This feature appears from time to time as a means of illustrating the challenges that many applicants for social security disability benefits experience, in their efforts to be approved. These challenges include the many levels of decision-making for a social security disability claim (Initial application, Reconsideration, Hearing, Appeals Council, Federal Court), the specific issues raised by alcohol and drugs, the need to demonstrate that you cannot do past work or sometimes, any work at all, and the like. Cases are derived from actual clients I have represented but their names, details and key facts are changed to protect privacy.
“I never know when I am going to have an attack.”
“Suddenly I am in such horrible pain. Like a 10 out of 10. An attack can last for a whole week sometimes. And the severe pain? It’s been continuous for two days straight before! I miss so much work because of the kidney stones. The irritable bowel syndrome is also painful. I get pain all up and down my side. I end up running to the bathroom three or four times a day. Combine that with the kidney stones – I feel like I’m always missing work.”
Mary suffered from Interstitial Cystitis, IBS and kidney stones. For the last few years Mary’s kidney stones have primarily been caused by a condition called medullary sponge kidney, a birth defect that causes cysts to form in the kidney. Because of this malformation, individuals with this condition often suffer from kidney stones.
“When I’m having an attack I also have to take narcotic pain medication – it’s the only thing that makes the pain less severe. They make me so tired and dizzy. I can hardly think straight. Try doing anything when you are taking pain killers like that!”
The Lawyer’s View
Mary’s case posed some difficult challenges. While the pain caused by kidney stones is debilitating when she has them, it’s not a regular occurrence. Will the judge find that her kidney stones occur frequently enough that to prevent her from being able to work?
Irritable Bowel Syndrome is a common condition that many people experience. More often than not, the symptoms are not disabling as Mary’s are. Will the evidence be strong enough to demonstrate the severity of her symptoms?
What happened?
Prior to the hearing, we scheduled phone calls with Mary’s physicians and submitted letters where they testified to the severity of Mary’s conditions. Unfortunately, Mary’s judge was skeptical and actually stated at the hearing that he knew many people with these conditions who were not disabled as result of them. The Judge found her not disabled. But we knew that Mary did meet the criteria for disability.
We appealed her case both to the Appeals Council and, when we were unsuccessful there (as more than 90% of appeals to the Appeals Council are), we appealed to the United States District Court. The District Court Judge found that the Social Security judge had ignored key evidence from Mary’s treating physicians as to the severity of her condition. The federal judge determined that Mary would have been approved for benefits if the Social Security judge had properly addressed the opinion of her doctors, and he ordered immediate payment of benefits!