Many of us caregivers have been right there with our veterans while fighting the jungle some call the VA. It’s not pretty and it’s far from easy. But little did I know, how difficult it would be for my husband to also fight for Social Security Benefits. For many of us, it can be extremely difficult to stay positive for our veterans during this process. Having access to tips on how to deal with disability claims could potentially ease this process. I have the great pleasure to introduce you to Tatiana, a Disability Attorney from Arizona who is sharing some great tips for Veterans’ Social Security Claims from the perspective of a disability attorney!
Tips for Veterans’ Social Security Claims
Veterans are treated so unfairly these days.
To add insult to injury, when veterans need to apply for disability, the system that should protect and help is actually rigged against them.
When a Veteran returns injured from overseas, there is an even higher uphill battle, (pun intended!) : Filing for Social Security disability benefits.
While the VA system offers benefits and that’s the subject for another post, getting Social Security disability as a veteran can be very tricky!
The VA Benefits System and How It’s Different From Social Security
VA benefits are different from Social Security simply because the VA system uses a rating scale of disability.
For example, you got injured on the knee and you were rated 10% disabled by the VA. While you get some benefits for having a “disability”, this injury does not prevent you from working. Which means you are not fully disabled.
Social Security, on the other hand, requires you to be completely disabled. Meaning, you can not work “any type of jobs” at all.
To win disability you basically have to prove that your working days are over.
100% Disabled through the VA and Applying for Social Security
Now, being 100% disabled through the VA doesn’t always mean you are “completely” disabled for Social Security disability purposes.
It’s all about math.
While it may show that you are really “messed up” due to your physical or mental impairments, this 100% does not always translate to “inability to work”.
Say you have the following conditions: an injured knee, sleep apnea, a herniated disk, and PTSD.
Because of the “VA rating math”, you can get 20% on the knee, 50% on sleep apnea, 30% on the herniated disk and another 50% on PTSD. While this math may take you to a 100% rating, it still may not mean your working days are over. It just means that the math adds up to 100% in the VA rating scale.
That’s why the VA system created yet one more step to show you are permanently unable to work: “TDIU” or Total Disability Individual Unemployability. So if you are able to get TDIU, then Social Security will start paying attention.
Of course, Social Security takes into consideration “combination cases”. These are cases where you have a bunch of smaller ailments that alone don’t really prevent you from working. But the “combination” of these ailments will prevent you from working because of the many symptoms you have to deal with daily.
In that case, you can still win Social Security even if you don’t have TDIU. As long as you can prove that the combination of all your impairments prevents you from working.
Veterans Treating in VA hospitals and Social Security Claims
The most basic way to win Social Security is through medical records reporting your disability. Here’s some great info about the importance of medical records in a Social Security case.
Good quality medical records should include diagnosis, your physical or mental limitations affecting your daily activities. It should also include any evidence of inability to concentrate or retain a job.
In addition to those requirements, you must also show that you are currently treating with doctors specialized in your individual conditions. If you have a heart problem you should be seeing a cardiologist. If you have PTSD, you should be seeing a psychiatrist and a therapist.
The biggest issue with veterans winning disability is their inability to control which doctors they see at the VA hospital. Also medical records from the VA lack organization with some of them not even including dates of visits.
While the VA system tries to accommodate the veteran’s needs, funding may be the biggest obstacle in providing them with proper specialists. It is not uncommon to see a general practitioner treating back problems or PTSD. Other times, you only see medical notes from a nurse or a physician’s assistant.
There is also the issue of the frequency of treatment. Because the VA system is underfunded, sometimes a veteran can only see a particular doctor once or twice a year. Social Security requires that a claimant sees their doctors with a “certain frequency”.
While they are not clear what that “frequency” should be, a visit once or twice a year is not enough. It is also not enough to see a general practitioner, or a nurse when you have a severe condition.
How Can a Veteran Win Social Security if This is All the treatment available?
It will take a little bit of creativity and a lot of researching to win a claim but it is possible. The key is not giving up and trying one or more of the options below:
The first thing you could do is apply for TDIU (or Total Disability Individual Unemployability).
Click here to see if you qualify to apply.
Here’s the “messed up” thing about the VA system: The same way they can use their own treatment notes against you, they can also use it in your favor. If your medical records from the VA including your C&P exams are enough to show that you qualify for “TDIU”, then, by all means, apply.
Even if your records are a little “iffy” for purposes of Social Security (treatment frequency, no specialists etc), the fact that you won TDIU will make a huge difference in your chances to win your Social Security claim.
The second possibility is to see if you qualify for “TriCare” or if you can join your spouse’s insurance: Check with your local VA if you qualify for TriCare.
The second possibility is to see if you qualify for “TriCare”, “ChampVA” or if you can join your spouse’s insurance: Check with your local VA to see if you qualify for TriCare or ChampVA. If you do, then you can actually go to private doctors of your choice and the VA or TriCare will pay for it.
The same happens if you can get into a spouse’s medical insurance.
Or try to apply for health insurance under the Affordable Health Care Act (ACA).
Then you can start improving your medical records to win your claim.
Here’s why this is important: To win Social Security you have to show that you are physically or mentally unable to work.
To show you are unable to work you have to show an inability to function.
A few examples of inability to function are the inability to sit for more than 15 minutes. Or the inability to concentrate or get along with others because you suffered a head trauma and you have poor short-term memory.
A lot of VA medical notes will not include that information. When doctor’s don’t include functional capacity information in the medical notes the next step is to have them complete a functional report. These are reports that clearly specify your inability to function.
Here’s the kicker: VA doctors will never, EVER, complete these reports. Even if your attorney or Social Security begs for it. But having one of those forms is so important in a Social Security case.
That’s why I suggest you get a private doctor through ACA or private insurance. Only private doctors are more likely to complete those forms.
Paying for a Functional Capacity Exam (FCE)
There are physical therapy outfits that, for a fee, will review your medical records and will determine your physical capacity to work. A physical functional capacity examination will include your ability to sit, stand, push and pull among other limitations. Once their examination is complete, they will write a report stating your physical limitations. Then you can add that information to your VA records. Even if the records are not that great, the FCE will give a better picture of your physical abilities in addition to your medical notes.
Or, if you have a brain trauma or PTSD you can have a neuropsychological exam done to evaluate your mental abilities. This is a report prepared by a neurologist. This report will include the ability to follow instructions, endurance, ability to pay attention and complete projects.
These types of exams are the “gold standard” in giving a clearer picture of your physical or mental abilities. While these alone will not win cases, they will serve as an additional important evidence of your inability to work.
Note that your C&P exam is pretty close to an FCE but not quite. While ironically this exam is what usually dictates your percentage rating of disability, for Social Security purposes it’s a tad incomplete.
A doctor’s letter
This is also another way to improve your medical evidence overall even if they are a little “sparse”. However, just like the FCE, these alone will not win cases. These letters have to be supported by and be consistent with the medical records.
Once again, it is highly unlikely that a VA doctor will agree to write that letter, but it is worth asking for one. The other option will be to try those private doctors we talked about before.
The Young Veteran and Social Security Disability
If winning Social Security is already difficult for an older person, try being younger and applying.
The mentality in the Social Security system is that a young person can “spring” back to normal quicker. Their bodies are young and therefore they can heal faster. But unless the case worker handling that young person’s file has lived through the hardships of military service, she will never understand that this young person will not “spring” back.
There is also the issue of paying benefits for a young person for the rest of her life. It’s very expensive to support a claimant in all those future years. Especially since the person didn’t contribute to Social Security as much as an older person.
To win a Social Security as a younger person, you must show as much evidence as possible that your condition is permanent. All of the above tips can help. But here’s another trick can add more “oomph” to your medical evidence: Letters from those who served with you.
The more detailed the letter is the better. The more it describes the “before” and “after”, the better.
For example: “John Doe and I served in the same infantry division in Iraq. I have known John Doe for 6 years and I remember how active and smart (insert qualities here) and I remember when (the incident) happened. It took him so many weeks to recover and once he was out of the hospital he was never the same…(add more details to the story and how John Doe is so different now). He can no longer do “this, that and the other”.
While this example is one of many ways to write a “buddy letter”, this may help persuade Social Security to approve the claim.
Understand that these tips and examples are not exhaustive but they can certainly help increase your chances at winning your claim.
Wishing you success in your claim.
About the Author
Tatiana Froes is a disability Attorney practicing in Phoenix, Arizona in the areas of Social Security and Long Term Term Disability. She is also a blogger at realtactics4disabilityclaims.com and amigas4all.com. In her free time, she rescues exotic birds and DIYing.
Disclosure: Everything I share is solely based on my personal experience and is for informational purposes only. This post contains affiliate links. For more details please view my disclosure policy.