium and mostly semi-skilled. The judge then asked three hypothetical questions:
Question I
Assume an individual with the claimant’s work and educational background. Assume that she is limited to medium work (lift 25 lbs. frequently, 50 lbs. occasionally, and can sit or stand for up to 6 hours in an 8 hour day). Could such a person perform the claimant’s past work?
A: Yes
Question II
Assume an individual with the claimant’s work and educational background. Assume this person is limited to light work. Could she perform her past work?
A: Yes. Except for her past job as a cotton machine operator, her past jobs could be performed at either the light or medium exertional level.
Question III
Assume an individual with the claimant’s work and educational background. Assume she is limited to light work with the following limitations:
- she cannot adhere to a work schedule because of limitations arising from PTSD
- she would likely have excessive absences from work
- she would need to nap for up to 1 hour
A: Such a person could not perform the claimant’s past work or any other work.
Analysis: Based on the judge’s hypothetical questions to the vocational witness, I am concerned about whether he will issue a favorable decision. Most judges give significant weight to the medical evidence in a file, and the evidence in this case was simply not overwhelming and the workers’ compensation medical evidence from the time of her accident tends to minimize her injuries. My sense is that my client has more limitations that what is suggested in the evidence but the combination of workers’ compensation quality treatment, non-compelling MRI reports and limited mental health records is not a good thing.