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Category: Social Security Disability FAQ

How Receiving Social Security Disability Can Help You Get VA 100%

How Receiving Social Security Disability Can Help You Get VA 100%. Receiving Social Security disability can help you get a 100% VA rating.  However, receiving Social Security disability doesn’t guarantee a 100% VA rating.  It can be used as powerful evidence for your VA claim.  Although, these decisions only help if you can show your conditions are service-connected. 

VA disability benefits

VA disability benefits require that you meet certain conditions.  You must have a current diagnosis.  That diagnosis must be service-connected.  You must also show a medical nexus or connection between your diagnosis and in-service incurrence.  The VA considers your disability service-connected if your medical condition:

  • Firstly, Was directly caused by military service
  • Secondly, Occurred while in the military
  • Thirdly, Was aggravated by military service or
  • Finally, Caused by conditions that are service-connected

VA disability rating and TDUI

Disability ratings range from 10% to 100%.  Next, it can be hard to earn a 100% disability rating when you have more than one disability.  Fortunately, the VA provides an alternate route to total disability rating based on individual unemployability (TDUI).  The VA considers your ability not only get a job but also to keep a job.  You meet the conditions for a TDUI rating if your disabilities prevent you from working and:

  • You have a single service-connected rating or have a combined disability rating of 70%

Social Security disability helps establish a current diagnosis

Firstly, SSDI looks at your medically determinable impairments (MDI).  Secondly, Social Security considers any condition that has an impact on functioning as an MDI.  Thirdly, a Social Security hearing decision includes a list of your disabilities.  Therefore, your Social Security approval helps determine your diagnoses. Receiving Social Security Disability Can Help You Get VA 100%. Call Now for a Free Case Review.

Social Security disability helps establish service-connection

Frequently, applicants for Social Security disability have to testify at a disability hearing.  During the hearing, the judge asks a lot of questions about your disabilities.  Often, applicants provide detailed explanations about their conditions.  They also explain when conditions started.  A Social Security hearing decision includes a summary of testimony.  Therefore, your Social Security hearing decision helps establish service-connection. 

Example:  Social Security hearing decision helps establish service-connection

Likewise, a veteran applied for disability benefits for PTSD.  During the hearing, he testified that he witnessed a young girl get hit by a vehicle while on patrol during his service.  He also testified that since his service, he started blacking out and became violent.  He testified that he didn’t sleep well, had significant paranoia and was very depressed.  The judge’s decision included the veteran’s testimony, helping to establish that his PTSD was connected to his service. 

Social Security disability helps establish severity

Social Security has a difficult standard to meet for eligibility.  You must show that your medical conditions prevent you from working in any job.  A judge’s decision must explain why a case meets the requirements for disability.  The decision includes specific reasons how significantly medical conditions impact a person’s functioning.  Therefore, a Social Security disability decision can help explain how severe your conditions are. 

Example:  Social Security hearing decision helps establish severity

Hence, a veteran applied for Social Security disability due to a lower back impairment, depression and anxiety.  During the hearing, the veteran testified that he injured his back during his service.  He could no longer perform his duties as a postal worker.  As a result of his chronic pain and limitations, he developed significant depression and anxiety symptoms, requiring medication and therapy.

In his hearing decision, the judge explained that his lower back condition caused significant limitations with standing, walking and sitting.  The judge also explained that his depression and anxiety symptoms caused significant problems concentrating.  The veteran provided the VA a copy of the decision, which helped him qualify for TDUI. 

Example:  Social Security hearing decision helps establish severity

For instance, a veteran applied for Social Security disability due to a traumatic brain injury.  He suffered from episodes of aggression, poor memory and difficulty getting along with others.  In his hearing decision, the judge referred to evidence in his record documenting that he needed a lot of help with his daily activities.  Specifically, he needed help with medication management and reminders to take care of his personal hygiene. 

His mother took him to all of his medical appointments and helped manage his bills.  His medical records documented that he could become very aggressive often.  The Social Security judge determined that the veteran would not be capable of maintaining any job.  The decision helped increase the veteran’s VA disability rating. 

Getting help with your Social Security and VA disability claims

Both Social Security and VA have complicated application processes.  The process can be even tougher when Social Security or the VA issues a decision that completely ignores the evidence.  Working with an experienced advocate helps increase your chances of getting approved.  They know how to turn a loss into a win.  An experienced advocate can analyze your case and help you receive maximum benefits.  It helps to have knowledgeable experts on your side. 

Call Now for a Free Case Review, 800-700-0652

Make sure you start your SSDI and VA disability claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

Can a Veteran Receive Both VA and Social Security Benefits?

Can a Veteran Receive Both VA and Social Security Benefits? Veterans can qualify for both VA and Social Security benefits.  Frequently, veterans apply for both VA and Social Security benefits.  However, VA and Social Security benefits have different requirements. 

VA benefits for veterans

VA benefits or service-connected disability, have specific requirements.  You must show that your disabling condition was “incurred or aggravated by your military service.”  You will not qualify for VA benefits if you have a dishonorable discharge.  You can receive partial disability benefits from the VA.  VA disability compensation rates range from 10-100%, in 10% increments. 

Social Security benefits

Social Security has two types of benefits, disability insurance benefits (SSDI) and supplemental security income benefits (SSI).  Under SSDI, you must have worked and earned at least 20 work credits.  Generally, this means you must have worked at least 5 out of the last 10 years.  Under SSI, you do not need any work credits.  However, you must meet certain financial requirements.  You must show that your medical conditions keep you from working for at least 12 months.  Unlike VA benefits, Social Security doesn’t offer partial disability. 

Applying for both VA and Social Security benefits

If you get approved for one benefit, it doesn’t increase your chances for getting approved for the other.  Social Security and the VA follow different rules.  However, Social Security considers medical evidence from the VA.  Similarly, the VA considers your Social Security records. 

Expedited processing for veterans

Fortunately, Social Security can fast-track certain cases for veterans.  Social Security expedites processing for veterans with a 100% VA rating.  You should identify as a “Veteran rated 100% P&T” when filing your application.  You should also include your VA rating notification letter.  Additionally, Social Security fast-tracks case for Wounded Warriors.  You should tell Social Security that your injuries happened while on active duty.  

Application process for VA benefits

Both the VA and Social Security reviews medical records.  The VA uses military doctors and other health personnel to evaluate your disability claim.  The VA may ask you to attend a claim exam, known as a C&P exam.  This exam helps the VA rate your disability.  Additionally, the VA assigns a disabling rate to each of your conditions.  These rates determine your Total Combined VA disability rating.  The VA uses this rating to figure out the amount of your benefits.

Application process for Social Security benefits

Unlike the VA, Social Security doesn’t rate your conditions separately.  Social Security looks at how the combination of your conditions impacts your functioning.  First, they consider if any of your conditions meet certain conditions under their listing of impairments, known as the “Blue Book”.  Most conditions will not meet these strict requirements.  Next, Social Security considers your residual functional capacity or RFC.  Your RFC includes both physical and mental limitations.  If Social Security determines that your conditions keep you from working, they will approve your disability claim.  Like the VA, Social Security may ask you to attend a medical exam to help evaluate your claim. 

Disabled veterans and your age

Social Security has special disability rules the older you are.  They look at a chart known as the Medical-Vocational guidelines to evaluate your claim called the “grid rules.”  The grid rules make it easier for older people to win their case.  Social Security considers your age, education and work background.  The older you are, the easier it can be to win your case. 

How much can I get from VA and Social Security benefits?

As discussed, the VA calculates your payments based on your Total Combined VA disability rating.  Social Security uses a complicated formula based on the amount of earnings you paid taxes on.  Therefore, everyone’s amount is different.  VA benefits will not affect your SSDI payments.  In other words, you can receive both payments in full.  Unfortunately, any VA benefits will reduce your SSI payments. 

VA and Social Security medical benefits

Veterans receiving VA disability automatically receive TRICARE benefits, which cover health costs found “medically necessary” for your condition.  SSDI recipients qualify for Medicare benefits which start two years after Social Security finds you disabled.  Medicare covers a variety of medical costs, usually regardless of a specific condition.  SSI recipients receive Medicaid benefits.  If you receive both TRICARE and Medicare, Medicare becomes your primary insurance.  However, if you receive both TRICARE and Medicaid, TRICARE becomes your primary insurance. 

Can a veteran work and receive both VA and Social Security benefits?

If you are working, you may not qualify for Social Security disability.  Social Security considers work earnings over a certain amount “substantial gainful activity” or SGA and if you earn over the SGA limit, you will not qualify for Social Security disability.  For 2021, SGA is earnings $1,310 per month or more (before taxes).  You can still qualify for Social Security disability benefits if you earn less than SGA.  However, any work may make it harder for Social Security to approve your claim.  Unlike Social Security, veterans can work while receiving VA disability benefits unless you receive Total Disability Based on Individual Unemployability (TDIU.)   

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

Can a Veteran Receive both VA and SSDI?

Disabled veterans can receive both VA and SSDI benefits.  In fact, it is common for veterans to apply for both SSDI and VA disability benefits.  However, some veterans receive VA disability benefits before applying for SSDI.  

What is SSDI?

Social Security disability insurance benefits or SSDI requires that you have worked and earned enough work credits.  You receive work credits each year that you work and pay taxes.  Generally, you need to earn a total of 20 work credits to qualify for SSDI.  Additionally, you must meet a recent work test.  Like other insurance programs, SSDI coverage ends after a certain amount of time from when you stop working.  SSDI also requires that your medical conditions keep you from working for at least 12 months. Call us now if you are Veteran and Want to Receive both VA and SSDI.

What is the difference between VA and SSDI?

Social Security doesn’t offer partial disability benefits.  Your medical conditions must prevent you from working on a full-time basis.  Unlike SSDI, VA disability benefits don’t require total disability.  Veterans receive compensation rates based on the degree of your disability.  The compensation rates range from 10-100%, in 10% increments.  Call us now if you are Veteran and Want to Receive both VA and SSDI.

SSDI expedited processing for veterans to receive both VA and SSDI.

Veterans may qualify for expedited processing for Social Security disability claims.  You may receive expedited processing under:

  • 100% Permanent and Total Veterans Initiative – you should identify yourself as a “Veteran rated 100% P&T” when filing your SSDI or SSI application.  You also should provide the VA rating notification letter to Social Security
  • Wounded Warriors – if you received disabling mental or physical health injuries while on active duty on or after October 1, 2001, you are eligible for SSDI or SSI expedited application processing.  You don’t need to have been injured during combat operations.  You should tell Social Security that your injury occurred while on active duty.  

What are the medical requirements for SSDI?

First, Social Security considers whether your medical conditions fall under their listing of impairments, known as the Blue Book.  Typically, the Blue Book requires that your medical conditions meet very specific requirements.  If you don’t meet the listings, Social Security considers your residual functional capacity or RFC.  An RFC includes both physical and mental limitations.  Social Security looks at your medical evidence to determine your RFC.  They can also consider the opinions of your doctors.  Call us now if you are Veteran and Want to Receive both VA and SSDI.

What medical evidence do veterans need for SSDI?

Your medical evidence should include records only for the period of time that you became disabled and unable to work.  Your treatment should also be continuous and ongoing.  The VA and Department of Defense (DOD) share medical records electronically with Social Security.  Social Security also considers any treatment veterans receive from civilian doctors.  Medical evidence can include:

  • Treatment notes and physical examinations
  • Imaging such as MRIs, x-rays, CT scans or nerve testing
  • Blood work or biopsy results
  • Pulmonary tests
  • Mental health records

SSDI “Grid Rules” 

Social Security has special disability rules the older you are.  They look at a chart known as the Medical-Vocational guidelines to evaluate your claim called the “grid rules.”  The grid rules make it easier for older people to win their case.  Social Security considers your age, education and work background.  The older you are, the easier it can be to win your case.  Call us now if you are Veteran and Want to Receive both VA and SSDI.

Example 1:  applying the grid rules for veterans over age 50

For example, John, a 53 year old veteran, applied for disability due to arthritis in his knees.  John underwent a total knee replacement but continued to have pain and swelling in both knees.  He previously worked in a factory.  John received most of his treatment at the VA hospital.  His medical records included MRIs and x-rays of his knees.  His doctors also documented that he required the use of a cane due to his symptoms.  Social Security found that he could not return to work in the factory.  Since he is over the age of 50, the grid rules allow Social Security to approve his claim.

Example 2:  applying the grid rules for veterans over age 55

As another example, Chris, a 58 year old veteran, applied for disability due to a right shoulder impairment and degenerative disc disease in his spine.  Chris previously worked as a truck driver.  However, he was unable to load and unload the trucks due to his pain symptoms.  Chris received treatment from both the VA hospital and civilian doctors.  His medical records documented his pain symptoms and limited motion in his shoulder and back.  Social Security found that he could not return to work as a truck driver.  Since Chris is over the age of 55 and he could not return to his past work, Social Security approved his claim.  

Working disabled veterans can receive both VA and SSDI.

If you are currently working, you may not qualify for SSDI.  Social Security considers work earnings over a certain amount “substantial gainful activity” or SGA.  If you earn over the SGA limit, you will not qualify for SSDI.  In 2020, earnings S1, 260 per month or (before taxes) are considered SGA. Although, if you are working part-time and earning less than SGA, you may still qualify for SSDI.  However, any work may make it harder for Social Security to approve your claim.  Call us now if you are Veteran and Want to Receive both VA and SSDI.

Does active duty affect eligibility for SSDI?

Active duty status or receipt of military pay doesn’t necessarily keep you from receiving SSDI.  Social Security evaluates your work activity to figure out your eligibility.  You can apply while in a rehabilitation program or attending outpatient programs.  It doesn’t matter whether your treatment is in a VA hospital or civilian facility.   If you are on limited duty or working in a designated therapy program, you should definitely apply for SSDI.  

Does getting approved for Veterans VA benefits help receive SSDI?

Unfortunately, the answer is no.  The VA and Social Security have completely separate processes and requirements for approving claims.   However, Social Security will consider any evidence the VA used when looking at your claim.  Similarly, the VA is required to consider Social Security records.  Call us now if you are Veteran and Want to Receive both VA and SSDI.

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

What is the Difference Between SSDI and VA Disability?

What is the Difference between SSDI and VA Disability? SSDI and VA disability benefits are both government programs that help disabled individuals receive benefits. Both programs have separate application processes.  They also have different requirements for determining disability.

SSDI vs. VA Disability:  general requirements

VA disability benefits provide payments only to US veterans.  The VA does not require any financial contributions.  Additionally, the VA doesn’t require you to have worked within the last 5 or 10 years.  Unlike VA disability, you don’t need to be a veteran to apply for SSDI.  SSDI does require that you meet certain medical and non-medical requirements. 

SSDI does require that you worked and earned enough work credits.  Generally, you need a total of 20 work credits to qualify for SSDI.  Typically, you need to have worked 5 out of the last 10 years.  However, if you are younger, you may qualify for SSDI with fewer credits.  

SSDI disability defined

SSDI requires that you have a medical condition that prevents you from working.  Your condition must keep you from working for at least 12 months.  Unlike VA disability benefits, SSDI does not need your disability to be connected to military service.  They also don’t consider your discharge status. 

VA disability defined

VA disability benefits, also known as service-connected disability, have specific requirements.  You must show that your disabling condition was “incurred or aggravated by your military service.”  You must not have a dishonorable discharge.  You must also submit a formal claim by completing an “Application for Disability Compensation and Related Compensation Benefits” or VA Form 21-526EZ.  Starting to understand the difference between SSDI and VA disability?

SSDI vs. VA Disability:  percentage of disability

SSDI doesn’t distinguish between partial or total disability.  Therefore, you must show that your medical conditions keep you from working in any job.  Social Security figures out your monthly payment based on what you paid into Social Security.  Even so, VA disability benefits don’t require total disability.  The VA awards benefits based in proportion to their percentage of disability.  Compensation rates range from 10%-100%, in 10% increments.  Therefore, SSDI does not have percentages and VA disability does.

SSDI application process

Firstly, Social Security considers whether your medical conditions fall under their listing of impairments, known as the Blue Book.  Secondly, the Blue Book requires that your medical conditions meet very specific requirements.  Thirdly, if you don’t meet the listings, Social Security considers your residual functional capacity or RFC.  An RFC includes both physical and mental limitations. 

Social Security looks at your medical evidence to determine your RFC.  They can also consider the opinions of your doctors.  Social Security may also ask you to attend an appointment with one of their doctors.  Social Security will schedule an exam when they need more information about your conditions.  

VA disability application process

Veterans go through a VA-directed medical review.  The VA uses military doctors and other health personnel to evaluate veterans for their disability.   Similar to SSDI, the VA may ask you to attend a VA claim exam, known as a C&P exam.  The exam will help the VA rate your disability.  The VA assigns a disable rating to each of your conditions.  This determines your Total Combined VA Disability Rating.  The Total Combined VA Disability Rating determines the amount of your benefits.  

SSDI:  your age matters 

Social Security has special disability rules the older you are.  They look at a chart known as the Medical-Vocational guidelines to evaluate your claim called the “grid rules.”  The grid rules make it easier for older people to win their case.  Social Security considers your age, education and work background.  The older you are, the easier it can be to win your case.  While SSDI considers your age, VA disability does not consider your age.  

Example 1: applying the grid rules for SSDI

For example, James, a 56 year old veteran, applied for disability due to knee, shoulder and neck pain.  He previously worked as truck driver, receives disability compensation related to a knee injury.  He has trouble standing and walking, needs a cane.  His medical records include MRIs and x-rays of his knees, shoulder and neck documenting his impairments.  His doctors have also documented that he has pain and limited motion of his knees and shoulder.  Social Security found that he could not return to work as a truck driver.  Since he is over the age of 55, the grid rules allow Social Security to approve his claim.  

SSDI and VA disability application wait time

Unfortunately, both VA disability and SSDI can take time to process before issuing a decision.  VA disability applications can take anywhere from a few months to 2-3 years for a decision.  SSDI has several levels of the claims process.  Firstly, it may take 4-6 months to receive an initial decision.  Secondly, if Social Security denies your claim, you file an appeal for reconsideration, Reconsideration can take 3-5 months.  Thirdly, you can file a request for hearing, where it can take several months for your case to be scheduled.  Social Security also has additional appeals if your case is denied at hearing.   

SSDI expedited processing for Veterans 

Veterans may qualify for faster processing for SSDI claims.  You may receive expedited processing if you have a 100% Permanent and Total disability rating.  Additionally, Social Security fast-tracks claims for Wounded Warriors.  It include veterans who received disabling mental or physical health injuries while on active duty after October 1, 2001.  

SSDI vs. VA disability:  medical insurance

SSDI recipients receive Medicare.  Medicare benefits start two years after Social Security finds you disabled.  Medicare covers a variety of medical costs, usually regardless of condition. Though, it does not always cover all primary medical care.  You may need an additional policy to supplement your benefits.

Veterans receiving VA disability are automatically covered by TRICARE benefits.  TRICARE covers health costs deemed “medically necessary” for your condition.  If you receive both SSDI and VA disability, Medicare becomes your primary insurance and TRICARE becomes your secondary insurance.  

Call Now for a Free Case Review, 800-700-0652

Make sure you start your SSDI and VA disability claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

Can a Disabled Veteran Receive SSDI?

Can a Disabled Veteran Receive SSDI? Disabled veterans can receive SSDI benefits. An award of VA disability benefits won’t prevent you from also receiving SSDI benefits. However, there are differences between qualifying for these types of benefits.

Disabled Veterans:  SSDI vs. VA disability benefits

SSDI requires that your medical conditions prevent you from working for at least 12 months.  SSDI doesn’t distinguish between partial or total disability.  Unlike SSDI, VA disability benefits don’t require total disability.  In fact, most veterans who receive VA compensation do not receive a total disability rating. 

How do disabled veterans qualify for SSDI? 

To qualify for SSDI, you must have worked a certain number of years and earned enough work credits.  You receive work credits each year that you work and pay taxes.  At most, you can earn four work credits per year.  Generally, you need a total of 20 work credits to qualify for SSDI.  However, there are some age exceptions.  If you are younger, you may qualify for SSDI with fewer credits. 

SSDI financial requirements for disabled veterans

As mentioned, SSDI requires that you earn a certain amount of work credits to qualify.  Therefore, there are no limits to the amount of assets, cash or other resources you own.  For example, VA disability benefits will not keep you from receiving SSDI benefits.  Additionally, they will not reduce your SSDI benefits. 

Working disabled veterans

Since Social Security defines disability as the inability to work, if you are working, you may not qualify for SSDI.  Social Security considers work earnings over a certain amount “substantial gainful activity” or SGA.  If you earn over the SGA limit, you will not qualify for SSDI.  In 2020, earnings S1, 260 per month or (before taxes) are considered SGA.  If you are working part-time and earning less than SGA, you may still qualify for SSDI.  However, any work may make it harder for Social Security to approve your claim. 

Medical requirements for disabled veterans

First, Social Security considers whether your medical conditions fall under their listing of impairments, known as the Blue Book.  Typically, the Blue Book requires that your medical conditions meet very specific requirements.  If you don’t meet the listings, Social Security considers your residual functional capacity or RFC.  An RFC includes both physical and mental limitations.  Social Security looks at your medical evidence to determine your RFC.  They can also consider the opinions of your doctors. 

Medical evidence for disabled veterans

Your medical evidence should include records only for the period of time that you became disabled and unable to work.  Your treatment should also be continuous and ongoing.  The VA and Department of Defense (DOD) share medical records electronically with Social Security.  Medical evidence can include:

  • Treatment notes and physical examinations
  • Imaging such as MRIs, x-rays, CT scans or nerve testing
  • Blood work or biopsy results
  • Pulmonary tests
  • Mental health records

Disabled veterans and your age

Social Security has special disability rules the older you are.  They look at a chart known as the Medical-Vocational guidelines to evaluate your claim called the “grid rules.”  The grid rules make it easier for older people to win their case.  Social Security considers your age, education and work background.  The older you are, the easier it can be to win your case. 

Example 1: applying the grid rules for disabled veterans

For example, Michael, a 57 year veteran, applied for disability due to back pain.  He previously worked as janitor, receives disability compensation related to a back injury.  He has trouble standing and walking, needs a cane.  His medical records include MRIs and x-rays of his back documenting his impairment.  His doctors have also documented that he has pain and limited motion of his back.  Social Security found that he could not return to work as a janitor.  Since he is over the age of 55, the grid rules allow Social Security to approve his claim. 

Does my VA approval help improve my chances receiving SSDI?

Generally, your VA approval will not help you get SSDI.  Social Security will consider any evidence that the VA used when making their decision.  Social Security may also use VA or DOD evidence to expedite SSDI claims for Wounded Warriors or veterans with a 100% disability compensation rating.  Similarly, the VA may not give Social Security’s decision much weight.  Usually, Social Security’s decision can be unclear whether the disability is based on service-connected or non-service disability.  However, the VA is required to consider your Social Security records. 

Does active duty affect eligibility for SSDI?

Active duty status or receipt of military pay doesn’t necessarily prevent you from receiving SSDI.  Since you can’t receive SSDI if you are engaging in SGA, Social Security evaluates your work activity to figure out your eligibility.  You can apply while in a rehabilitation program or attending outpatient programs regardless of whether your treatment is in a VA hospital or civilian facility.   If you are on limited duty or working in a designated therapy program, you should definitely apply for SSDI. 

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

How Do I Appeal my Social Security Denial?

How Do I Appeal my Social Security Denial? Social Security may deny your Social Security disability claim for several reasons.  Social Security could deny your claim for non-medical reasons.  They could also deny your claim for medical reasons.  However, you can only appeal a denial for medical reasons.

Non-medical denials

Social Security offers two types of disability benefits.  First, Social Security offers disability insurance benefits (SSDI).  To qualify for SSDI, you must have worked and earned enough work credits.  You cannot appeal a denial based on not having enough work credits.  Second, Social Security offers Supplemental Security Income (SSI) benefits.  To qualify for SSI, you must meet certain financial requirements.  You cannot appeal a denial for SSI based on exceeding the financial requirements. 

How can I appeal a medical denial? 

You can file an appeal several ways.  First, you can appeal your denial online.  This can be the easiest way to appeal an unfavorable decision.  Second, you can file an appeal with your local Social Security office.  If you have a representative, they can help you file an appeal of your SSDI denial. 

When should I appeal my Social Security denial?

You have 60 days to appeal a Social Security denial from the date on the denial letter.  Social Security gives you an extra 5 days to allow you to receive your denial in the mail.  Therefore, you have a total of 65 days from the date on your denial to appeal your claim.  If you don’t file within the 65 days, you may have to re-file your claim.  Social Security allows you to file an appeal in more than 65 days if you have good cause for missing your deadline.

What is good cause for missing my appeal deadline?

Good cause can include several reasons.  Social Security considers:

  • What circumstances kept you from making the request on time;
  • Whether Social Security’s action misled you or you didn’t understand what you needed to do to appeal
  • Whether you had any physical, mental, education or language limitations that prevented you from appealing on time

Examples of good cause for missing your deadline

  • You were very sick when the appeal was due and couldn’t have contacted Social Security yourself or through someone else.  You would need proof that you were seriously ill.
  • There was a death or serious illness in your family
  • Records needed for your appeal were destroyed by an accident or fire.
  • You never received your denial notice
  • Some other type of unusual or unavoidable circumstances and you could not reasonably be expected to have met the deadline

Why was my Social Security claim denied?

Many people receive a denial for SSDI benefits the first time they apply. Understanding why Social Security denied your claim can help increase your chances on appeal.  Specifically, you will know what your claim was missing or where your claim can be improved.  Common reasons include:

  • Firstly, You are working
  • Secondly, Lack of medical evidence
  • Thirdly, Not following your doctor’s orders
  • Finally, Ignoring requests

Appealing a denial for working

Social Security considers disability as the inability to work for at least 12 months.   Not all work activity prevents you from filing for disability.  Social Security considers earnings over a certain amount “substantial gainful activity” or “SGA.”  If you earn over the SGA amount, you won’t qualify for Social Security disability benefits.  For 2021, Social Security considers $1310 SGA for non-blind individuals.  Additionally, you must be out of work for at least 12 months to qualify for Social Security benefits. 

Appealing a denial for lack of medical evidence

Frequently, Social Security denies claims because there was not enough medical proof to show your condition keeps you from working.  Important medical records might be missing from your claim.  On appeal, you need to tell Social Security about all the doctors you’ve seen since becoming unable to work.   You should see your doctors regularly so that you have documentation of your conditions and limitations.  Additionally, you should see specialists for your conditions.  Often, specialists keep better records about your symptoms and problems better than a general doctor.

Appealing a denial for not following your doctor’s orders

When you don’t follow your doctor’s recommendations, Social Security can decide that your limitations would be less serious than if you followed their orders.  This includes refusing or declining certain treatment.  For example, your doctor recommended physical therapy but you didn’t go.  Additionally, it includes taking your medications as prescribed.  It can also include certain lifestyle changes such as diet or exercise.  You should speak with your doctors directly about any difficulty you have following their recommendations.

Appealing a denial for ignoring Social Security’s requests

Social Security often asks for additional information when processing your claim.  Generally, this includes additional forms about your daily activities and work history.  However, it also includes medical examinations with a Social Security doctor.  Social Security may not be able to make a decision without this information.  Social Security denies your claim when you don’t respond to their requests. 

Why should I appeal my Social Security denial?

Appealing a denial improves your chances for approval.  In fact, most cases have the best chance for approval at the hearing level.  Re-filing a new application won’t increase your chances for getting approved.  Actually, it only delays the appeals process. 

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

Make sure you start your claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

What Evidence Do I Need for SSDI?

What Evidence Do I Need for SSDI? Social Security pays SSDI benefits when you have a medical condition or combination of conditions that prevent you from working.  Your medical impairments must keep you from working for at least 12 months.  Additionally, you must have worked for a certain number of years.  Generally, you need to have worked for at least 5 out of the last 10 years.  Social Security requires certain evidence to support your SSDI claim.

Non-medical evidence for SSDI:  Disability Report

Naturally, SSDI applications require a lot of information.  Part of the application process includes providing a form called the Disability Report.  This form includes information about your doctors, hospital visits and medications.  You should only include treatment information for the time that you have been unable to work.  Social Security contacts the doctors and hospitals you provide in the Disability Report.  If you don’t provide complete information, Social Security may not get important medical records.  This could end up resulting in Social Security denying your claim. 

Non-medical evidence for SSDI:  Work History Report

Social Security requires information about your work history going back 15 years.  You should provide a clear description of each of your past jobs.  Social Security could deny your case if they don’t categorize your past work accurately.  Social Security can deny you for not returning the work history report forms. 

Non-medical evidence for SSDI:  Function Reports

Social Security needs to understand how your conditions impact your daily functioning.  Therefore, they send you a Function Report to complete.  This form asks you to describe how you perform normal daily activities.  It is important to describe any problems you have or any assistance you need for your daily activities. 

Medical Evidence for SSDI

Your medical evidence should include records only for the period of time that you became disabled and unable to work.  Your treatment should also be continuous and ongoing.  Medical evidence can include:

  • Firstly, Treatment notes and physical examinations
  • Secondly, Imaging such as MRIs, x-rays, CT scans or nerve testing
  • Thirdly, Blood work or biopsy results
  • Fourthly, Pulmonary tests
  • Lastly, Mental health records

Example 1: medical evidence for SSDI

For example, Kelly injured her neck in a car accident.  She required a cervical spinal fusion surgery.  Despite surgery, she continued to have severe pain and difficulty moving her neck.  She also still had problems using her hands due to numbness and tingling.  Kelly sees her doctors regularly for her symptoms.  Her records include x-rays, MRIs and nerve testing documenting her neck impairments.  Her doctors also continue to note limited range of motion and decreased sensation and strength in her arms and hands in their office notes.  Kelly provided proof through her medical records that her conditions caused a serious problem using her arms and hands.  As a result, Social Security approved Kelly’s claim. 

Medical evidence for SSDI from specialists

The type of treatment you receive can also impact your disability claim.  Often, records kept by specialists record your symptoms and problems better than a primary doctor.  They focus on specific information that Social Security needs to approve your disability benefits.  This can include special tests or examinations.  This can especially be true for any mental health impairments.  Generally, receiving medication from your primary doctor will not be enough to document your mental health conditions.  

Example 2:  medical evidence from specialists 

As an example, Julie suffers from anxiety and panic attacks.  Her panic attacks happen unexpectedly.  She receives medication from her psychiatrist.  She also sees a therapist regularly.  However, she still suffers from panic attacks many times during the day.  She has even had to go the emergency room during her panic attacks.  Her panic attacks make it hard for her to finish things she starts.  At times, her panic attacks keep her from leaving the house.  Social Security finds that Julie would miss work a lot due to her panic attacks.  Therefore, Julie qualifies for disability benefits. 

Medical evidence for SSDI and RFC forms

Residual functional capacity (RFC) forms can help support your disability claim.  RFC forms explain how your symptoms impact your ability to work.  An RFC form can include both mental and physical limitations. 

Physical RFC forms

A physical RFC form includes questions about your ability to do things like:

  • How long  you can sit, stand or walk at one time or in an 8 hour work day
  • How much weight you can lift or carry
  • If you need an assistive device such as a cane, walker, wheelchair or crutches
  • Using your arms and hands for activities such as reaching, pushing, pulling, gripping or grasping objects
  • If pain, fatigue, other symptoms or side effects from medications cause limitations with concentration, persistence or pace

Mental RFC forms

A mental RFC form includes questions about your ability to do things like:

  • Your ability to understand, remember or carry out instructions, interact with others such as supervisors, co-workers or the general public
  • Your ability to maintain attention and concentration
  • If your symptoms interfere with your ability to show up to work, arrive on time or have to leave early

Example 3:  medical evidence and RFC forms

For example, say you are under the age of 50 and worked before as a waitress.  You have a back injury that interferes with your ability to do this type of work.  You also have side effects from your medications that make you drowsy.  In an RFC form, your doctor states that you cannot sit for more than 3hours or stand or walk for more than 2 hours in a work day.  Your doctor also states that you have problems with attention and focus due to your medications.  These limitations help support your disability claim because it shows that you could not work a full 8 hour day. 

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What Are the Legal and Financial Requirements of SSDI?

What Are the Legal and Financial Requirements of SSDI? You can file for Social Security disability benefits (SSDI) if you are unable to work.  However, there are certain requirements that you must meet.  First, you must meet the non-medical requirements for SSDI.  Second, you must meet the medical requirements. 

To qualify for SSDI, you must have worked a certain number of years.  You must be between the ages of 18-65 years old.  You do not need to be a US citizen.  Any worker with a valid Social Security number who paid into Social Security may file for benefits.  Your medical conditions must keep you from being able to work for at least 12 months. 

Each year that you work and pay into Social Security, you earn work credits.  Generally need to earn 20 work credits to meet the requirements for SSDI.  However, if you are younger, you may meet the requirements for SSDI with fewer credits.  Additionally, you must have worked recently for SSDI.

Your date last insured (DLI) is the last date you can qualify for SSDI benefits.  Your coverage for SSDI ends after a certain amount of time from when you stopped working.  Generally, your DLI expires five years after you stop working.  However, your DLI may be within less than five years if your earnings were low or inconsistent.  You can still meet the requirements for SSDI if your DLI has expired.  You would need to prove that you meet the medical requirements for SSDI before your DLI. 

For example, say you stopped working in 2014.  As a result, your DLI would expire in 2019.  Therefore, you would need to show that your medical conditions kept you from working before 2019. 

Financial requirements for SSDI

As mentioned, SSDI requires that you earn a certain amount of work credits to qualify.  Therefore, there are no limits the amount of assets, cash or other resources you own.  Additionally, there aren’t any limits to the amount of unearned income you make.  There aren’t any limits to the amount of income your spouse makes either. 

Financial requirements for SSDI and unearned income

Social Security considers any money you receive outside of a job as unearned income.  Under SSDI, you can receive income from other sources and still qualify to receive benefits.  Examples of unearned income include:

  • Income from retirement accounts, dividends or stocks
  • Unemployment benefits
  • Rental income
  • Alimony or child support

Financial requirements for SSDI: substantial gainful activity

Since Social Security defines disability as the inability to work, if you are working, you may not qualify for SSDI.  Social Security considers work earnings over a certain amount “substantial gainful activity” or SGA.  If you earn over the SGA limit, you will not qualify for SSDI.  In 2020, earnings S1, 260 per month or (before taxes) are considered SGA.  If you are working part-time and earning less than SGA, you may still qualify for SSDI.  However, any work may make it harder for Social Security to approve your claim. 

Social Security disability requires that your medical conditions keep you from working at least 12 months.  Unlike workers’ compensation or veterans’ disability benefits, Social Security doesn’t offer partial disability.  You can qualify for SSDI:

  • If You meet strict requirements of a Social Security impairment listing
  • You fall under a medical-vocational allowance
  • Your medical conditions prevent you from working in any job at all

Social Security considers whether your medical conditions fall under their listing of impairments, known as the Blue Book.  Typically, the Blue Book requires that your medical conditions meet very specific requirements.  SSA reviews clinical findings and laboratory tests to determine if your disability meets the listing.  If you have not had the clinical or laboratory tests required in the listing, you should ask your doctor to perform them. 

Social Security uses a chart called the Medical-Vocational guidelines to evaluate your disability claim.  These guidelines are known as the “grid rules”.  The grid rules make it easier for people 50 or older to win their case.  Social Security understands that it may be harder for older people to do new or different work.  However, you must first show that you can’t do any past work.  Even if Social Security thinks you can do something else, you may still qualify for SSDI.  The rules are even more favorable if you are over 55. 

Applying the grid rules

The grid rules consider different factors.  These include your age, education, work background, work skills and your residual functional capacity (RFC.)  Your RFC is what you can do despite your medical conditions.  Once Social Security determines your RFC and work background, they will look to the grid rules.  There are separate charts for sedentary, light and medium physical categories.  For people over age 50, he more physically limited you are, the more likely the grids will show you should be found disabled. 

Example 2:  applying the grid rules over 55

For example, Andy, a 56 year old man previously worked as a janitor.  He could no longer work because he has severe arthritis in his shoulder.  He could no longer lift or carry up to 50 pounds.  Since Social Security found Andy could no longer do his past work, the grid rules allowed them to approve his disability case. 

Example 3:  applying the grid rules over 50

As another example, Barbara, a 53 year old cashier stopped working because she had severe arthritis in her knees.  She could no longer stand or walk for long periods.  Social Security found that she could not perform her past work as a cashier.  The grid rules allowed Social Security to approve her case, even though she could have done other types of work requiring less standing and walking. 

If your conditions don’t meet the listings and you don’t fall under the grid rules, you can still qualify for SSDI.  Social Security evaluates your medical records to determine your RFC.  You want to provide as much documentation and records as possible related to your medical conditions.  You should see your doctor consistently.  Your doctor can also provide an opinion to explain how your conditions impact your functioning.  If Social Security determines that your conditions keep you from working in any job, you would qualify for SSDI. 

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How is Disability Amount Determined?

How is Disability Amount Determined? Social Security bases your disability insurance benefits (SSDI) on the amount of earnings that you paid taxes on.  Therefore, everyone’s amount is different.  

How are benefits calculated?

Earnings you paid taxes on are called “covered earnings.”  Social Security calls your average covered earnings Average Indexed Monthly Earnings (AIME).   Social Security uses your AIME to figure your Primary Insurance Amount (PIA).  Your PIA determines the amount you would receive from Social Security.  Make sure your Disability Amount Determined is correct.

Average Indexed Monthly Earnings

Social Security adjusts or indexes your lifetime earnings to account for the increase in wages that happened during the years you worked.  Social Security uses up to 35 working years in their calculation.  First, they take the years with the highest indexed earnings and add them together.  Next, they divide them by the total number of months for those years.  Then, Social Security rounds down to reach your AIME which will be used to determine your disability amount. 

Determining AIME for your disability amount

If you don’t have 35 years work history, Social Security calculates your AIME a little differently.  Firstly, they will count the number of years between the time you turned 21 and the year you became disabled.  Secondly, they subtract one-fifth of that total number of years or five years, whichever is less. 

Your Social Security earnings statement

You can also check your estimated benefit amount on your Social Security benefits statement.  Generally, checking your statement is the easiest way to find out your disability amount, which you can do by logging on to Social Security’s website at www.ssa.gov/mystatement.  You would need to set up an account before accessing your statement.  Additionally, you can request your statement from Social Security. You want to make sure your disability amount determined is accurate.

Other disability payments can reduce your disability amount

Social Security will reduce your disability payments if you receive other disability benefits.  For example, these would include worker’s compensation benefits.  They might also include temporary state disability benefits.  Generally, you can’t receive more than 80% of the average amount you earned before you became disabled.  Therefore, if both your Social Security disability benefits and other disability payments are more than 80%, Social Security reduces your disability payments. 

Other disability payments that do not reduce your disability amount

Private long-term disability insurance benefits won’t reduce your Social Security disability amount. VA or SSI benefits won’t reduce your SSDI benefits either. You want to make sure your disability amount determined is accurate.

Disability back pay

Under SSDI, you can receive benefits back to the application date.  However, you can also qualify to receive retroactive benefits.  Social Security pays retroactive benefits for the months between when you became disabled and when you applied for benefits.  Additionally, these benefits can go back one year before the application filing date. Therefore it will be involved in determining your disability amount.

SSDI back pay and the 5 month waiting period

Social Security does not pay back pay for the first five months after your disability began.  This will determine your disability amount. You start receiving benefits at the beginning of the sixth month.  Typically, the 5 month wait period can be much shorter than the time it takes for Social Security to approve your application. 

Cost of living adjustment (COLA) and your disability amount

Each year, Social Security benefits may be increased to adjust to the increasing cost of living.  Generally the Consumer Price Index (CPI) determines any COLA amounts increases each year.  Therefore it will be involved in determining your disability amount.

Determining your disability amount for SSI

Unlike SSDI, SSI is a needs based program and doesn’t depend on your work history.  Therefore, SSI has a maximum monthly rate.  Firstly, the federal SSI payment standard for 2020 is $783 per month.  Secondly, most states provide an additional small supplemental payment.  Thirdly, Social Security calculates your SSI disability amount based on your income, assets and resources.  Fourthly, your SSI benefit can be reduced by wages you or your spouse earn and other resources you receive. You want to make sure your disability amount determined is accurate.

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How Do I Appeal an SSDI Denial?

How Do I Appeal an SSDI Denial? Has Social Security denied your claim for SSDI benefits?  You may think filing a new claim can be better than appealing.  However, you should appeal any denials.  Re-filing can delay the appeals process.  Your chances for getting SSDI benefits improve when you appeal. 

Where do I appeal an SSDI denial?

You can file an appeal several ways.  First, you can appeal your denial online.  This can be the easiest way to appeal an unfavorable decision.  Second, you can file an appeal with your local Social Security office.  If you have a representative, they can help you file an appeal of your SSDI denial. 

How long do I have to file an appeal?

You have 60 days to appeal an SSDI denial.  Social Security gives you an extra 5 days to allow you to receive your denial in the mail.  Therefore, you have a total of 65 days from the date on your denial to appeal your SSDI claim.  If you don’t file within the 65 days, you may have to re-file your claim.  Social Security allows you to file an appeal in more than 65 days if you have good cause for missing your deadline.

What is good cause to appeal an SSDI denial for missing your appeal deadline?

Good cause can include several reasons.  Social Security considers:

  • What circumstances kept you from making the request on time;
  • Social Security’s action misled you
  • Whether you didn’t understand what you needed to do to appeal
  • Whether you had any physical, mental, education or language limitations that prevented you from appealing on time

Examples of good cause for missing your deadline

  • You were very sick when the appeal was due and couldn’t have contacted Social Security yourself or through someone else.  You would need proof that you were seriously ill.
  • There was a death or serious illness in your family
  • Records needed for your appeal were destroyed by an accident or fire.
  • You never received your denial notice
  • Some other type of unusual or unavoidable circumstances and you could not reasonably be expected to have met the deadline

What information should I include in my appeal for SSDI denial?

Most importantly, you need to include updated treatment information on your appeal.  You should tell Social Security about all the doctors you’ve seen since filing your application.  You should include any emergency room visits, also include any hospitalizations.  On appeal, Social Security looks at any new or missing information that might change their minds. 

Why was my SSDI claim denied?

Many people receive a denial for SSDI benefits the first time they apply. Understanding why Social Security denied your claim can help increase your chances on appeal.  Specifically, you will know what your claim was missing or where your claim can be improved.  Common reasons include:

  • Lack of medical evidence
  • You are working
  • Not following your doctor’s orders
  • Ignoring requests

SSDI denials for lack of medical evidence

Frequently, Social Security denies claims because there was not enough medical proof to show your condition keeps you from working.  You must show that your symptoms cause serious problems in your functioning.  Therefore, you should see your doctors regularly.  Additionally, you should see specialists for your conditions.  Often, specialists keep better records about your symptoms and problems better than a general doctor.  They focus on specific information Social Security needs to approve your SSDI benefits. You need to Appeal your SSDI Denial on time or you will have to start over.

SSDI denials for working  

Social Security defines disability as the inability to work for at least 12 months.  Therefore, if you are working, you may not qualify for SSDI benefits.  Social Security considers earnings over a certain amount “substantial gainful activity” or SGA.  If you earn over the SGA limit, you won’t qualify for SSDI.  If you have not been out of work for at least 12 months, you won’t qualify for SSDI. 

SSDI denials for not following your doctor’s orders

If you don’t follow your doctor’s recommendations, Social Security could deny your case.  Your doctor’s treatment plan shows that you cannot work due to your condition.  Without a treatment plan, Social Security can have trouble establishing that your condition impacts your work ability.  This also includes taking prescribed medications correctly.  Additionally, when you don’t follow your doctor’s orders, Social Security can decide that your limitations would be less serious if you followed their recommendations.  This can result in an SSDI denial. You need to Appeal your SSDI Denial on time or you will have to start over.

SSDI denials for ignoring requests

Often, Social Security requires additional information to process your SSDI claim.  This may include more information about your treatment or work history.  Social Security may not be able to make a decision without this information.  When you don’t respond to their requests, Social Security denies your claim for failure to cooperate. 

Get help appealing your SSDI denial

If you’ve been denied for SSDI benefits, you should consider working with a disability advocate.  Hiring a disability advocate can significantly increase your chances of winning.  A disability advocate makes sure you don’t miss any deadlines for appealing.  They can help get your claim on the right track for winning your claim. 

Disability Help Group, Call Now for a Free Case Review, 800-700-0652

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