Children’s Law Clinic restores disability benefits for 6-year-old client with sickle cell anemia

August 27, 2019Duke Law News

The Children’s Law Clinic won a Social Security Administration appeal in August, restoring disability benefits for a 6-year-old girl living with sickle cell anemia.

Sickle cell anemia is an inherited condition in which irregularly-shaped red blood vessels make it difficult for sufficient oxygen to circulate throughout the body, causing debilitating episodes of pain, swelling of the extremities, infections, vision problems, and slowed growth in children. It is incurable but can be managed with treatment and lifestyle modifications.

The young client, who was diagnosed shortly after birth, lost her Social Security Disability Benefits last spring, after tests showed some improvement in her condition. Her family reached out to the clinic for help in appealing that decision. With a hearing scheduled for June, intern Bailey Sanders ’21 had less than two months to conduct an investigation, develop a case theory and prepare her brief for appeal.

Working with Senior Lecturing Fellow and Supervising Attorney Crystal Grant, Sanders combed through hundreds of pages of medical records and interviewed the child’s mother and medical providers. They crafted a brief arguing that the client’s symptoms, along with the regimen the young child must follow to manage her condition, demonstrates marked functional limitations. In doing so, they adopted a novel interpretation of a self-care theory, building it around the finding that to manage her illness, their client would have to drink water hourly. A child her age, they argued, cannot be solely responsible for her own self-care; their client needs almost constant adult supervision in this regard as an interruption in her hydration care schedule could – and has – resulted in hospitalization for the child and work disruption for her parent.

“Dehydration can cause a pain crisis to come on but a 6-year-old doesn’t realize you have to drink water every hour and she doesn’t have the maturity yet to reach out for help when she needs it,” Grant said. “That’s where our theory came together.”

Under Grant’s guidance, Sanders learned to identify evidence in the medical records, interview the child’s health care providers, and construct a narrative that would convince the administrative law judge to restore benefits.

“I understand why the Social Security Administration denied her at first, because if you just look through the records and haven’t talked to the provider, it looks like she’s doing better,” Sanders said. “But when you sift through and pull out the details it becomes clear that she’s still suffering a significant detriment. I enjoyed getting to weave that story of her experiences and make the argument for why she should be receiving benefits.”

Grant presented Sanders’s brief in court along with the child’s mother, who conveyed how her daughter’s sickle cell disease had impacted her overall health and physical well-being. In late August, they received the judge’s fully favorable decision.

Winning the case was the highlight of the summer for Sanders, who enrolled at Duke Law after earning her doctorate in political science. She said it “reaffirmed my decision to go to law school.

“This felt great. It’s been a big confidence booster,” Sanders said. “One thing I learned at the clinic is you can make a big change with not a lot of hours. I spent five summers doing research for my PhD program here at Duke and that was great, but I feel that this summer I had a real impact on the world.”

The case was also a learning experience for Grant. “I’ve been practicing disability law for many years and I think this is my first sickle cell client,” she said. “So a lot of time as professors, we’re learning something new right alongside our students.”