Statement of Social Security Disability Coalition

My name is Linda Fullerton, and I have an inoperable blood clot and tumor in my brain, and suffer from several incurable autoimmune disorders that are too numerous to list, which have caused me to become permanently disabled.  I currently receive Social Security Disability Insurance/SSDI and Medicare.  You can get even more detailed information about my personal horror stories, which are not for the faint of heart, on my websites:

http://www.frontiernet.net/~lindaf1/bump.html

Social Security Disability Nightmare - It Could Happen To You!

http://www.frontiernet.net/~lindaf1/SOCIALSECURITYDISABILITYNIGHTMARE.html

Social Security Disability is an insurance policy which was created to be a safety net for millions of disabled Americans, and for many such as myself, it has become their only lifeline for survival.  I filed an SSDI claim in December 2001, was denied in March 2002 by the NYS ODTA (Office Of Temporary And Disability Assistance), filed an appeal, and then had to wait until June 2003, due to the severe hearing backlog in the Buffalo NY Office Of Hearings & Appeals, before my SSDI claim was finally approved.  It is hard enough to deal with all the illnesses that I have, but then to have my entire life destroyed with the stroke of pen by neglectful government employees, to whom I was just an SS number, is more than I can bear.  So now, not only will I never recover from my illnesses, but I also will never recover from the permanent financial devastation this has had on my life.  I don’t know how I am going to survive without some miracle like winning the lottery. I lost all my resources, life savings, and pension money during the 1-1/2 year wait for my SSDI claim to be processed.  Due to the 24 month waiting period for Medicare, (I didn’t become eligible for it until June 2004) I had to spend over half of my SSDI check each month on health insurance premiums and prescriptions, not including the additional co-pay fees on top of it.  All the SSDI retro pay is gone now as well – used to pay off debts incurred while waiting for 1-1/2 years to get my benefits.  I know first hand about the pain, financial, physical and emotional permanent devastation that the SSDI process can cause.  My “American Dream” will never be realized.  I have now been forced to live the “American Nightmare” for the rest of my days, because I happened to get sick, and file a claim for Social Security Disability benefits, a Federal insurance policy that I paid into for over 30 years.  As a result, I will never be able to own a home, replace my lost financial resources, or replace my only means of transportation – a failing 11 year old car, and several other necessities.  When things break down now, I cannot afford to fix or replace them and have to do without.  I currently live strictly on the inadequate, monthly SSDI check I receive, always teetering on the brink of disaster.  I do not qualify for any public assistance programs.  I am doomed to spend what’s left of my days here on earth, living in poverty, in addition to all my medical concerns.  I struggle every day to pay for food, medicines, healthcare, gas etc, and this totally unbearable, continuing source of stress and frustration, along with my worsening health conditions, is killing me.  I did not ask for this fate, and I tell you this not for pity or sympathy, but so you can get an accurate picture of what is really happening to disabled Americans in this country, whom you were elected to serve and protect.

 Call For Open Congressional/SSA Disability Hearings 

I was forced to watch this hearing on the internet, because my repeated requests over the last several years to testify in person, have been blatantly ignored.  I have made it very clear in previous written testimony submitted for the hearing record, through faxes, e-mails and phone calls, to all the Congresspeople in my district, others on this Subcommittee, including you Congressman McNulty, Congressman Rangel, and many others in both the House and the Senate Committees that affect the Social Security Disability Program in any way, that I want to testify in person at these important hearings that directly affect me and others like myself.  For some reason beyond my comprehension, you still will not let me do that.  I have been following these hearings, for over five years now, and I find it deeply disturbing, and glaringly obvious, that not one panelist/witness selected to appear, has been an actual disabled American who has tried to get Social Security Disability benefits, and who has actually experienced this nightmare.  Unfortunately this continues to be the case with this current hearing as well.  While the witnesses you continually rely on may be very reputable in their fields, unless you personally have experienced trying to file a claim for Social Security Disability, you cannot begin to understand how bad this situation really is, and therefore are not fully qualified to be the only authority on these issues.  I watched in amazement as Congressman Levin, actually mentioned that what was missing from these hearings was a “face” on this problem.  This is the first time I felt that someone finally realized what I have been trying to tell you.  But even this brief moment of brilliance, was quickly swept away as the hearing proceeded on like he had said nothing.  Based on this apathy toward Congressman Levin’s remarks, and my repeatedly denied requests to testify, it is my opinion, that you don’t want to know what is REALLY going on.  If you do not have to face someone such as myself, that has actually experienced this horrible nightmare, and has had their whole life permanently devastated as a result, we remain just a bunch of statistical SS numbers whose lives can be destroyed without guilt.  We are in fact, your mothers, fathers, sisters, brothers, children, grandparents, friends, neighbors, and honorable veterans who have served this country.

It is my understanding that there are also those within the SSA itself, who have wanted to testify for several years, and until recently have also been shut out of these hearings as well.  Something is severely wrong with this picture!  How you get an accurate handle on this situation without all the facts and possible witnesses who wish to testify in person?  I find it hard to believe that these hearings cannot be scheduled in such a way that more appropriate witnesses could be chosen to testify. 

I heard some of you talk about hearing waiting times 200 days vs 600 days, like it was nothing but a number to you.  Everyday that a disabled American must wait for their benefits, is a day that their life hangs on by a thread, or worse yet, they do not survive.  The stress from that alone is enough to kill you.  Since it has been proven over the years that the average American has about two weeks worth of savings, anything over a 14 day waiting period in any phase of the SSDI process is totally unacceptable.  Cutting the hearing wait time down to even 200 days, is nothing to tout as some great accomplishment on your part.  If any other company or organization operated with the processing times that you still consider acceptable, they would be shut down and all the employees fired within the first 6 months of operation.  Commons sense would lead you to the conclusion, that there is a strong correlation between the crisis that disabled Americans face while trying to get their benefits, and the housing, and economic meltdown this country is in the midst of.  I challenge anyone of you to try and live for more than two weeks, not relying on your assets (since many SSDI applicants lose all their assets while waiting for approval) and with absolutely no income, and see how well you survive.  Also keep in mind that you are not disabled on top of it, which adds its own challenges to the problem.

As an actual disabled American, I ask again as I have in the past, that in future Congressional hearings on these matters, that I be allowed to actively participate instead of being forced to always submit testimony in writing, after the main hearing takes place.  I often question whether anybody even bothers to read the written testimony that is submitted when I see the results of hearings that were held in the past.  I am more than willing to testify before Congress, to risk my very life for the opportunity, should I be permitted to do so.  I want a major role in the Social Security Disability reformation process, since any changes that occur have a direct major impact on my own wellbeing, and that of millions of other disabled Americans just like me.  Who better to give feedback at these hearings than those who are actually disabled themselves, and directly affected by the program’s inadequacies!  A more concerted effort needs to be utilized when scheduling future hearings, factoring in enough time to allow panelists that better represent a wider cross section of disabled Americans, to testify in person.  It seems to me if this is not done, that you are not getting a total reflection of the population affected, and are making decisions on inaccurate information, which can be very detrimental to those whom you have been elected to serve.  I also propose that Congress immediately set up a task force made up of SSDI claimants, such as myself, who have actually gone through the SSDI claims process, that has major input and influence before any final decisions/changes/laws are instituted by the SSA Commissioner or members of Congress.  This is absolutely necessary, since nobody knows better about the flaws in the system and possible solutions to those problems, then those who are forced to go through it and deal with the consequences when it does not function properly. 

I must report with great sadness and disgust, that all these hearings have not brought about much progress, if any at all, and things continue to worsen by the day.  In our country you’re required to have auto insurance in order to drive a car, you pay for health insurance, life insurance etc.  If you filed a claim against any of these policies, after making your payments, and the company tried to deny you coverage when you had a legitimate claim, you would be doing whatever it took, even suing, to make them honor your policy.  Yet the government is denying Americans their right to legitimate SSDI benefits everyday.  This is outrageous when something this serious, and a matter of life and death, could be handled in such a poor manner.  Based on my own experience, the experiences of thousands of others which have been shared with me, and current conditions, I firmly believe that the Social Security Disability program is structured to be very complicated, confusing, and with as many obstacles as possible, in order to discourage and suck the life out of claimants, hoping that they “give up or die” trying to get their SSDI benefits!  The following statistics back up my statement:

During 2006 and 2007, at least 16,000 people fighting for Social Security Disability benefits died while awaiting a decision (CBS News Report – Disabled And Waiting -  1/14/08).  This is more than 4 times the number of Americans killed in the Iraq war since it began.

During 2007, two-thirds of all applicants that were denied - nearly a million people - simply gave up after being turned down the first time (CBS News Report – Failing The Disabled - 1/15/08)

In 2007 there were 2,190,196 new applications for SSDI benefits, and as of August 2008 there have already been 1,564,160 new applications. 

As of April 2008 there are about 1,327,682 total pending cases and out of that number, 154,841 are veterans.

Nationally as of August 2008, over 63% of disability cases were denied at the initial stage of the disability claims process and it took from 101.9 – 111 days for claimants to receive the initial decision on their claim.

If a claimant appeals the initial denial asking for reconsideration, in all but 10 test states where the reconsideration phase has been removed, 86.3% of cases were denied and the waiting time for this phase was an average of 89.6 days.

As of August 2008 there are 767,595 cases waiting for hearings with an average wait time of 532 days.

As of August 2008 over 290,840 hearings (38 %) have already been pending over a year, and there are only 962 Administrative law judges (ALJ’s), to hear all those cases, with an average of 660.58 cases pending per judge nationwide. 

If a claimant appeals an ALJ hearing decision to the Federal Appeals Council, the average time from request for AC/Appeals Council Review to Appeal Council's Decision is 8 months.   NOTE:  It is not unusual to find cases pending for up to 24 months for various reasons.  Cases pending longer than 24 months are then considered for expedited processing.   In 2006 - 71% of  the 88,907 cases that were sent to the Appeals Council were denied.

In 2007 - 637,686 disabled Americans were forced by law to endure the mandatory 24 month waiting period for eligibility to receive much needed  Medicare benefits.

Source: Social Security Administration Reports

According to Health Affairs, The Policy Journal of the Health Sphere, 2 February 2, 2005: Disability causes nearly 50% of all mortgage foreclosures, compared to 2% caused by death. 

“The escalating pace of foreclosures and rising fears among some homeowners about keeping up with their mortgages are creating a range of emotional problems, mental health specialists say.  Those include anxiety disorders, depression, and addictive behaviors such as alcoholism and gambling.  And, in a few cases suicide.

“Historically, research shows, rates of depression and suicide tend to climb during times of economic tumult.”

“Studies show a strong connection between financial distress and emotional stress, including anxiety, depression, insomnia and migraines.”

Excerpts from Foreclosures Take Toll On Mental Health – Crisis Hotlines, Therapists See A Surge In Anxiety Over Housing - USA Today – Stephanie Armour – 5/15/08

AARP/USA Today: Health Care To Get The Hollywood Treatment – 5/28/08 - “More middle-class people file for bankruptcy because of health care related expenses than for any other reason.”

MarketWatch: Illness And Injury As Contributors To Bankruptcy - February 2, 2005 – found that:  Over half of all personal U.S. bankruptcies, affecting over 2 million people annually, were attributable to illness or medical bills.  15% of all homeowners who had taken out a second or third mortgage cited medical expenses as a reason.

According to an insurance survey, conducted by the International Communications Research of Media, PA from Jan 10-14th 2007, on behalf of the National Association of Insurance Commissioners, researchers found 56% of U.S. workers would not be able pay their bills or meet expenses if they become disabled and unable to work.  71% of the 44% who had insurance, stated it was employer provided, so if they lose or change jobs they would no longer have disability coverage. 

In April 2006, Parade Magazine in an article called “Is The American Dream Still Possible?” - published the results of their survey of more than 2200 Americans who earned between $30,000 and $99,000 per year, most stating that they were in reasonably good health.  66% say they tend to live from paycheck to paycheck and nearly 83% say that there is not much money left to save after they have paid their bills. 

Nearly 1 in 2 (133 million) Americans live with a chronic condition.

20.6% of the population, about 54 million people, have some level of disability

9.9% (26 million people) have a severe disability

Note: The sources for these statistics and even more information is listed here:

http://www.mychronicillness.com/invisibleillness/statistics.htm

Approximately 54 million Americans, an estimated 20% of the total population, have at least one disability, making them the largest minority group in the nation, and the only group any of us can become a member of at any time.  As our baby boomer population ages and more veterans return from war, this number will double in the next 20 years.  It is a diverse group, crossing lines of age, ethnicity, gender, race, sexual orientation and socioeconomic status.

Between 1990 and 2000, the number of Americans with disabilities increased 25 percent, out pacing any other subgroup of the U.S. population.

Of the 69.6 million families in the United States, more than 20 million have at least one family member with a disability.

People with disabilities are nearly twice as likely as people without disabilities to have an annual household income of $15,000 or less.

There are 133 million people in the United States living with a chronic health condition. That number is expected to increase by more than one percent a year to 150 million by 2030.  75% of people with chronic health conditions are younger than 65

Notwithstanding the strides made in disability rights in the past 25 years, the majority of people with disabilities are poor, under-employed and under-educated due largely to unequal opportunities.

The source for these statistics: Disability Stats And Facts – Disability Funders.org

http://www.disabilityfunders.org/disability-stats-and-facts

52% of Americans would rather die than live with a severe disability, according to a recent national survey commissioned by Disaboom (www.disaboom.com), the premiere online community for people touched by disability.

Disaboom Press Release – July 2008

Two-thirds of those who appeal an initial rejection eventually win their cases (New York Times 12/10/07)

It is also important to mention here that I am also President/Co-Founder of the Social Security Disability Coalition, which is made up of thousands of Social Security Disability claimants and recipients from all over the nation, and our membership increases by the day.  It was born out of the frustration of my own experience, and the notion that others may be dealing with that same frustration.  I was proven to be totally correct in that notion beyond my wildest imagination.  Our group is a very accurate reflection and microcosm of what is happening to millions of Social Security Disability applicants all over this nation.  If you visit the Social Security Disability Coalition website, or the Social Security Disability Reform petition website:

Social Security Disability Coalition – offering FREE information and support with a focus on SSD reform:

http://groups.msn.com/SocialSecurityDisabilityCoalition

Sign the Social Security Disability Reform Petition – read the horror stories from all over the nation:

http://www.petitiononline.com/SSDC/petition.html

You will read over five years worth of documented horror stories on our Messageboard (over 19,000 messages), and see thousands of signatures (over 7800) and comments on our petition, from disabled Americans whose lives have been harmed by the Social Security Disability program.  You cannot leave without seeing the excruciating pain and suffering that these people have been put through, just because they happened to become disabled, and went to their government to file a claim for disability insurance that they worked so very hard to pay for.  I must take this opportunity to tell you how very proud I am of all our members, many like myself, whose own lives have been devastated by a system that was set up to help them.  In spite of that, they are using what very little time and energy they can muster due to their own disabilities, to try and help other disabled Americans survive the nightmare of applying for Social Security Disability benefits.  There is no better example of the American spirit than these extraordinary people!  

This organization fills a void that is greatly lacking in the SSDI/SSI claims process.  While we never represent claimants in their individual cases, we are still able to provide them with much needed support and resources to guide them through the nebulous maze that is put in front of them when applying for SSDI/SSI benefits.  In spite of the fact that the current system is not conducive to case worker, client interaction other than the initial claims intake, we continue to encourage claimants to communicate as much as possible with the SSA in order to speed up the claims process, making it easier on both the SSA caseworkers and the claimants themselves.  As a result we are seeing claimants getting their cases approved on their own without the need for paid attorneys, and when additional assistance is needed we connect them with FREE resources to represent them should their cases advance to the hearing phase.   We also provide them with information on how to access available assistance to help them cope with every aspect of their lives, that may be affected by the enormous wait time that it currently takes to process an SSDI/SSI claim.  This includes how get Medicaid and other State/Federal programs, free/low cost healthcare, medicine, food, housing, financial assistance and too many other things to mention here.  We educate them in the policies and regulations which govern the SSDI/SSI process and connects them to the answers for the many questions they have about how to access their disability benefits in a timely manner, relying heavily on the SSA website to provide this help.  If we as disabled Americans, who are not able to work because we are so sick ourselves, can come together, using absolutely no money and with very little time or effort can accomplish these things, how is it that the SSA which is funded by our taxpayer dollars fails so miserably at this task

There are three key reasons why the Social Security Disability program has been broken for decades, lack of proper funding for the SSA, apathy on the part of Congress and the SSA to fix the problems, and lack of crucial oversight on all parts of the program.  In order for the hearing backlog to be eliminated these problems must be addressed.

I continually hear talk at these hearings about increasing the funding for the SSA, and you asking witnesses for answers, on how much the SSA will need to fix the current problems, and prevent new ones from arising in the future.  Still I see that the SSA is under funded almost every year, and there is a continued challenge to get the money that the SSA requests.  All money that is taken out of American’s paychecks for Social Security should not be allowed to be used for anything else other than to administer the program and pay out benefits to the American people.

Excerpt from: Social Security Administration: Inadequate Administrative Funding Contributes to the Disability Claims Backlog Crisis and Service Delivery Challenges

“Due to budget constraints in recent years the amount of administrative funding the Social Security Administration (SSA) has received through the annual appropriations process has been significantly below the level necessary to keep up with the agency’s workloads.  From 2001 to 2007, Congress appropriated approximately $150 million less per year for SSA’s administrative funding needs than the President requested.  In FY 2006 the final funding level approved by Congress was $300 million less than the President’s Budget Request.  In FY 2007 it was $200 million less.  The FY 2008 enacted level was $148 million above the President’s requested budget and it was the first time this decade that Congress has been able to provide funding above the President's request.  However, the funding for Fiscal Year 2008 was $127 million less than the Conference Agreement on the FY 2008 Labor-HHS Appropriations bill would have provided.  The level agreed to by Congress was reduced due to the Presidential veto of the Labor-HHS Appropriations bill.”

Source: National Council of Social Security Management Associations (NCSSMA) September 17, 2008

One thing is said at the hearings, but when push comes to shove to vote for the SSA budget money, other programs or projects become higher priority, even though properly funding the SSA is literally a matter of life and death for millions of Americans.  Even as I write this testimony, both the Senate and the House are voting on a continuing resolution package to provide stopgap funding for the Federal Government through March of 2009, but there are no special provisions for the SSA in this CR, which is going to make a horrendous situation even worse.  Nothing is more important than the health and wellbeing of the American people, and as elected officials it is crucial that you never lose sight of that priority!  SSA should not have to compete each year for funding with the Departments of Labor, HHS and Education which are highly  publicized and therefore, often more popular programs.   As stated in the previous testimony provided by Witlold Skierwczynski – President – National Council Of Social Security Administration Field Operation Locals to the House Ways And Means Committee on 4/23/08 it is recommended that:

Congress should enact off budget legislation including SSA administrative expenses with benefits which are already off budget.  Congress should retain appropriations and oversight authority albeit unencumbered by artificial budget caps and scoring restrictions.

Congress should enact legislation requiring the Commissioner to submit the SSA appropriation request directly to Congress.

Congress should support the House Budget Committee recommendation to increase the SSA administrative budget by $240 million over the President’s budget request.

The SSA Commissioner Improperly Allocated ALJ's For SS Disability Hearings - Recently SSA Commissioner Michael Astrue asked Congress to approve extra funding in order to hire additional ALJ’s to try and reduce the severe SS Disability hearings backlogs across the country.  While I agree that the SSA does need more funding, in fact way more than was actually finally given to them in 2008, there must be some major oversight by independent entities to ensure that these funds in fact are actually used/allocated appropriately.  Here is a recent example that raises a red flag for such oversight and an immediate investigation.  At the link below you will find a spreadsheet that shows the locations where the newly acquired ALJ hires announced by the SSA Commissioner had been allocated:

http://www.ssa.gov/legislation/ALJAppointmentsbyState032508.xls

As you will see on this report – no ALJ’s were originally allocated to the Buffalo/Rochester NY area, which is one of the worst in the nation for processing SS Disability hearings.                                                                                                                                                                          

As of August 2008:

 It took 715 days (nearly two years) for the average Western New Yorker to have their SSA case heard and processed in the Buffalo NY Office Of Hearings & Appeals.  This office is the worst in NY State for SS Disability hearing backlogs and out of 147 hearing offices reporting nationwide, Buffalo ranks at #130, as one of the worst processing times in the country.  It ranks at #114 out of 150 hearing offices reporting, where the average age of a case pending a hearing is 349 days.  Administrative Law Judges in Buffalo have some of the largest caseloads in the country, ranking at #107, out of 137 hearing offices reporting nationwide, with an average of 796.64 cases pending before each judge.

As of July 2008:

 47% (5,542) of cases in the Buffalo Hearing Office (which is higher than the national average) had been pending for over a year.

Commissioner Astrue used the argument that there was not enough office space in the Buffalo hearing office but that was immediately refuted by Congressman Brian Higgins:

Congressman Higgins Says Lack of Space Is Poor Argument for Staffing Shortfalls in Local Social Security Disability Office – 4/24/08

http://higgins.house.gov/newsroom.asp?ARTICLE3116=7715

“If the problem is office space, I would be happy to find them available space in downtown Buffalo tomorrow,” Higgins added, pointing out that according to a Militello Realty report on downtown Buffalo property, as of January 779,228 square feet of Class A office space was vacant in the immediate downtown area.  Congressman Higgins noted that staffing shortages aren’t exclusive to the Administrative Law Judges.  Staffing at Western New York field offices have decreased substantially – by approximately 170 employees - over the past 25 years, even though the need for services has increased.”

It was only after heavy pressure by Congress, and major media exposure, that additional ALJ’s were added to the Buffalo/Rochester NY  area.  How many other states is this happening to?  Where is the much needed oversight to ensure that these ALJ’s are properly allocated where they are needed the most?

In an editorial letter from SSA Commissioner Astrue dated 8/21/08 to the Atlanta Journal Constitution in regards to the severe hearing backlogs it was stated that “We have taken a big step toward resolving that problem by bringing onboard 175 additional administrative law judges and additional staff to support them..”

In reality:

At of the end of fiscal year 2007 the amount of ALJ’s available to hear cases was at 1006.  That number has steadily declined over the past several months and as of August 2008 there were in fact only 962 ALJ’s currently available to hear cases*.  The 175 new ALJ’s that the SSA Commissioner has hired, (NOTE: most of the 175 newly hired ALJ’s may actually already be factored into the August 2008 - 962 number - the report does not distinguish) once they are fully operational.  In January 2008 there were 945 ALJ’s * (a significant drop) from FY 2007 and that may in fact only increase the available ALJ level to 114 judges (not 175), over the number that were available to hear cases at the end of FY 2007.  Basically this is still inadequate level, since it does not account for the fact that more judges may continue to leave for various reasons (retirement etc), and that the level of disability claims continues to increase instead of decrease, based on past history.  So the likelihood of the claims backlog being resolved with this so called “current fix” is slim to none.  In other words “this is like putting a band aid on a gushing wound.” More investigation of this problem by Congress, the Inspector General and GAO needs to happen immediately!

*Source: Social Security Administration Reports

In a January 2007 Harris poll designed to evaluate the services provided by 13 federal agencies, the public rated SSA at the bottom of the public acceptance list and it was the only agency that received an overall negative evaluation.  SSA Field Offices have lost over 2,500 positions since September 2005 and nearly 1,400 positions since September 2006.  In 2007 SSA Field Offices saw about 43 million visitors a week, and that number is expected to increase by over a million more in 2008.  Constituents visiting these local Field Offices continue to experience lengthy waiting times and the inability to obtain assistance via the telephone. 

Here is just a small sampling of some of the major problems with the current Social Security Disability program and State Disability (DDS) offices who process the initial phase/medical portion of disability claims:

Severe under staffing of SSA workers at all levels of the program Claimants waiting for weeks or months to get appointments, and hours to be seen by caseworkers at Social Security field offices Extraordinary wait times between the different phases of the disability claims process

Very little or no communication between caseworkers and claimants throughout the disability claims process before decisions are made.

Employees being rude/insensitive, not returning calls, not willing to provide information to claimants or not having the knowledge to do so

Complaints of lost files and in some states, case files being purposely thrown in the trash rather than processed properly

Security Breaches - Complaints of having other claimants information improperly filed/mixed in where it doesn't belong and other even worse breaches

Fraud on the part of DDS/OHA offices, ALJ's, IME's – purposely manipulating or ignoring information provided to deny claims, or doctors stating that they gave medical exams to claimants that they never did.

Claimants being sent to doctors that are not trained properly, or have the proper credentials in the medical field for the illnesses which claimants are being sent to them for.

Complaints of lack of attention/ignoring - medical records provided and claimants concerns by Field Officers, IME doctors and ALJ's.

Employees greatly lacking in knowledge of and in some cases purposely violating Social Security and Federal Regulations (including Freedom of Information Act and SSD Pre-Hearing review process).

Claimants cannot get through on the phone to the local SS office or 800 number (trying for hours even days)

Claimants getting conflicting/erroneous information depending on whom they happen to talk to at Social Security - causing confusion for claimants and in some cases major problems including improper payments

Proper weight not being given to claimants treating physicians according to SSA Federal Regulations when making medical disability determinations on claims.

Complaints of ALJ's "bribing" claimants to give up part of their retro pay (agreeing to manipulation of disability eligibility dates) or they will not approve their claims

Poor/little coordination of information between the different departments and phases of the disability process

Complaints of backlogs at payment processing centers once claim is approved

Federal Quality Review process adding even more wait time to claims processing, increasing backlogs, no ability to follow up on claim in this phase

NOTE: These complaints refer to all phases of the SSDI claims process including local field offices, state Disability Determinations offices, CE/IME physicians, Office of Hearings and Appeals, the Social Security main office in MD (800 number)

Excerpts from: Social Security Administration: Inadequate Administrative Funding Contributes to the Disability Claims Backlog Crisis and Service Delivery Challenges

SSA has two classes of phone service: 800 Number and Field Office.  The 800 Number had a busy rate of 7.5% in FY 2007 and handled about 59 million calls through agents and automation.  At the same time over 60 million phone calls are directed to SSA Field Offices each year.  In FY 2007, 45% of callers who eventually reached a Field Office by telephone said that they had received a busy signal or were told to call back at another time on an earlier call.  Consequently, the actual busy rate is higher than 45%.

About 43 million people visited SSA Field Offices for assistance in 2007.  SSA Field Offices continue to receive more and more customers.  This year SSA Field Offices are expected to see more than a million more customers than last year.  One manager stated this in a recent NCSSMA survey:  “The staff usually feels overburdened with the never-ending volume of interviews.  They are usually one after the other daily with no ending.  They are in need of time at their desk to process the numerous listings and actions that go with them.”

 In a survey by the National Council of Social Security Management Associations (NCSSMA) of their members performed in May 2008, they received the following feedback:

81% stated they did not have enough staff to keep workloads current

64% stated waiting times for the public were longer than they were one year ago

65% stated the quality of their office work product has declined in recent years

45% stated they could provide prompt telephone service 0-40% of the time

49% stated their staff did not receive adequate training which was primarily due to lack of time an increasing pressure to process workloads

Since Social Security Disability is a Federal program, where you live should not affect your ability to obtain benefits. Sadly this is not the case.  While funding is a major problem that SSA faces, the other primary reason for these hearing backlogs, continues to be ignored during these proceedings, and that is the initial phase of the disability qualification process which is handled by the individual state DDS/Disability Determination Services offices.  There, the most crucial part of your disability claim, the medical portion, is reviewed by a caseworker/adjudicator and medical doctor on their staff who never sees you, and in most cases never even communicates with you at all. 

Excerpts from GAO Report GAO-04-656 – SSA Disability Decisions: More Effort Needed To Assess Consistency of Disability Decisions – Washington – July 2004 which can be found at:

http://www.gao.gov/new.items/d04656.pdf

 “Each year, about 2.5 million people file claims with SSA for disability benefits...About one-third of disability claims denied at the state level were appealed to the hearings level; of these, SSA’s ALJ’s have allowed over one-half, with annual allowance rates fluctuating between 58 percent and 72 percent since 1985.  While it is appropriate that some appealed claims, such as those in which a claimant’s impairment has worsened and prohibits work, be allowed benefits, representatives from SSA, the Congress, and interest groups have long been concerned that the high rate of claims allowed at the hearing level may indicate that the decision makers at the two levels are interpreting and applying SSA’s criteria differently.  If this is the case, adjudicators at the two levels may be making inconsistent decisions that result in similar cases receiving dissimilar decisions.”

“Inconsistency in decisions may create several problems... SSA rulings are binding only on SSA adjudicators and do not have to be followed by the courts...Adjudicators currently follow a detailed set of policy and procedural guidelines, whereas ALJ’s rely directly on statutes, regulations, and rulings for guidance in making disability decisions...If deserving claimants must appeal to the hearings level for benefits, this situation increases the burden on claimants, who must wait on average, almost a year for a hearing decision and frequently incur extra costs to pay for legal representation...SSA has good cause to focus on the consistency of decisions between adjudication levels.  Incorrect denials at the initial level that are appealed increase both the time claimants must wait for decision and the cost of deciding cases.  Incorrect denials that are not appealed may leave needy individuals without a financial or medical safety net...An appeal adds significantly to costs associated with making a decision.  According to SSA’s Performance and Accountability Report for fiscal year 2001, the average cost per claim for an initial DDS disability decision was about $583, while the average cost per claim of an ALJ decision was estimated at $2,157...An appeal also significantly increases the time required to reach a decision.  According to SSA’s Performance and Accountability Report for fiscal year 2003, the average number of days that claimants waited for an initial decision was 97 days, while the number of days they waited for an appealed decision was 344 days...In addition, claimant lawsuits against three state DDS’s have alleged that DDS adjudicators were not following SSA’s rulings or other decision making guidance...However, according to DDS stakeholder groups, SSA has not ensured that states have sufficient resources to meet ruling requirements, which they believe may lead to inconsistency in decisions among states.  Furthermore, SSA’s quality assurance process does not help ensure compliance because reviewers of DDS decisions are not required to identify and return to the DDS’s cases that are not fully documented in accordance with the rulings.  SSA procedures require only that the reviewers return cases that have a deficiency that could result in an incorrect decision.”

Excerpt from: Social Security Administration: Inadequate Administrative Funding Contributes to the Disability Claims Backlog Crisis and Service Delivery Challenges

“The Disability Determination Services (DDSs) have lost about 1,270 positions since the beginning of Fiscal Year 2006, as a result their staffing levels are down about 8.7%.  The attrition rate in recent years at the DDSs has averaged 12.7 % versus 6.8% for Federal government employees.  This has forced the DDSs to invest significant resources to train new staff.  The DDSs will not be able to adequately address staffing losses either.”

Source: National Council of Social Security Management Associations (NCSSMA) September 17, 2008

What would be an incentive for states to deny Federal claims?  Since many Social Security Disability claims are SSI or both SSI/SSDI combined claims and many states offer to supplement SSI payments at a higher benefit amount, therefore they want to keep as many off the rolls as possible so they do not have to pay out this supplement.  Also since there is a different pay scale for government vs state employees who are often underpaid, lack training, are overworked, and must meet quotas of cases processed, the tendency is greater to rubber stamp denials to move claims off their desk when a case needs too much development.  Thus the explanation for the fluctuation in denial/approval/backlog rates by state.  Unfortunately there is very little if any training or oversight on the state DDS offices to make sure they are making the proper decisions on disability claims.  This is why so many claimants appeal to the hearing level where a huge percentage of bad claims decisions are overturned and cases are finally approved.  Anyone who doesn’t see that a “Culture Of Denial” has become a pervasive part of an SSDI claimants encounter with the SSA, is either totally out of touch with reality or is reacting evasively to the subject. 

The SSDI/SSI process is bogged down with tons of paperwork for both claimants and their treating physicians, and very little information is supplied by Social Security, as to the proper documentation needed to process a claim properly and swiftly.  When you file a claim for benefits, you are not told that your illness must meet standards under the Disability Evaluation Under Social Security “Blue Book” listing of medical impairments, or about the Residual Functional Capacity standards that are used to determine how your disability prevents you from doing any sort of work in the national economy, or daily activities, when deciding whether or not you are disabled.  In other words since the process is so nebulous from beginning to end, the deck is purposely stacked against a claimant from the very start.  Also many times medical records submitted are lost or totally ignored.  If more time and effort were put forth to communicate with claimants, and to make the proper decision at the onset, there would be no need for all these cases to be appealed to the hearings level in the first place.  That in itself would be a huge factor in reducing the hearing backlogs, but again, this fact has been greatly ignored and it is a major failure on your part.  Until you properly devote the time and energy to look into this crucial part of the problem, the hearing backlogs will continue to grow at an uncontrollable rate, no matter how much money you give to the SSA.  

All phases of disability claims processing should be moved to and handled out of the Social Security individual field offices, including the DDS phase which is the medical determination phase currently handled by the states, and all hearing phases of the disability process.  All people who process Social Security disability claims should be employees of the Federal Government to ensure accuracy and uniform processing of disability claims under Federal regulations and Social Security policies which is currently not the case.  If the states are to continue to handle the DDS phase of the disability process, then all state employees handling Social Security claims should be required to receive a minimum of 3 months standardized training by the Social Security Administration, in SSA policies and Federal regulations governing SSDI/SSI claims processing.

Too much weight at the initial time of filing, is put on the independent medical examiner’s and SS caseworker’s opinion of a claim.  The independent medical examiner only sees you for a few minutes and has no idea how a patient’s medical problems affect their lives after only a brief visit with them.  The caseworker at the DDS office never sees a claimant.  There needs to be more oversight that disability decisions be based with controlling weight given to the claimant’s own treating physicians opinions and medical records in accordance with (DI 24515.004) SSR 96-2p: Policy Interpretation Ruling Titles II And XVI: Giving Controlling Weight To Treating Source Medical Opinions.  Even though this policy ruling is in place, this is very often not happening.  Since many times doctors, hospitals etc often do not respond to SSA requests for medical information in a timely manner, or sometimes ignore these requests entirely, ALL doctors, and medical professionals including those at the VA should be required by Federal or State law, to fill out any medical forms and submit documents requested by the SSA within strict timelines or they will not be allowed to practice medicine in this country.  Also as part of their continuing education program in order to keep their licenses, doctors should also be required to attend seminars provided free of charge by the SSA, in proper procedures for writing medical reports and filling out forms for Social Security Disability and SSI claimants.  More communication between caseworkers and claimants throughout all phases of the disability process.  Review of records by claimant should be available at any time during all stages of the disability determination process.  Before a denial is issued at any stage, the applicant should be contacted as to ALL the sources being used to make the judgment.  It must be accompanied by a detailed report as to why a denial might be imminent, who made the determination and a phone number or address where they could be contacted.  In case info is missing or they were given inaccurate information the applicant can provide the corrected or missing information before a determination at any level is made.  This would also eliminate many cases from having to advance to the hearing or appeals phase.

 There seems to be a relationship, between SSDI claims processing issues/backlogs, and the need for claimants to also apply for state funded Medicaid/Social Service programs.   Many are forced to file for Medicaid, food stamps and cash assistance, another horrendous process.  For example in New York State, about half the 38,000 people now waiting on disability appeals, for an average of 21 months, are receiving cash assistance from the state (New York Times 12/10/07).  Those who file for these programs while waiting to get SSDI benefits, in many states, have to pay back the state out of their meager benefit checks once approved.  As a result they’re often kept below the poverty level, almost never able to better themselves since they can’t work, and now are forced to rely on both state and federally funded programs instead of just one of them.  This practice should be eliminated. 

 Utilize Hearing On The Record/Pre-Hearing Review Option To Reduce Backlogs

 More emphasis and support staff need to be devoted to the pre-hearing review process which could greatly reduce the current hearing backlog.  This would obviously and should require more communication between hearing office staff and claimants or their representatives to update case files.  Once the files have been updated, many would be able to be decided solely on the records in the file without having a full hearing in front of an ALJ.

When a veteran has a 100% disability rating , receives VA benefits approval for that rating, and it is deemed by the VA that they can no longer work at any job under SSA Guidelines, that veteran should automatically be approved for their Social Security Disability/SSI, as long as they also meet the Non-Medical requirements for  those benefits.  In addition all VA doctors should be trained and required to fill out Social Security Disability forms for their patients, whose VA disability rating is less than 100%, but may still be unable to work due to their disabilities and require SSDI/SSI benefits.  These claims should be processed by a special division within the SSA or the VA that is equipped to process both claims simultaneously.  Congress and the SSA should designate special funding to see that this is implemented immediately for our veterans, so it moves a large group of claimants through the system faster thus reducing the backlog problem. 

Regulation Is Necessary To Avoid Improper Social Security Disability Claim Filings Due To State And Private Insurance Company Policies

There is a growing number of claims being filed by people who may not actually qualify for disability benefits under Social Security guidelines, but who are being forced to file Social Security Disability/SSI claims by their private disability and state disability carriers or risk not being eligible for benefits under those programs.  Recently there has been media coverage on this issue which can be found here:

Trial Against Unum Over Handling of Disability Insurance Claims Opens Today - Market Watch - PRNewswire via COMTEX - Boston - 9/22/08

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=109&STORY=/www/story/09-22-2008/0004890097&EDATE=

Senate Asks 9 Insurers To Furnish Information - NY Times – Mary Williams Walsh – 7/25/08

http://www.nytimes.com/2008/07/25/business/25insure.html?_r=2&adxnnl=1&oref=slogin&ref=business&adxnnlx=1216988114-xUJWefbXim4ZjKuyMloRVA&oref=slogin

Insurers Faulted As Overloading Social Security – NY Times – Mary Williams Walsh – 4/1/08

http://www.nytimes.com/2008/04/01/business/01disabled.html

Congress and the SSA needs to look into this issue and this practice needs to be stopped immediately as this too greatly adds to the disability backlog problem. 

Americans Most Sensitive Data In Jeopardy

I was very disturbed to learn as I watched this hearing, about the practice of allowing SSA employees to take work home with them.  The following article discusses the SSA employee work at home situation. 

Concern Over Federal Times Article: Arbitrator Tells SSA To Restore Telework, Negotiate Changes – Federal Times - Courtney Mabeus – 4/16/08

http://www.federaltimes.com/index.php?S=3482166

I am very concerned with the increased possibility of identity theft if SSA employees are allowed to take work home because they are too overloaded on their jobs.  Employees should never be allowed to take this sensitive data home for any reason.  Sensitive data has already been compromised at the VA, and this should not be allowed to happen ever again, especially jeopardizing our most vulnerable citizens to this very real and stressful possibility.  I have personally caught the SSA in some major security breaches already, and this practice will only make those incidents even more common.  Every effort must be made to properly secure this most sensitive information for the American people.  In order to properly protect citizen's identities ALL sensitive data should only be able to be accessed on government secure systems at the job site only.  This is obviously going to require more manpower and financial resources, and Congress must make sure that the SSA has every resource it needs to protect this data, at their disposal immediately.  

There are some very detrimental, regulations that SSDI applicants are subject to as well, and are a great shock to them.  Under Federal law, there’s a five month benefit waiting period, and five months of back money withheld, which claimants will never see again.  It was originally six months but Congress voted to reduce it to five.  Apparently it is assumed that disabled Americans do not need that money.   SSDI recipients must also wait another 24 months, in addition to the 5 month waiting period from disability date of eligibility (the date that SS determines that you were officially disabled) in order to qualify for Medicare benefits.  Keep in mind that if you let any sort of health insurance policies lapse for too long, and don’t maintain continuous health coverage, you may have a very difficult time getting a new insurance carrier, since they may hold your poor health against you, and consider many things as “pre-existing conditions” so you may not be covered for those illnesses.  Congress expects a population who can no longer work, to go without five months of retro pay, have no health insurance, and wait several months to several years to have their disability claims processed.  In my state when a healthy person loses their job, provides the necessary documents and files for Unemployment Insurance, their payments automatically start within a few weeks.  It is blatantly obvious that those who find this to be acceptable standards are totally out of touch with reality and have no regard for human life. 

Permanent Devastation Resulting From The SSDI Claims Process

Unbearable stress, severe depression and suicidal thoughts are very common side effects of the SSDI/SSI claims process.  Many are under the mistaken notion that when the SSDI benefit checks finally come, if one is in fact finally approved, that everything will be OK.  Often the abuse and worry that applicants are forced to endure, and the devastation caused while waiting for SSDI claims to be processed, leaves permanent scars on one’s health and financial wellbeing as it did for me. It causes even further irreparable damage to their already compromised health, and it is totally unacceptable.   As a result use of the highly promoted SS Ticket to Work program, or any future chance of possibly getting well enough to return to the work force, even on a part time basis, becomes totally out of the question.  Then if you eventually get approved for benefits, there is always the added stress of having to deal with the SS Continuing Disability Review Process every few years, where the threat of having your benefits suddenly cut off constantly hangs over your head.

I not only have complaints which I have presented today, but also many solutions to this crisis, so I hope you will join me in my quest for total reform of this program.  Please introduce/support - Fullerton - Edwards Social Security Disability Reform Act:

http://groups.msn.com/SocialSecurityDisabilityCoalition/fullertonedwardssocialsecuritydisabilityreformact.msnw