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SSA and VA Disability Benefit Tips for Veterans

SSA and VA Disability Benefit Tips for Veterans. Applying for SSA and VA disability benefits can be frustrating and time-consuming.  Both programs help disabled individuals receive benefits.  However, they have very different requirements for determining disability.  The following tips will help with both. 

SSA and VA Disability Benefit Tips for Veterans 1:  Understand the difference between SSA and VA disability benefits

The VA doesn’t require that you prove total disability.  Compensation rates range from 10%-100%, in 10% increments.  However, you must show that your conditions were “incurred or aggravated by your military service.”  You must also show a nexus between your diagnosis and in-service incurrence.  Unlike VA benefits, SSA doesn’t distinguish between partial and total disability.  Therefore, you must show that your medical conditions keep you from working in any job.  Although, SSA has some more favorable rules for people over the age of 50. 

SSA and VA Disability Benefit Tips for Veterans 2:  Be prepared when filing your application

SSA and VA disability benefits applications require a lot of information.  Providing complete information gives you a better chance of winning your case.  For SSA, you should provide all of your medical treatment information on your application.  It should include doctors you see regularly as well as any hospitalizations or emergency room visits.  For VA disability claims, you should be very specific with what you’re claiming.  You should include your diagnosis as well as how it is connected to your service. 

SSA and VA Disability Benefit Tips for Veterans 3:  Understand the rules

Generally, Social Security disability requires that your medical conditions keep you from working at all.  However, 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 older people to win their case.  Typically, if you are over the age of 50, the grid rules can allow Social Security to approve your case even if you can do other work.  The rules are even more favorable if you are over age 55.  However, the VA doesn’t consider your age.  Therefore, an approval from SSA doesn’t guarantee a 100% VA rating. 

SSA and VA Disability Benefit Tips for Veterans 4:  Get treatment with specialists

For both SSA and VA disability benefit claims, you should be in treatment with specialists.  Frequently, records kept by specialists record your symptoms and problems better than a general doctor.  They focus on specific information such as special tests or examinations.  Both SSA and the VA look at the severity of your medical conditions.  Generally, records kept by specialists can help document how severe your conditions affect you. 

SSA and VA Disability Benefit Tips for Veterans 5:  Stay in treatment

Again, both SSA and the VA need to assess the severity of your conditions.  Ongoing treatment with your doctors help document the length of time your conditions have affected you.  Ongoing treatment can also show the different types of treatment you’ve received for your conditions. 

SSA and VA Disability Benefit Tips for Veterans 6:  Getting your doctor to complete forms

Many times, medical records alone won’t clearly translate how your symptoms cause problems doing things.  Therefore, your doctors can complete forms that help make the connection.  For SSA, your doctors should complete an RFC form.  An RFC form includes both physical and mental limitations.  It details how your conditions impact your life on a daily basis.  For the VA, your doctor can complete a Disability Benefits Questionnaire (DBQs) provided by the VA.  These DBQs apply to every kind of disability.  These forms provide check boxes that make it easy for doctors to complete.  If the symptoms noted in the DBQ satisfy the criteria for a higher rating, the VA will likely grant that rating. 

SSA and VA Disability Benefit Tips for Veterans 7:  Attend all appointments

You need to cooperate with SSA and the VA in order for your claim to be approved.  At times, SSA will schedule a medical appointment to provide additional information.  Similarly, the VA will likely schedule a VA compensation and pension (C&P) exam.  You must attend any C&P exam.  If you miss either a SSA exam or a C&P exam, SSA and the VA will deny your claim. 

SSA and VA Disability Benefit Tips for Veterans 8:  Check on the status of your claim

Checking on the status of your claim can be important.  It allows you to make sure SSA and the VA handle your case properly.  You can check to make sure your doctors’ records were received.  You should confirm that they received any forms you completed.  It also allows you to check for any additional information SSA or the VA requests from you.  Lastly, it ensures that you don’t miss any important deadlines. 

SSA and VA Disability Benefit Tips for Veterans 9:  Appeal unfavorable decisions

SSA often denies claims.  You should appeal any denials.  Re-filing a new application doesn’t help you get approved for benefits.  It actually only delays the appeals process.  Your chances for getting approved improve when you appeal an unfavorable decision.  In fact, most cases have the best chance for approval at the hearing level.  The VA often assigns a lower disability rating that you believe you have. Similar to SSA, it is best to appeal your disability rating.  You only have one year to file an appeal.  If you don’t appeal in time, then you must submit a new claim and basically move to the back of the line. 

SSA and VA Disability Benefit Tips for Veterans 10:  Work with a disability advocate

Navigating the SSA or VA disability process can be overwhelming and exhausting.  Both require a lot of information and paperwork.  Working with an experienced disability advocate ensures that they get the information they need to process your claim.  You disability advocate walks you the process and answers all of your questions.  They regularly check on the status of your case.  Your disability advocate also files any necessary appeals. 

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.

VA Benefits Appeal

Posted on by Ken LaVan

VA Benefits Appeal. To win a VA disability claim, a veteran must prove all elements.  Generally, VA will approve a VA benefits claim when a veteran proves the following:

  1. In-service event, disease or injury,
  2. Current disability, and
  3. Medical nexus between the in-service event and the current disability.

After you submit your claim, VA is obligated to issue a decision.  Based on the evidence, VA may decide to approve your claim completely.  Alternatively, VA may either deny the claim outright, or grant your benefits at a low disability rating.  Regardless, veterans have the right to appeal any VA benefits decision to a higher authority.

What is the point of an appeal?

VA decision-makers are not perfect.  They often make mistakes.  For a disabled veteran who is barely making ends meet, VA’s mistakes can be costly.  This is why Congress created the appeals system.  It gives veterans a fighting chance to correct VA’s mistakes without losing years of benefits.

VA benefits appeals are great because they preserve the earliest effective dates.  Take the example of J. Stone, who filed a claim for PTSD in 2011.  VA denied his claim in 2013 because they could not confirm the traumatic in-service event.  His friends told him to just file another claim.  Instead, he consulted the experts at Disability Help Group (DHG). 

A DHG representative helped him file an appeal along with evidence of the in-service event.  In 2015, VA decided the appeal in Mr. Stone’s favor.  As a result, he received a 70% rating effective 2011, the date he filed his claim.  He received

Appeals in the Legacy System

The Legacy system refers to the VA appeals structure for decisions issued prior to February 19, 2019.  When VA first denies a claim in Legacy, the veteran may appeal with a Notice of Disagreement (NOD).  The deadline to file a legacy NOD is 1 year from the date of the decision. 

When you file a timely NOD, you are asking a senior VA officer to overrule the previous decision.  If the VA agrees with you, then it will issue a new decision awarding benefits.  If not, VA will issue a Statement of the Case (SOC) to explain why the previous decision should stand.

Fortunately, an SOC is not the end of the road.  Using a VA Form 9, you can appeal an SOC to the Board of Veterans’ Appeals (the Board).  Unlike the lower decision, you have only 60 days to appeal an SOC.  A VA Form 9 is a request for a Veterans Law Judge to take a fresh look at your case.   If the judge finds in your favor, he/she will award benefits effective the date you first filed.  If the judge finds against you, then you can appeal to the U.S. Court of Appeals for Veterans’ Claims.

The Appeals Modernization Act changed everything

Any decisions issued on or after February 19, 2019 fall within the Appeals Modernization Act (AMA).  If VA denies your claim, or approves it with a very low rating, you can appeal it by filing one of these forms:

  • VA Form 20-0995 Supplemental Claim, 20-0996 Request for Higher Level Review, or 10182 Notice of Disagreement to the Board of Veterans’ Appeals

Each lane has its pros and cons.  Visit this link for more details [Link to the AMA article].

What’s the downside of an appeal?

First, a VA benefits appeal can take a very long time.  Take a look at the search results when you Google “VA appeals backlog.”  Prior to the AMA, VA took an average of 2.5 years to process appeals. 

Second, you may have to appeal several times to get the job done.  If your first appeal is not successful, then you should appeal to a higher tribunal (like the Board of Veterans’ Appeals).  When you believe in your claim, you should never give up.  Don’t let VA win.

Hire an expert to give yourself the best chance to win

Every VA benefits appeal is different.  The best indicator of success is having an experienced representative.  This is a very complex system.  Most veterans are not equipped to force VA to change a decision.  Some cases already have the evidence needed to win, but are lacking a good legal argument.  Other cases lack both evidence and argument.  An experienced representative can plug the holes in your case. 

At DHG, our experts review each case with a fine-toothed comb.  This is how we figure out the best path forward.  We don’t just file a VA benefits appeal and then wait around for VA to act.  Instead, we actively develop winning evidence and arguments to deliver for our clients.

Do you need help with your VA benefits appeal?  Contact the experts at DHG for a free consultation.

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.

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Additional Information

What is the Appeals Modernization Act?

Posted on by Ken LaVan

What is the Appeals Modernization Act?

The Appeals Modernization Act has reduced the average time to receive a VA disability decision. Older claims typically took 3-7 years to receive a decision. In order to address this issue, Congress passed the VA Appeals Modernization Act in 2017.  On February 19, 2019, VA officially implemented this new law.  As a result, VA’s new goal is to complete claims and appeals in an average of 125 days.  This reflects VA’s renewed focus to deliver timely decisions to veterans and their survivors.

The VA Disability Claims Process Applying the Appeals Modernization Act

Filing an Original VA Disability Claim

The Appeals Modernization Act applies if you have already applied for VA Disability Benefits. Therefore, if you are filing an Original Claim it will not apply at the time of filing.  If you never filed a VA claim before, then you’ll need to file an Original claim.  Per VA rules, you can only file an original claim using a VA Form 21-526EZ.  The form asks for your Social Security number, dates of active duty service, branch of service, and other biographical information.  Most importantly, you must briefly explain why your claimed disability is related to your active duty service. 

Filing a VA Disability Supplemental Claim

When VA denies a claim, it must explain why.  VA has always had this duty.  However, the Appeals Modernization Act has enhanced this duty in the veteran’s favor.  As of February 19, 2019, VA must explain to the veteran which elements he successfully proved.  With that knowledge, a veteran should focus on getting evidence for the unproven element(s).  This New and Relevant evidence could change VA’s mind.  A veteran who obtains such evidence should submit it to VA with a Supplemental Claim.

Take the example of Joe Smith

Joe served in the Coast Guard for 3 years.  In 1991, he filed an Original claim for PTSD.  In a 1993 decision, VA denied the claim because there was no current diagnosis of PTSD.  Joe was so discouraged by this decision that he did not file an appeal.  During a 2019 visit to the local VA hospital, doctors diagnosed Joe with PTSD.  Unsure of what to do, Joe contacted DHG for a free consultation.  The experts at DHG agreed to represent him in a Supplemental Claim.  DHG filed a completed VA Form 20-0995 on Joe’s behalf, along with a copy of the current diagnosis.  Four months later, VA granted his PTSD claim at a 70% rating.

Appeals Modernization Act: Filing a Higher Level Review

This path improves on the Decision Review Officer (DRO) lane from the legacy system.  The main difference is that if the claimant requests a telephonic hearing in Higher Level Review, VA must grant it.  In the DRO lane, VA could reject a request for a telephonic hearing for any reason.  Thanks to the Appeals Modernization Act, VA cannot delay your right to a hearing.

Sometimes, VA denies a claim even though it has evidence to satisfy all 3 elements.  Either VA overlooked evidence, or it misunderstood the law it applied to the case.  In either scenario, it’s not that the veteran failed to prove his case.  VA just made a mistake.  If VA’s decision is infected by that kind of mistake, then your best bet is to file a Request for Higher Level Review.  This path involves an experienced VA adjudicator checking a Rating Decision for errors.  This adjudicator may issue a revised Rating Decision that corrects these errors.  And it does not require new evidence.

Appeals Modernization Act, but with slightly different facts 

In this example, assume Joe filed an Original claim for PTSD in 1991.  He filed the claim with a copy of a 1991 PTSD diagnosis and his service treatment records, which showed an in-service diagnosis related to a combat incident.  In a 1993 decision, VA conceded all other elements were met except the diagnosis.  Joe became discouraged and gave up.  Years later, he asked a DHG rep to review his case.  The DHG rep noticed that VA overlooked the 1991 PTSD diagnosis.  DHG immediately filed a Request for Higher Level Review on VA Form 20-0996.  DHG also attached a two-page argument that explained the legal errors.  Five months later, VA issued a revised Rating Decision that granted his PTSD claim effective 1991. This is the benefit of the Appeals Modernization Act.

Filing a Notice of Disagreement to the Board of Veterans’ Appeals (BVA), using Appeals Modernization Act

What do you do if VA denied your Original Claim, Supplemental Claim, and Request for Higher Level Review?  Your next option is go over their heads to the Board of Veterans Appeals.  VA Form 10182 gives you 3 lanes:

  1. Direct,
  2. Evidence, and
  3. Hearing

The Direct lane is for cases where all evidence and legal argument is already in VA’s records.  The Evidence lane gives you 90 days to provide additional evidence.  The Hearing lane gives you the right to make your case directly to a Veterans Law Judge.  In the Hearing lane, you also have 90 days after the hearing to submit additional evidence.

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

Allow us to help you win the most money you can receive in the faster manner possible. You may be entitled to significant compensation that you were not even aware of.  Contact us now for a free consultation, 800-700-0652.

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