Summary: 44 year old female alleges disability arising from pain and need to urinate several times per hour, arising from severe and chronic interstitial cystitis
Client profile: 44 year old female
Education: masters degree in education
Past work: 17 years as an elementary school teacher occasional supplementary part time work as a college adjunct professor and private tutor
Claim background: my client filed for benefits in December 2010, alleging that she became disabled in September, 2008, when she was terminated from her long time teaching job for excessive absenteeism. A hearing was held in July, 2012 before a judge new to the local hearing office.
Medical background: my client has been dealing with interstitial cystitis since she was a teenager. She was formally diagnosed by her urologist in the 1990’s and has undergone over 15 procedures, including surgery to insert a spinal stimulator. She has also treated with two pain medicine physicians who have tried without success to control her pain with narcotic pain medication. She has long term relationships with her internist and her urologist, both of whom note the severity of her condition and the 3 to 4x per hour frequency of her need to urinate. There is also evidence of depression and one of her physicians suggests a fibromyalgia overlay as well.
Factors in our favor:
- my client has a long and consistent work history
- my client has a consistent and extensive medical treatment record
- my client has been compliant with her physicians’ treatment suggestions
- the medical record repeatedly notes functional limitations in the form of extreme pain, the need for frequent unscheduled breaks to urinate, and inability to sleep restfully
Factors not in our favor:
- my client is relatively young for Social Security disability
- interstitial cystitis is a somewhat rare condition for a Social Security disability claimant and judges may seen milder cases more regularly
- I have not previously appeared before the judge assigned to our case
My strategy: I felt that the medical record really spoke for itself. My client comes across as sincere and credible and since all of the medical evidence in the file is consistent with her complaints of significant impairment, my main goal for the hearing was to have my client briefly explain the details of her symptoms.
Hearing Report: my client and I entered the hearing room and were greeted by the judge, who came across as very professional and polite. I noted that during the 30 minutes my client I were waiting she used the restroom 3 times.
The judge introduced himself the vocational witness, the made some preliminary statements and accepted the record into evidence. He asked my client a few introductory questions then he asked me for a brief opening statement about my theory of the case and I gave an opening explaining our argument that my client’s functional capacity for work has been so reduced by her IC that she would not be a reliable employee.
The judge asked me to examine my client and I began with her work history. I had her testify about her long tenure as a teacher and about the awards she had won and her dedication to her job. She also mentioned that she had one and sometimes two part time teaching jobs.
We then turned to her condition and I asked her about her IC and how it affected her. She discussed her need to use the restroom as often as 4 times per hour, and she testified about regular episodes of pain throughout an average week. She explained that she had very irregular sleep patterns because of her need to constant urinate and she explained that her cognitive capacity and memory had suffered because of this.
We then talked about the various types of treatment she had received from her doctor. None of these treatments, including several painful and invasive procedures has provided any significant relief and even strong pain medication has not allowed her to return to a productive existence.
After I finished my direct examination, the judge asked a few follow-up questions then turned to the vocational witness. He first asked the VE to describe my client’s past work as a teacher, which he described as light and skilled, and that this job would produce transferrable skills.
Next the judge asked the following hypothetical questions about a hypothetical person who is the same age as the claimant with the same work background and education:
1. Assume this person is limited to light work. She can only climb stairs occasionally and she cannot perform work that requires the use of ladders, ropes or scaffolds. Could such a person perform the claimant’s past work?
2. Are there other jobs such a person could do?
A. Yes – such a person could perform the duties of an administrative clerk or a customer service representative.
3. Assume the person from hypothetical #1, and add the following limitations
due to interstitial cystitis she would need to take a work break of approximately 7 minutes three to four times per hour
she would need to lie down and not perform productive work for up to one hour per day.
A. Based on those limitations such a person could not perform the claimant’s past work or any other work. The interruptions from work would be too excessive for any type of competitive work.
Conclusions: the judge should approve this case. The medical evidence is overwhelming and supportive and the judge did not ask any hypothetical question that described a less severe version of interstitial cystitis.