July 19, 2019

Crohns/Colitis Case Study #1

This case arose from the claim of a 54 year old male with a high school education who had worked mostly standing jobs that did not allow for multiple bathroom breaks.  This case resulted in a favorable decision.  This case study was submitted by attorney Jonathan Ginsberg of Ginsberg Law Offices, P.C. in Atlanta, Georgia.

Claimant: 54 year old male

Occupations: Housekeeping Supervisor at high end downtown hotel, Security Guard Supervisor, Office Manager, Cook, Professional Musician

Education: High School Graduate

Hearing info: The client applied for benefits in September of 2006, alleging disability as of February 2005. His last day of work was in February of 2005, when he was fired from his job at a security company following a dispute with a co-worker. The client believes that the underlying reason behind his dismissal was his chronic medical condition.

Hearing strategy: The client’s primary medical problem is Crohn’s Disease. It is a disease that causes inflammation of the digestive or gastrointestinal tract, thus inducing another illness called colitis, which is the inflammation of the colon. In the client’s case, his disease causes cramping and pain, and painful bowel movements. He has also developed chronic anal fissures.

I have generally had good results in cases documented as Crohn’s disease. Affected individuals frequently experience a great deal of pain in the restroom and have a difficult time getting through the workday. Most affected individuals take restroom breaks for 30 minutes at a time, thus causing work performance issues because of the time consumed in going to the restroom. Nonetheless, most judges recognize that gastrointestinal irritation can and does cause a great deal of pain and discomfort.

The medical record in this case was solid – it documented my client’s history of treatment for Crohn’s disease. In addition to the diagnosis of Crohn’s disease, the client also has chronic back problems caused by the standing nature of his work. Previous MRI reports reveal at least one herniated disc, and that the client will need a cane for ambulation.

The strategy used was to present a clear and compelling opening statement then to ask the client several “big picture” questions about what it is like to live with Crohn’s disease and/or chronic back pain.

I also recognized that the judge in our case was a no-nonsense judge who would conclude the hearing in 5 minutes if he heard what he needed. I prepared my client by walking him through a “regular” 60-minute hearing but I advised him not to be surprised if we finish in less than 10 minutes.

The Hearing: The judge called the hearing to order and quickly went through preliminary matters. There was no vocational witness present, which suggested that the judge had read the file and did not see a need for vocational testimony. The judge asked me to make a brief opening statement and I explained that this case involved a 54 year old individual with a solid work history who was unable to work because of his gastrointestinal problems. I noted that he needed to take frequent, unscheduled restroom breaks and that he might need 15 to 45 minutes of restroom time for three or four times a day. It was also emphasized that the client walked with a cane because of back problems. But it was noted that the most significant and medically supported issue is related to the client’s Crohn’s disease diagnosis. The judge listened to my explanations and then asked me to present my case.

I turned to the client and asked a “big picture” question – “Can you describe for us what it is like to live with Crohn’s disease?” The client explained the pain and frequent restroom breaks as well as the embarrassment he experienced from his previous job because of his frequent long visit to the restroom. The judge then interrupted and asked the client about how his medication is helping him. The client testified that he had been on Prednisone for many months and that other medications were given to control the inflammation. However, the prescribed medications only work for a while and would eventually lose effectiveness. This makes the client go for another set of prescriptions.

At that point the judge turned to me and said that he had heard enough and was approving the case. As predicted, we were out of the hearing in less than 10 minutes.

Observations:

  1. This was a very strong case. It would be unusual to see judges turn down the case.
  2. I think it was helpful that I knew the judge and his habit of conducting 10-minute hearings. Whereas my normal opening statement covers past work, applicable dates and anticipated testimony, I know that this judge wants a concise argument and a 2-minute opening.
  3. Gastrointestinal disease cases generate multiple vocational issues – as silly as it may sound, unscheduled bathroom breaks can make it impossible for an entry level worker to get and keep a job.