POTS | Disability | Social Security Disability Hearing

Summary: 43 year old female with past work as an executive for a real estate company alleges disability based on postural orthostatic tachycardia syndrome (POTS), Ehlors Danlos syndrome, back pain associated with multiple herniated discs, and frequent urination.

Client profile: my client is a 43 year old female with a 10th grade education and a GED. Her past work was as an executive for a company in the real estate industry.

Claim background: my client filed for disability benefits in August, 2016 and her hearing was held in the Atlanta area in August 2018.

Factors in our favor:

we had a very reasonable judge assigned to our case
we had 3 very supportive functional capacity evaluation forms from treating doctors in the file
the medical record in the file was very comprehensive
my client has a very clear understanding about her medical condition and can explain it clearly

Factors not in our favor:

my client is young (under 50)
my client has several transferable work skills

My strategy: because POTS and Ehlers Danlos are somewhat rare conditions, I thought that it would be helpful to spend some time during both my opening statement and in my direct examination of my client to explain what these conditions are and how they impact my client’s daily functioning.

I then wanted to make sure to focus on practical job limitations like the frequent urination as well as my client’s very limited daily activities.

Hearing Report: my client and I entered the hearing room and were greeted by the judge. After accepting the medical record into evidence and swearing in my client and the vocational expert witness, the judge started the hearing by asking my client to verify her address, age, height, weight and current living arrangements. He then asked her to describe her past work over the past 15 years, which she did.

The judge then turned the questioning over to me. I started by asking my client why she left her last job, which seemed be a very solid career. She responded that her last job was her “dream job” and that she resigned because she could not perform her duties despite significant accommodation from her employer (including working from home).

At that point we engaged in a thorough question and answer discussion about POTS and Ehlers Danlos Syndrome. My client explained that her condition represents a failure of the autonomous nervous system and that, in particular, blood would pool in her lower extremity while her heart rate increased dramatically in response to a lack of oxygenated blood to the brain.

As a result of this condition, my client testified that she could stand for no more than 10 to 20 minutes at a time, and that she was always at a risk of falling when she attempted to leave her home. She testified that she could periodically take an anti-anxiety medication that had been prescribed off label for her that would keep hear heart beat in check for 60 to 90 minutes.

My client also discussed her Ehlers-Danlos condition and a Chiari malformation in her brain – both of which are associated with the POTS.

Ehlers Danlos Syndrome, Type III, is a connective tissue disorder which causes hypermobile joints, chronic pain, joint dislocations, deterioration of connective tissue throughout the body, and can often cause a herniation of the brain stem into the foramen magnum, which is known as a Chiari Malformation (or cerebellar ectopia).

EDS Type III frequently results in multiple disc herniations and/or severely degenerated discs (which is reflected in the medical record) and my client testified that she is on long term pain management with narcotic pain meds to reduce her pain level, and that while she underwent an emergency cervical discectomy with fusion several years ago (prior to her EDS III diagnosis), she has not yet undergone a lumbar fusion, which would likely cause accelerated degeneration of the surrounding discs, which would be further exacerbated by the EDS III.

Finally, I asked my client to clarify a statement she had made earlier about needing to constantly drink water. She explained that patients with POTS often have low blood volume, and are directed by their cardiologists to dramatically increase sodium and water (or electrolyte drinks) intake to increase blood volume. As a result of the drastic intake in fluids, she has the need to urinate at least twice an hour.”

After completing my direct examination the judge stated that he had no more questions for my client and he turned to the vocational witness. The VE classified my client’s past work as:

Leasing agent – a light, semi-skilled job
Leasing manager – a light skilled job

Both of these jobs would generate transferrable skills to light or sedentary occupations.

The judge then posed the following hypothetical questions:

1. Assume an individual who is the same age as the claimant, with the same education and work background. This hypothetical person is limited to light work with the following restrictions:
occasional use of ramps and stairs
occasional balancing, stooping, crouching and crawling
never use ladders, ropes or scaffolds
no work at unprotected heights or near dangerous machinery
limited to simple tasks with minimal variation

Could such a person return to the claimant’s past work?
A: No

Are there other jobs such a person could perform?
A: such a person could preform light unskilled work such as a marker, a ticket seller or a cashier.

2. Assume the same limitations as hypothetical question #1 but let’s limit work to the sedentary level?

Could such a person perform past work?
A: No

Are there other jobs such a person could perform?
A: Yes, such a person could work as a document preparer, a telephone salesperson or an inspector.

3. Assume that because of medical conditions and medication side effects, our hypothetical person would be off task for 20% of the day?

A: there are no jobs in the regional or national economy such a person could perform.

The judge then asked me if I had any questions. I did:

4. If our hypothetical person had to take unscheduled restroom breaks of 5 to 7 minutes twice an hour every work day, would that be consistent with competitive work?

A: No.

5. If our hypothetical person needed to take an hour break outside normal break time to lie down during a workday, would that be consistent with competitive work?

A. No.

Conclusions: I think that the judge will approve this case. The evidence in the file is overwhelming that my client has POTS and symptomatic Ehlers Danlos syndrome. The judge in our case is new to this particular hearing office but his approval statistics from SSA’s database show that he approves a higher than average number of claims.

My client came across as very credible and we have multiple functional capacity evaluations from long time treating doctors that support our contention that my client does not have the capacity for full time work.