What Vets should know about the Social Security Disability process
Disabled veterans will usually find themselves dealing with the social security administration, at some point or another. And this is only to be expected. However, many vets may end up very surprised when they learn how different the two systems really are. In this article, we'll discuss the principle aspects of the SSA system as well as a couple of differences that exist between the two systems.
To begin with, how does Social Security Disability work? Basically, like this: a person who feels that he or she is disabled contacts the social security office that is closest to them. They inquire into how a disability application can be filed and an appointment is set, either for an in-office interview, or an over-the-phone interview. This is for the purpose of filing what is called an initial claim.
Once the paperwork for the initial claim is complete, the claimant's file is transferred to a state agency known as DDS, which stands for disability determination services. At DDS, the claimant's file is assigned to a Disability Examiner, a specialist who will gather the claimant's medical records and, then, in consultation with a physician and/or a psychologist who is assigned to the examiner's unit, make an approval decision or denial decision. Unfortunately, the decision that is made is typically a denial. In fact, denials occur roughly seventy percent of the time at the initial claim level.
After the initial claim is denied, the claimant may file a new claim (a mistake) or may follow the appeal process and file what is known as a request for reconsideration.
The reconsideration works exactly as the initial claim. The paperwork is filed at the social security office which, once more, sends the claimant's file off to disability determination services. When the reconsideration (or recon, for short) is received at DDS, it is assigned to a reconsideration-level examiner'who does exactly what the initial examiner did. He or she gathers whatever medical evidence is thought to be needed and then makes a decision. Typically, this is also a denial. And, in fact, recons are denied at an even higher rate: about eighty-five percent of the time.
After a reconsideration denial, a claimant may elect to follow the appeal process again and file a request for hearing before an administrative law judge.
Fortunately, this is where most claimants will have the best chance of winning their claims. Unfortunately, because the system is so backed up, it may take an extremely long time to have a hearing date set. Depending on which part of the country the claimant resides in, and how backlogged their local hearing office is, it may take a year or longer to have a hearing date set.
In a nutshell, this is how the disability process plays out for most individuals (this is an abbreviated version, of course). Now, how is the federal Social Security Disability system different from the the VA system?
Primarily, the SSA system is different from the VA system in that there are no percentages of disability. While the system that exists for vets allows the veterans administration to conclude that a vet is 40% disabled and then receive benefits based on that determination (and potentially have that percentage upgraded over time to a full 100% rating), in the social security system it is all or nothing.
With the Social Security Disability system, a claimant is either awarded 100% of their eligible benefits, or zilch. Without a doubt, the SSA system is fairly draconian. In fact, the definition of disability used by the social security system stipulates that not only must your condition have kept you out of work(from the ssa.gov website) Your disability must also last or be expected to last for at least one year or to result in death.
The percentage approach is the greatest single difference between the ssa and va disability systems. However, there are other aspects regarding Social Security Disability that veterans should probably know about.
First of all, if your primary source of treatment is a VA medical center, don't assume that the DDS examiner who is assigned to your case will be successful in obtaining your VA medical records. The VA has been notorious in some areas for not supplying needed medical records. And for this reason, it's never a bad idea for vets to personally obtain their medical records themselves so they may turn these records in when they apply for disability, or file an appeal. One word of caution, though: never submit anything to social security without making a copy first since the social security administration is fairly notorious itself for loosing things that have been sent to them.
Veterans should also know that you're entitled to attorney representation from the very start. In the social security system, an attorney works off a contingency-fee basis from the moment they represent a claimant. In other words, if they win the case, they get paid 21% of whatever backpay that SSA decides it owes the claimant. The corollary of this, of course, is that the attorney receives nothing if the case is not won.
Is an attorney always needed in a Social Security Disability case? No. And, in fact, there are many outstanding disability representatives who are not attorneys at all and are referred to as 'non attorney representatives' (many of these non attorney reps are former social security employees who put their experience to use representing disabled individuals).
The rule of thumb for getting an attorney (or non-attorney) is usually this. If you get denied on your initial claim, you might as well get an attorney. Because in most cases, the first appeal (the recon) will be denied and a claimant will have to request the second appeal:, a hearing before an administrative law judge. And, of course, to go before a judge without representation is never a good idea.
The SSA disability system can be exasperating and difficult. Most individuals who've gone through the system have, at some point, concluded that the system is rigged against them. And, to be honest, it would be difficult to argue completely against that conclusion.
However, the best advice any claimant can utilize with regard to filing for disability is simply to learn as much as possible about the system and use that information to avoid simple mistakes, and even costly ones.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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