June 26, 2024 by Natalie Cochran
Lone Star Legal Aid’s Client Suffering Multiple Medical Conditions has Benefits Retracted: Lone Star Legal Aid Fights to Reverse this Decision
Alex suffers from a kidney disorder, insulin-dependent diabetes, a learning disability, and severe depression. Alex also cannot walk without a walker or wheelchair. He was diagnosed with diabetes at age six but wasn’t diagnosed with depression until 18. His condition has been worsening over time, causing fluid in his legs and requiring one to three hospital visits year on average.
Alex is unable to talk to communicate his symptoms and express how he is feeling so his mother Diane makes decisions on his behalf. Alex communicates with his mother with his eyes, crying and staring intensely and by squeezing her hands and arms to let her know he is in pain. Meanwhile seeing doctors to treat his conditions, his Social Security Income was cut off.
Confused and frustrated, Alex’s mother Diane contacted Lone Star Legal Aid’s Public Benefits Unit (PBU) to assist her son with getting this decision reversed. LSLA PBU Staff Attorney, Channing Guidry represented Alex in this case.
“I observed Diane to be extremely stressed by the entire process. She is a single mother with little to no help from Alex’s father and she has to get dialysis two times a week and is in very poor health herself. Diane has been overwhelmed by her own circumstances, meanwhile concerned for her child,” Guidry said.
Diane requested a hearing on Alex’s behalf in hopes of reversing this decision by the Social Security Administration. However, Alex’s father Richard received a notice in the mail concerning Alex’s benefits and filed a request for an Administrative Law Judge Hearing (ALJ) without notifying Diane, in which he had no authority to do so. The ALJ decided the case without giving Guidry the hearing she originally requested. Guidry filed an appeal to the Appeals Council and mentioned in the appeal that the ALJ failed to schedule the supplemental hearing she requested in response to the proffer of new evidence and the judge’s failure to provide a notice to Alex’s Counsel (Guidry).
“I should have been able to cross examine the psychologist because my client wasn’t even able to talk, walk or go to the bathroom. At this point, Alex’s condition had not changed in a year, and that should have been enough to support his case,” Guidry said.
The ALJ hearing resulted in an unfavorable decision. The judge had a difficult time understanding why his diabetes was so bad and why this meant he needed SSI. Unfortunately, nothing from his medical records supported his claims. The judge also struggled to understand Alex’s condition had worsened and how his condition greatly impacted his depression and eventually led him to not being able to talk.
Guidry filed an appeal to the Social Security Administration Appeals Council in which they remanded the case back for another ALJ. Guidry represented Alex at this hearing and received a favorable decision. Alex started receiving SSI benefits, as well as backpay; the money he wasn’t receiving when his benefits were cut off.
“The client’s mother was in tears when we won the case. She was appreciative. It was an emotional situation. Diane hugged me and expressed many times how grateful she was for all of my help. What stood out the most about this case is that it was so complicated and there is no way the client could have navigated this on their own. There were so many moving parts such as requesting delays and accessing medical records. I am so glad clients have a place like us to call because if we hadn’t been there to help, he would have had to start all over. It was such a success for him and us,” Guidry said.
*Names were changed to protect the identity of the client(s).
