Depression Case Study #3

Summary:  this case involved the claim of a 37 year old female with a general labor background and a GED who is asserting disability based on depression

Claimant:  37 year old female

Past Work:  short order cook, vehicle dryer at car wash, housekeeper at hotel

Education: 10th grade + GED

Background: my client advises me that her depression stems from a history of childhood sexual abuse.   Like many abuse survivors, she was able to function relatively normally for a number of years until 2009 when she hurt her wrist on the job.  Medically the damage to her wrist (in the form of carpal tunnel) was relatively mild but she had an excessive psychological reaction to it, culminating in a hospitalization where she was admitted to a psychiatric hospital when she voiced a desire to cut off her hand because of the discomfort.  My client also testified that she has very poor capacity for attention and that she frequently senses that she is being watched or followed.  All told, my client has been hospitalized a total of 4 times for suicidal thoughts or attempts.

Factors in our favor included:

• existence of a significant childhood trauma that could reasonably be expected to cause long standing psychological damage
• multiple psychiatric hospitalizations
• multiple suicide attempts
• limited education
• limited work skills
• supportive consultative psychological evaluation which included a diagnosis of major depressive disorder, severe with psychotic features and panic disorder

Factors not in our favor included:

• my client is young (age 37)
• the medical treatment for her wrist comes from workers’ compensation doctors who imply that she is exaggerating her claims
• because of financial constraints, my client has had limited psychiatric care other than her hospitalizations
• my client does not express herself well – she comes across as someone who has basically given up

Jonathan’s hearing strategy:  I felt that the record of multiple psychiatric hospitalizations and suicide attempts, combined with the strong consultative evaluation report gave us a good medical record.  My client easily becomes tearful and her outward demeanor does not reflect someone with the capacity to work.  I wanted her to talk enough to paint a picture for the judge but not more than that.  Generally I find that clients with significant mental health issues often have a hard time describing their behavior because they have been living with symptoms of depression for so long that they do not have perspective to understand how they are different.  This was certainly the case with my client in this matter.

Hearing Report:  the judge opened the hearing by introducing herself, the hearing reporter and the vocational witness. The judge in our case is somewhat formal, although the statistics about her decision approval rate show that she approves 60% of her cases which is right at the average for judges in her hearing office.

The judge asked me for an opening statement which I provided and then I began questioning the claimant.  I began by asking my client about her past work.  She had a difficult time remembering dates or specifics and she presented herself as someone with poor communication skills.

I did have her testify that she was abused as a child and about the flashbacks and emotional trauma she has incurred since that time.  We discussed her reaction to the wrist injury and her psychiatric hospitalizations and suicide attempts.  During my direct examination the judge periodically interrupted to ask questions – it was clear that the judge was paying close attention to the testimony.

As noted above, I felt that the medical record was strong in this case and that my client’s testimony would be helpful mainly in highlighting her poor communication skills and emotional instability.  My client did tear up several times during her testimony.

After I concluded my questioning the judge turned to the vocational witness and asked him to classify my client’s past work.  The VE testified that the only job she held long enough to qualify as “substantial” was her past work as a short order cook, which is a light, low-end semi-skilled job.

The judge then asked the following hypothetical questions:

I.  Assume an individual who is the same age as the claimant with a GED and the claimant’s past work.  Assume further that

1. she has no exertional or environmental limitations except that she may use her right upper extremity for handling, fingering and touching frequently (as opposed to constantly)
2. she can understand and complete simple job tasks
3. she has the capacity to maintain attention and concentration for simple tasks for 2 hours at a time
4. she can complete a work week without interruption from psychologically based symptoms
5. she can interact with co-workers and supervisors
6. she can adapt to chanages in the workplance

A:  such a person could return to the claimant’s past work

II.  Take Hypo I but add:

1. her ability to perform tasks at a workmanlike pace are moderately affected (moderately is defined as more than slightly but able to perform satisfactorily)
2. she has a moderate capacity to work with co-workers without being distracted by them and to accept simple instructions from supervisors

A: such a person could perform the claimant’s past work

III.  Take Hypo I but add

1. she has a marked limitation in her capacity to perform tasks at a consistent and workmanlike pace without unreasonable interruptions (“marked” is defined as a “substantial loss in capacity to function”)
2. she has a marked limitation in her capacity to adapt to changes in the workplace that occur more than once a week
3. she has a marked limitation in her capacity to maintain a schedule, maintain attendance and be punctual at her job

A: such a person could not perform the claimant’s past work or any other job

Analysis:  I sense that the judge will approve this case.  Clearly the last hypothetical includes limitations consistent with my client’s testimony.  The evidence in this case is not overwhelming in terms of volume but what we have does suggest that my client has some serious mental health issues.  As we were leaving the judge got my attention and said that she would be recommending a representative payee and that she would recommend a review in 2 years – statements that suggest she intends to grant this case.

The judge asked my client several times about her psychiatric hospitalizations and suicide attempts.  I think that these factors were the deciding elements that helped the judge decide that my client’s testimony was credible.