Will I Qualify For Disability Benefits in Virginia?

You may qualify for disability benefits in Virginia provided you meet all of the medical and non-medical qualifications of the Social Security Disability or SSI disability program. A claim for disability can be approved by satisfying the Social Security Administration of disability. This definition is substantially different than other disability benefit programs, such as long term disability, workman's compensation, or VA disability.

To qualify for disability under SSD or SSI, an individual must have at least one medical condition (physical or mental) that:

A) Significantly affects normal activities of daily living,

B) Significantly affects the ability to do basic work activities,

C) Lasts at least one full year,


D) Is severe enough to prevent the ability to work and earn a substantial and gainful income during this one year minimum length time period.

Individuals who are disabled but whose condition does not last for at least one full year will be denied on the basis of duration. Individuals who are disabled but still manage to work and earn a substantial income will be denied for earnings.

In the case of claims taken for children, the child's ability or inability to engage in age-appropriate activities will be used in place of evaluating work activity or the potential to engage in work activity.

Filing for disability in Virginia

When you file your initial disability claim by phone, in person, or online with one of the thirty'two Social Security offices in Virginia, a CR, or claims representative, will send it to a state disability agency (Disability Determinations Services) for a medical decision. Currently, Virginia has DDS offices in Fairfax, Richmond, Roanoke, and Norfolk.

When your disability claim arrives at Disability Determination Services, it will be assigned to a disability examiner. The examiner requests your medical records from the medical treatment sources that you provided to Social Security when you applied for disability.

If the disability examiner determines that they do not have enough medical information, or enough current information (current being defined as not older than 90 days) to make their determination, they may schedule you for a consultative medical examination to evaluate the current status of your disabling condition or conditions.

Additionally, the disability examiner may send out a form SSA 3369 (a Work Report form) to more thoroughly evaluate your work history.

The ability to perform substantial work activity (self-supporting) is an integral part of every Social Security Disability determination. If the disability examiner determines that you are capable of performing any of your past work or any other kind of work, your disability claim will be denied.

Disability approvals, denials and appeals in Virginia

The approval rate for an initial disability claim, i.e. disability application, in Virginia is 36%; unfortunately this leaves an initial disability claim denial rate of 64%. If you wish to continue your disability claim you can file a Request for Reconsideration Appeal. Reconsideration appeals are sent back to the same DDS for a decision, the only difference being that the appeal is assigned to a different disability examiner.

It stands to reason that most reconsideration appeals are denied when you consider that the same rules and guidelines are being used. The initial disability examiner would have to have made an error in the first determination, or there must be new and convincing medical evidence to support a finding of disability.

The approval rate for reconsideration appeals in Virginia is 14.1%, meaning that Virginia still denies about 85.1% of these appeals.

Disability hearings in Virginia

If your reconsideration appeal is denied, you can appeal the decision with a Request for an Administrative Law Judge Review, a.k.a. a Social Security Disability hearing.

The good news about the hearing appeal is that it offers the best chance for you to qualify for disability benefits. The approval rate for disability hearings in Virginia is nearly 60%.

However, this is an aggregate statistic. The rate of approval for claimants who are children is probably much lower (child disability claims are typically more difficult to win). Also, the rate of approval for claimants who appear before a judge is sometimes as much as 50 percent lower versus represented claimants.

This should not be surprising considering that few claimants will have any knowledge of Social Security regulations, SSRs (social security court rulings), or the medical vocational framework of rules (the grid) that directs decisions on most SSD and SSI claims.

It takes a long time to get a disability hearing scheduled, so you may wish to consider the services of a qualified Social Security representative to represent you at your hearing. Social Security representatives are allowed a fee of 21% of any back payment, up to a $6000.00 maximum for their services. They can also charge for incidental expenses such as copying, calls, medical records, or even a medical or vocational expert's fee.

All expense charges should be clearly defined in the fee agreement that you sign with your representative, but, as with all legal documents, you carefully read any fee agreement because they are legally binding.

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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