Nov. 27, 2014

This Week's SFR Picks

Newsletters

Choose your newsletter(s):
* indicates required

SFR Events

Special Issues

 

 
Home / Articles / News / Features /  SOS
SOS_main

SOS

Can anyone fix social security's broken benefits system?

February 26, 2013, 12:00 am

Angelo Rotunno has never lived a stable life. At a young age, he was molested and raped. At home, his father beat him.

“I lived in constant fear,” Rotunno, who at 31 has the physical appearance of someone older, tells SFR.

By young adulthood, Rotunno had learned to numb his trauma with drugs. At 23, he became addicted to crack cocaine.

“I no longer had my hands on the wheel,” he says. “It took me to a place—in less than two months—that brought me to facing 54 years in prison for eight armed robberies that I committed in this town in less than two weeks.”

Rotunno spent various stints in jail. Eventually, he was introduced to Christianity and began to turn his life around. He entered a drug rehab program and wrote apologies to the owners of each of the Cerrillos Road stores he robbed.

Today, as a result of the abuse and pain he endured, Rotunno suffers from posttraumatic stress disorder. Recently, he sat with a reporter in an empty restaurant. As Rotunno told his story, patrons began to trickle in for dinner; soon, live music filled the room.

Busy settings like these can trigger Rotunno’s traumatic memories. In those situations, he loses control and experiences them all over again. This eventually leads him back to addiction.

“Once drugs are in the equation, all bets are off—that’s it,” he says. “And I’m not OK with that.”

Rotunno’s sensitivity to external factors and his history of drug use limit his ability to work a full-time job. Two years ago, in order to help him get back on his feet while he copes with these problems, his counselors recommended he apply for Social Security disability benefits. The benefits could help pay for food and rent while he continues therapy. His goal is to get to a point where he’s completely independent.

“I opened up my heart out to the Social Security office,” he says. “I know I’m not physically incapable. But, for whatever reason, in time I become emotionally unstable and incapable of carrying out my duties.”

But in the two years since he first applied for disability benefits, Rotunno has experienced long waits, many interviews and repeated rejections, including one that came two months ago. In the meantime, he has no source of income and is living through limited support from The Life Link, a local nonprofit that provides housing and behavioral health services. He worries that, without the supplemental income and health coverage Social Security can provide, he’ll fail to complete his treatment and sink back into a downward spiral.

“I want stability in my life more than anything,” he says. “I’m living in a lot of fear most of the time.”

Rotunno embodies one side of a complex set of problems facing New Mexico’s Social Security system. Desperate for the benefits that could keep him fed and housed while his mental health improves, Rotunno is stuck waiting indefinitely as his case grinds through years of state and federal bureaucracy.

But he’s not the only one fed up with New Mexico’s Social Security system.

On the other side are people like Bernadette Rodriguez, who for seven years, worked to help mentally and physically disabled people like Rotunno get the benefits they need. But Rodriguez says the system is broken—and now, the former claims adjudicator turned whistleblower is trying to change that.

 As a senior adjudicator for the state’s Disability Determination Services, Rodriguez often faced what felt like an overwhelming workload.

“You could expect several hundred pages [per disability claim],” Rodriguez says. “[You’d have to check] every medical source, if they were current. You’d have to go to every single page and highlight it.”

Through it all, she cared for her sick husband, who last spring lost an eight-year battle with colon cancer.
When his condition worsened during the last three years of his life, Rodriguez took personal time off, which she says caused her to fall behind on the number of cases she was supposed to process each week.

When she got back to work, Rodriguez says management punished her by putting her on performance review plans, which subject employees to more rigorous evaluations until they improve their numbers. Last month, DDS fired Rodriguez for failing to meet her performance goals.

But Rodriguez says the issue isn’t about a lack of productivity, but rather a hostile and retaliatory workplace that discriminated against her for taking time to care for her husband and having a disability of her own, major depression disorder.

“I am being set up for failure as an older employee, a woman, and Hispanic,” Rodriguez wrote to two US Equal Employment Opportunity Commission investigators in September 2011. “I have been berated, insulted, and have evidence. When my claimants call to give me thanks, I have not been given credit…I am worn down by this.”

Sitting at a café on a recent Sunday afternoon, Rodriguez, who has long, flowing gray hair and emphasizes her vowels when she speaks, recalls her time at DDS.

“I gave my heart and soul to that job,” she says.

Many current and former DDS employees say the insurmountable workload and unfriendly atmosphere are behind what has become a worrisome level of employee attrition.

“When I was there, people were leaving left and right,” says Anthony Barela, a former adjudicator who, after eight years at DDS, left the agency in 2011. “You just can’t work in this environment. It’s unhealthy.”

One current adjudicator, who spoke to SFR on the condition of anonymity, adds that management punishes staffers for raising concerns.

“It’s just a stressful situation because you’re under scrutiny for everything,” the adjudicator says. “You’ve been labeled a troublemaker by some certain people, and you get the stink-eye from people [who] are afraid to talk to you.”

Today, New Mexico DDS—a crucial gatekeeper for Social Security benefits—faces two major problems. First, there’s internal discord: Low morale contributes to employee attrition, which leaves the remaining staffers with an ever-burgeoning workload. Second—and perhaps more importantly—there’s the practical outcome: As DDS staffers grow more and more overworked, a smaller share of claims make their way through the system. And increasingly, that means patients like Rotunno are being left behind.

A complex web of bureaucracy governs DDS. First, there’s the federal Social Security Administration. As DDS’ sole source of funding, SSA imposes performance requirements on local DDS offices, which must close out a certain number of cases in order to qualify for funding. But DDS must also answer to the Division of Vocational Rehabilitation, a state agency that manages DDS operations directly and falls under the New Mexico Public Education Department (see chart below). It is, at the very least, a confusing mass of acronyms to remember—and to many employees, the fact that an agency charged with providing federal benefits to disabled adults is part of a state department that deals primarily with education further complicates matters.

“Nobody even knows this agency exists,” Angelica Martinez, another former adjudicator who spent six years at DDS before leaving the agency last August, tells SFR. “And that’s the problem.”

Yet DDS’ mission is undeniably significant. Anyone suffering from a disability and in need of benefits—an estimated 170,000 New Mexicans—must go through one of DDS’ adjudicators.

“They develop the medical evidence that’s going to lead to either a decision of, ‘Yes you’re going to qualify for medical benefits’ or ‘No, you don’t,’” explains Dan Bertoni, a director for disability issues at the US Government Accountability Office’s Education, Workforce and Income Security team.

On a recent weekend, Rodriguez and Martinez talk over coffee and snacks at a diner in midtown Albuquerque. As adjudicators, both took pride in their work.

Martinez, wearing a blue and white striped shirt with a large “Coca-Cola” logo, speaks forcefully when recalling how she went out of her way to establish relationships with the people whose medical futures she helped decide. She remembers how patients, expecting a long, impersonal bureaucratic process, were often surprised when she called them up.

“I loved talking to them, because they were so happy [to talk to a real person],” Martinez says. “And that’s what I miss the most.”

Rodriguez worried especially about Spanish-speaking claimants, who she says were most likely to “get lost in the system.”

“I felt like they fell through the cracks,” she says.

When disability applications would come back in Spanish, not all adjudicators knew how to read them. As a result, according to Martinez and Rodriguez, some adjudicators would simply disregard them.   

Both claim that this kind of mismanagement was common [news, Feb. 6: “Social Insecurity”].

Many of these concerns were first expressed in a mass grievance, filed in early 2011 by New Mexico DDS employees through their union, the American Federation of State, County and Municipal Employees. The grievance, which was signed by 15 DDS employees, alleged “unfair claims processing and non-equitable treatment.” In other words, some adjudicators felt they were assigned heavier workloads than others.

Angelo Rotunno dreams of living a mentally stable life. For two years, however, he’s waited for Social Security benefits.
Joey Peters

 


While DDS responded to some of the concerns—AFSCME Council 18 spokesman Miles Conway says management made “good-faith concessions” after the grievance was filed—complaints about workplace conditions have continued to mount.

Since 2009, Rodriguez has filed multiple grievances, as well as two complaints with the federal Equal Employment Opportunity Center. Barela and other adjudicators also filed EEOC complaints.

Last summer, Rodriguez finally sued the state for violating New Mexico’s Human Rights Act and Whistleblower Protection Act. She is one of two former adjudicators currently suing DDS for workplace discrimination.

Both current and former DDS employees say the agency’s dysfunction has been festering for years. According to former adjudicator Roy Archuleta, not much has changed since he left the agency in the mid-1980s.

“They scrutinize and monitor the adjudicators,” says Archuleta, who since leaving DDS in 1986 has been working independently to help disabled people in Española get Social Security claims through independent work. “You really have to go by their book. If you work over there, you[’ve] got to keep your mouth quiet.”

People who apply for Social Security benefits must go through various stages. First, they must file an initial claim. If that claim is rejected, they can appeal for “reconsideration,” or a second chance. (If the initial claim is accepted, a claimant must eventually go through “continuing disability review,” a process designed to evaluate whether he or she remains eligible.) The final stage—a last resort that often means a claimant has been waiting around two years for benefits—is a hearing. Archuleta spends much of his time helping disability patients who have reached the hearing level. There, an administrative judge makes the final decision on whether a claimant qualifies for Social Security benefits.

Peter Shams-Avari does similar work as a specialist at the New Mexico Independent Living Resource Center in Albuquerque. He says he’s currently working on around 200 cases.

Both Shams-Avari and Archuleta estimate that nine out of 10 of the claims they work on go all the way up to the hearing level. And many of those succeed; both say they’re able to win 80 percent of their hearing-level cases.

In part, that may be because DDS denies so many claims to begin with. In New Mexico, only 37 percent of disabled people who filed initial claims were granted disability benefits, as of December. The national average is even lower: less than 33 percent.

Over the past two years, New Mexico’s DDS office has been closing fewer and fewer Social Security disability cases.

 


“When I was [at DDS], they had me denying most of the cases,” Archuleta says. “I didn’t feel good about it.”

He adds that DDS adjudicators do much of their work on the phone rather than in person, which can put disabled claimants at a disadvantage.

“They haven’t seen the client,” Archuleta says. “When my client comes in limping at 89 pounds, how can they make a determination on him?”

Shams-Avari says allowing adjudicators to spend more time on each case could help. But that seems nearly impossible given the realities of the recession. 

Chief among them is a decrease in staff. In the New Mexico office, Conway says DDS is currently running on less than half the adjudicators it would need to complete its current workload. He concedes that management is in a tough spot.

“They’re dealing with the federal hiring freeze,” Conway says, “which makes it kind of impossible to fill those positions.”

(SSA’s hiring freeze is partial and exempts hearings operations, but the agency has still seen its share of cutbacks.)

At the same time, DVR Director Ralph Vigil adds, more and more people are applying for disability benefits. Nationwide, the number of people applying for disability benefits has almost doubled, jumping from 1.2 million in 1998 to 2.8 million last year (see graph, below). During that same timeframe, the percentage of applicants approved for benefits dropped accordingly, from 52 percent to just under 34 percent. On top of that, Vigil says, DDS employees haven’t had raises in four years.

But even taking into consideration these issues, New Mexico’s DDS office still underperforms.

For instance, over the past three years, DDS offices across the nation have seen their staffs decline by around 6 percent. New Mexico’s, by contrast, shrank by more than 16 percent. 

 New Mexico DDS has also struggled to keep up with its caseload. According to internal emails obtained by SFR, the average number of cases closed per week declined from 613 in 2011 to 502 last year.

New Mexico’s DDS office also struggles with a higher-than-average backlog. In April 2011, DDS Supervisor Rebecca Calvert sent an email to staffers noting the “backlog of unassigned claims” that “has been growing each week.” Calvert urged adjudicators to work quickly to close the gap.

But by all indications, the problem persisted. If DDS were to stop taking in new disability claims, it would need almost 20 weeks to catch up—nearly two months longer than the national average, according to SSA statistics from November 2012.

Over the past 15 years, the number of people applying for disability benefits has skyrocketed nationwide.

 


New Mexico’s backlog is especially high for reconsideration claims—the second stage of the claims process, where adjudicators reconsider claims that DDS initially rejected. As of December, New Mexico DDS had 2,470 reconsideration claims in its backlog. Completing them all would take nearly 39 weeks—more than triple the national average of 12.6 weeks.

In human terms, that can mean an excruciatingly long wait for the two-thirds of people whose initial request for disability benefits is denied.

A complex web of state and federal bureaucracy governs New Mexico DDS, the agency responsible for processing Social Security disability benefits.

 


To be fair, DDS has made attempts to fix its performance problems.

One solution is shipping New Mexico disability cases to DDS offices in other states. Since 2009, more than 15,000 disability claims—roughly 73 a week—have been sent to other states.

And Vigil says DDS Director Daniel Roper recently sent federal authorities a “wish list” of positions he wants to fill. The agency is also in the process of hiring five new adjudicators.

But as for ongoing morale issues, Vigil acknowledges “we’ve had a challenging and negative element.”

In a June 2011 email to staffers, Vigil recognized the need to meet with management about “avoiding perceptions about being overbearing.” And while DVR has methods of responding to each complaint, he says, “I can’t say that we can please everybody all the time.”

But other emails show that DDS managers, too, were worried about performance and morale.

One from June 28, 2011, for instance, notes that DDS staffers had closed 449 claims previous week, which supervisor Kathryn Bode wrote was “not our norm.”

“While I wish all the numbers were positive,” her email reads, “I am hopeful that many of you will step back and take a look at not only what the agency can do differently, but what we can each do individually to make a difference.”

Bode sent another email from Bode on May 7, 2012, urging staffers to “sail full steam ahead!” to reduce the agency’s backlog.

“The NM DDS has 1,621 claims over 100 days in house as of 5/11/2012,” Bode wrote. “How appropriate is our call for S.O.S. this week!”

In July, Bode struck an even more dramatic tone. 

“Sometimes the work we do here can seem monotonous and repetitive,” she wrote to staffers. “Sometimes it feels like it is much easier to ‘burn out’…than it is to draw from our inner strength and re-kindle the fire for what we do. Perhaps part of a burn out is the feeling that nobody really notices what we do, nobody really cares about us on an individual basis, nothing ever changes, no real dents are made, it is too stressful etc. Perhaps the burn out is much simpler and comes about just because we are tired? It probably varies. Today I challenge you to reach deep inside and pull from that resource you carry around with you.”

Former DDS claims adjudicators Bernadette Rodriguez (left) and Angelica Martinez say mismanagement and a hostile environment plague the state agency.
Joey Peters

 


Despite repeated complaints about DDS’ work environment, federal authorities have deemed most of them unfounded.

In March 2012, after conducting a two-day, in-person investigation of 16 allegations by New Mexico DDS employees, SSA concluded that all but one complaint—that DDS didn’t have enough staff to handle its workload—were baseless.

After that report was released, some DDS adjudicators sent it to US Sen. Martin Heinrich, D-NM, with a rebuttal arguing that “a true and valid investigation” would have been “more discreet.”

“Management was fully aware of all staff members being interviewed,” the rebuttal reads. “There were staff members who feared retaliation and therefore may not have disclosed as much or been as truthful as they could have been. There was one staff member [who] was conveniently out of the office every time the investigators were in the office.” 

By all indications, DDS is meeting the minimum performance requirements to keep receiving federal funding—but SSA has had its own challenges. In 2011, Republicans on the House Ways and Means Committee requested a probe into long delays in disability cases nationwide. Last March, the US Office of the Inspector General found that some SSA offices were intentionally delaying cases from one year to the next to increase their bureaucratic performance numbers.

That hints at a larger trend: Nationwide, federal disability assistance programs are what GAO considers “high-risk” and “in significant need of transformation,” Bertoni says. In a report released this month, GAO concluded that federal disability programs “together represent a patchwork of policies and programs without a unified strategy or set of national goals.”

In addition, SSA relies largely on “out-of-date” criteria when making decisions about people with disabilities. GAO’s recommendations include finding new ways to develop cost estimates and risk assessments, paying closer attention to claimants’ “functional capacity” and—ironically—improving workplace accommodations for disabled people.

But back at New Mexico DDS, former and current adjudicators may be out of options. After Rodriguez took her concerns to US Sen. Tom Udall, D-NM, in 2011, Udall’s office referred them to the federal Office of Inspector General. OIG, in turn, referred the matter to New Mexico State Auditor Hector Balderas, who then forwarded Rodriguez’ concerns to Attorney General Gary King. AG spokesman Phil Sisneros declined to comment on the matter.

As for workplace issues, Vigil says he sees no need for “additional alarm.” During a recent visit to DDS, he says he saw adjudicators sitting quietly at their desks, working on their claims cases. 

“That really speaks to the fact that folks are just focused on what they are doing,” Vigil says. “It’s not a job for everyone. But I am confident we’re focused on the right things.”

Yet to many, that doesn’t outweigh the chronic dysfunction—which Bode’s July 2012 email tries desperately to alleviate. 

“Do you know how many lives you touch by casework in a day?” she writes. “In a week? In a month, a year? Consider that each case you touch…has a story. Consider that each person who has filed a claim has at least several other people in their lives who will be directly impacted by your contribution to DDS.”

Rotunno, meanwhile, is still waiting. He says Social Security could provide the help he needs until he can work on his own.

“I know that our nation is struggling,” he says. “I don’t believe that I should be given anything for the rest of my life. I enjoy working. I am a good worker. I am literally good at anything that’s put before me. If it’s something I don’t know, give me a little time, show me how to do it and I will grab onto it. I have the ability. But what I don’t have the ability of is dealing with my emotional and mental struggles in a healthy way.”

Rotunno dreams of someday helping other drug addicts get sober. But when it comes to disability benefits, he can’t wait much longer. His friends and family don’t have the means to support him. After March, his housing assistance expires.

But before people like him can get help, disability assistance programs must find ways to cure their own problems.

“These people need you to be the very best you can each and every day,” Bode’s email plea continues. “It’s easy to burn out. It is challenging to find reasons to undo that burn out, but it is so much more rewarding. Consider the enormity of the impact your actions have every day…it is mind[-]boggling really. So much more important, and long lasting than numbers.”

 

comments powered by Disqus
 
Close
Close
Close