writing sample - ssi hearing

Representative for Claimant


No. xxx


Hearing Date:  March xx, xxxx
Hearing Time:  xx:xx

              LaRea Client is 44 years old.  She is unemployed and living in Milpitas, California.  Ms. Client has suffered from severe depression for twenty years.  Her impaired mental state, along with her physical debilitations, have prevented her from working for any significant period of time.  It is the Claimant’s position that as a result of her depression, she meets the Listing for Affective Disorders and is rendered “disabled.”
              Since an industrial accident twenty years ago, Ms. Client has undergone several years of physical treatments and psychological therapy.  She has been diagnosed repeatedly with depressive disorders over the past two decades.  Seven years ago, Ms. Client was diagnosed with a depressive disorder by Dr. Smith, who is Ms. Client’s current treating psychiatrist.  Dr. Smith found that Ms. Client was preoccupied with thoughts of death, guilt, and hopelessness; that she had lost her energy, appetite, and interest in her activities; and that migraine headaches, which she had experienced for most of her adult life, had increased in severity, frequency, and duration.  Ms. Client remains clinically depressed, despite continuous medical treatment with various antidepressants.  The Claimant’s depression and other physical symptoms have worsened as financial and social stresses have built up in her life.  Ms. Client spends most of her day isolated at home, lying down, and unable to work.
              At issue in the present hearing is whether Ms. Client suffers from a medical condition that is “severe” and “disabling” under the Social Security Act.  The medical evidence and testimony will show that Ms. Client is “disabled” and entitled to SSI benefits, retroactive to the date of her application.
              Ms. Client is not presently working.  She has not worked since 1995, when she was employed as a street sweeper at the Great Mall in Milpitas.  Prior to that, she was employed sporadically and for short periods of time, due to her medical condition.  She presently spends the bulk of her time at home, resting.
B.               The claimant suffers from a “severe” impairment that has lasted at least twelve months in duration.
              Ms. Client suffers from severe depression.  Her diminished cognitive and intellectual functioning prevents her from understanding, carrying out, or remembering simple instructions and severely impairs her ability to respond appropriately in work-like settings. 
              Ms. Client also suffers from lower back pain, chronic migraines, carpal tunnel syndrome, tendinitis, and a shoulder injury.  As recently as December 14, 1998, Dr. Arnold, who is Ms. Client’s treating physician, found that Ms. Client’s lower back pain was at a level which made her “unable to walk or stand for long amounts of time, or carry heavy objects” (Claimant’s Exh. 1).  On June 18, 1998, Dr. Monte completed a CE report which states that “[Ms. Client] cannot sit in one position for more than one hour at a time” (SSA Exh. 3F/4).  Dr. Hatfield, in a worker’s compensation evaluation of her chronic tendinitis on March 4, 1997, found that “[Ms. Client] is considered to have a chronic disability” (SSA Exh. 4F/3).
              As discussed further below, Ms. Client’s depression, coupled with her other physical impairments, is more than a "slight abnormality.”  SSR 85-28 (a claimant will be denied at the “severity” step of the disability evaluation process only where the claimant’s mental impairment is a “slight abnormality” which has “a minimal effect” on the claimant).  The Claimant’s condition continues to be severe, and has prevented the Claimant from returning to work.
              Listing 12.04 sets forth the requirements that a claimant must meet to demonstrate that s/he suffers from an affective disorder.  Affective disorders are defined as:
Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome.  Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation.  The required level of severity for these disorders is met when the requirements in both A and B are satisfied.
A. Medically documented persistence, either continuous or intermittent, of … [d]epressive syndrome characterized by at least four of the following:
1.    Anhedonia or pervasive loss of interest in almost all activities; or
2.    Appetite disturbance with change in weight; or
3.    Psychomotor agitation or retardation; or
4.    Decreased energy; or
5.    Feelings of guilt or worthlessness; or
6.    Difficulty concentrating or thinking; or
7.    Thoughts of suicide; or
8.    Hallucinations, delusions or paranoid thinking … AND
              B. Resulting in at least two of the following:
1.                                      Marked restriction of activities of daily living; or
2.                                      Marked difficulties in maintaining social functioning; or
3.                                      Deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or
4.                                      Repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behavior)
20 C.F.R. Pt. 404, Supbt. P, App. 1 § 12.04.
              1.              Signs & Symptoms of Depression
              On April 22, 1998, Ms. Client was examined by Dr. Norman, a clinical psychologist who performed a Consultative Exam on Ms. Client.  Dr. Norman’s report indicates that Ms. Client has a pervasive loss of interest in almost all activities and decreased energy.  She has little or no motivation, no outside hobbies, she is isolated from people, including friends and family.  She does not manage her own money.  She relies on her brother for transportation. (SSA Exh. 2F/3)  She is withdrawn, irritable, tearful, and minimally cooperative (SSA Exh. 2F/2).  She is in “frequent and chronic pain,” and on a daily basis, she sits, looks at the television, and reports little or no motivation to perform household chores (SSA Exh. 2F/3).
              The report also indicates Ms. Client’s difficulty concentrating and thinking:  She showed carelessness, and a lack of concentration and focus (SSA Exh. 2F/3).  She has trouble concentrating and difficulties with her short term and long term memory (SSA Exh. 2F/2).  Her “attention was poor,” and her insight and judgement were minimally adequate (SSA Exh. 2F/2).  The report continued, “Her mood was depressed, her affect sad and tired, and her stream of thought was tangential at times…She became confused, and showed a looseness of association.” (SSA Exh. 2F/2).  The report diagnoses Ms. Client as having depressive disorder, NOS severe (SSA Exh. 2F/4).
              Ms. Client’s medical file reports that she has attempted suicide five times in the past, and presently worries a great deal and feels depressed, to the point where she was placed on a 14 day suicide hold in a hospital after attempting to shoot herself with a police officer’s pistol in late 1997.
              Numerous letters from Dr. Smith, Ms. Client’s treating psychiatrist, indicate that Ms. Client “remains very depressed” (March 5, 1998) and suffers from “a severe, recurrent major depressive disorder.” (November 6, 1997).  Dr. Smith, in a letter dated August 6, 1997, noted that Ms. Client was experiencing “increased depression accompanied by suicidal ideation.”  He also commented on her fatigue, and difficulty with concentration. (SSA Exhibit 1F).
              2.              Marked Impairment in Daily Activities, Marked Impairment in Social
                         Functioning, and Deficiencies in Concentration, Persistence, and Pace.
              The Claimant’s impaired functioning has resulted in marked restrictions in her daily living activities and her social functioning.  Ms. Client is incapable of performing her daily activities in an appropriate, independent, and effective manner.  She does not drive, clean her house, shop for groceries, or pay the bills.  Instead, her brother helps her with these responsibilities.  (SSA Exh. 2F/3).  Ms. Client’s mental condition has also left her unable to function socially.  She does not attend church, participate in any organizations, visit relatives, visit friends, or talk to neighbors.  She does not have a support group, and she tends to isolate herself either in her home or bedroom.  (SSA Exh. 2F/3).  According to her brother, Ms. Client is unable to fill out forms – such as an SSI application, Request for Reconsideration, or Request for an Administrative Law Judge Hearing – without the assistance of others.  When she attempts a task, she frequently loses energy or forgets the task that she is supposed to perform.
In addition, Ms. Client suffers from severe deficiencies in her concentration, persistence and pace.  Her brother states that she is frequently unable to complete tasks in a timely or effective manner.  For instance, when Ms. Client attempts to do paperwork, clean the dishes, cook, or clean the house, her family reports that it takes her the entire day because she cannot focus on her task.
              Dr. Norman, in a report dated April 22, 1998, found that Ms. Client’s GAF level is 45.  This indicates:  “Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).” (DSM-IV, p. 32).   Coupled with his findings that her IQ was 68, Dr. Norman’s report evidences Ms. Client’s marked impairments in her functioning.  (SSA Exh. 2F/4).
In sum, the medical evidence, the claimant’s statements, and the reports of individuals who know the claimant indicate that Ms. Client meets Listing 12.04.
              The evidence shows that Ms. Client meets the Listing for Affective Disorders.  As such, no examination of the claimant’s residual functional capacity is necessary.  However, even if the claimant’s residual functional capacity is taken into account, the evidence from claimant’s physicians, psychologists, and family establishes that Ms. Client is unable to do any substantial gainful work.
1.              Physical Impairments
              Ms. Client’s diminished functioning precludes her from performing basic work-related activities.  Dr. Arnold stated in her February 2, 1999 RFC Questionnaire that Ms. Client suffers from “severe depression”, “severe asthma”, and low back pain which is “worsened by standing, walking, or long periods of sitting” (Claimant’s Exh. 2/1).  The pain requires two types of pain medications (Claimant’s Exh. 2/2), and “frequently” interferes with Ms. Client’s ability to pay attention and concentrate (Claimant’s Exh. 2/2).  In fact, Dr. Arnold estimates that if Ms. Client was placed in a competitive work situation, she would only be able to sit for 15 minutes at a time, up to a maximum of fewer than 2 hours in a work day, and stand for 10 minutes at a time, up to a maximum of fewer than 2 hours in a work day (Claimant’s Exh. 2/3).  This means she would need to lie down, while at work, for at least half of her work day, in addition to needing unscheduled breaks during the workday.  When she is able to walk, she requires a cane.  (Claimant’s Exh. 2/4).
Dr. Arnold states that her Ms. Client has shortness of breath, experiences chronic wheezing, and requires three different types of inhaled medications to be taken through the day.  She is “unable to tolerate dust, fumes, pets [and] gases” because of her asthma.  (Claimant’s Exh. 2/5).
Dr. Arnold finally states that Ms. Client’s impairments can be expected to last at least twelve months, and would result in Ms. Client being absent from work about twice a month.  Additionally, Ms. Client has a “marked limitation” in her ability to deal with work stress.  (Claimant’s Exh. 2/3).
These factors significantly erode the number of jobs available to Ms. Client.
2.                                      Mental Impairments
Social Security Ruling 85-15 provides that:
[T]he basic mental demands of competitive, remunerative, unskilled work include the abilities (on a sustained basis) to understand, carry out, and remember simple instructions; to respond appropriately to supervision, coworkers, and usual work situations; and to deal with changes in a routine work setting.  A substantial loss of ability to meet any of these basic work-related activities would severely limit the potential occupational basis.  This, in turn, would justify a finding of disability because even favorable age, education, or work experience will not offset such a severely limited occupational base.

Id. (emphasis added).
              Dr. Norman’s Consultative Examination Report states that Ms. Client “[W]ould have trouble even to learn simple repetitive skills and understand and comply with one instruction.  From a mental capacity standpoint, the claimant seems to be totally withdrawn and does not care to relate to others, most likely including workers and authority figures in an appropriate manner.” (SSA Exh. 2F/4).  Dr. Norman’s report is consistent with Dr. Smith’s finding that Ms. Client “often experiences lapses of memory in conjunction with other depressive symptoms” (SSA Exh. 1F/5).
Dr. Norman also states that Ms. Client’s “insight and judgment were minimally adequate.”  He reported that, “She became confused and showed looseness of association.” (SSA Exh. 2F/2). In performing psychological examinations for Dr. Norman, Ms. Client was “hasty, careless, and clearly showed poor motivation,” as well as anxiety.  (SSA Exh. 2F/3).
              This evidence indicates that Ms. Client’s mental capacity would preclude her from working, even assuming that her physical condition permitted employment.
              The evidence in this case demonstrates that the Claimant meets the Listing for Affective Disorders.  The Claimant respectfully requests that the Social Security Administration find her “disabled” and award SSI benefits retroactive to February 17, 1998,  the date of her application.


Respectfully Submitted,
                                                                                                  Travis A. Wise                  

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