Wisconsin man makes dire fight for Social Security Disability Insurance

Troy Walker is preparing for the end. His race against time started a year and a half ago, and he is running on fumes as he seeks assistance from La Crosse County and the Social Security Administration.

Walker suffers from a list of serious health conditions. Liver failure, hypertensive heart, a bad leg, embolus pulmonary, blood from injuries not coagulating and extreme mental health disorders are some of the conditions on his inventory.

He speculated that many of his issues stem from a gastric bypass operation he had four years ago and his family's health history.

"The doctor said, 'We've got to get this weight off you,' and then when they did, to be honest with you, it seemed like things started progressively getting worse," Walker said. "Everything's catching up to me."

Walker believes his time is short. His heart and liver conditions can lead to sudden organ failure, so he has adopted a mindset that he could go any day. He even has consulted with a local funeral home.

"My daughter, she's young. … She's having a hard time, too, but she doesn't quite understand all this," Walker said. "I planned my life. I went to Schumacher (funeral home) down the road. I found out what's going to cost me and stuff like that."

He passed his final wishes to a close friend and has started deciding what possessions he will save for his daughter.

Walker has been out of work for the past year and a half because of his health, and the lack of income has created issues with essential payments. His final straw will be to sell his home in La Crosse and all of his possessions to keep him afloat.

"I don't have anything. I mean, what you see is what I have in the house. That's it. I don't have a car. I can drive, I just don't. The last two years now I've burned through my 401(k) because I had no money coming in," Walker said.

Before totally waving the flag, Walker is seeking Social Security Disability Insurance. He said his first application was denied, and he is working on an appeal. He also said it is becoming too little too late.

With his health conditions, Walker has concluded that he will not last long out on the street if he has to sell his home. He struggles to walk, has trouble breathing and does not heal from injuries.

The race for Walker's future is now between a decision from the Social Security Administration and the assets he has left.

Medical professionals at the Disability Determination Bureau and the Social Security Administration use piles of information requested to find one thing: Is the applicant able to work in a meaningful way?

Determining disability

By the Social Security Administration's definition, substantial work requires a person's full ability to perform mentally and physically meaningful work. Essentially, substantial work requires substantial ability to perform.

The administration also looks at how "gainful" work is for the applicant. Gainful work is performed for pay or profit, is usually performed for pay or is intended to generate profit, whether or not it is profitable.

If an applicant is currently performing work that is substantial and gainful, they will likely not qualify for benefits. If the applicant is not found to have substantial gainful work, they have passed the first of five steps in determining disability.

The next four steps look at the severity of the applicant's impairment and the ability of the applicant to work in any capacity. The rules bend depending on the applicant's experience and education, according to La Crosse County Aging & Disability Resource Center supervisor Jenna Helminski Juve.

Helminski Juve said she could not speak about details of any specific request for benefits, but she talked generally about the process.

"Say you're a truck driver … if you've been a truck driver for 30-40 years and that's all you've ever done. Now you're 50 years old, are you going to go back and retrain yourself?" Helminski Juve said. "Now say you have a degree and you were doing X. You might have a physical limitation from doing X, but that doesn't mean you can't sit and do a job over the phone or something that involves brain work."

Walker has a work history in sales and college credits. He said his medical conditions prevent him from taking a job at his home desk, plus his internet and phone services routinely get cut off because of missed payments.

To prove he cannot work, Walker must present his medical history and current state as evidence he cannot provide substantial gainful work for an employer or himself.

The only way to immediately see benefits is to have a condition on the "compassionate allowances" list. There are 278 conditions on the list, all of which have accelerated timelines toward death or a more severe disability.

Despite Walker's list of ongoing issues, he does not make the compassionate allowance list. His main fear is that he won't get benefits in time before he is made homeless or his conditions worsen.

"I have no idea what's going to happen tomorrow. I don't know if PennyMac is going to want to do a foreclosure. I don't know," Walker said. "I've lost hope because I can't count on this anymore. I hate to say it. I can't count on people anymore."

Wrapping his head around the process has been burdensome. The decision process for disability insurance can last many months. Cases filed in 2023 had expected wait times of a year or more.

"Other people get it. I don't. I don't know why I don't," Walker said.

Walker has provided medical records and evidence for considering his disability. Now, he said, it is mostly a waiting game beneath a blanket of uncertainty.

Seeking benefits

Applying for Social Security payments carries a sort of urban legend.

"They always say you get denied the first time," Walker said. "It feels like they want to test how much you want it."

In the Social Security Administration's most recent report, only 19% of applicants were awarded disability benefits with their first application in 2021. The highest acceptance rate in recent history was in 2010, when just under 23% of applicants received initial awards.

On average, 67% of applicants are denied Social Security Disability Insurance. There are two types of denials for applicants: medical or technical.

A medical denial happens when an applicant is determined able to work or heal within a year, given the skills and education they have. Applicants can also be denied if their impairments stem from addiction or alcoholism.

A technical denial can occur if the applicant has not paid into Social Security enough in their life, missed a follow-up deadline, has too much income or there are discrepancies in their application. The only detail guaranteed to deny an applicant is their income level being too high.

The application process for Social Security is intense, and simple mistakes along the way can disqualify an applicant quickly. Deadlines are tight, background checks are thorough and waiting on a decision is drawn out.

"It is daunting," Helminski Juve said. "It is bureaucracy at its finest in all honesty, truly."

According to the Social Security Administration, almost 8,000 Wisconsin residents 19-64 years old were awarded disability insurance payments in 2022. The total number of Wisconsin residents receiving benefits in 2022 reached 147,000.

In Minnesota, the number of disabled benefit recipients is a bit lower. In 2022, 114,000 Minnesotans received disability benefits. Most benefit recipients in both states were working-age adults.

'You can't give up'

In the basement of the La Crosse Main Library on Monday night, Patty Netwall and Mary Wruck stood in front of 20 empty chairs and two Zoom guests on a laptop.

The duo hosted a workshop for county residents with questions about Social Security benefits. With packets of information to comb through in any application, the two aim to simplify the instructions and encourage more eligible people to apply.

Netwall and Wruck are benefits specialists working for the Aging and Disability Resources Center in La Crosse. The two are responsible for working individual Social Security cases and guiding applicants through the process.

"You have to follow through on each step. You can't give up," Wruck said. "If they send you anything with a deadline, you have to see it through. Even if it's feeling like a lot, it is much more worth it to just finish the application and follow-ups."

If an applicant drops out, the time spent on it cannot be considered in a future application. The Social Security Administration will only use events that happened after the first application window. But, if someone completes the application and is denied, they can still use that first application window on a later application.

This presents a challenge for people who are homeless. Locating and contacting people without a specific address is notoriously difficult for any agency. Missing an important deadline can constitute a technical denial, closing months of potential health history from future applications.

"We're working with Salvation Army making the ADRC services and, in particular, benefit counseling more accessible to people who have the greatest need. Bringing our services to them versus asking them to come to the office is important to us right now," Helminski Juve said.

For Walker, losing progress on his application is becoming a real concern. Without an address, a working phone and internet services, Walker fears he will be left in the cold at an important crossroads.

Case workers from New York recently were contracted to help Walker with his appeal. He said he hopes the extra attention will move things along, even if it means more phone calls and organizing.

"I just want a decision, some clarity, no matter what they decide. Even if they deny me, I just need to know so I can figure out what I'm doing from here," Walker said. "The uncertainty is one thing, but I know the inevitable is coming. And I'm not talking about death. Well, that's bad, too. But I'm talking about how I don't know where I'm going to be living."

If Walker is approved, he will earn back pay for the time spent waiting. With the limit for an individual at $1,550 a month, Walker could see close to $19,000.