Case Study 1

Background

The claimant was a 45-year-old female with a high school education and varied work experience.  Previous work included business management, retail sales, receptionist work, cashier work, etc.  She applied for benefits in January 2005 alleging disability as of May 2003, when she left her job as a receptionist due to more frequent and severe migraines.  Although she had suffered from migraines since she was a teenager, she claimed that by May 2003 they were so bad that she was forced to stop working.  Additionally, her migraine medications were of little help.

After her claim was denied at the initial application and reconsideration levels, a hearing was scheduled for May 2008.

Hearing strategy

In reviewing my client’s file, I felt that this case was fairly straightforward.  My client had been experiencing migraine headaches since she was a teenager, but as she entered her 40s, the frequency, duration and intensity of the migraines began to increase.

In 2002, my client worked as a manager for a business in the advertising industry – she felt that the position was very stressful, perhaps bringing on more headaches.  In 2003, my client worked for just a couple of months in a receptionist position, but had to leave because of her migraines.

My client had been treating with a neurologist for several years, and had been prescribed Topomax and Imitrex – two medications that are frequently prescribed for migraines.  In our pre-hearing meeting, my client told me that the medications would reduce the headache pain slightly, but they did not affect the frequency of the headaches.  For the past three to four years, she was experiencing migraines three to seven days a month, with each episode lasting a minimum of 8 hours and a maximum of several days.

As I prepared for this hearing, it appeared to me that the only real issue would be whether the judge would accept my client’s testimony or not.

The Hearing

The morning of the hearing, I prepared my client by going over her entire work history and educational background, and then we practiced answering questions about the frequency and duration of her headaches.  On the morning of the hearing, I could see right away that my client was not feeling well at all.  She looked very washed out and quickly became tearful.

When we entered into the hearing room, I got the sense that our judge was going to be reasonable and friendly.  I think that he could see that my client was not comfortable, and after I asked her just a few questions, I think he made up his mind to approve this case.

I started my questioning with work history.  Whenever I have a client with a solid work history, I like to emphasize that point early on as I am more and more convinced that a solid work history lays a very helpful foundation for a successful hearing result.  Generally, judges don’t mind if I “lead” my clients when asking about work history and here I think the message we sent was that my client had been a capable and reliable employee.  She did have more jobs than I would have liked, although it turned out that she had left several jobs because her husband had been transferred frequently.

When we turned to questions about the migraines, my client became quiet and tearful.  She testified that she had been dealing with migraines her entire life, but that the headaches had become much worse after she left her manager’s job in 2002.

I think that anyone seeing her testify would have been convinced that she was telling the truth and that she did not have the capacity to function in any work environment.  The judge asked a few follow-up questions to confirm that her migraine experiences were frequent enough to result in a minimum of four or five days out during a calendar month.

The judge then turned to the vocational witness and asked her two questions.  The first limited her to light work and limited her to simple, low stress jobs.  The vocational witness was able to identify three light, unskilled jobs that a hypothetical employee could perform – a housekeeper, a labeler for retail products and a laundry worker.  Next the judge asked the vocational witness to add a limitation – 4 to 7 migraine headaches in a calendar month, with each resulting in 1 missed day from work.  Based on that reliability limitation, the vocational witness testified that no jobs existed.

Assessment

In this case the judge told us after the hearing that he intended to award benefits, but even if he had not, I knew we had won.  There was incontrovertible medical evidence that the claimant had migraine headaches.  In order for the judge to deny her claim he would have needed to ask a question to the vocational witness that acknowledged that there were headaches, but at a frequency and severity less than what the claimant testified – for example, headaches that might cause 2 missed days per month (as opposed to 4-7 missed days).

The claimant was awarded benefits based on her diminished functional capacity resulting from frequent and severe migraine headaches.