When Teresa (fictitious name) came to Community Legal Aid SoCal in August of 2022, she was a 55-year-old immigrant from Mexico whose education ended at 4th grade. She was recently separated from her spouse and had no income, which resulted in her reliance on her two adult children for financial support and transportation.
She had filed an application for Supplemental Security Insurance (SSI), which was denied. She then requested a reconsideration of her application and when she was once again denied she contacted CLA SoCal for help.
Teresa had several surgeries on her on back, neck, shoulder and most recently her foot. She complained of constant headaches, back pain, and swelling of her hands and knees. In addition to her orthopedic treatment, she was seeing a chiropractor and acupuncturist for back pain.
After meeting with her, the CLA SoCal Public Benefits Unit advocates prepared and filed a request for hearing before an administrative law judge (ALJ) in September 2022. The advocates referred Teresa to CLA SoCal’s Case Management Unit for assistance with an application for CalFresh benefits, which they prepared on her behalf.
Public Benefits Unit paralegal Emylou Vergel de Dios spent considerable time requesting medical records from Teresa’s treatment sources. After several requests, current records were received and then submitted via the electronic records system.
No record of request
In April 2023, Public Benefits Unit paralegal Alton Donatto checked the status of the case and learned from the hearing office that there was no record of Teresa’s request for hearing. He contacted the local Santa Ana field office and managed to reach the operations manager. The request was found among a stack of documents and the matter was expedited. The operations manager promised to send the case to the Department of Disability Services marked as “urgent”.
By this time, Teresa was no longer receiving support from her adult children and had to rely on her estranged spouse for the rent, which was causing her increased anxiety and stress. She was forced to rely on CalFresh and was given referrals to various local food banks and Catholic Charities by the Case Management Unit. Concurrently, the case management team assisted her with finding subsidized housing.
Hearing date set, prep begins
After receiving a notice of hearing for September 25, 2023, Emylou began preparing a hearing brief and requested updated medical treatment records from Teresa’s providers, which she obtained and submitted. The updated records showed that Teresa’s physical pain and her ability to perform activities of daily living had worsened. She was diagnosed with severe right hip pain, lumbar pain, stenosis, and sciatica. A mental health questionnaire was completed by her provider, and she was diagnosed with PTSD, depression, anxiety, and a sleep disorder and deemed unable to tolerate severe stress.
The representation and emotional testimony
Alton represented Teresa at the hearing. She brought new records from July 13, 2023, which went into detail regarding her physical limitations and documented that she was undergoing physical therapy for the next two months. The judge reluctantly agreed to consider the untimely submission of the records.
Teresa was emotional as she testified about her physical and mental problems. After her testimony, the ALJ called the vocational expert to testify regarding Teresa’s past employment and her current ability to perform gainful employment. The vocational expert stated Teresa could perform her prior employment as child manager. However, after questioning by Alton, they conceded that Teresa could not perform the job as generally defined by the Dictionary of Occupational Titles (DOT). Furthermore, it was noted that her prior work did not amount to sufficient gainful employment based on her relatively low earnings. The vocational expert testified that Teresa’s need for daily physical therapy, the needs for unscheduled breaks, inability to handle stress, and excessive absenteeism would eliminate all jobs.
The ALJ stated he would review the records and the hearing brief in detail, and that if Teresa’s condition was found to be at the sedentary exertional level, she would meet the grid for a person of advanced age, limited education, and a sparse employment history of unskilled work.
A favorable outcome
On September 27, 2023, the ALJ issued a Fully Favorable Decision with an onset date of March 22, 2021. He found that the voluminous medical records supported Teresa’s allegations and that her testimony was credible.
Teresa was given an eligibility interview at the local office and on November 27, 2023, the Notice of Awards was received. Teresa was found eligible to receive $1,184 in monthly benefits with and underpayment of $23,620, which is to be paid over the next year. She was informed of the SSI spend-down rules.
Teresa was thrilled and grateful to learn of the award. It freed her from having to rely on her estranged spouse for support and has greatly relieved her day-to-day stress. She stated that she can now concentrate on finding housing without having to worry about her month-to-month finances and her dependence on unsupportive family member.
