In January I wrote a blog about a hearing that I had attended and I was complaining about the vibe in the hearing room. I had strongly felt that the client was going to be denied - based strictly on the panel that had convened to hear that appeal.
An this week I got the decision and sure enough it was dismissed.
You cannot win every appeal - I understand that - and if the decisions are evenly written and reasons are well thought out - I have no problem taking a denial - you have a different interpretation on the information that is fine - no complaints and that is why there are various levels of appeals.
However, this decision I am going to describe to you. The client has appeal rights thank goodness.
This client - let's call him James.
James is middle aged. He has several diagnoses - including systemic arthritis as well bowel disease due to adhesions from previous surgeries - and chronic pain and fatigue due to these conditions. He has been under specialist treatment since 2002 - so now ten years on.
He has an MQP of December 2008- remember that is the magic date - the date he needs to be found disabled.
He could not work in a competitive work force due to his disability - so he decided to do a home based business - which continued to grow - but soon he could not keep up with the demands because of his disability.
He bought equipment to help him manage the business but eventually he had to turn business away - he continues to earn around $200 per month as that is his capacity.
He has pain in his knees, hips, back, he has adhesions on his abdominal wall which leads to significant bowel issues. He also has chronic fatigue due to his systemic arthritis.
He was prescribed medical marijuana to manage his pain as well as other medications to manage the degeneration of his joints.
The analysis of the Panel and the reason for the denial.......
The Panel agrees that James has ongoing "problems" related to his medical condition. No significant increase in his symptoms from Jan 2002 to October 2007 - note this is one year before the MQP - and the doctor does not give an opinion as to whether the condition is disabling - note these where consultation reports from one doctor to another.
There is little medical evidence regarding the bowel issue- really??? Well James had been referred to several specialists as well as surgeons to see if they can do anything to help - all doctors say no. That if there is surgery it could make the situation of the adhesions worse - and James did not mention this pain enough to his doctor - yet he has been prescribed medical marijuana by the doctor who notes "for ONCE I am comfortable with this as a means of CHRONIC PAIN management" and the doctor also notes in evidence - that mobility is seriously impacted 8/10 - that the paitent is in pain sitting, standing, and lying down.
The medical conditions do not individually or collectively appear to disable him and that he is intelligent and articulate - and that he has not made attempts at employment - okay????? As explained he has been trying to operate within his functional capacity for many years.
So yeah there are pages of medical reports from specialists - his doctor characterizes his medical condition as severe.
There is no discussion about productivity - there is no discussion about how pain interferes with his day to day functiioning - there is no discussion about how this client cannot regularly attend at a place of employment - there is no discussion about his excellent work history. There is no discussion about his efforts at mitigation.
And one last thing that James mentioned to me when I called to see if I could put his story on the blog was - that the hearing was in the mid morning - the hearing took about an hour - and after the hearing James and I sat in the lobby and I was telling him about my negative feelings - less than ten minutes later the Panel left the hearing room and went to the restaurant to eat lunch - so James said to me - how much time was spent deliberating and discussing the file - he was not at confident that his case was given its due - and you know what I tend to agree.
Anyway just wanted to update you.