Yesterday, I tried a case before a very creative Administrative Law Judge and I think that my experience demonstrates the need for disability lawyers to know their files and to know their judges.

My case involved a 55 year old woman with a long history of heart problems.  She has a pacemaker and a defibrilator and experiences extreme fatigue, shortness of breath, and chest pain.  My client also has a long work history, with several jobs lasting almost ten years.  She has two treating physicians – a family doctor and a cardiologist – both of whom fully support her claim for disability.  In fact, both physicians were very helpful in this case and they both provided extensive treatment records as well as functional capacity evaluations.  The file contains at least four functional capacity evaluations detailing activity limitations that clearly preclude any type of competitive work.

So, what was the problem?  In most cases, the formula of (1) a complete set of medical records + (2) one or more functional capacity forms detailing severe work activity limitations + (3) a credible claimant + (4) a long work history equals an approval.

Here, the judge carefully read the medical records and he noted that the objective test results (i.e., the cardiac tests that measure the heart’s pumping capacity) appeared to show only a moderate pumping capacity limitation, whereas the doctor’s notes and functional capacity forms described a severe limitation.

We actually stopped the hearing for a few minutes so I could try to call the two doctors for an explanation of the discrepancy.

The judge gave me a few minutes to address this issue and I was able to formulate an argument that the claimant did have a significant medical problem but that her inability to work arose from associated symptoms, medication side effects and fatigue.

I believe that the judge recognized that the treating doctor’s conclusions were inconsistent with the objective tests.  In such a situation, the Appeals Council could reverse his decision on its own review.  I believe that he recognized early on that my client was disabled, but he had to have a sound justification for issuing a favorable decision.

I also suspect that this judge looks at certain impairments different than others.  Cardiac cases (like pulmonary/lung, liver function cases) yield objective evidence from diagnostic testing.  By contract, back pain cases are often more subjective – two individuals each with herniated disks can have very different pain experiences.

Because this was a case that lends itself to objective evidence,the judge was focused on that.  I learned from this experience that I need to look at the “trees” as well as the “forest.”  I knew I had a winning case and a credible client and I had all the documentation that would result in a “win” 99% of the time.  However, I relied on the assumption that this judge would take a “big picture” approach to this case.  Now I recognize that (for cardiac cases at least) medical opinions about work capacity need to have a clear basis in the diagnostic testing.  And, recognizing that that test results do not always tell the full story, be prepared to present an argument explaning why my client meets the definition of disability.

Fortunately, this judge here used his “judgment” to see in a big picture sense that my client was disabled, and he recognized the need to support his decision by looking at the details.  He will be issuing a favorable decision.
Although this was probably one of the more stressful hearings I have been involved with, I most definitely gained useful knowledge about improving my hearing preparation.  That’s why they say we “practice” law because we are always practicing and hopefully, always improving.

–Jonathan