Outside the modest red brick home, the grass is overgrown and shrubs are encroaching on the concrete walkway that’s crumbling slightly and in need of repair. Inside, Ronald Golden is sprawled out on the couch in the living room. The shades are drawn, blocking out the early afternoon sun. When the doorbell rings, Golden doesn’t even try to get up and greet his guests, and instead his wife shows them into the cavernous room, lit only by the little daylight seeping through the front door, and a television that’s airing cartoons for two young children seated on the carpet. Golden apologizes for not answering the door himself, then cringes in pain as he sits up and readjusts the six or so pillows propping up his large frame. “I’m sorry, but I’m having a bad day here,” Golden says as he carefully settles back into the crook of a sectional sofa strewn with sheets and blankets. Next to the couch there’s a TV tray with magazines and an insulated plastic travel mug. Golden leans slightly forward and reaches for the cup, trying not to move too much, but it’s just out of his range. His wife hands it to him and he takes a drink. “I’m getting worse,” he says. “My knees feel like they have razor blades in them.” Golden apologizes for speaking slowly, a result of the various medications he takes daily. It’s here in this room where this once strong, active and energetic 43-year-old man spends most of his days and nights since an on-the-job accident two-and-a-half years ago left him incapacitated and unable to work. When the debilitating injury occurred, Golden still was feeling the effects of a previous accident that left him temporarily disabled. Golden—who for years drove a tow truck servicing large commercial vehicles—was on the side of the road hooking up a broken down bus in 2001 when he was hit by a passing day care van. He underwent two surgeries on his shoulder and returned to work after enduring months of intensive physical therapy. Then, in February 2004, he was trying to hook up an 18-wheeler when, Golden says, “I felt something pop and my left arm went limp.” The pain was excruciating, he recalls, and spread throughout his neck and back. Doctors determined he suffered a ruptured disc and Golden went through another surgery, this time to insert a metal plate in his spine. But following the operation, the pain only intensified. After visiting various specialists, a doctor discovered a loose vertebra was putting pressure on Golden’s spinal cord. Having gone unnoticed, the vertebra had crushed some of the nerves in his back. By then, the damage was irreversible. Among the damaged nerves were those that control his balance. “That’s why I have this,” says Golden, holding up a cane with four feet at the bottom to provide more support. “My legs just feel like rubber,” he adds, as he slowly rises from the couch with a groan. Wearing a pair of ratty house slippers that have become his typical footwear, Golden motions down to his legs, which he says are sometimes so swollen that he can’t even make it to the mailbox. His doctors have urged him to start using a walker, but he says, “My mind just isn’t ready for that.” Despite a dire prognosis, Golden was determined to return to work to support his family. But as reality set in, he says he felt helpless and became increasingly depressed. Eventually, he realized his life would never be the same, and after much resistance, he finally applied for Social Security disability insurance in March 2005. Because he had worked and paid Social Security taxes his entire adult life, and because he obviously was disabled, Golden assumed the complicated application process was just a formality. Three months later, though, Golden was shocked when his claim was rejected. Now he’s one of nearly 27,000 Tennesseans currently awaiting a chance to appeal denied claims for disability benefits. In 2003, the state of Tennessee denied more initial requests for Social Security disability benefits than any other state, according to the most recent numbers from the Social Security Advisory Board, a bipartisan commission appointed by Congress. In fact, statistics indicate Tennessee consistently has one of the lowest allowance rates year after year. About three-quarters of initial claims are rejected annually in Tennessee, creating a backlog of cases. That high rate of rejection, combined with an increase in disability claims in recent years—in part because of the aging baby-boomer population—has created a bottleneck in the system, forcing claimants to wait up to 18 months before their cases are heard. “Of course it’s troubling when you’re in the state that has the lowest approval rate,” says Frank Bloch, a Vanderbilt law professor and member of the National Organization of Social Security Claimants’ Representatives. “Demographically, there’s no reason that should be the case.” Given that Tennessee has long been notorious for performing poorly in its role of deciding who should receive the federal benefits, many local attorneys who specialize in such cases say they aren’t surprised. The federal government bestows this responsibility on the states, which operate federally funded offices called Disability Determination Services. Tennessee’s DDS office is located in Nashville and employs about 200 examiners who review disability applications and ultimately approve or deny claims. Critics say that Tennessee’s examiners have consistently been among the lowest paid in the country, and that the state has one of the highest attrition rates among examiners nationwide, suggesting inexperienced employees and frequent turnover might be to blame for the state’s high rate of rejections. But Social Security officials who oversee operations in Tennessee insist local examiners are making the most accurate decisions based on the information provided for each claimant, and that both the salaries and high attrition rate of DDS examiners are improving. Regardless of whether the high rate of denials is justified, the system is undeniably backlogged in Tennessee as a result. The lag time between denial and appeal is a period of limbo, during which appellants frequently find themselves in dire financial situations. It’s not unusual for applicants awaiting a decision to drain their pensions and retirement funds. Some lose their savings and homes while their cases make it through the bureaucratic maze. Lawyers say the system is so jammed that it’s not unusual for chronically ill clients to die while seeking another chance to prove they are too sick or injured to work. One lawyer tells of a client who was on his deathbed and still waiting for an appeal hearing. He suffered from multiple chronic problems, including a damaged heart and weak lungs, and struggled just to breathe. He died of heart failure before a judge ever heard his case. Another attorney recounts stories of several clients who committed suicide midway through their battle to obtain benefits. Most already are broken down physically, some mentally. As time passes without a paycheck or benefits, many become destitute. It’s a grim and often demoralizing situation that some, tragically, can’t endure. As for Golden, it’s been almost nine months since he filed for an appeal and he still is waiting for his hearing. And now, the stakes are even higher for his family. In the spring, Golden’s wife, Pat, was diagnosed with breast cancer, which has forced her to drastically scale back her work as a home daycare provider. Between her radiation therapy and caring for her husband, their 14-year-old daughter and a 4-year-old grandson, she now has the energy to provide childcare services for only two children. “I lost a $50,000-a-year-plus job, and we depended on that to pay for our house and everything else,” says Golden, adding that the minimal income his wife earns does little to offset their mounting expenses. If not for a friend who is helping the family financially, Golden says he would have lost everything by now, including the family’s Mount Juliet home. But his friend can’t continue supporting them for much longer, Golden says, and he already owes him nearly $75,000. Both Golden and his wife say they still are baffled that someone who has worked and paid taxes for nearly 30 years could be denied benefits when he is obviously disabled. Holding up a plastic yellow bowl containing more than a dozen of her husband’s prescription pill bottles, Pat Golden rattles off the names of muscle relaxers, painkillers, sleeping pills and antidepressants he takes daily. Then Golden names a list of physicians he visits regularly, including a neurologist, spine surgeon, pain-management doctor, physical therapist, psychologist and primary care physician. “Disability isn’t the answer to everything. I’m still going to have cancer, and he’s still going to be sick. We know it’s not going to solve everything, but it would help,” says Pat Golden, struggling to hold back tears. Shaking her head, she adds, “I’m scared to death of the hearing. If they deny him, I don’t know what we’ll do.” Across the nation, about 2.5 million people seek disability benefits through the Social Security Administration every year. Since its launch 50 years ago, the federal disability program has grown to become one of the largest adjudication systems in the country, offering two types of benefits: the traditional insurance program for disabled workers, and a need-based program for low-income individuals. As the number of applicants has increased over the years, so has the complexity of the program, becoming a labyrinth of paperwork and appeals. The process starts with an application, about three out of four of which are rejected in Tennessee. That decision may then be appealed on several levels, including before one of approximately 40 special administrative law judges throughout Tennessee who hear only Social Security disability cases in a state Office of Hearings and Appeals. These administrative law judges are among nearly 1,100 working for Social Security nationwide. Ultimately, cases can be appealed all the way to federal court. Last year, nearly 68,000 Tennesseans filed for disability benefits at local Social Security field offices, like the one tucked behind shopping centers and fast-food restaurants along Nolensville Pike. On a recent Monday morning, dozens of people fill rows of brown chairs, staring ahead at the five customer service windows, only three of which are in service. Every few minutes a number is called and someone shuffles up to a window. Occasionally, a door opens and an employee steps out to call someone’s name. And for that brief moment, those waiting—a mother bouncing a restless toddler on her lap, an elderly woman seated next to her ailing husband—perk up, but only until they realize it’s not yet their turn. In a monotone voice, the employee calls out a name, and a weathered old man in overalls makes his way back to a sea of cubicles. For those who remain, there’s no television or music to pass the time—just a quiet hum from the fluorescent lights. One woman, wearing a hospital bracelet, walks in and, upon seeing the crowd in line before her, sighs aloud as she takes a number. The scene in this office is representative of what’s to come for many of those applying for disability. But instead of a wait that lasts an hour, maybe two, they could be stuck in a holding pattern for years. Once an application for disability benefits is prepared at a field office, the case is sent to the state’s DDS office at Metro Center, which clears about 2,100 claims each week. Last year, DDS handled about 111,000 cases, nearly half of which were ongoing from previous years. There, each case is assigned to an individual examiner who gathers evidence, such as medical records, education and past work history. Last year in Tennessee, it took an average of 128 days from the time a claim was received by DDS to the time an examiner made a determination, according to the Social Security Administration. That’s compared to the national average of 87 days. “It is all very individualized. It is a very complex system,” says Tamra Smith, director of Disability Determination Services in Tennessee. If a claimant’s records are incomplete, Smith explains, the examiner arranges for any necessary medical exams to be performed by doctors working as contract physicians for Social Security. Such exams, which are paid for by the federal government, are necessary in more than half the cases that come through DDS. More than 60 in-house physicians also work in an administrative capacity at DDS, consulting with examiners on cases. Many of these doctors are retired from medical practices, while others do this to earn extra income on the side. But according to some lawyers familiar with the system, there are a handful of physicians who are consulting for Social Security because it’s their only option. One lawyer says he knows of at least a few who, for one reason or another, have been disciplined by the medical board and are restricted to the administrative practice of medicine, meaning they are prohibited from actually treating patients. One of those doctors had his medical license revoked in 1999 after he was convicted on felony drug charges, according to the state medical board. He later was issued a restricted license. DDS confirms that this particular doctor has been with DDS since September 2003. In 2003, DDS examiners denied 77 percent of the claims they considered, compared to the national average of 64 percent that same year. “I think we’ve always had one of the highest accuracy rates, so I think it balances out,” says Michelle Mowery Johnson, director of communications for Tennessee’s Department of Human Services, which oversees DDS. Johnson says the accuracy rate of examiners is about 95 percent, a rate determined by Social Security’s regional office in Atlanta, where representatives randomly review case files. But some critics suggest that the accuracy rate is misleading, countering that of those Tennesseans who are denied and choose to appeal, the majority of them are successful and ultimately receive benefits. So far this year, judges in Tennessee have granted 73 percent of appeals, according to numbers provided by Social Security. In comparison, the national average for judges overturning DDS denials is 61 percent. “These people are disabled and eligible, they are just waiting for their hearing to come up…and that wait is just excruciatingly painful,” says David Ettinger, an attorney with the Legal Aid Society of Middle Tennessee. Unfortunately, he adds, roughly two-thirds of applicants DDS turns down are discouraged and don’t appeal, despite the success rate of those who do. Of the DDS decisions reviewed by the Social Security Administration to determine accuracy, about 80 percent are approvals, according to Ettinger. “That may create an incentive to deny claims.” That’s a notion local Social Security officials adamantly deny. By the time a denied claim is brought before an administrative law judge, it’s likely that the individual’s condition has significantly worsened, says Johnson, which in many cases explains the reversal of a previous DDS decision. If an applicant is found by an examiner to be terminally ill—a classification dictated by Social Security—DDS expedites the claim so the person receives benefits as quickly as possible. Also, some claimants don’t have health insurance and are unwilling to cooperate in exams arranged by Social Security, yet another reason why “medical evidence can be limited on the front end,” Johnson says. Finally, she notes that Social Security has strict standards to determine whether a person is eligible. “Our examiners make a decision based on what they have in the record. If the person does not meet the complex requirements that the federal government has set out, they are denied,” says Johnson, adding, “The cases are being adjudicated correctly and fairly based on the information we have.” Lankford Hinds first applied for Social Security disability in 2001. Hinds, who is HIV-positive, also suffers from chronic pancreatitis, bipolar disorder and major depressive disorder. After working many years as a cook and as a kitchen supervisor at Shoney’s, Hinds says he was no longer able to work all day, particularly standing for hours at a time in a steamy kitchen. He was just too weak. When Hinds’ first request for benefits was denied, he gave up, opting not to appeal. Too ill to return to work, however, he reapplied in May 2003 and eventually contacted a lawyer. At one point while Hinds was awaiting appeal, he contracted a fungus that attacked his immune system and landed him in the hospital for weeks. Hinds couldn’t walk, he says, and he shriveled to less than 80 pounds. His feet swelled so much that his mother had to buy him size-12 house slippers, even though he wears a size 9. “Still they said I could work, even though I could barely walk. They suggested I get a job at the Goodwill or something like that,” says Hinds, 50, from the living room of his mother’s apartment in an East Nashville public housing complex. Hinds leans forward from his seat on the couch and pulls up the leg of his sweatpants, which hang loosely on his bony figure. His skinny legs are covered in dark welt-like scars, a result of the infection. “There was a time when everybody just knew I was dead. Even then, Social Security kept sending me letters, hoping I would give up.” As Hinds recounts his experience, his mother hovers in the doorway, arms crossed. Esther Hinds has cared for her son since he became ill. When his health took a grave turn, she recalls helping him bathe and seeing the skin from his legs slough off into the tub. Hinds says there was a time, while he still was fighting for disability benefits, when his mother was making funeral arrangements for him. When he says this, she nods in agreement. From the time he first applied, Hinds says he’s been treated as though he’s seeking a handout he doesn’t deserve. He says that was particularly true during doctor visits arranged by Social Security. “These doctors, they’ll tap you on the knee and ask you what day it is, who the president is, and that’s it. They never really examined me or asked me about my illness.” It’s a typical scenario described by many claimants, and it’s a serious flaw in the system, according to Peter Skeie, a Nashville attorney who has spent seven years representing clients seeking Social Security disability. Skeie says that since the state drastically scaled back its TennCare program for low-income residents last year, many individuals applying for benefits must rely on the doctors provided by Social Security to garner proof of their disability. “These doctors, as far as I’m concerned, set up a little cottage industry and they know who butters their bread,” Skeie says. “I just consider them denial factories.” But officials say that doctors are paid by the case, not whether they recommend an approval or denial. “DDS isn’t sending memos saying make sure you meet a certain number of denials,” Johnson says. Local doctors are paid a fee for each exam, which typically lasts anywhere from five to 15 minutes, those interviewed for this article say. Skeie also faults DDS for its staff of in-house doctors, some of whom are working on restricted medical licenses, meaning their employment options are limited. According to Skeie, a doctor with such a history “is vulnerable to subtle and even overt pressure to deny claims.” To that, Johnson says all doctors working for Social Security have valid medical licenses and are closely monitored: “If there is anything that seems out of the ordinary, it is immediately addressed.” But Hinds no longer is consumed with such worries. In March, an administrative law judge overturned previous DDS decisions and determined Hinds was eligible for disability and that, in fact, he had been completely disabled since October 2002. Now Hinds is out of the hospital, weighs 107 pounds and is able to walk again. He recently started receiving $617 a month from Social Security. Hinds says he knows there are many people who are worse off than he is, and who might never get the benefits they deserve. And despite having to wait nearly five years, he considers himself “one of the lucky ones.” Mary Sue Bennett kept getting in car wrecks, but she couldn’t understand why. During a nine-month period, she was involved in five crashes, one with a tractor-trailer that caused serious injuries. After an endless battery of neurological tests, doctors finally determined she probably had been falling asleep at the wheel because of sleep apnea, a disorder that causes repeated lapses in breathing while asleep. But what typically is considered a manageable disorder was more severe for Bennett, who underwent surgery on her tongue and jaw in an attempt to correct the problem. The surgery didn’t work, though, and Bennett continued to stop breathing repeatedly while asleep, causing severe fatigue during the day. The 48-year-old Murfreesboro woman says she also experienced debilitating headaches, memory loss and even a few minor strokes. Bennett—who also suffers from diabetes and major depression—continued to work for several years. She held jobs in factories for Dell Computers and Whirlpool, and also worked as a home health aide. But she had trouble functioning and was either fired or felt she had to quit each job because she couldn’t adequately perform. Eventually, surgeons inserted a tracheotomy tube in her neck to help her breathe. She also began sleeping with a ventilator. Although her condition improved slightly, the trach caused a serious staph infection, which doctors say is likely to recur again and again. She first applied for disability in 2002, and her claim was rejected by a DDS examiner, and subsequently by an administrative law judge, both of whom determined she was not disabled according to Social Security’s strict definition. “They said I chose to have this trach put in my throat.… I can’t understand why anyone in their right mind would think that I would want a trach in my throat just to keep from working,” she says. For a while she got by on her savings. When that ran out, an uncle helped her for as long as he could. Now Bennett says a friend is supporting her, paying her bills and the monthly rent she owes for the small plot of land where her trailer sits. Her car was repossessed last year, and she now receives food stamps to help pay for groceries. If and when her friend can no longer help her financially, Bennett is afraid she will end up on the streets. “If I could work, don’t you think that I would? They seem to think I want to make a profit off of them,” she says. “I enjoyed my independence. I had everything I wanted before I got sick.” Now, Bennett relies on a cane to help her walk. She recently tore some ligaments in her left leg during a fall, which she says happens frequently as a result of the strokes she suffered. Earlier this year she broke three ribs in a fall. If she has to travel long distances, she now uses a wheelchair. At the urging of her friends and doctors, Bennett has reapplied and retained a lawyer to help her through the process. The doctors who treat her for sleep apnea wrote a letter to Social Security saying, “Bennett is definitely a candidate for long-term disability. She is most likely destined to wear the nocturnal ventilator the rest of her life.” Her psychologist also wrote a letter on her behalf, stating, “We are working on issues relating to a diagnosis of major depression, recurrent and severe with psychotic features…and it is my professional opinion that she is unable to consider employment at this time.” In many ways, Social Security’s disability program is the epitome of bureaucracy. The sheer size, coupled with a complicated process and funding shortfalls, create what many applicants refer to as “a nightmare.” But even its harshest critics admit the system is struggling in part because of limited resources. “It’s horrible when some folks have to wait. There are instances where gravely ill people are denied benefits, but there are no evil intentions here,” says Nashville lawyer Joseph Calandriello, who’s practiced Social Security law in several states throughout the past decade. He blames decision makers in Washington, D.C., for not providing local offices with the necessary resources. And while attorney Mark Fraley agrees that inadequate resources are a problem, he says that doesn’t excuse Tennessee for all its failures. “The fact that they have the lowest approval rate in the country to me is indicative of a culture of looking for fakers and denying claims. There needs to be a cultural change at DDS. They need to be objective, but I’m afraid there is a culture over there of finding ways to turn people down,” says Fraley, whose practice has focused on this kind of work for nearly 20 years. But local Social Security officials say examiners are thoroughly trained and that salaries were raised just last year to be more competitive. Historically, Tennessee’s DDS examiners have been among the lowest paid, ranking 45th nationwide in 2004 with a starting salary of $24,000. That has since been bumped up to $26,000, with examiners stepping up to nearly $30,000 after one year. And what’s for years been considered an appalling attrition rate among examiners in Tennessee also is improving, according to Tamra Smith, who was appointed director of DDS in 2001 after serving years as a lawyer specializing in claims representation. In 2004, Tennessee had the second-highest turnover rate in the country, losing 28 percent of its examiners annually, compared to the national average of 13 percent. But Smith says the salary increase has since cut the attrition rate nearly in half. Perhaps the toughest challenge DDS has faced in recent years has been the inability to hire enough employees to meet rising workloads, Smith says, adding that budgetary shortfalls had prompted officials in Washington to prohibit new hires until recently. In fact, a class of 28 new examiners is slated to start work next week. Tennessee has taken other steps to improve service, Smith says, citing last year’s launch of a claims inquiry unit, which enables claimants to call for updates on their case. In the past, such calls were made directly to the examiner, in effect stalling productivity. Major changes also are on the horizon for the entire Social Security disability system, such as revamping the appeals process and shifting from paper files to an entirely electronic system. The electronic filing system still is being rolled out across the country, but has been in use in Tennessee since last fall. But even with these strides, the future of the program is uncertain. In a July 19 letter to Congress, Social Security Commissioner Jo Anne Barnhart warned what lies ahead if lawmakers slash the budget for next year, as proposed by one congressional subcommittee: “After implementing a staffing freeze and reducing overtime to minimum operating levels in SSA and the Disability Determination Services, achieving a $401 million reduction would require employee furloughs of approximately 10 days agency-wide,” which she says would disrupt the public’s ability to file for disability. As for Ronald Golden, last month he received a letter from Congressman Jim Cooper’s office updating him on the status of his claim. Golden—like many applicants who are denied—contacted his congressman, hoping he could somehow expedite the process. As he opened the letter, he thought for a fleeting moment that it might be good news, but his hope was short-lived. “We were advised that your file is still waiting to be worked up. Their office is running several months behind in getting cases processed due to the large backlog of cases pending there,” the letter stated, adding that Cooper’s staff will continue to monitor the progress of his claim, pending in the Office of Hearings and Appeals. Now all Golden can do is continue waiting to learn his fate, at the same time dealing with the excruciating pain from his injuries. At times he lies on the couch and cries because his muscles ache and burn. For the past few months he’s slept on that couch, because it’s easier to get up in the middle of the night there, and also so his sleepless nights don’t disturb his wife, whom he says needs her rest to battle her own affliction. Although he realizes his pain probably will never subside, disability benefits would at least ease his mind, which is preoccupied with worries about his family’s uncertain future. Pat Golden says her husband constantly struggles with feelings of guilt for no longer being able to support his family. If he could be out there on the road again, or in any job for that matter, he would. “These people don’t care that we could lose everything,” he says. “I understand that people try to defraud the system, but I have a legitimate claim.”