Cancer (Prostate) – Case Study #1

Metastatic Prostate Cancer, Shingles and
Elements of Depression – Case Study #1

Claimant: 60 year old male

Occupation: Claimant last worked as maintenance supervisor for apartment complex.  Prior to that he earned money by trading stocks and prior to that he owned a used car lot.

Education: engineering degree from a university in another country.   My client speaks with an accent but he understands and speaks English fluently.

Hearing info: my client applied for benefits in August, 2006 alleging a disability onset date in October, 2005 (when he last worked as a maintenance supervisor).  The hearing was held in April, 2009 (2 1/2 years after application date).

Analysis: this case was a very strong case.  In reviewing the file the first question that came to my mind was why wasn’t this case approved at initial or recon?  I am thinking that back in 2005, the medical records were not entirely clear that the prostate cancer had spread although the symptoms my client was experiencing at that time (rectal bleeding, extreme abdominal pain) appeared to me to be fairly significant.  Ultimately however I think that this case was not approved early because my client did not know to ask his doctor for a statement or a functional capacity evaluation that identified these work capacity limitations.

Certainly by 2009, my client’s prognosis and work limitations were apparent.   The only questions in my mind were:

• what was his date last insured
• would the judge accept that his limitations were significant enough in October, 2005 to warrant a fully favorable decision or was there some other date that might apply

The date last insured issue should not have been an issue.  Normally, a printout showing a claimant’s insured status is provided to me as part of the case file.  It was not provided to me in this case.  The judge had it and showed it to me during the hearing, but it would have been helpful if the hearing office had provided this to me ahead of time.  As it turned out the date last insured was October 31, 2007.

The onset date issue could have been an issue with a different judge.  The judge assigned to this case is a very capable jurist who conducts a fair and thorough hearing.   I like appearing before this judge because he looks at both the details and the big picture and he listens to the claimants that appear before him.

You will find that I often write about the impact of a particular judge on the course of a hearing.  This is unfortunate but it is true.   As clear as this case was to me, I think that there are some judges who might have granted but with an onset after October 31, 2007, meaning that my client would not have received full SSDI benefits.

The Hearing: the hearing in this case was quite brief.  Prior to the hearing I submitted a three page pre-hearing brief that set out the issues and summarized my client’s medical condition and course of treatment.   My client’s main problems were:

• metastatic prostate cancer – cancer that originated in the prostate but had spread beyond the prostate (although it has not yet settled definitively in another organ)
• shingles (herpes zoster) – which causes painful rashes at various places on my client’s body
• depression – my client was (obviously) depressed by his medical condition, and he also experienced depression, anxiety and PTSD as the result of his exposure to a violent criminal act in the late 1990′s
• pain – as a result of both the shingles and the prostate cancer, my client experiences chronic rectal bleeding and severe abdominal pain

The judge opened the hearing by going over preliminary matters, and apologizing to my client about the delay in getting a hearing scheduled.   The judge continued by saying that he had read my brief and that what I had said seemed consistent with what was in the medical record.

The judge then asked the claimant to explain why he felt that he could not work.   My client replied that he experienced extreme pain in his rectum and abdomen all day long, whether sitting or standing and that the only relief he was able to obtain was by lying down every two to three hours.

The judge then turned to the vocational expert witness and asked the following hypothetical:

Assume we have an individual the same age as the claimant who has the same education and work experience.  Assume that he is limited to light work but because of severe abdominal pain, he has to lie down for an hour at least twice a day during a workday.

Q:  Would such a person be able to perform the claimant’ s past work?

A:  No

Q:  Is there any other work such an individual could perform in the national or regional economy?

A:  No.

The judge then turned to my client and announced that he would be issuing a fully favorable “bench decision.”

Summary: this case turned more on the severity of my client’s medical condition than anything else.  Although my client’s work history suggested that he was a motivated individual, his past work suggested that he was more of an entrepreneur as opposed to an employee/worker.  The pain and discomfort associated with my client’s cancer, as well as the progressive nature of that disease made this a fairly straightforward case and I suspect that 95 out 100 judges would have seen this case exactly as our judge did.