Interviewer:

Ed, I'd like to focus, in this interview, mostly on the Black Lung program and the history of the Black Lung program, because I know you were involved in that and have a lot of back ground about the administration of the Black Lung program. But before we get to that I'd like you to sort of walk us through your career and tell what else you've done at SSA and take us up to that point where the black lung history comes in to play. To let's start, if you would, by telling us how you came to work for SSA and where you started and when.

Tall:

Okay Larry. Let's go back a little before I actually started with SSA. Just to note the fact that I'm an SSA brat. My father was one of the first Social Security employees, having gone through the Candler building doors in 1937, one of the first nine employees to walk through the Candler building doors. So it almost came naturally to me as I was finishing college, in the late 50s, to decide on a career for myself and I had two choices. One of going with my father to, what my mother called social insurance, or into my mother's business, which was private insurance. She had offered me a partnership in her company, if I stayed with her--she worked for a number of insurance companies, as well as being self employed as a broker. So I had a very tough choice to make. And needless to say, let me just digress for a second to mention that Mom and Dad had a number of disputes and arguments about which was the better, private insurance or "social insurance."

In any event, in 1958 I had been working as an assistant loan manager, and I had just taken the federal entrance examination, and had a number of job prospects lined up. One was with the Department of Defense's Material Air Command up in Pennsylvania; the Railroad Board out in Chicago; and one from the Social Security Administration. Well I took a few hours off one afternoon from my job as a loan manager to walk down to have a panel interview with the Area Director for Social Security, Fred Work, with Ella Kate Wilson and I believe it was Bill Delum, district manager down in my father's office. Needless to say my father could not participate in the panel interview, for obvious reasons.

Indeed, at the time, it was fully expected that if I was accepted with Social Security as a claims representative trainee that I would probably be sent off to Welch, West Virginia, Hazard, Kentucky, Bluefield, some place like that, since I was at that time in Region III, which was located in Charlottesville, Virginia under the leadership of Mr. Maurice Dewberry. Mr. Dewberry had a philosophy that said in effect if you want to work in my region you are going to be highly mobile and go where ever the work requires or dictates you to go. So the expectation was fully that I be sent off to some place in West Virginia or Kentucky.

I was pleasantly surprised, first that I had passed the panel interview with flying colors, and it was unusual in one sense in as much as I was the only person being panel interviewed that day. Usually it's done in groups, where the Social Security management would bring in a number of individuals who were applying for a claims rep job and there I was all alone for several hours in the afternoon with this group of distinguished individuals. It was quite an experience just starting off on that footing alone. Not only was I pleasantly surprised by the interview, but also by the fact that I was ultimately assigned to the Baltimore North District Office, starting in March 1959, as a claims rep trainee. Thus began my career for the Social Security Administration.

At that time the disability insurance program had just started up, just a few years before, in 1956, so I was in effect still in on the ground floor of the disability program, although taking claims in the District Office instead of working as a Disability Examiner later on. A lot of new amendments were taking place back in the 50s, self employment, farm material participation, change in the number of quarters of coverage that a young individual needed to obtain their insured status.

There were a lot of exciting things going on at the time. Not the least of which is disability, and it's so fascinating to me because in those days we took a very long narrative disability interview from the claimants, rather then completing a form or forms as we do today. In fact, it was called Temporary Instructions 206, TI-206, where you would end up probably with a six, seven, eight, nine page handwritten report of observations of the claimant, medical treatment, medical sources, what the problems were, when they became unable to work, things of that nature.

Interviewer:

Now this is before we had the form 401, which came later on?

Tall:

That is correct. That's even before the 401 and the 3368, in 69, which I'll get to a little later on. So anyhow because I was so interested in it, I would sit there and track my cases, especially disability cases, and make predictions about the likely outcome of that case, just from the interview with the individual and my observation and the medical evidence, which in those days all came into the District Office before it went to the State Agency for review. I found that my success rate in looking at individuals and talking to them was probably around ninety percent in terms of the likely outcome of that case. So I was pleasantly surprised.

A few years later, the opportunity opened up for a job in the Bureau of Disability Operations, in fact this was a big "dragnet" in 1961 the Bureau of Disability Operations had gone out nationwide looking for people to come in and work in their Division of Disability Operations. So I made an application for the job as a Disability Examiner and to the surprises of surprises, Mr. Dewberry found out I had put in for this promotional opportunity, in Central Office, and he said "would you be interested in taking a Field Rep job down in Norfolk, Virginia?" This is three o'clock in the afternoon. "Let me know your answer by nine o'clock tomorrow morning." Well, I had a brand new house, new houses being built all around me, two new babies, what was I going to say? I mean the promotional opportunity was just too great here and the prospect of trying to sell the house and moving down to Norfolk was not exactly appealing to me, particularly since I had been stationed there as a sailor, and I still had images of what Norfolk was like in those days, and it hadn't, unfortunately, changed that much. In any event I came into the Bureau of Disability Operations in May 1961, after having worked in the District Office for a little over two years.

Interviewer:

Can I ask you one thing about the DO time before you go on? You mentioned that all the medical evidence came in to the District Office rather than going to directly to the DDS. So you developed the case, you basically requested the medical evidence and did what's now medical evidence development that the DDS does?

Tall:

We gave to the claimant the forms to take to the doctor or the hospital and would have them returned directly to the District Office. It's interesting that one of the short term disability projects right now involves what they call FOMER, Field Office Medical Evidence Record, where they are trying out, experimentally, what we used to do that was national policy for all cases. In other words, the wheel has turned full circle. It amuses me no end to find we are going back to some of the things we were doing routinely in those days.

Be that as it may, I came into the Bureau of Disability Operations in 1961 and went through the Disability Examiner training classes. One of the major attractions at the time was not only getting in on the floor of a really exciting program, but the prospect for promotional opportunities was considerable. As a grade seven Claims Rep, here is an opportunity to go up to a grade eleven Disability Examiner in a relatively short period of time. In fact, I got an immediate promotion coming in from the field into the Disability Examiner training class.

At the end of the Disability Examiner training class you were required to take a little experience on the floor, a test. I believe there were twelve cases you had to look at, and they were all subject to expert review by consultants and disability examining chiefs in the disability operations, who would take a look against preset models of what the outcome was in those cases, as adjudicated by a whole bunch of experts, and you were required the pass at least nine out of those twelve in order to become a Disability Examiner. We got to take it several times.

In fact, let me just digress here. This is something very interesting. At the time in Social Security, in order to jump from Claims Rep trainee and become a full Claims Representative, you had to take a Claims Rep course test, at the end of nine months, in the District Office. Needless to say, all Claims Reps had a lot of psychological pressure put on them to take and pass that examination, because it was only given to you twice. If you did not pass it on the second go around, you could have been out the door.

Interviewer:

Now was this a written exam or test cases like disability?

Tall:

No, this was a written examination on all of your nine months of training in the District Office as a Claims Rep. You were given two opportunities and you could be out the door at the end of that time if you didn't pass it on the second go around. Well, just so with the Disability Examiner, you had to pass this test if you wanted to become a Disability Examiner.

Interviewer:

Where was the Division of Disability Operations located? What was the facility it was in at that time?

Tall:

It was physically located in the Butler Building downtown, on Redwood Street. That was back in the late 50s and early 60s. I believe they were also in the Miller Building, if I'm not mistaken.

Interviewer:

So now you've passed your test for Disability Examiner. What happened next?

Tall:

I was assigned to a brand-new examining section, Section 12, that was headed up by Mr. Roger Leverton, Commander Leverton, ex-navy commander who served in the second World War. Very, very ship-shape individual. He insisted on his unit doing a good job, having desks looking neat and clean. He wanted to make sure you got there on time and that you stayed on the job and you did your work. He was good, he was a good Section Chief, excellent in fact.

It was interesting, at one time we were allowed to smoke while sitting at our desks, and I had my ashtray filled up. Well, Mr. Leverton didn't care for that, being a ship-shape individual and recommended strongly that I keep the ashtray clean. He had no objection to smoking, but if you were going to smoke, at least be neat and clean about it.

And while working as an Examiner I was given the opportunity to prepare State Agency reports. We were also assigned additional responsibilities to look at State Agency performance, in those days. For some reason they liked my writing ability, or talents or whatever, and asked me to work on the states that we were involved with in our examining section. Prepare state reports of performance, how they performed, what problems were involved, and these would go back to State Agency Directors and Administrators.

Apparently, the word got out that I did a fairly good job, because in September 1962, just a little over a year or so since I became an Examiner, I was given the opportunity to go up to the Division of Disability Policy, to write and work on disability policy. Both looking at cases and writing back to State Agencies on problems we had with cases, as well as writing policy for the old Disability Insurance State Manual, which was the States' counterpart to the District Offices' Claims Manual.

Interviewer:

Now organizationally, was Disability Policy in a different organization then Disability Operations, the way it is today?

Tall:

It was a separate entity, but it was still part of the same bureau. It was just beginning to become the Bureau of Disability Insurance, around that time. As an interesting aside Larry, I was very honored to be selected to go up to Disability Policy, because I was only the second gentile that was ever invited to join that group.

Interviewer:

How large of a group of people are we talking about?

Tall:

We're talking about forty-some people, at that time involved in aspects of disability policy. Vocational policy, medical policy, work evaluation policy, what they call substantial gainful activity. So as I say, it was quite an honor for me to have been selected and believe me I learned an awful lot. I learned really how to sharpen my writing skills up there. I thought I was good before, believe me I was taken down quite a few pegs, once I got up there.

Interviewer:

What were the main policy issues that you were working on at that time?

Tall:

The main policy issues were work evaluation, medical evaluation, and substantial gainful activity. I'm sure you're familiar with the medical listed impairments, individuals whose condition meets one or more listed impairments are found disabled in the absence of having actually worked in substantial gainful activity. So it was almost automatic that people who met the medical list where put on the rolls, in the absence of SGA. That was fairly well established, although we were developing new criteria for the medical listings.

Tuberculoses was still a very active area of concern because up until that time people with tuberculoses who were confined to a hospital or a TB sanitarium with TB, automatically met the listed criteria. As you may be aware, over the years that criteria changed from a socially-oriented condition, where, because the individual was, in effect, incarcerated, many times against their will, because of social concerns. We gradually got away from that to where we removed the institutionalization as a condition of entitlement. But that really was a socially oriented disability listing at the time.

Vocational factors in 1962 and 63 were really just beginning to take hold, because once we got away from the medical listings then it became necessary to let the claimant know in denying their claim what kinds of jobs they could be expected to perform in the national economy. The technical or standard answer in those days was, well, if you don't meet the medical listing then you have the residual capacity to do lighter sedentary work. You could be an elevator operator, or a watch repairman. Those were the two primary jobs cited most often. So you can see as more and more we became in touch with reality of the way an individual's impairment impacted upon them and the reality of what can they really do with their residual functional capacity, we had to start developing a whole new set of criteria in the vocational area, occupational outlook area, with these individuals.

It's interesting because, and again I'm going to digress slightly, because I look at today's highly developed regulatory and Program Operation Manual System criteria for determining disability, and permit me the observation that the reality is that it places people in boxes in order to be found disabled or not disabled. When we started out in the program, in the early 60s and probably before then, our trainers in our training classes emphasized something very important to us, the whole person concept, you're looking at these people not as numbers, but as individuals. It's your job, as a grade eleven or twelve to use sound judgement, medical vocational judgement in making that determination whether that person is or is not disabled, and you will not do it in isolation, you do not let personal prejudices and biases bear on the case. In effect, you were required to divorce yourself completely from your internal personal feelings about an individual or their background or anything else. And so in looking at this whole person concept standpoint, you take into account everything, it wasn't just looking at little tiny boxes of regulations saying, "ah this person has the ability to do sedentary work, along with past relevant work experience, we find that the individual is not disabled." And then they would go along and enumerate the various types of jobs the person could do, looking at an occupational handbook of vocational guides. So times have changed in a way.

Interviewer:

Are you saying that now you see it as being a more mechanical process?

Tall:

I'm sorry to say that the notion that we disabused of, and that is cookbook adjudication, has come down to, in effect, a form of cookbook adjudication. I guess I find that somewhat distressing because we as examiners were called on to exercise sound judgement. We had a lot of training, we had a lot of experience, and thought we were good at the job we did. I think the program has so changed over the years with the economic picture in the country and the people who have little or no income coming in that they feel almost like they're forced to file a claim, and actively pursuing it all the way to the appeals level.

Interviewer:

Ed, in these early years of the disability program, what were the workloads like? Were a lot of people coming on to the program at this time? Was it growing slowly?

Tall:

It was a relatively slow growth in the early days. We did not have the volume anywhere near the volume of claims we have today. And I'm going to digress again to note that part of the function of the Disability Examiner in the State Agency was not only to adjudicate disability, just as we did when we reviewed the state determinations that came into us for review, but the Disability Examiners were also required to look at that individual from the vocational rehabilitation standpoint, particularly in allowed cases. Denied cases were also involved in that rehab side and most of the State Agencies, early on, were designed by Congress, specifically intended by Congress, to be vocational rehabilitation agencies. Because it was not enough just to put the individual on the rolls, that was important from the cash standpoint of the individual and replacing lost earnings as a result of disability, but also to see what could be done to rehabilitate that individual back to the point where they can get off the Social Security rolls.

Interviewer:

Were we more effective and successful at that, in the early days, then we have been in recent years?

Tall:

That's a very good question Larry. Unfortunately, no. In fact, in the 1960s I was also involved in preparing a lot of charts, and it got me in the disability program, a number of which had to do with vocational rehabilitation (VR) and in checking things out to see what kind of job we were doing in the VR area. It was very distressing to find out that only a few thousand were coming off the rolls each year. It was probably as bad, certainly no better than it is today.

You may have seen that article in yesterday's paper about the vocational rehabilitation concern addressed by Congress and the fact that so few are coming off the rolls, and something like 1/16th of one percent are actively removed from the rolls because of either medical improvement or rehabilitation. Well that is a very sad commentary, but there is a very good reason why that is happening. One, the law needs to be changed to bring the definition of disability into line with the definition of vocational rehabilitation, and when I say vocational rehabilitation, I'm talking about the variety of definitions out there in the State Agencies none of which have to do with returning an individual or restoring an individual's functional capacity to the point that they can go out and do substantial gainful activity at a level that would be enough of an incentive to get them off the rolls. There is too much of an incentive right now in Social Security between Medicare, Medicaid, cash benefits, food stamps from the SSI program, a whole variety of things to serve as a disincentive for going back and motivating a person to get off the Social Security rolls.

Interviewer:

Now, how would we change the definition of disability to facilitate vocational rehabilitation, what do you have in mind, I'm not sure I understand that.

Tall:

I'm not saying you want to change the definition of disability, per se, but that is a distinct possibility that's going to be looked at in the coming years.

We need to look at whether our medical listings are viable in light of the changes in medical advances and medical science. There is a very distinct possibility that the medical list criteria could be changed to more accurately reflect the individual's ability to do work, even in spite of a severe impairment, one that would put them on the rolls today.

Where the change would be needed is drawing together the definition of disability with the vocational rehabilitation. VR has a different look at the individual than Social Security does. Different philosophical bases for their respective programs, and what needs to be done, with Congress getting into the act, is bring the two closer together. First, to fund the "R" services. Two, to change the philosophy and the mind set of vocational rehabilitation of one from getting the person back to the point where they're waking up in the morning feeling good about themselves, where they are able to function at a certain level to the point where they are actually able to have restored function, and in effect, almost hold them by the hand, and get them a job.

Now, one could argue and say that's beyond the intent of the Federal Government to get involved in, but the reality is that if we ever hope to rehabilitate we are going to have to do a lot more, both Social Security and vocational rehabilitation services, to change things around and get people motivated.

You know, the reason people do not get off the rolls, not only because of financial disincentives to get off the rolls, because they are simply not going to make the kind of money that they made prior to their disability and all the other fringe benefits that go with that. It's a matter of the limitations we place on ourselves. As a disabled individual I'm going to set two kinds of limitations. One I impose on myself internally, and one that's externally imposed upon me from without. Employer bias, prejudices, lack of anybody going out to companies and to encourage them and solicit them to bring disabled individuals, who are on our rolls, into the work place. Even with the Americans with Disabilities Act, which has had a certain limited improvement in terms of removing physical barriers and access to handicapped individuals, even that has not gone far enough. There are so many things out there that are already in existing legislation that could be done, if people only had the will to get out and do it. I know Susan Daniels, the head of Office of Disability, is actively involved in these things. I think that a lot more can be done though. It's not just a matter of getting pilot projects out there, it's a matter of getting together people who have the will and ways to move things--Congress, state legislators.

We are always being criticized in the press for not doing enough, without anybody out there, who writes these articles, being fully aware of all these vast distinctions between disability and vocational rehabilitation. There's an ocean of difference out there in terms of bringing these two together. So when people are critical, they should be mindful of what they are saying, and get all their facts lined up.

Interviewer:

Lets go back in your story, so in the early 60s you're in the Division of Disability Policy?

Tall:

Let me just mention, while I'm there, I worked in three major different areas: Medical Policy, Work Evaluation Policy, and Vocational Evaluation Policy. So for a number of years, first as a grade twelve Disability Policy Specialist and then as a Senior Policy Specialist grade thirteen, I have a lot of exposure to a variety of jobs in the disability policy area.

Interviewer:

Did you have any involvement with Medicare, which came in of course in 65, did that impact on your job at all?

Tall:

No, only marginally in terms of providing input to the Bureau of Health Insurance at that time. The Bureau of Health Insurance was around for a relatively short period of time as a part of Social Security before it was split off as a separate entity into the Health Care Financing Administration.

Interviewer:

We're going to talk in a minute about the Black Lung program, which came in 69, but I was wondering whether prior to that, did we have any kind of awareness of the issue of black lung as a disease, and whether there was a sense that the workers' compensation programs for miners weren't adequate, and the whole issue that became the Black Lung program, prior to that, were we working on this, were we aware of it?

Tall:

Our involvement or awareness of black lung or coal worker's pneumoconiosis was limited only in the sense that in the medical listing criteria we considered pneumoconiosis a disabling condition. Provided that you had arterial blood gas studies and had met the other criteria to establish a very decided and severe impairment. I think at that juncture that's probably one of the major distinctions between our medical listing criteria and what ultimately became known as the federal Black Lung program, which I will get into. So that really there was no separate entity called Black Lung or coal worker's pneumoconiosis in the medical listings at the time, but there were conditions, including the kind of conditions that came about as a result of working in a coal mine, that could be considered disabling, provided the individual met the rest of the criteria, and had the examination test to establish it.

Interviewer:

So we were not pushing for legislative change in this area, this was not an SSA initiative?

Tall:

No. Absolutely not. In fact, the Black Lung program was unlike any other program Social Security ever had up until that time, including Medicare, including SSI later on, including the disability program, because in every other program we usually had a number of months, and usually typically a year and a half to two years lead time to prepare for the legislation.

A famous date sticks in my mind, only because I was there. On December 9, 1969, the head of our policy component, Mr. Ed O'Brien, was called on to go down to a meeting in Washington, D.C. with the Department of Labor and some individuals from the House of Representatives, who were actually drafting legislation in the black lung area. He was unable to attend and they asked my Branch Chief to attend and he was otherwise occupied so it devolved to me, being the low man on the totem pole, to go down to Washington and see what this was all about. We had no idea, no idea. It was the foggiest thing in the world to imagine what was going to happen to us. To say that we lived in chaotic, exciting, challenging, interesting times would be an understatement, because on that very day, it's one of these little twists of irony or fate, call it what you will, we were not supposed to bring this material we were looking at down in Washington away from the meeting room. Fortunately, or unfortunately a copy of it was found in my folder when I got back to Baltimore. I won't say how it got there, but it did. And I prepared a report that same afternoon, which went up to the Assistant Bureau Director, which ended up going up to Mr. Ball. Either that day or the next day Wilbur Mills, the Chairman of the Ways and Means Committee called Mr. Ball to say that you are going to be getting Black Lung.

Well, the legislation we were looking at, at the time, was not clear at all who in Health Education and Welfare was going to be getting this. The Public Health Service, were they going to be developing the criteria? Was Social Security going to develop criteria? It was limited to just to complicated coal worker's pneumoconiosis, category A,B,C. No provision was made in there for simple coal worker's pneumoconiosis at all. The question of who would make benefit payments? Nobody knew, until Wilbur Mills called up Mr. Ball and said you're going to get this program. From December the 9th until the legislation was signed by President Nixon on December 30, 1969, we were busier than a hound dog with fleas, that's all I can say.

Interviewer:

So they told you about this legislation on December 9th and it was law three weeks later?

Tall:

Correct. That is correct. Now, you can imagine what this did to us. The Disability Policy group established a separate black lung committee, of which yours truly was a member, along with several others, to get the initial planning started up for this whole program. One of the very first things we did was to develop a little tear-off receipt that you could send out in magazines and papers and the "United Mine Worker's Journal," and use as a coupon to sign up for black lung, because we had notified the field, yet we had no regulations, we didn't know who would get paid, how many were going to get paid. We had estimated, just eye balling it roughly with the Actuaries, may be a hundred thousand claims in the first year.

Interviewer:

Now the effective date was immediately after they signed the legislation?

Tall:

Effective immediately. No retroactivity, but effective immediately. January 2, 1970, miners and survivors started trooping in to the District Offices and the claims started to pile up all over the place. By the hundreds, by the thousands, by the tens of thousands and by the end of the first year we had one million claims filed, where we had anticipated a hundred thousand claims. I'd like to just mention, I was only one part of this process on the policy side. There were literally hundreds, if not thousands of people involved. Ed O'Brien, Hugh Meade, the list is endless of people who took part in this process. I just happened to be privileged to be there at the very start and because I was there at the start, within a few months they gave me a promotion to a grade fourteen and said, now along with that fourteen, you're stuck with it. Well, they didn't say it in those terms, but I became a Branch Chief of one of the components in Policy for Black Lung.

Interviewer:

You mentioned about this huge flow of claims coming in. I saw one report that said something to the effective that several of the offices in Region III received more Black Lung claims in the first month of the program then they had been used to receiving in an entire year from all types of benefit claims in SSA.

(Ed. Note: During the first two weeks of the program five District Offices in Region III received more Black Lung claims than their normal annual receipts of all types of claims. For example, the Hazelton, PA office received 5,361 Black Lung claims by January 20, 1970, and in all of fiscal year 1969 the office received only 3,507 claims of all types.)

Tall:

That is probably an accurate statement Larry. You had to have visited the offices to see the claims folders just stacked up in the aisles, on the floors, everywhere, you could just see folders backed up. It was so bad they had to bring volunteers from Disability Determination Services, the State Agencies, to come over and assist the District Office personnel in handling those claims, starting out.

Black Lung got such heavy publicity, that back in the spittin' hollows of Appalachia we had several thousand individuals come in and file for Title II, Retirement and Survivors claims, that never heard of Social Security or had never taken the trouble to file for those benefits before. Since you could file for both Retirement and Survivors and Black Lung, and keep the benefits for both, there was no off-set mechanism in that. You could double-dip in effect. But it brought thousands of people out of the hollows of Appalachia who were eligible for Title II benefits. That just shows you the effectiveness of the publicity that went out. We worked with United Mine Workers, who had coupons and articles included in the "United Mine Workers Journal," starting out early on. In fact, a lot of our early activities were with the United Mine Workers, and the coal mine operators too.

Interviewer:

So initially you didn't have an application form, because you didn't have time to develop one, so you actually had people sign up on coupons?

Tall:

That's correct.

Interviewer:

Then did you take a more detailed application later?

Tall:

Yes, these were designed to be used as a protective filing for the individual and they needed to be followed up later on with formal applications. There were a number of cases where we didn't have a formal application, we just used that and paid benefits, but you had to develop additional information about children, number of dependents, that kind of thing.

Interviewer:

But you had no regulations, no policy statements, no instructions?

Tall:

We started from scratch, with a matter of three weeks to bank up this program. Never realizing what it was going to be like a year, two years, five years, six years down the road. When it was amended and amended again, because starting out it was designed--there are a number of ways a person can look at the black lung program. You can look at it from an administrative standpoint, what was the administrative impact on Social Security, in terms of the work required to be done to develop all the policies and regulations, the applications, the claims-taking mechanism, and the payment process, all those good things, the same as with any other program. And then the impact upon the coal miner, and the impact upon Appalachia and the coal mining regions. The case was made in enacting the Federal Coal Mine Health and Safety Act that there was a very definite need to improve coal mine health and safety. This was the major emphasis of Title IV of the Federal Coal Mine Health and Safety Act, and President Nixon acknowledged right up front the importance of the need to improve upon coal mine health and safety and the fact that the federal Black Lung program was designed to be just a temporary program which was to help out the coal mine operator and the state Workers' Compensation from not taking on all the financial responsibility for a large group of individuals who had already been disabled by virtue of having worked in the coal mines and who had died as a result of working in the coal mines. So in a very real way it was designed to relieve the coal mine operator from financial responsibility during a transition period during which the coal mine operator was required to make radical changes in coal mine health and safety, in terms of methane gas, in terms of shoring up the coal mine, in terms of ventilating a coal mine, in terms of providing miners with respirators and faces masks and all those good things, to help improve, so that black lung, over time, would gradually disappear, it would not be an occupational disease.

Interviewer:

So the program, and this is an important point, so when the Black Lung program was passed, the intention initially was that it was a temporary program, that SSA would be involved for a time and then go out of the business. Is that right?

Tall:

That is correct. Now I'm talking about the black lung benefit portion of this. The Coal Miner Health and Safety Act itself is probably only 40-60 pages thick, with Part A constituting the bulk of the act, which had to do with coal mine health and safety, and the kind of changes and improvements that the coal mine operator needs to made in the coal mines. (By the way, when this started out it was limited to just underground coal mining and did not at that time include surface or strip mining.) Part B was the benefit payment program under Social Security, and Part C were the provisions under the Department of Labor.

The whole purpose was to do a transition and gradual phase-out over time of Social Security adjudicating claims, and making payments and gradually transferring over to the Department of Labor under Part C of Title IV. It was designed to be transferred in 1972, that was when we were originally scheduled to transfer it over to the Department of Labor.

Interviewer:

And then the Department of Labor was going to stop somewhere down the road and the whole program would end, is that right?

Tall:

No, that's not correct. The Department of Labor was given responsibility for insuring that when the time came for miners to file claims for benefits, with coal mine operators or insurers of coal mine operators, I would not go so far as to say workmen's compensation, because it was designed that a coal mine operator set up either self-insurance, co-insurance, or have a private carrier to carry their liability for future claims under black lung. That's an on going program, that is still under the Department of Labor, under Part C. There is no sunset provision in there that I'm aware of.

The essential distinction between Social Security and Department of Labor and the coal mine operators is that we were not adversarial. We developed the claim, adjudicated it, paid it, it's on our rolls under Part B, it stays on our Part B rolls. All those claims that were filed prior to 1976, when we transferred it to the Department of Labor, stay with Social Security. We have an on going vestigial responsibility for those claims filed under Part B. Any new claims filed, I think after January 1, 1976, starting with the Department of Labor, are, very honestly, adversarial type claims in as much as the coal mine operator is allowed to bring forth their own evidence to rebut presumptions in the Coal Miner's Health and Safety Act. In fact the allowance rate, were we had it up around 90 percent, dropped down to presently around 4 percent, under the Department of Labor, because the coal mine operators are contesting those claims, virtually everyone of them.

Interviewer:

I just want to clarify this point and then we can go on to the next point. There was some aspect of the legislation that had to do with Federal involvement ending by 1981. Was that the original idea before it was made permanent?

Tall:

I'm sorry Larry, that doesn't ring a bell in my memory. As I said, the Department of Labor, to my knowledge, is still continuing forward to process claims filed under Part C. (Ed. Note: The original 1969 law intended the Black Lung benefit program to be temporary, with all federal involvement ending in 1981. As a result of the 1977 Amendments the Part C program run by the Department of Labor became permanent.)

Interviewer:

Okay. Let me go back. So now we are inundated with these claims, hundreds of thousands of claims. So you're busy developing policy and procedures and promulgating regulations and doing what you need to do, correct?

Tall:

Laying out the definition of what is a coal miner, what is an underground coal mine, length of employment in a coal mine to meet the definition of a coal miner, having served ten or more years, things of that nature.

Interviewer:

You said earlier that this program was unlike any other program. Now were the procedures or the policies or the rules under which we adjudicated Black Lung different than the rules that we use for Title II disability?

Tall:

Yes. Absolutely.

Interviewer:

How so?

Tall:

Far more generous. Far more liberal, because many of the individuals who could qualify for Black Lung benefits ended up not meeting our definition of disability in filing for Title II Social Security disability benefits, because they could not meet the medical criteria for it. And even in conjunction with vocational factors, were found to do other past relevant work, along with their residual functional capacity. So to say that it was a liberal program would be an understatement. I'm mindful of a statement that Carl Perkins (Democratic Representative) of Kentucky made to me when one day I went down to meet with a bunch of coal miners and survivors, sitting down in the Congressional Committee room. After the meeting was over, Mr. Perkins turned to me and said, "Mr. Tall until you have paid every last coal miner and every last survivor of every last coal miner, you haven't done your job, and I will keep amending your program until you get it right." Those words are etched into my memory.

Interviewer:

That's very interesting, because the act was amended in 72 and as I understood it one of the reasons was because people like Congressman Perkins thought the allowance rate was too low and wanted to liberalize the criteria to make it easier to allow claims. Is that correct?

Tall:

Originally starting out we had developed fairly conservative criteria. It was not at the level of the Social Security Title II disability listing criteria, but it was still more restrictive than what it later became, because the individual coal miner needed only to establish having met the definition of coal miner and working underground in a coal mine and those good things, and the other rebuttable presumptions, he could come under an irrebuttable presumption that where he had complicated pneumoconiosis category A.B., or C--by roentgenographic or other evidence, for example in the case of a deceased individual, meaning an autopsy or whatever, shown to have complicated pneumoconiosis--could be found to be entitled to benefits. It was an irrebuttable presumption. We, the coal mine operator, no one could adduce evidence that would off-set that presumption, because by definition it was irrebuttable. Now, if you take those individuals with that complicated pneumoconiosis and gave them, say, Social Security's list of criteria which requires blood gas studies, pulmonary function studies, they came up short in many instances, they simply did not satisfy it, but yet they still roentgenographic evidence of complicated pneumonoconiosis.

The reason complicated pneumonoconiosis was felt to be disabling was because of the extent of damage to the lung fields that the coal mine dust had caused. Almost like an eating away of the lung fields. Coal mine dust that was larger than five millimicrons was ordinarily expectorated from the lungs. Coal mine dust of three millimicrons or less was generally absorbed into the body or the blood stream. So that those who had inhaled dust greater than five millimicrons, ordinarily that was of such size that it was usually expectorated as part of cough or sputum or whatever out of the coal miner's lungs. Anything smaller than three millimicrons was generally absorbed into the blood stream and system, therefore, was of no particular consequence. But between three and five millimicrons is where the problem area lays, in terms of coal dust. More so with anthracite coal miners, for example up in the Pennsylvania region, than bituminous coal miners for soft coal mine in the other parts of the Appalachia down in West Virginia, Kentucky and Tennessee, because the silica content of anthracite coal dust was so much harder that it was far more destructive of lung tissue then soft coal was.

Anyhow, with roentgenographic x-ray evidence of these nodules in the lung fields we felt we had criteria that was adequate to put the individual on the rolls. Well needless to say not a whole lot of people had that severe a degree of Black Lung disease and so it was decided, and I think we did this internally, to develop criteria for simple pneumoconiosis category one, two, three, which was far less pronounced and complicated, but still productive of roentgenographic x-ray changes in looking at the lungs. This was a distinct liberalization, to say the least. Again, not only with complicated, more so with the simple pneumoconiosis, if you were to test them on pulmonary function, like blood gas levels, oxygen saturation studies, you may find that the majority of them were not really impaired to any significant degree under Title II, but would still qualify under Black Lung.

Interviewer:

Now this was intentional, right? I mean the Congress intended this definition of disability to be easier.

Tall:

Again I get back to the point that at the time we saw the draft legislation it was not clear who was going to get this. Was it going to be the Public Health Service, who had developed the criteria? Was it going to be Social Security? If Public Health developed the criteria would Social Security pay the benefits? Who was going to develop all these definitions of a coal miner, was that going to be the Department of Labor? So there was a lot of confusion early on in terms of "Who was on first base and What's on second, I Don't Know is on third," before it finally became manifestly apparent who was going to have primary administrative responsibility for administering the program, and it was Social Security.

Interviewer:

Now, one other thing that struck me that was different about the Black Lung program from regular Title II benefits is how payment amounts were determined. Under regular Title II, of course, your payment amount depends on your past earnings. Under this program everybody got a flat fixed amount that was defined as a percentage of the amount of benefits that a disabled federal employee GS-2 received, which seemed to me to be a very unusual way to define a benefit amount, almost arbitrary.

Tall:

I do not know the historic or legislative background in what was in the minds of the committee members who were drafting this legislation by picking upon that particular type of payout and break point, how they arrived at that. It was always fascinating to us too. But regardless of how they arrived at that payout, it's interesting to note that in various travels I made to Appalachia early on in the program, and over a period of a number of years thereafter, to see the flow of money going into Appalachia and the kind of changes that were taking place in the economy in a number of the coal mine towns. Hazard, Bluefield, various other towns in Appalachia with small shops that suddenly built on annexes for television repair, for auto sales, it was quite fascinating.

There are several schools of thought. Was the Black Lung program really designed to help out the coal mine operator by providing him with a transition? Was it designed in recognition of the coal miner's themselves who spent many long hard years mining the nations coal? Or was it designed to pump money into the Appalachia region, which was economically devastated and depressed? Well I don't care what argument a person makes, it had a number of intended and unintended consequences.

Interviewer:

It did all those things?

Tall:

It did all those things. That is correct.

Interviewer:

So the program, even though the benefit amounts seemed fairly modest, if you look at them, had a very visible impact on the economy of the region?

Tall:

That is correct, because for the past, well since 1970, what almost twenty-five years, my understanding, and you would have to check up on the payment side of it, is that we averaged about $1 billion a year out of the general revenue taxpayer money for this program. A billion dollars a year Larry can make a very decided impact in the isolated coal mine areas, and whatever the intended or unintended side effect, it did breathe new life into the Appalachia regional area.

Interviewer:

So the legislation was passed in 69, then it was amended in 72?

Tall:

That's correct.

Interviewer:

And my reading of what happened, as I said earlier, was that Congress wanted to liberalize the program in various ways to, as Congressman Perkins said, "make sure you put more of those miners on there."

Tall: "Until you paid them all you haven't done your job right. And I will keep on amending it until you do get it right."

Interviewer:

So it was amended in 72 and then it was amended again in 77. What happened between 72 and 77? Can you tell us how things developed?

Tall:

In terms of program growth we did, in light of the 72 Amendments, change the criteria, develop new criteria to expand the definition to include surface and strip miners. To bring in an additional number of survivors whose deceased husbands would not have qualified under the old or original definition, because of the strictness of the criteria. Taking a more liberal view of the evidence that survivors would submit to us, to terms of the way we looked at death certificates and the information on the death certificate. Arteriosclerotic heart disease, poor pulmonary function, a whole host of respiratory type conditions that opened up the program to individuals, who, prior to that, couldn't qualify. So these were some very major changes which impacted on us and on the coal miner population.

Interviewer:

Let me take you back to a point you made earlier and make sure I have it right. You eluded to the fact that eventually our allowance rate for the Part B claims was around ninety percent, but as I understand it, initially, the allowance rate was about fifty percent, prior to the 72 amendments.

Tall:

That is correct.

Interviewer:

The 72 amendments liberalized the definition and procedures and evaluation criteria, which increased the allowance rate?

Tall:

Right.

Interviewer:

Then the 77 amendments put in a very unique feature and that was the requirement that we go back and re-review all the denials that we had previously done, or some part of the denials, which again, of course, had the effect of pushing the allowance back up. I take it that would have been a workload for us too, the appeals process associated with this?

Tall:

This was a tremendous workload because we had to go back out, renotify all the individuals who had been denied, and I'm talking now, hundreds of thousands of individuals, literally, who's claims had been denied earlier during prior amendments and still hadn't gotten on the rolls, and say, "there is a prospect of your being qualified under new criteria." And equally important, if not more important, this is sort of your last chance, but if you don't do this now within a certain time frame, if you come in later on you are liable to be under Part C with the Department of Labor and have to face the coal miner operators and their adversarial proceedings against you. Now we didn't say it just that way, but that was the net effect of it. It was a last gasp effort to bring everybody into it not previously qualified just that if they could qualify now under the more liberalized extended criteria.

And that also resulted in an increase in the allowance rate. And I'm looking at, say starting at fifty percent and going to seventy percent, ninety percent, this is a gradual process evolving over time to the point it gets back to Mr. Perkins statement, why he was amending the program. He made no bones about it. Indeed, I said, Mr. Perkins, I said, "you know you and I may not always agree on the Black Lung program, but I'll say one thing I'd love to have you as my Representative," because he really was a strong advocate of the coal miners. Yes, that was his constituency and you would expect him to, but he went beyond the pale, he really did go to bat. And I admired the man for many many reasons, he was a tremendous World War II hero, having won the Congressional Medal of Honor, among other things. Quite an individual, so I had a lot of gutsy admiration the gentleman.

But in terms of the program, I've heard various epithets applied to it and, being a polite individual, I will not mention what they were, because there are a number of ways you can look at the program and did it serve these particular aims and did it serve to get the money benefits into the hands of a miner and the survivor, who were either getting nothing under a State workers' compensation plan or a State disability plan and most States did not have such plans. Pennsylvania was one of the few exceptions, they had an occupational disability program under State workers' comp, I think it paid a hundred dollars a month, and that was one of the few States that had any such plan.

The coal miners didn't have anything going for them because if they filed, typically the mine operator was going to contest it, because they didn't want to pay out of their own pocket. Lets face it Larry, a lot of these small independent operators didn't have the money to pay these kind of claims. So it served the coal miners and it served them well. Did it serve Appalachia and the region? Well, absolutely. If you took a look at the changes over time and what it did for the economy, no question about it, that it did.

Interviewer:

You said a couple of times that this program was unlike the other programs that SSA had been called on to administer. How did we as an institution receive this program? Was there resistance within SSA to this? Was there people who didn't like the program because it was so different? How did we react institutionally to this program?

Tall:

That's a tough question to answer. You have to again look at it or answer it in several ways.

When Mr. Ball was told by Mr. Mills that we were going to get the program, well, you've got your marching orders. And Mr. Ball, being Mr. Ball, said we are a "can do" outfit, we'll do it. We did this with other programs when Mr. Ball was Commissioner and there was no reason why we couldn't do it with Black Lung.

So we had adopted a "can do" mentality, but the pressures upon, particularly the field people, were so great that their heads were swimming with all these cases, what do we do with these things? It was a matter of heading them up and moving them out and getting them developed, adjudicated and paid, or decided. And giving people their appeal rights, the same as with any other program. So I think the field was the most heavily impacted from the standpoint of volume, just sheer volume of cases in relatively isolated areas of the country. Probably every District Office across the country had one or more Black Lung cases, because miners had moved to California, Arizona, Texas, wherever the case happened to be, but the majority were in the Appalachia area and that's where the biggest impact was. Did it impact on operations in central office? Absolutely. They had us set up all the payment process. The claims folders, where to store, where to house, what to do with them. How do you handle benefits for dependents. All these things had to be decided. These all came out of our policy and procedures group, that's true, but we still had to coordinate closely with the field and with the operating components here in central office. It had a big impact.

Interviewer:

Let me make a contrast for just a second with the SSI program. When the SSI program first came in, we had a lot of difficulty getting started with the administration of the program and a lot of start up troubles and some people say that was the first time SSA really failed to successfully meet the challenge that had been put to it to administer a program, at least in the early months of that program. It sounds like you had some of the same kind of start up programs in the Black Lung program, but I don't hear people saying that we stumbled or in any way didn't come up to that challenge. How do you assess that?

Tall:

It depends on who you talk to. Our field people were upset, in particular they didn't have adequate staff, for example. They had to bring in Disability Examiners from state agencies, or ask people to temporarily take a TDY or transfer up to high impact offices, so they were upset. Disability Examiners from the state agencies were upset at the fact that their Claims Rep counterparts in the District Office were making more money then they were, and they were just Claims Reps, not Disability Examiners like they were in the state agencies.

There were things that were going on that were below the surface level, when you started getting deeper down there was some resentment, absolutely. Resentment, as I say, at the large volume, the inadequate leadtime to prepare for this thing. We had few answers for the field offices as to what to do. We were doing a lot of fly-by-the-seat-of-your-pants kind of ad hoc decision making before we were able to develop the policy and procedures that could refine, hone, polish, that kind of stuff, down the road.

Hostility, we encountered hostility early on. The United Mine Workers welcomed us with opened arms, we worked very closely with them. I think even the coal mine operators pretty well accepted us, but then came an organization known as the Black Lung Association in the early 70s. That was an advocacy group or a variety of advocacy groups under the generic term Black Lung Association, that had various chapters throughout different parts of coal mine land, throughout Appalachia. And they started writing into Social Security, being highly critical of our allowance rate, of the way they thought we treated miners and their widows and dependents. Indeed, the very first missive we got from them was a list of ten demands, which opened with the line "stop treating us like dogs,"and we were called upon to respond to each and every one of those missives from the Black Lung Association, and from Congress and from taxpayers. Literally, I wrote hundreds of replies, personally, to organizations all across the country explaining, acting as an apologist, not apologizing for the Black Lung program. Even to the congressman themselves who enacted the legislation, who even helped to draft the legislation, who asked us to explain it to them. They didn't ask us in those terms, but they would appreciate a reply to their constituent's letter to them questioning certain aspects of the program. So we had to go back and explain to them what it was they had enacted.

This was brand new in the annals of Social Security, Larry. For the first time we were getting involved in an adversarial relationship for a program. Up until that time, we had always considered ourselves more an advocate on the individual's behalf rather than anything else, even though we had a dual stewardship responsibility for the programs. At worst we were neutral, and at best we were an advocate. And here we were flooded all of a sudden with the Black Lung Association writing letters to Congress, to us, to Ball, to everybody and their brother, blasting the hell out of us for the way we were administering the program. So we were required not only to reply to them, we went out and met with them and talked to them.

I recall a meeting I went to down in Charleston, West Virginia, because Bernie Popick the Director of the Bureau of Disability Insurance could not go that particular day, so he sent his Executive Officer with me and we went down there and because the Executive Officer was not the Bureau Director they called him a flunky and said "we don't want to speak to you" and we got back on a plane and came on back to Baltimore.

It goes to the heart of coming from a very early meeting down in Charleston, West Virginia, the state capitol, we were coming out of a meeting in 1970 and as I was coming down the stairs, people were down below shooting a camera, taking pictures of us, and we were very flattered. And they asked for our names and implied they were going to do an article on us. I said, "that's great, what is your magazine called?" "SCREW." I'm saying this Larry, because I want whoever follows in my wake to understand, and who hears this conversation to appreciate the situation. Social Security had never, up until that time had this kind of experience. This is before the SSI program, before the negative and hostile attitudes that developed into SSI ever came into being. We were already getting experience in dealing with advocacy groups and developing the sensitivity and the political finesse for dealing with advocacy groups. And I think we became very effective. It's a shame more of that couldn't have been utilized early on in the SSI program, because we had several years of experience under our belt by the time it came in, in 74.

Following the 77 amendments and we were calling or asking everybody to troop back in again who had their claims denied, we finally came to the point, this is the final turning point, this legislation is unique in the sense that I draw the analogy to the hand in the box. You pushed the button, the lid opens the hand comes out pushes a button then goes back in and the lid closes. Well that was like Social Security's responsibility under Part B. We were set up to put ourselves in business and to put ourselves out of business. And putting ourselves out of business. And putting ourselves out of business we did when we transferred this over to the Department of Labor, in 1977 and 78. We worked with the Department of Labor very closely, both here and in Washington to affect this transition over to Part C. So this legislation has what we call a "sunset" provision in there, at least for Social Security. The only thing, as I mentioned earlier, it does have continuing responsibility for all those claims filed under Part B, and approved under Part B.

I've heard it said, by more than one person, after the Department of Labor took over, when the coal mine operators starting contesting all the Part C claims that were filed, "Boy, the Black Lung Association sure does regret that Social Security ever gave up this program." Well friends, you're just a little late now aren't you. Where were your kind words earlier on?

Interviewer:

Let me ask you about that criticism from the advocacy group. Was some of that merited or did you see it as all basically sort of unfair criticism and failure to appreciate the predicament we were in?

Tall:

I think there was initially a very defensive reaction on our part. First, because we had never dealt with anything like that before on such a wide scale basis; and secondly, because we weren't used to it; and third, because we didn't know how to respond. How do you respond to statements like "stop treating us like dogs"? What is your answer? You are the writer of disability policy, how do you reply to a list of ten demands that start out with "stop treating us like dogs"? Well, you do a very,very fine reply, good old bureaucratic reply, that everybody can say "boy that sounds awful good." The reality is, it's like "when did you stop beating your wife?" The first question is, when did you start beating your wife? We didn't feel like we were treating them like dogs. If anything, we were defensive because we thought we had bent over backwards to accommodate the United Mine Workers, to accommodate Congress, to accommodate the Black Lung Association, to accommodate the coal mine operators. What the hell more could we do guys? What do you want, blood?

So you can see there was a certain innate defensive reaction on our part to what we thought was unfair criticism, and yet we went ahead and got the job done. We had to develop pretty thick hides Larry, to be able to go forward and to get on with the job and the task at hand. I'll never forget one day going out to Pueblo, Colorado to meet with coal miners and the survivors at a meeting with one of my Department of Labor counterparts, he and I went out there. We walked into the meeting hall and there where two hundred and fifty people waiting on a hot, humid July day, 100 degrees or more, and we walked into this hall and there was a larger than life picture of Che Guevara with his bandoleer across there with his machine gun, his AK-47, slung over his shoulder. And Bob Littlemeyer and I turned and looked at each other and almost simultaneously said, "we've got problems." We're going to have a tough audience. This is a miners hall. You have to understand that at some of these meeting we had to almost literally wear flack jackets and pith helmets. But you get out there and you meet with them and you give your program acclamations. In fact, we ended up taking applications right there on the spot. Took off our coats and ties, rolled up our sleeves and went to work taking applications.

One of the things that was very interesting, that I had a privilege to take part in, was giving a presentation to the National Academy of Science, to their Committee on Resources and the Environment Group, what they call COMREG, that was getting into the epidemiology and the causes of pneumoconiosis. They have a number of individual different departments, Public Health Service, Department of Labor, Social Security, go around and give presentations, and I entitled mine "Black Lung Revisited." This is around 1974, we were now retracing back over the steps to the very beginning. So that's the only claim to fame that I have, that appears anywhere in any kind of National Academy of Science journal.

Interviewer:

Let me just mention two other little points I noticed that stuck in my mind along the way. Back on this theme of how different this Black Lung program was, and is, from Title II disability. Apparently prior to the 1977 amendments if the person who had Black Lung disease was still working and was still gainfully employed that would be grounds for denying their claim, sort of the way it is in Title II, but after that even if they were still working they could be found disabled, although they wouldn't get any benefits until they stopped work. Is that correct?

Tall:

You're close, but not quite. The coal miner could receive benefits, Black Lung benefits, and still work full time and have earnings and he was looked upon as the same as if he had been retired under Social Security, the annual earnings test has to apply to the individual. And that was uniquely different from anything we had in the Title II disability program, where the definition includes the concept of gainful activity, which at certain income levels and levels of work you were taken off the rolls, in spite of a severe impairment. That was not true with the coal miners. Once the coal miner was on the rolls, they were on for life, or until death they do part. And indeed, what you're going to see coming up, since SSA has residual responsibility for Part B, and since a lot of these coal miners had married women who were substantially younger then themselves, babies are probably still being born today that will be coming on the rolls now and for the foreseeable future, probably the indefinite future, under Part B. Unless Part B is transferred over to the Department of Labor and they want to take over our full time employment positions here and all those kinds of things, which I understand is being considered, I can't see Social Security getting out of that business for a long long time to come, because until that very last survivor comes off our rolls, which will probably not be until 2025 or 2030, at the earliest, we're still going to have at least one claim around the halls of Social Security. Interviewer: We're still going to be maintaining these rolls? Tall: That is correct. Unless there is legislation or something else takes place that we have it transferred.

Interviewer:

You mentioned SSI. Let me just go back to your own career for a second and what you did in your career. Did you have any involvement with SSI in 74? You were still in Disability Policy at this time right?

Tall:

Yes, I was in Disability Policy practically until the time I retired.

Interviewer:

Did you have any involvement in SSI disability?

Tall:

I had involvement with several things. Drug addiction and alcoholism.

Interviewer:

Lets talk about some of that other stuff besides Black Lung.

Tall:

And de-institutionalization.

Interviewer:

Okay, tell us about that.

Tall:

That's a big word isn't it. De-institutionalization. The process of de-institutionalization came about back in the late 70s when state governors were very concerned about the high cost of operating mental institutions for individuals, maintaining them, in effect, warehousing individuals into mental institutions, and the high cost to the state and the state taxpayer. So the idea came into being that as a result of advances in development of psychotherapeutic drugs, and other forms of medicines that were designed to help the mentally ill, a lot of them could function independently outside of an institution. To the extent that the state governors were looking forward to closing down a number of mental institutions, which in fact occurred. Individuals who were confined because of mental illness, suddenly found themselves on the outside.

And it's very interesting because I attended a number of meetings on the subject down in Washington and down in Arlington with the National Institute of Health, who had guest speakers come in, some of whom had been released from mental institutions who had regained their functional capacity, or reasonably so. And I'll never forget a speech given by one of the mentally institutionalized individuals, a lady, highly articulate speaker, who gave a speech called " The Back Wards of Our Minds." And in affect she was saying, society doesn't understand us. "You don't understand that with our mental impairments we're in our own little world, and would you believe it we're very happy there, thank you very much. If you would all just stop and leave us alone, we would be very very happy, thank you. But you in society try and preach so hard to change, to make us normal, when we see ourselves as normal, in our own little worlds." Quite an impressive speech she gave.

And in the process of closing down mental hospitals--society, the National Institute of Mental Health, a whole variety of groups were involved--to establish a whole structured system that was geared toward independent living by these individuals who were being released from mental institutions, of having them come in periodically for examinations by psychiatrists, psychologists, to obtain their medication, to follow up to see if they got housing, food, clothing, jobs. There was a whole array of services that was to be brought to bear on them. Tragically, it never materialized the way it was envisioned or conceptualized. That's why today you have so many people out who are really not getting any assistance. Of course there just isn't any money at the federal or state levels these days for a lot of them to have a lot of treatment or assistance out there.

Interviewer:

How did this movement impact you and impact SSA? How were you involved in it?

Tall:

We were required to develop policies and procedures for dealing with it, under the SSI program, even though I was on the Title II side primarily at that stage, Title XVI on the other side involving the de-institutionalization. The disability policy side got into developing the criteria for de-institutionalization, and paying benefits under certain circumstances, depending upon particular houses with more than sixteen individuals or fewer than sixteen individuals, these kinds of things came in to play.

Interviewer:

In recent years we've seen increased use of mental impairments as a disabling condition and an increased emphasis on how we define and evaluate mental impairment. Did that start around this time or did that start later?

Tall:

The use of what is now called the psychiatric review technique or PRT, came into being I believe in the late 70s or early 80s, if I'm not mistaken. It has evolved gradually over time to become a far more sophisticated tool for helping to determine disability then the way we operated in the past. Mental impairments and back conditions are the two most difficult types of disability to evaluate. Just ask any examiner and they will tell you the same thing, because it is very difficult to utilize the kind of test as you can with other impairments. Tests are used to extend the senses, I can see obvious disabilities in some individuals, others you can't see a thing wrong with them. So medical tests are used to extend the senses and see what's going on inside the individual and make an educated guess about its effect upon them externally. With mental impairments it's extremely difficult for the very reason, and I don't mean to sound critical of this Larry, you can't get two psychiatrists to agree with one another. You don't see any trial, any case, that you get two psychiatrists, experts in the field, to agree. And if two psychiatric experts are diametrically opposite, how is a Disability Examiner, an adjudicator, supposed to evaluate that impairment in terms of inability or ability to do substantial gainful activity. So the medical listing criteria are geared or fixed at a level which is pretty severe in terms of, it's pretty obvious this individual has some real mental problems going for them, and with those conditions that they are unable to do substantial gainful activity. It's when you get away, outside the listing of impairments or into "equals" the listing of impairments, or doesn't meet or equal those impairments--but that person has severe depression, has bipolar schizophrenia, has a whole, you know, anti-social behavior--you get into areas where it is really very,very difficult to say if that person is or isn't able to engage in SGA, given their particular impairment or condition.

Interviewer:

You mentioned drug addiction and alcoholism, as well. It's an area that you had worked in. Tell us a little bit about that.

Tall:

Well, it has always been a part of the Title XVI legislation. That individuals who are drug addicted or alcoholics are required to be referred for treatment, as a condition of receiving Supplement Security Income benefits. That where treatment is available, they are required to undertake referrals for treatment for that condition. This meant lining up, in each state, organizations or companies or charitable groups who would take on the responsibility for having a drug addiction and alcohol referral treatment program out there. This is probably one of the most difficult things we face today, from a societal standpoint there are not enough drug treatment facilities available for them, not enough referral slots available and not enough money. As a result, the vast majority of drug addicts and alcoholics are simply not referred for treatment or if referred for treatment they don't take them in because there is no slot for them. So we were required to go out and line up organizations that would be willing to take part in this rehabilitation process. And that was our responsibility on the disability side of Title XVI. Today there is a whole separate entity established for the purpose of handling this process. It was headed up by a friend of mine, in fact my former Deputy Director, is working this program today. (Ed. Note: In March 1996 Congress enacted legislation to end entitlement to Social Security or SSI disability benefits based on drug addiction or alcoholism --effective January 1997.)

Interviewer:

So let me just look at the chronology of your career and then we can wrap up here fairly soon. After we turned Black Lung over to the Department of Labor in 77, 78, I'm sure that diminished our involvement with Black Lung and policy making. You retired in what year?

Tall:

I retired in 89.

Interviewer:

So from 78 to 89 you worked on the impact of the de-institutionalization and the impact of DA and A.

Tall:

All the medical development policy, I should say disability development policy, medical and vocational development, specifically. Out of my shop came the revised SSA-831, Disability Determination Transmittal form, the SSA-3368 and SSA-3369, which many District Offices would love to shoot us for, because of the involvement and the length of time it takes to complete the thing, and all of the policy and procedures that were related to the various forms. And the District Office interview, whether we should conduct interviews in person, by phone, make home visits, visit institutions. All of the policy and procedures that came out of my shop related to those areas.

And I'd like to make an observation, it has always been my considered judgement that Social Security should never have gotten away from interviewing every single individual who files a disability claim, whether it's Title II or Title XVI. There's nothing like first-hand, personal observation of the individual. First you help to eliminate the prospect of fraud, fraud taking place in case where applications and things were taken over the phone for a period of time. I am hopeful that, if they haven't done it already, they get back to that kind of one-on-one approach, at least in the initial application. I think it's important every single time up, that somebody from Social Security, if not the state agencies, see that person face-to-face. Video conferencing and telephone, I think these are all nice techniques in the sense of helping to expedite claims processing, but it doesn't get away from the questions that having an interview will lead a good Claims Rep or disability adjudicator.

Interviewer:

Alright, anything else to sum up?

Tall:

Well after I left disability policy I went work in Social Security's Office of Disability, Division of Field Disability Operations as an Operations Branch Chief, where we had responsibility for the various state agencies, in terms of their performance. Satisfying or insuring ourselves that they met regulatory performance standards. We had several critical elements in the regulations that they had to measure up to or they could be in substantial non-compliance or failure and therefore ended up having the prospect of being taken over by the Feds. That never happened, although the threat came very close in several states that had been substantial non-compliance for two consecutive quarters, and they got out of it at the last minute by providing them more help, assigning workloads to other agencies and things of that nature to help them out. Unfortunately, the regulatory criteria dealing with claims processing time is still in the regulations and I forget the exact number of days, I think it's around forty-five days in a Title II claim. In the past three, four, five or more years state agencies haven't come close, to even double that amount, in terms of meeting it. It's fortunate, on the accuracy side of that critical element, they have been able to hold their head above water, and everyone meets the accuracy part of that dual standard. Because if left to the processing time alone we would have taken over just about every State Agency in the United States. Anyhow, our job was to develop the data, interpret the data, provide reports to top management, talking to regional offices, work with the regional offices and the state agencies on bringing performance up to snuff, going out and visiting state agencies, things of that nature.

Interviewer:

Give me your summary, to close it out. Thirty years basically you worked in the disability program, give me sort of your overview of the program and how you've seen it change over the years and your overall assessment, and we'll end on that.

Tall:

That's probably the toughest question of all to answer, that's open ended. Let me first start by saying I probably had one of the more, from my own personal standpoint, interesting careers that a person could have in Social Security. To say that it was exciting, challenging, interesting would be an understatement. It was all of that and more. In terms of the changes in the program, over time, my own strong feeling Larry, and I've got to say this for on and off the record, I'll talk to anybody who'll listen to me, I still am a firm believer in the whole person concept of adjudication. Of no cookbook approach to adjudication, which is what the VA used to use years ago and still uses today. And the more refined I see our criteria becoming the more concerned I become about the cookbook approach, and I understand why it's refined in that fashion, from a claims process standpoint and all those good things, to speed things along in developing evidence. I'm of the old school of looking at the person as a human being and not just a social security number. When I see you sitting there with your bad back and I'm taking you application and I'm adjudicating your disability claim, you Mr. Larry DeWitt you are a human being, you've got these genuine concerns. You're out of work. You have an impairment. Forget how severe it is for the moment, you have an impairment, you are unable to work. Nobody will hire you, you've gone around and tried to get jobs. Man, I can understand, I can empathize with that, you see what I'm saying. And I guess I want to see the evidence coming in to establish whether the person is in fact disabled or not disabled. You can argue all day and night and till hell freezes over what the adjudicative criteria should be, but there has to be a better way at looking at a person, including those who meet the listing of impairments. Including that kind of a person that you saw in the newspaper article the other day, Mary Jane Owen who talked about her severe disability, how she couldn't return her checks to Social Security, because they didn't think she should want to lose her benefits. And she said, "no I'm perfectly capable, yes I'm severely impaired, but that doesn't stop me from working, I've got the motivation, the drive, the talent, the whole nine yards." That's fine for Mary Jane Owen, but that's not the majority of our people, not the majority of our applicants. And I'm not saying I would ever pay a claim that was not justified, that's not the point. I'm saying we need to look at our criteria from a standpoint of is this person realistically able to do work. And in the process do you want to use a workers' compensation definition, do you want to use the more stringent Social Security definition, or something in between. It needs for Social Security and the Congress, I think, to decide on what changes are necessary, in light of medical science, in light of advancement in prostheses and prosthetic appliances, kidney dialysis. There are a host of things out there that are supportive of a severely handicapped person so that they could possibly do substantial gainful work. And on the completely opposite side of the coin is the individual who has maybe minimal impairment, by your standards and mine, but realistically couldn't get a job on a bet. No employer will hire them, no employer will take them on, because their bias, prejudice, age, whatever. I don't care, we have to somehow develop some criteria that more realistically can take into account that whole individual. I hate to say holistic, but that's what it comes down to. I think we're off the mark today. I think we have overly refined our criteria, people get put in boxes, and I don't like to put people in boxes.