Raising Cane
By Rob Perez
Sunday, September 16, 2001
PATRICIA ADKINS was in constant pain. Her joints swelled. She easily tired. Legal Aid cuts through
disability bureaucracyShe had difficulty walking, standing or holding objects and stopped working in 1997.
By the middle of last year Adkins, who was suffering from lupus, needed two blood transfusions and had to have her spleen removed.
Yet several months later the federal government, for the second time, denied Adkins' request for Social Security disability benefits.
It wasn't until Adkins got the help of the Legal Aid Society of Hawaii that an administrative law judge last month awarded her benefits, overturning the two previous rejections.
The Adkins case underscores what some say is a shortcoming of the benefits system:
Someone who is intimidated or overwhelmed by a bureaucratic and sometimes confusing process can be denied benefits mainly because they don't know how to work the system. The problem often is aggravated by the person's medical condition.
"It can be very frustrating," said Adkins, 31.
In that regard, a knowledgeable advocate can make a big difference.
Numbers help tell the story.
Nearly 50 percent of the 6,000-plus Hawaii residents who applied for disability benefits in the fiscal year through July were denied, according to Social Security Administration data. Nationally, the denial rate was even greater, at 60 percent.
Since 1996, Legal Aid has helped 361 clients appeal their denials to an administrative law judge. Of those cases, more than 70 percent were reversed.
The numbers, of course, don't tell the human side of the story.
For Adkins, the two rejections were psychological blows, not the kind of news she needed as her disease became progressively worse and undermined her ability to help her young son.
She couldn't drive. She couldn't do the laundry. She couldn't even use a pen to write a letter, according to the judge's ruling.
"They denied me so many times, I almost gave up hope," said the former dry cleaning worker. "It just affects your whole self-esteem. It brings it down."
When someone applies for disability benefits, the initial evaluation is based purely on reviews of medical documents and other related records.
The problem, especially for someone who doesn't feel well and isn't up to navigating the bureaucracy, is figuring out what is needed to prove the disability, advocates say. It's knowing what the buzzwords are and knowing how to effectively present one's story in record form.
"It's a sterile process, and what you think is needed isn't always what's needed," said Susanne St. Clair, the Legal Aid paralegal who helped Adkins. Legal Aid provides assistance at no charge to low-income people.
Tim Walsh, a Social Security Administration spokesman, acknowledged that the paperwork requirements for seeking disability benefits can be daunting.
But he said the process is fairly straightforward, with decisions based on a strict definition of what constitutes a disability.
If the initial application is denied, the person can request a reconsideration, and a different analyst will review the paperwork -- and request more if needed -- before making a decision.
If the second review also results in a denial, the applicant is entitled to appeal the decision to an administrative law judge, who can seek additional medical evaluations and hold a hearing to take testimony.
Cynthia Lefever, administrator of the state branch that evaluates applications for the federal government, said the vast majority of denials result because the applicants simply aren't eligible for benefits.
She said her agency helps people through the process to ensure the paperwork is completed correctly. "We pretty much walk people through it."
In Adkins' case, the paperwork in the first two stages often was vague and didn't really tell her story, St. Clair said. The paralegal said Adkins typically didn't tell her physicians the full scope of the problems she was having because of her lupus.
The turning points were getting a physician with expertise in the disease to do an evaluation and then having Adkins tell her story to the judge, St. Clair said.
Henry Tai, the administrative law judge who reviewed Adkins' case, ruled that the initial assessments were incomplete and made without the benefit of hearing testimony or seeing subsequent reports. He ruled that Adkins had been disabled since September 1999, about four months before she applied for disability insurance.
Star-Bulletin columnist Rob Perez writes on issues
and events affecting Hawaii. Fax 529-4750, or write to
Honolulu Star-Bulletin, 500 Ala Moana Blvd., No. 7-210,
Honolulu 96813. He can also be reached
by e-mail at: rperez@starbulletin.com.
