Case Study 8

Claimant: a 50 year old female

Occupation: The client worked as a nurse for over fifteen years until February 2003, when she became physically incapable of performing her duties. She got another job in April 2003, reviewing patient records for an insurance company. This job lasted until November 2003. My client tried to work at a booth retail store in 2005 and 2006, but she could not work more than ten hours each week. She claimed an onset as of November 2003, when she stopped working full-time.

Education: The client has both a college degree and a diploma from a nursing school.

Hearing Information: the claimant filed for benefits in June 2006, alleging disability as of November 1, 2003. In December 2008, the hearing was held as a video teleconference in front of a judge from the National Hearing Center in Falls Church, Virginia.

Background: The client was typical for a fibromyalgia case in that she was a well-educated middle-aged woman who had a type A personality and a long medical history.

This client had been a nurse for many years. She worked in a doctor’s office, in the ER, did hospital work, clerical nurse work, etc. At the end of 2002, the client began to experience a multitude of problems including fatigue, shortness of breath, and digestive problems – alternating constipation and diarrhea.

The client went to a gastroenterologist for treatment, but the doctor was unable to find the cause of the problem. Then, she went to a cardiologist concerning her fatigue and shortness of breath. The cardiologist did find that she had hypertension and mild congenital heart problem. Additionally, the doctor suggested the possibility of fibromyalgia.

In 2005, the claimant had been unemployed for nearly two years. She was going to an orthopedist because of neck and back pain. Additionally, an internist was treating her for fatigue, migraines, and hypertension. Because of numbness and pain and tingling in the claimant’s hands and arms, she had cervical spine fusion surgery in October 2006. The client lamented that as soon as one problem was fixed, some other ailment became worse.

Social Security had a psychologist exam the claimant in 2006. The doctor discovered that the claimant had concentration problems and was incapable of following a work schedule or completing tasks necessary in a simple job.

The internist also filled out a functional capacity form, recognizing different reliability limitations of the client.

Analysis: The judge reviewing the case was located at the National Hearing Center in Falls Church, Virginia and carried out the hearing over video. The judge was well prepared and deliberate, as I have observed from several previous hearings.

In my opinion, this was a very strong case. In addition to on-going treatment, the claimant had extensive support from her doctors administering treatment. The claimant had observable medical problems, such as neck problems (which needed surgery), hypertension, and a mild heart problem. Although none of these problems alone was reason for disability, together and combined with a fibromyalgia diagnosis, the claimant had a compelling case.

Description of Hearing: After greeting me, the claimant, and vocational witness, the judge discussed the evidence contained in the file. One question that the judge posed was why the claimant received $3,500, which was recorded on her 2004 tax forms, after she had apparently stopped working. This was a usual question because the judge would want to know why the claimant earned money after the claimed onset date. The $3,500 turned out to be vacation time from one of the nursing jobs the claimant had held.

The judge then swore in the witnesses, and the claimant described her condition. A good witness, the claimant methodically described what parts of her body caused her pain. I only asked a few questions because the claimant did such a good job with her own testimony.

In answer to a hypothetical question posed by the judge, the vocational witness testified to the claimant’s limited abilities and said there were no jobs that the claimant was capable of performing.

The judge informed the claimant that he was aware of her extensive work history and a long-term, consistent medical history. He said that he would approve the case.

Summary: I think that the following factors greatly helped the claimant’s case: a solid, long-germ work history, regular doctor visits, support from the doctors treating her, competent judge who carefully examined the records and believed a fibromyalgia diagnosis.