Hi kendeebrad
welcome to the Apple (user-to-user) Community!
Re: "Voiceover stopped working with Sequoia Update" :
"System settings are not responding"
Am no expert in this this area, yet your post certainly deserves some response:
If you haven't already, you may want to try restarting the Mac: Eg: Apple menu > Restart. (Deletes temporary files, re-establishes connections, may update recent setting changes, and often restores order if something is not working as expected,)
Also: wondering if you have seen the latest Voice Over User Guide for Sequoia, or whether it may be at all useful right now:
Eg: See the: "Table of Contents" in VoiceOver User Guide for Mac - Apple Support
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If needed: More info /support / contact options:
Eg: You may want to contact Apple's Accessibility Support Team:
How to contact Apple for accessibility support - Apple Support
or
Apple's Accessibility Support Website
(NB: You can "Get Support" from the link at the bottom of their website:)
Accessibility Support - Official Apple Support
Provide feedback:
To provide feedback about an accessibility feature on an Apple product, email the Accessibility team: accessibility@apple.com
All the best :-)