Her husband filed for disability after a 3rd heart attack. He died waiting for an answer

Eileen Gabaldon read about John Tovar’s struggles to get an answer on his Social Security disability claim, and her heart ached. He is still waiting, but at least, she thought, he is still alive.

Her husband, Larry, isn’t. He died waiting for a ruling on his disability claim.

Gabaldon and many others in Fort Worth and from across the country called and emailed the Star-Telegram to share their horror stories of long waits to get to a disability benefits hearing before an administrative law judge, the third step in a lengthy process.

More than 1 million Americans are awaiting a hearing with an average wait of two years. The average wait time in Fort Worth is 483 days, which is one of the faster rates in the country, according to statistics provided by the Social Security Administration.

The system is broken and backlogged to the point that some people who can no longer work because of physical disability or debilitating illness are losing their homes and life savings.

In Richmond, Va., Katie Pegram, a former nurse, lives in dire pain because of nerve damage. She made a desperate call for help to the Star-Telegram regarding three denials for benefits. She says she has lost her home and dignity.

The average wait time for a hearing in Richmond is 652 days. Living with her brother a few days each week and then a friend for the other days, Pegram, 51, waited three years to learn she did not qualify for benefits.

“I just went to pieces and I’m really trying to keep it together,” said Pegram, whose husband died from lung cancer in 2012, the same year she applied for disability benefits. “I was a nurse, a good nurse. I made good money and I can’t even take care of myself now. I received a letter that said I can appeal again, but it can take eight to 19 months.

“I’m breaking down. I am not going to survive another eight to 19 months. I know I’m not.”

Last year, 7,400 people on wait lists had died, according to a report by Social Security’s inspector general.

Fears unfounded

Initially Gabaldon, and others who contacted the Star-Telegram, said they were hesitant to air their grievances publicly for fear it would be detrimental to their cases.

Those fears are unfounded, said prominent disability attorney Charles Hall of Raleigh, N.C. He believes the Social Security Administration follows press reports and “perhaps usually speeds up the process when a case gets reported.”

A staff member for Rep. Sam Johnson, a Plano Republican who serves as the chairman of the Social Security Subcommittee on the House Ways and Means Committee, said claimants who think they have been retaliated against or treated unfairly can file an unfair treatment complaint. Johnson has implored President Donald Trump to nominate a commissioner to head the SSA.

A spokeswoman for Trump did not reply to questions inquiring if the president has a plan for selecting a nominee.

“Americans rightfully expect that they will hear back from Social Security quickly, but unfortunately that’s not always the case,” Johnson said in an email to the Star-Telegram. “Social Security’s hearing backlog is simply unacceptable, and it’s going to take real leadership to turn things around.”

Social Security experts argue Congress must significantly increase funding to the SSA so it can hire more staff to run the organization more efficiently. Citizens who have paid into Social Security throughout their working lives and are now caught up in the chaos of a broken system aren’t holding out hope for progress.

From September 2015 to September 2017, the number of SSA workers decreased from 65,717 to 62,297 while the workload continued to increase. The administration has not had a Senate-confirmed commissioner since 2013, the equivalent of a major corporation operating without a CEO.

Speaking out

Assurances that grievances could not be used against her claim was not enough for a Westworth Village woman, who first filed for disability benefits in December 2015 and is scheduled for a hearing in March 2018.

A former medic, her email detailed her medical history that included Hodgkin’s disease, a heart transplant, heart damage because of radiation, chronic obstructive pulmonary disease and a bout with breast cancer from which, she said, surgery led to nerve damage in her back and arms.

“I heard all the horror stories about trying to get disability, but I thought because of all my health problems I wouldn’t have any problems getting SSDI, but I sure was wrong,” she said, unwilling to use her name. “I am very lucky that my ex-husband helps me pay the bills. Otherwise, I would have lost my house and filed for bankruptcy.”

After learning that her status could not be negatively affected by speaking out, Gabaldon, a human resources manager for a law firm in downtown Fort Worth, permitted the Star-Telegram to use her full name. She detailed her frustrations with the system in a lengthy email that opened:

“My husband Larry had a heart attack with cardiac arrest for over an hour in February 2015. It was his third heart attack. He had a brain injury from lack of oxygen. He spent over a month in the hospital and 5 months in an outpatient brain injury rehabilitation program.”

Larry, who worked for CVS Caremark, was never able to return to work. He lost his memory going back 20 years. He thought it was the early 1990s. A widower, he thought he was still married to his first wife.

When Eileen told him she was his wife, he thought he had two wives. In addition to severe heart problems, Larry suffered from anxiety, had almost no short-term memory and had dexterity and balance issues.

He was twice denied disability benefits, setting him up for the long wait for a disability hearing in front of an administrative law judge.

The second denial came with the reasoning that Larry could return to a former job as a bank teller. Eileen, who said he was left with limited use of his hands, scoffed at the notion.

Larry died after a fourth heart attack in July 2016. Nine months later in April 2017, Eileen appeared on his behalf at his disability hearing before a judge. Larry was awarded nearly $17,000 in benefits, money Eileen said she will use to pay toward $40,000 in out-of-pocket medical expenses.

However, eight months after the hearing, the check still has not arrived.

“I was told [Monday] they would send another high-priority message to the payment center, but they may or may not get to it any quicker because of the volume of cases,” Eileen said.

Help for the most needed

Experts recommend those who become disabled and submit a claim for Social Security disability benefits retain a lawyer or seek representation from a company that specializes in disability claims, such as Allsup.

For the hardest hit financially like Pegram, who are living with family or friends, or are forced to live out of a vehicle or in a shelter, or who live in a residence without utilities, there is an avenue to expedite the process. Wounded veterans, those with terminal illness or people who are suicidal also qualify to have their cases expedited.

Hall, the attorney, created a cover letter for such clients that clearly states the reason for expedition and he includes the designations where each provision can be found in the agency’s manuals.

Yet every hardship case that gets expedited pushes another case behind.

Hall’s advice for anyone who believes they qualify for disability benefits is to start the process immediately. Too many people, he said, are convinced they will get better and will be able to return to work.

“They view filing for Social Security disability as unpleasant and demeaning. They think of it as a one-way trip, that if they file a disability claim that they can’t ever return to work. That’s not the way it is,” Hall said.

“If a claimant gets better, they can always return to work. It’s frustrating to me that many of my clients wait until they’re destitute before ever filing a claim,” he said.

“It’s bad enough if you file the claim quickly. It’s so much worse if you wait until you’re homeless.”

This story was originally published December 6, 2017 at 9:41 AM with the headline "Her husband filed for disability after a 3rd heart attack. He died waiting for an answer."