The new doctor was a brisk, young man who seemed impatient with her cane, her wince, her slow answers. “On a good day, can you make a sandwich?” he asked.

The hearing was six months after her initial application. She sat in a small, sterile room, facing a three-person panel. Her hands were wrapped in arthritis gloves. Darnell spoke for her, laying out the evidence, the medical reports, the functional assessment the first doctor had botched. He brought a new letter from Dr. Singh, this one more forceful, more desperate: “Ms. Kostas cannot maintain gainful employment. Her condition is permanent. She requires financial assistance for basic survival.”

The denial letter arrived on a Tuesday, just as the peanut butter ran out.