PORTSMOUTH, N.H. — Bob Sprankle speaks by whispering through clenched jaws into a microphone, struggles to walk around the block, and spends much of his day squeezing a plush ball in a futile attempt to control his pain.
“It feels like you are either being cut with long knives, or like a rat is chewing at your gut,” said Sprankle, 52, who used to run 4 miles nearly every day but is now largely confined to his home in Portsmouth.
YOU CAN HELP
Family and friends of Bob Sprankle are raising money to help defray the costs of his medical expenses, the loss of his job as a teacher at Wells Elementary School because of his condition, and failing to obtain disability from the Maine State Employees Retirement System.
To donate: www.youcaring.com/bob-sprankle
Sprankle suffers from chronic lower abdominal pain related to a hernia surgery in 2007, medical professionals say. He is so sick he can’t work, said his nurse practitioner, but when he applied for disability through the Maine public retirement system, he was rejected twice, befuddling his family and colleagues.
“I have never seen someone more deserving of disability than Bob Sprankle,” said Marianne Horne, principal at Wells Elementary School, where Sprankle was a longtime technology teacher.
Sprankle’s case is not unique. Since 2009, the medical board that reviews disability retirement applications for the Maine Public Employees Retirement System has slashed the number of applications it approves from 75 percent to 30 percent, according to retirement system records. The sharp decline resulted from reforms implemented in 2010 that were designed to speed up the application review process, but which had the unintended consequence of driving up the denial rate to disability applicants, officials say. That’s because applicants have less time to prove their case.
As a result, hundreds of public employees who are so sick they can’t work are being denied disability payments and forced into a difficult dilemma – quit their jobs and lose their livelihoods and ability to pay their bills, or try to work even though they’re unable to do the job.
The disabled workers are not eligible to apply for Social Security disability because they forgo that benefit as participants in the state retirement system. And those who cannot work also lose their state health insurance coverage.
For Sprankle, that meant giving up his $71,000 salary while also being ineligible for Social Security.
About 1,600 former public employees are now on disability through the state retirement system, out of 44,000 retirees. About 150-250 people apply for disability every year, but the percentage granted disability has declined by 40 percentage points in five years.
PHYSICAL PAIN, FINANCIAL PAIN
Officials with the retirement system agree there’s a systemic problem, and they are working on finding a solution through a 10-member task force.
Sandy Matheson, executive director of the Maine Public Employees Retirement System, or PERS, said she could not discuss Sprankle’s case specifically, but she agreed that reforms are needed to ensure that people who are disabled can be taken care of.
For Sprankle, meanwhile, financial pain is now coupled with physical pain, as he reluctantly left his teaching job for the final time in 2014, eight years after he was named Maine’s instructional technology teacher of the year.
After being denied disability in 2013, Sprankle came back to work for a few months in 2014 despite his increasing pain.
He was the type of teacher who played kickball with the children at recess and read to them at lunchtime when he was the lunch monitor.
Sprankle said he would lie down in a supply closet between classes to try to maintain his energy to teach.
“I really wanted to stay teaching,” he said, but in November 2014 he left Wells Elementary permanently after the pain became unbearable and he could no longer walk the hallways. “Teaching is my passion. I miss it dearly. I miss having that purpose in my life.”
Horne, the school principal, said she has seen Sprankle’s condition deteriorate over the past few years and had to drive him home a number of times because pain had overcome him during the day.
Waves of pain passed through Sprankle during a recent interview with the Maine Sunday Telegram, forcing him to stop talking at times.
Mara Lamstein, a nurse practitioner who has treated Sprankle for many years, said Sprankle’s routine hernia surgery in 2007 – in which a mesh was inserted – is the root cause of his health problems. His pain has gotten worse over time, and while Lamstein said she believes it’s because of the mesh, she can’t prove it, which likely was a factor in Sprankle’s disability claim being denied. The mesh was removed in 2012, but the pain has continued to worsen, Lamstein said.
“He’s definitely lost his ability to work. He is clearly someone who needs to be on disability,” she said.
But Sprankle’s application for disability benefits was denied twice in two years by the state’s retirement disability program. Public employees in Maine pay into the Maine PERS system, which is supposed to replace Social Security, and so Sprankle can’t apply for Social Security disability.
Increasingly, public employees who try to claim disability under the Maine Public Employees Retirement System are being turned down.
In 2009, 140 employees applied for disability and 105 of those applications, or 75 percent, were approved. In 2014, 164 employees applied for disability and 49 of those applications, or 30 percent, were approved, according to Maine PERS documents.
A DIFFICULT STANDARD TO MEET
Reforms to the system in 2010 designed to help applicants have evidently had the opposite effect and are a reason that more people are being denied disability, Matheson said. She said at the time, lawmakers and attorneys for disability applicants wanted to shorten the amount of time it took to process applications, from about a year to three months. The state changed its policies to streamline claims through rulemaking – a formal process that requires public comment.
In Maine, about 60,000 public employees pay into the Maine PERS system – 7.65 percent of their income. The employer – such as the state or a school district – pays 15 percent, to make up for years when the state underfunded the pension system.
The fund, which pays out $71 million per month, is financially solvent because in the 1980s the Maine Legislature passed a law forcing the state to fully fund the pension system.
But while public employees pay into a Social Security-like system, the disability program at Maine PERS is different from Social Security disability, which is more flexible than the Maine PERS system.
Matheson said to qualify for Maine PERS disability, applicants must prove they are permanently disabled, which is a difficult standard to meet.
“You are considered retired at that point, but retired with a disability,” Matheson said.
With a three-month time period to decide cases instead of a year, workers have less time to prove that they are permanently disabled.
“We think our shortened procedures we adopted in 2010 to provide members with a quick decision was a factor in the resulting decline in approvals. They don’t have as much time to provide information that might be helpful to their case,” Matheson said.
She added that when it took a year to decide cases, as applicants’ medical condition deteriorated, it sometimes became more evident to the medical board that they couldn’t return to work. When the medical board has to make quicker decisions, it’s at times not as clear that the patient is permanently disabled, she said.
Lamstein, Sprankle’s nurse practitioner, said that in Sprankle’s situation, it was difficult to prove a permanent disability because he has a rare illness that is not easy to define or explain. She said not being able to prove that the mesh from the hernia operation caused his chronic abdominal pain also didn’t help his case.
Matheson said that aside from lengthening the amount of time it takes to decide claims, another possible solution could be to also offer long-term disability, which is different from what Maine PERS currently has and does not require that someone prove he is permanently disabled. Under long-term disability, the threshold to qualify for disability is lower.
Matheson said some employers in the Maine PERS system separately offer long-term disability, but many do not.
Sprankle and his attorney, Jerry Conley, also raise concerns about the lack of transparency while the medical board is deliberating. The board meets in private and does not allow applicants or their attorneys to appear in person before the board.
Conley said it would be better for clients if they could attend the board meetings in person.
“It’s kind of like asking a question of the ‘Great Oz.’ You send in all the paperwork, and you get your answer,” Conley said.
“You are made to feel like a criminal,” Sprankle said. “It’s very dehumanizing.”
Matheson said she does not see transparency as a problem, and that medical boards in many states typically meet in private to consider cases.
Keith Brainard, research director at the National Association of State Retirement Administrators, said most states have a disability program for public employees, although how states structure their programs varies significantly. Some states may have more categories of disability – short-term, long-term, permanent and total – while others like Maine are more limited.
“Something every state grapples with is trying to prevent fraud,” Brainard said.
Because states have such different programs, comparisons are difficult, he said.
Matheson said that in Maine, retirement system officials were not trying to tighten standards in response to abuse – as they are using the same criteria to make decisions on disability – but the high denial rate is simply an unintended consequence of the reforms.
PAIN WON’T GO AWAY
As the state reconsiders the 2010 reforms, Sprankle and his family have moved from their home in South Berwick to Portsmouth, New Hampshire, and are struggling financially after he lost his $71,000 income. Had he been granted disability, Sprankle would have been paid 59 percent of his income until he turned 65. Jody Breneman, his wife, works at a toy store.
After he was first denied benefits in 2013, Sprankle tried to return to Wells Elementary in 2014 and applied for disability again when he couldn’t continue working. After he was turned down a second time, he could have appealed, but instead pursued a part-time job working remotely as a technology instructor.
“At that point, I was at a crossroads, and had two paths I could take,” Sprankle said. “I thought I could do this part-time job. I didn’t think there was any more information I could give to the state that would make a difference in my case.”
So Sprankle gave up his disability appeal, and then couldn’t do the part-time job as his pain got progressively worse.
Now he’s stuck in great pain, without any income from his teaching job.
State Rep. Bob Foley, R-Wells, said he’s monitoring the progress of the retirement system task force and hopes it comes through with meaningful reforms, including better communication and transparency for those applying for disability.
Meanwhile, he is working on a solution for Sprankle even though he has given up his appeals.
“We’re still figuring out what we can do to help Bob,” Foley said.
Sprankle said his pain keeps getting worse. They’ve tried many therapies and medications. Some would seemingly help for a few months. But always, the pain returned, worse than before.
“If someone has thought of it, we’ve tried it,” said Lamstein, his nurse practitioner. “I don’t know what else he can try.”
Sprankle said rather than getting their hopes up over every new therapy, he and his wife have accepted his condition as what he’s going to have to live with. He has taken up drawing, in part because it’s one of the few activities he can do.
Still, it’s hard not to reminisce about better times, Jody Breneman said.
“Bob loved those children and would have done anything to stay there,” Breneman said. “He wasn’t trying to take advantage of the system. For him not to get his disability, it’s just wrong.”
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