Stuck between a rock and a disability hearing
The massive waitlist at the Social Security Administration leaves many without care
Ricky Sanders’ new grandbaby is sick. Little Josh is 3 months old and has an upper respiratory infection. Ricky would love to buy him a humidifier to loosen the congestion, but the money simply isn’t there. As he holds the baby and listens to him wheeze and struggle to breathe, he curses Social Security once more.
Times have been tough for the Sanders family, who live in the Portland neighborhood, since Ricky suffered a massive heart attack in January of 2000. “I woke up in the middle of the night and my chest was burning real bad. It just got worse and worse. I broke out in a sweat and couldn’t breathe,” he said.
The blockage of arteries leading to his heart meant Ricky needed quadruple-bypass surgery. Too weak to have it done immediately, he underwent the surgery about a week after the attack. Ricky applied for temporary disability benefits from the Social Security Administration in February of 2000, while recovering from surgery; he was immediately turned down.
He took a sick leave at work, a Louisville factory where he’d spent 25 years. But because he was no longer able to work the long, hard hours he always had, the company forced him to retire.
“They told me at work to retire or get fired, so I retired. I tried everywhere to get a job after that,” he said. Unfortunately, no one wanted to hire a 55-year-old with a large portion of his heart damaged.
A second procedure was necessary two years later; Ricky had two stents inserted into arteries around his heart. One stent went into one of the replacement arteries from the bypass surgery. The arteries were blocking up again, and his condition was deteriorating.
These days, Ricky is perpetually tired and feels exhausted all the time from the reduced capacity of his heart. He is also at very high risk for another heart attack, which his doctor told him could come at any time. He was hospitalized recently for a week with a potentially deadly case of septic pneumonia. He was unaware of how ill he was until breathing became almost impossible one night, and his daughter Jessica had to call an ambulance.
I know all of this because I am Ricky’s friend, neighbor and former sister-in-law. And I have been through something similar.
“I put off trying to get disability for a while. I felt like I was trying to get something for nothing. Then it hit me: I have paid into that my whole life. I worked and earned that.”
Ricky applied again for Social Security disability benefits almost two years ago. He has been denied twice now, and the Social Security Administration’s Disability Board seems to be in no hurry to bring his case before an administrative law judge. “(My attorneys) said it could be another six months,” Ricky said, “and there’s no guarantee I won’t be denied again.”
Meanwhile, Ricky’s wife Connie drives her Ford Ranger to work on dangerously worn tires, and her trips to the nearby Kroger include lots of items from the generics aisle. She works doggedly at UPS, sorting packages in good weather and deicing airplanes in bad, to support the family on her own. She also puts tremendous effort into keeping stress out of Ricky’s life, discouraging him from helping with household chores or worrying about finances.
“She tries to hide the bills from me,” he said. “But I’m disabled — not stupid.”
The Social Security Disability Board determines cases like Ricky’s by a measurement of how well your heart is performing called an ejection fraction (EF) rating. An average EF rating is between 55 and 75; the evaluation guide, called Social Security’s “Blue Book,” lists an EF rating of 30 or below as permanently disabled. According to his doctor, Ricky’s EF rating was 28 when he first applied, and has now dropped to 25.
“It’s a shame that you work your whole life and pay into (Social Security), and then when you finally need it, you can’t get it,” Ricky said, shaking his head in disgust. “I know I’m not the only one like that either. There are a lot of people in the same boat as me.”
The Social Security Administration is tremendously backlogged, with about 750,000 cases waiting for a hearing, according to figures from the agency’s website. The agency cites the average wait time for a hearing with an administrative law judge — which you reach after being denied benefits twice and appealing — as 512 days. Their track record, according to their own statistics, is to initially deny about two out of every three claims filed. This is not altogether different from a modern American medical insurance company.
The agency is aware of the problems with backlogged cases. In 2007, the SSA announced it was hiring 175 additional administrative law judges. But in February, the agency announced a moderate pullback: It would offer positions to 144 new judges.
I called the SSA several times to ask about what appears to be a degraded bureaucracy. I never got through to anyone who could give a straight or satisfactory answer.
It wasn’t the first time I’ve been through this. The same thing that’s happening to Ricky also happened to my son, Josh Sanders, who is also Ricky’s nephew. Josh filed for disability when he ruptured discs in his back at age 23. He originally applied on Oct. 14, 2005, but was perfunctorily denied. He filed for reconsideration and was denied again.
He had appealed for a hearing with an administrative law judge when he died. Twenty-five years old. We learned that Josh suffered from undiagnosed heart problems, and his heart stopped when he accidentally overdosed on prescription medication. He had waited almost two years for benefits.
“Josh was in terrible pain all the time,” his father, Jack Sanders, said recently. “I’ve seen him trying to walk down the hall to the bathroom and have tears in his eyes. Sometimes he had to scoot around on the floor to do things. He hated to ask anyone to wait on him, and sometimes the pain was just so bad he couldn’t walk at all.”
Josh had been hospitalized several times for the disc damage, but was always treated and released once the pain was under a modicum of control. Because he had no medical insurance, surgery could not be an option.
The Social Security hearing was scheduled for June 15, 2007. We — Jack and I, who’ve been divorced now for more than 20 years — testified, accompanied by Josh’s attorney. The judge granted his benefits posthumously.
“We went in and fought for Josh’s case, and we won. It’s just a damn shame that it took so long and he never got to see it,” Jack said afterward.
We used the money to buy a headstone.
Five hundred and sixteen days passed between the day Josh applied for Social Security disability benefits and the day he died. Ricky has already waited more than 570 and his hearing has not been scheduled.
Attempting to gather more information on Ricky’s case, I called the 1-800 number for the SSA. I was told that his case was being held in Frankfort, so I called the state SSA office and asked for an explanation about why a hearing date hadn’t been settled. I was told, not so politely, that no information would be offered, even after I explained that I had Ricky’s consent. So I asked Ricky to call. The results were equally frustrating: He was told his case was pending in the hearing office, and that no other information was available.
While they continue waiting, Ricky and Connie get deeper in debt as the co-pay bills roll in from his last hospitalization. “If Connie hadn’t got to go full time at her job when she did, we would have already lost our house and everything,” Ricky said. “My lawyer even said he can’t believe it and doesn’t understand it. I guess they’re just waiting for me to die.”
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