Carl Boatner suffers from chronic obstructive pulmonary disease, coronary artery disease, two liver diseases, diabetes, obesity, hypertension, major depressive disorder and anxiety disorder.

The administrative law judge handling his appeal of the denial for disability payments determined those medical conditions “could reasonably be expected to cause” disabling symptoms.

And then he denied Boatner’s appeal.

He concluded the Carthage man’s severe medical conditions failed to “meet or medically equal the criteria for any listed impairment,” despite the fact they had once landed him in hospice, a care facility designed to give supportive care to people in the final phase of a terminal illness.

Boatner didn’t die before getting his benefits, but that wasn’t the case for Phillip E. Herring of Tupelo.

Vonda Peters of Tupelo received her brother’s third denial letter in the mail the day after his funeral in July 2019. “I don’t normally cuss, but I thought, what the f—?” Peters said.

U.S. District Judge Carlton Reeves, in a ruling that eventually awarded Boatner disability benefits, pointed to a pervasive attitude among many administrative law judges to view applicants with skepticism, adding Boatner’s judge issued denials at a rate 25 percent higher than the national average.

“The injustices of the disability payment system are both many and deep,” Reeves ruled. “Research suggests the majority of denials may be incorrect, and applicants struggling to manage their disabilities say such denials can amount to a ‘death sentence.’”

In a statement to MCIR, Mississippi Disability Determination Services said it “makes determinations in strict accordance with SSA Policies and Procedures” and that SSA would have to address those policies and procedures. SSA did not respond to a request for comment.

“Examiners are required to look at many different things in determining eligibility, not just the disability itself,” according to the DDS statement. “Determinations are based on a combination of medical and vocational evidence. Vocational evidence includes Age, Education and Past work experience. All of the evidence is factored together utilizing a process established by SSA to make a final determination. Our DDS office has consistently maintained an average accuracy rate of 95% or higher.”

‘I felt plumb stupid’

After the administrative law judge rejected Boatner’s appeal, Rick Clark, his attorney, took the case to the Appeals Council in Falls Church, Virginia, as a final step before suing the U.S. Department of Health and Human Services. “I really believed in Carl’s case,” Clark said.

The Appeals Council hearing usually takes a year to hear a case, and such was the case with Boatner, Clark said.

Boatner, who is now 55, said he got so tired of all the appeals that he told his lawyer, “You just tell me when I’ve got to show up and where.”

Success was doubtful. Clark said only 10 percent of cases are sent back to the administrative law judge and 1 percent are overturned.

After being turned down by the Appeals Council, Boatner sued the federal Social Security Administration.

In a May 11, 2018, ruling, Reeves posed the question: Did the administrative law judge review the evidence properly?

Reeves’ response: No.

In his blistering opinion, he detailed where each component of the disability process had failed Boatner before he then awarded the veteran truck driver his long-denied benefits.

Reeves turned his focus on the state agency acting on the Social, Security Administration’s behalf — Disability Determination Services.

DDS, which is under the Mississippi Department of Rehabilitation Services, processes cases of people filing for disability benefits from the Social Security Administration.

In his ruling, Reeves described the “waiting” Boatner had to do, saying, “Boatner has spent nearly a decade seeking disability payments from the Social Security Administration, filing his last application in 2014. Despite acknowledging the severity of Boatner’s medical conditions and his trips to death’s doorstep, the Administration has denied each of his four applications. These denials have been painful. One caused Boatner to walk out of his house, put a gun to his head, and threaten to kill himself.”

Boatner told the Mississippi Center for Investigative Reporting that throughout his two-decade career as a truck driver, he had always made sure his Social Security taxes were paid up, saying that as he understood it, you paid in and Social Security took care of you if you got old.

When his claims were denied over and over, Boatner said, “I felt plumb stupid.”

In his ruling, Reeves took aim at the disability examiners and the administrative law judge that handled Boatner’s case, noting the ALJ had resolved more than 600 cases in 2016. Reeves also said examiners are not prepared to handle as many cases as SSA asks them to handle.

Mississippi DDS’ 111 examiners processed approximately 64,000 cases last fiscal year, according to Patti Patterson, regional communications director for the Atlanta regional office of the Social Security Administration. Caseloads per examiner range from 65-125 cases, said Chris Howard, head of the Department of Rehabilitation Services.

In Mississippi, examiners must have a four-year degree from an accredited college and are paid anywhere from $27,000 to $47,000 a year, starting off around $14 an hour, according to state Personnel Board guidelines for hiring examiners.

‘Fear of the disability con’

There’s a human cost of so much time processing cases and waiting to be approved, says Doron Dorfmann, associate professor at Syracuse University College of Law. He studied the effect of the disability determination process on the claimants, how it affected their perception of themselves as disabled citizens. In a paper cited by Judge Reeves, Dorfmann noted that disability is a fluid concept rather than the rigid definition adopted by the Social Security Administration.

“There’s not a lot of people who look at the procedure from the point of view of the person going through it,” Dorfmann told the Mississippi Center for Investigative Reporting.

Dorfmann told the Mississippi Center for Investigative Reporting that he has studied what he calls the “fear of the disability con” which is the idea that “the way disability law generally is implemented in the U.S. is that everybody is faking disability. I show in my research that this fear is a driving force in disability law.”

Dorfmann’s studies showed that disability is often a pride issue, with people not wanting to portray themselves as disabled when that is precisely what the Social Security disability process is asking them to do. Such a display plays into how people feel about themselves and their vision of what disability means, Dorfmann noted.

“Do we as a country ask that not all people can ‘overcome’ their impairment?” Dorfmann said.

Boatner said his condition has stabilized in the years since he finally was awarded benefits, but not after more medical interventions, including a defibrillator/pacemaker implantation and four months of dialysis for kidney failure.

According to Vonda Peters, her brother was restricted to using a wheelchair and bed-bound under her care in their parents’ home in Tupelo when he died at age 64. He had Type I diabetes and nonalcoholic cirrhosis of the liver when he died.

“He never took a drink that I know of in his life,” Peters said.

Herring first applied for disability in 2002 after suffering from three pulmonary emboli. That was the end of his career as an engineer, installing and maintaining x-ray equipment, Peters said. He was denied and did not appeal, Peters said, “He wouldn’t confront people.”

He filed gain after August 2017, spending 209 days in the hospital for amputations, one on his forefoot, due to diabetes, another on the same leg six inches below the knee and again above the knee on the same leg in quick succession. He was never fitted for a prosthetic because of wound infection. Toward the end of his life, his other leg was threatened as well.

“He couldn’t sit up long—his other leg would swell; he was about to lose the other leg,” Peters said, He was denied at that point again by DDS.

His final application was in early 2019—he was on the list to be evaluated for a liver transplant when he went into North Mississippi Medical Center, the last time at the end of June after speeding nine days in a nursing home.

Peters says Disability Determination Services called her at that point about his condition.

“They asked when he would be discharged, and I said upon his death and they asked when that would be,” Peters said, adding that her brother was on the hospice floor at that point.

He had just been informed that he was also in kidney failure. “He was offered dialysis, but it would only have delayed his death for a little while,” Peters said.

“We did our best to comply with everything they asked,” Peters said.

Reeves noted that many of the decisions made by examiners on whether a person was disabled involved interpreting complicated medical exams and lab results, far beyond the scope of an examiner’s training.

Howard of the Department of Rehabilitation Services said Mississippi DDS examiners receive three months of classroom training before receiving their own caseloads and that ongoing training needs are constantly provided by unit supervisors throughout an examiner’s career.

Reeves also noted that examiners worked in concert with medical case consultants, doctors who worked part time for DDS in evaluating findings beyond the scope of an examiner’s training. And to fill in gaps in the claimant’s medical records, DDS and administrative law judges rely on consultative exams to provide current medical information where none may be available.

In Boatner’s case, the administration hired a psychologist to evaluate his mental conditions. The psychologist’s report concluded that Boatner’s “mood, anxiety and personality difficulties” were “likely to persist for the next twelve months” and “have a significant negative impact on his ability to function in a normal work setting.”

“One would assume the Administration would give reports it paid for great deference,” Reeves wrote in his opinion. ‘However, the Administration gives ALJs wide latitude to disregard such reports. Boatner’s ALJ rejected the psychologist’s report as ‘vague,’ despite it being nearly 2,000 words in length.”

Reeves noted in his ruling that justice delayed is often justice denied:

“Doing justice means finding truth,” he said. “Finding truth takes empathy, expertise, and time. Without those resources, people who decide disability cases are doomed to do injustice.”

This story was produced by the Mississippi Center for Investigative Reporting, a nonprofit news organization that seeks to inform, educate and empower Mississippians in their communities through the use of investigative journalism. Sign up for our newletter.