ptsd Ptsd And Ssa

[usmcgirl]

Section IX. SOCIAL SECURITY BENEFITS

Duel Compensation.

Under current regulations you can receive VA disability compensation and Social Security disability benefits at the same time, without a decrease in either. That's the good news. The bad news is....

The Social Security Administration (SSA) is another government agency, ergo, more waiting and frustration is in store for you. Knowing what to expect and what forms are required will help eliminate a great deal of frustration and will cut down on the time required to receive your benefits.

The SSA Internet web page is located at www.ssa.gov, where you can download blank forms and find up-to-date information on rulings and regulations. The SSA falls under CFR (Code of Federal Regulation) 20, Chapter III.

Read, understand and accomplish the following BEFORE applying for benefits.

Preparing for the Interview and application process

Qualifying for Benefits.

You are not eligible for SS payments until you have been out of work at least 6 months.

The SSA explains how they determine a disability in their Publication 05-10029. They state "It's a step-by-step process involving five questions". They are:

a. Are you working? If you are and your earnings average more than $500 a month (this amount may change), you generally cannot be considered disabled.

b. Is your condition "severe"? Your impairments must interfere with basic work-related activities for your claim to be considered.

c. Is your condition found in the list of disabling impairments? We maintain a "List of Impairments" for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step. (Note: PTSD is not specifically identified in the "List of Impairments" which normally causes the SSA to continue to step "d" below. However, I will explain how to avoid going to step "d" and "e" and forcing the SSA to accept PTSD later in this section.)

d. Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.

e. Can you do any other type of work? If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.

The First Thing You Should Do

Obtain and submit a Form SSA-7050-F4 (Request for Social Security Earnings Information)(Available at www.ssa.gov/online, bottom of page in the "Other SSA Forms section). As part of your initial application packet you will be required to fill out two documents that require work history for the past 15 years. Obtaining the information form the SSA insures that you do not submit incorrect data and also serves as a reminder of your work record in case you no longer have that information available in your own files. You may be required to pay as much as $50 for this information. It will take approximately 3 weeks to receive the information you request but it is well worth the wait if you do not have past records showing your employment. The following is provided:

1. Name, address and Federal ID # of employer.

2. Years of employment with each employer and how much you received each year.

You also need to do the following:

1. Arrange for a Medical Assessment by your psychiatrist. Attach this information to your application.

2. Obtain an ORIGINAL copy of your DD 214 and birth certificate.

Interview and filing your Claim.

You can go to the nearest SSA office for an interview or, if you prefer, file your claim by telephone. Save yourself time and aggravation and take the phone interview (if they do not offer this option, ask for it). Call 1-800-772-1213. The original call is to set up an interview at a later date, usually 15 to 30 days out. A representative from a nearby SSA office will call you and that call can come anytime within an hours time, thirty minutes prior to or after, the agreed upon time.

The phone interview will take approximately 30 minutes and will consists of questions about your work history with emphasis on unusual changes in your work habits (sharp increases or decreases in income). You will be asked if you were ever self employed, or if you are currently drawing Workman's Comp., and if you have ever received a print-out of your SS contributions (they will offer to send you one if you say no).

You will receive a packet, in two or three working days, containing a medical questionnaire, other assorted forms (listed below) and a list of documents you may need to send in.

You will be told how much you will receive if your claim is approved and asked if you a bank account available for automatic deposit.

You will be informed that the disability claim evaluation will be done by a "State Disability Determination Services (DDS)". These DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical evidence and rendering the initial determination on whether the claimant is or is not disabled or blind under the law.

You should receive a letter from the DDS doing your evaluation in approximately two weeks. This letter will inform you that your doctors will be contacted along with past employers, schools and other sources that you list on the forms you filled out for your application. The letter will also inform you to forward any treatment records that occurred during the evaluation period.

You will normally receive the following in your original claim packet:

a. Stamped return enveloped.

b. Cover letter. This letter will request that you mail them an ORIGINAL birth certificate and DD Form 214 within 10 days. If you have more than one DD 214, mail ALL copies.

c. Letter SG-SSA-16. This was a three page documents more or less containing the information covered in the telephone interview. Make certain the information presented is accurate or make corrections and initial where appropriate. You will also find several items you will be agreeing to when you sign the letter such as a change in your medical condition and your work status. You will need to sign and date this letter.

d. Form SSA-3369-BK (Work History Report).

e. Form SSA-3368-BK (Disability Report - Adult).

Both of the above SSA Forms are tedious and will require your patience to complete properly. Get someone to assist you if necessary, but do not submit incomplete or inadequate information.

f. Form SSA 827 (Authorization for Source to Release Information to the Social Security Administration (SSA). This is the SSA version of VA Form 10-5345 (Request for and Consent to Release of Medical Records). Do not do anything to these forms except sign them and have them witnessed. IMPORTANT - Have the form witnessed by a "competent adult", which the SSA states can be a spouse or social worker. Have them witnessed even if they do not ask for it. Make extra copies of the originals as you may need them again later in the process.

g. Personal Data Questionnaire. You may or may not receive this questionnaire.

You will find instructions for all the above Forms on the SSA Internet site.

Make copies of everything before you mail it in. You may wish to send the packet back by Registered mail. Approximately two weeks after you submit your claim you will receive a letter of acknowledgement and the return of the original documents you submitted with the application.

What follows could very well get you SS benefits on your first attempt. I recommend that you attach the following to your application:

Document of Clarification

I understand that the Social Security Administration uses DSM-IV to determine if an applicant has a particular mental disability. I have been diagnosed by the Veterans Administration with Post Traumatic Stress Disorder (PTSD). While I understand the SSA is not required to accept the diagnosis of the VA I wish to bring the following to your attention:

Under CFR 20, Appendix 1 to Subpart P, paragraph 12.06 (List of Impairments) Anxiety Related Disorders (the DSM-IV has PTSD listed under a "Stress Response" category, which comes under their "anxiety disorder" category) the List of Impairments says:

"A. Medically documented findings of at least one of the following, referring to items 1 through 5 under "A"

Your # 1(d) corresponds directly with item d (4) in section 309.81, "Anxiety Disorders", of DSM-IV.

Your # 2 corresponds directly with item c (2) in section 309.81, "Anxiety Disorders", of DSM-IV.

Your # 5 corresponds directly with item b (1) in section 309.81, "Anxiety Disorders", of DSM-IV.

As you can see PTSD fulfills THREE of the requirements, not just ONE.

AND

B. Resulting in at lease two of the following:

Your # 2 corresponds directly with item c (2) in section 309.81, "Anxiety Disorders", of DSM-IV.

Your # 3 corresponds directly with item d (3) in section 309.81, "Anxiety Disorders", of DSM-IV.

Your # 4 corresponds directly with item d (2) & d (3) in section 309.81, "Anxiety Disorders", of DSM-IV.

PTSD fulfills THREE requirements, not just two.

Your attention is invited to 20 CFR 303.1520 (d) which states, "If you have an impairment(s)which meets the duration requirement and is listed in appendix 1 OR is equal to a listed impairment(s), we will find you disabled without considering your age, education, and work experience."

The introduction to the List of Impairments says "The listings are so constructed that an individual with an impairment(s) that meets or is equivalent in severity to the criteria of a listing could not reasonably be expected to do any gainful activity" therefore a residual functional capacity (RFC) evaluation should not be required.

If you do not agree with the "List of Impariments" data presented above please provide the reason for disagreement."

Representation.

You may wish to hire a lawyer that specializes in SS benefits. You must file a Form SSA-1696-U4 (Appointment of Representative) with the SSA as soon as you have chosen your representative. The selected representative may not charge you without first receiving permission from the SSA. (SSA Publication 05-10075). A lawyer is entitled up to 25% of the recovery or a maximum of $4000.00. Normally if he does not win your case you pay NOTHING except possibly fees incurred for obtaining medical or other records. You will need to mail a copy of the Form SSA 1696-U4 and the lawyers contract to the SSA and a copy of all the documents you have accumulated concerning the claim to the lawyer. However, if you follow the instructions I have set forth in this section you should not require the services of a lawyer. If you do not feel comfortable defending yourself then by all means engage a lawyer and share the information in this section with him/her.

Appeals

If you need to submit an appeal you will have to "update" your claim file at each level. I make this statement now because you will need to keep track of anything that happens that might concern your claim. If you have any change in medication, visit a doctor or hospital or are treated for anything related to your claim you will have to note this on required forms between each appeal. Get in the habit of noting these things in the beginning of the process.

Types of Appeals

a. Reconsideration - If the claimant files for a reconsideration of an initial unfavorable determination, the appeal is usually handled much the same as the initial claim, except that the disability determination is made by a different adjudicative team in the DDS than the one that handled the original case. You can be awarded benefits if they approve your reconsideration or you can be denied benefits and have to take the next step.

b. Hearing by Administrative Law Judge - This appeal is accomplished by an administrative law judge (this is a judge who presides over public hearings involving the promulgation (to post in public) of regulations and decides contested cases and appellate cases) within 75 miles of your home. You may request NOT to attend this hearing in person, however, this is not advisable unless you have a representative present. There is move information on the ALJ below.

c. Review by the Appeals Council - This is a SSA council which will make a decision based on the material presented or return your claim to the administrative law judge for further review.

d. Federal Court review - For this appeal you must file a lawsuit in a federal district court.

Timely filing

Let me take a moment here and emphasize the importance of filing your appeals on time (within 60 days). If you do not file your appeal on time you may still file another application, BUT, you may lose some benefits, or not qualify for any benefits. This is because you are starting all over again.

The following pertains to the 60 day appeals filing requirement:

"Our rules in 20 CFR sections 404.909(a), 404.933(b), 416.1409(a), and 416.1433(b) provide that a request for reconsideration and a request for hearing before an administrative law judge (ALJ) must be filed within 60 days after the date of receipt by the claimant of the notice of the determination being appealed. However, the regulations also provide that a claimant can request that the 60-day time period for filing a request for review be extended if the claimant can show good cause for missing the deadline. The request for an extension of time must be in writing and must give the reason why the request for review was not filed timely.

When the claimant fails to timely request reconsideration or an ALJ hearing, the Agency applies the criteria in section 404.911 or section 416.1411, as appropriate, in determining whether good cause for missing the deadline exists."

Section 404.911(a) states:

"In determining whether you have shown that you had "good cause" for missing a deadline to request review we consider -

(1) What circumstances kept you from making the request on time;

(2) Whether our action misled you;

(3) Whether you did not understand the requirements of the Act resulting from amendments to the Act, other legislation, or court decisions; and

(4) Whether you had any physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) which prevented you from filing a timely request or from understanding or knowing about the need to file a timely request for review. "

If you have to show "good cause" for submitting ANY document late it MUST fall within one of the categories listed in 20 CFR Section 404.911(a) and must be stated EXACTLY as it appears in the Section.

(If you submitted the documentation I indicated above you should not have to go through the following appeals, however, I am providing the information just in case this does not happen.)

Requesting a Reconsideration

Before filing your request for reconsideration ask that the SSA send you copies of any documents submitted by your doctors and the DDS agency Staff psychiatrist and any other documents added by other than yourself. Normally just asking in a letter will not produce results. Two separate laws, the Freedom of Information Act and the Privacy Act, have special significance for Federal agencies. Under the Freedom of Information Act (FOIA), Federal agencies are required to provide the public with access to their files and records. This means the public has the right, with certain exceptions, to examine records pertaining to the functions, procedures, final opinions, and policy of these Federal agencies.

The Privacy Act (PA) permits an individual or his or her authorized representative to examine records pertaining to him or her in a Federal agency. For disability applicants, this means that an individual may request to see the medical or other evidence used to evaluate his or her application for disability benefits under the Social Security or the SSI programs. (This evidence, however, is not available to the general public.)

Request your records under the PA. If the requested documents do not arrive within 59 days submit your appeal without them, unless you can prove "good cause" as stated above. You should also inquire as to why they did not accept the "List of Impariments" cross references you presented in your Document of Clarification.

You will need to file a Form SSA-561-U2 (Request for Reconsideration), which they do not always provide, it is however obtainable at the SSA Internet site. You can save yourself another couple of weeks by submitting a Form SSA-3441-F6 (Reconsideration Disability Report) along with the Form SSA-561-U2 and a half dozen SIGNED AND WITNESSED Forms SSA-827 (Authorization for Source of Release Information to the Social Security Administration). I was not informed of this in my letter of denial but if you go to the SSA web site and then the "Forms" area you will find the following statement, "If you determine you need to complete an SSA-561-U2 and your disability claim was denied because we determined you do not meet our medical, or vocational, requirements, you need to complete the SSA-3441-F6.........". Resubmit your Document of Clarification if they to not answer as to why they do not accept it.

Administrative Law Judge Hearing

You will need to submit the following forms (all of them are available on the SSA web site):

a. Form HA-501 (Request for Hearing by Administrative Law Judge) - The instructions say you may write a letter instead of this form but you can bet the SSA will send you this form after you submit a letter because some required data will be missing.

b. Form HA-4486 (Claimant's Statement When Request for Hearing is Filed and the Issue is Disability).

c. Form SSA-827 (Authorization to Release Medical Information). Send in 5 of these forms, SIGNED and WITNESSES.

d. Form HA-4608 (Waiver of Your Right to Personal Appearance Before an Administrative

Law Judge). Required only if you are unable to attend the hearing.

e. Form HA-4631 (Claimant's Recent Medical Treatment). If you have NOT had any medical treatment since your "Reconsideration" appeal submit this form anyway and check "NO" in section B (1).

f. Form HA-4632 (Claimant's Medications).

g. Form HA-4633 (Claimant's Work Background) Fill out and return ONLY if you have WORKED since you filed your "Reconsideration" appeal.

Once again I advise you to submit your "Document of Clarification" and ask why they do not agree with the "List of Impairments".

You will receive a letter within a few days stating the following:

"We will mail a Notice of Hearing to you at least 20 days before the hearing to tell you its time and place."

"At the hearing the ALJ will consider the issue(S) raised and the evidence now in the file and any additional evidence you provide."

"The Notice of Hearing will state the issues the ALJ plans to consider at the hearing."

"If you wish to see the evidence in your file, you may do so on the date of the hearing or before that date. If you wish to see the files before the date of the hearing, please call us."

"The ALJ or the ALJ's designee may decide to meet with you before the hearing to review the case. If so, we will write to tell you about the conference."

It will take another 2 to 6 months before you are notified of the ALJ hearing.

Eventually you will receive a Notice of the ALJ Hearing packet with the following documents:

a. Notice of Hearing - This document announces the place and time of the hearing. It states the issues in the case. It may or may not state that a Vocational Expert and/or psychiatrist will be present to testify.

b. Letter to Vocational Expert - A request for the Vocational Expert to appear at the hearing. (This might be for a psychiatrist or both.)

c. Acknowledgment of Notice of Hearing - A document with your name an SSN on it asking if you will or will not be present for the hearing. You must check the appropriate box, sign and date the form and provide your telephone #. Mail the form to the SSA in the postage free envelope provided.

The ALJ Hearing.

You will be given the opportunity to review your case files just prior to the hearing itself. There will be a ALJ, yourself and your lawyer (if you engage one), a transcriber and a Vocational Expert and/or psychiatrist present.

(If you reach this stage it is obvious that the SSA has ignored the "Document of Clarification" I had you submit earlier. I advise you to politely try to introduce the information early in the hearing process as it will eliminate a great deal of the proceedings if the ALJ is not trying to find "other work you can perform".)

The hearing is usually conducted in the following sequence:

a. The ALJ will start by asking you questions for about 15 minutes. He asked such questions as Can you bend and lift items?, what do you do on a typical day? What is your education level, and what your work history has been for the last 10 years, and about your last job. These questions set the table for the Vocational Expert to tell what type of work you might be able to do. (If you can get the ALJ to acknowledge PTSD as being severe enough to prohibit work you will not have to go through the rest of the hearing).

b. At this point your lawyer, if you have one, may ask clarification questions related to answers you gave the ALJ that would act in your favor.

c. The ALJ will next called on the Vocational Specialist and/or Psychiatrist to have him/her attest to types of work you might be able to do.

d. You or your Lawyer will next be permitted to ask the Vocational Specialists and/or Psychiatrist questions about your limitations as relates to their testimony.

e. The Judge will ask if you have anything to add. If you were not given the opportunity to bring up the information on the "Document of Clarification" now is the time.

f. The Judge will officially close the hearing.

It may take up to 6 months before you receive a determination from the ALJ.

There will be a List of Exhibits attached to your Notice of Decision. If you application is denied, submit a request for a copy of any of these you do not already have so you can submit an appeal to the Office of Hearings and Appeals (OHA).

Office of Hearings and Appeals (OHA)

You may file an appeal to OHA by submitting a SSA Form HA-520 (Request for Review of Hearing Decision/Order), available on the SSA Internet Page. This appeal may be sent to your local SSA office, a hearing office or mailed directly to the Appeals Council (save time by sending it directly to the Appeals Council). If you have a lawyer it needs to go to him/her for signature. You have 60 days to file your appeal. Make certain you either make this deadline or file a request for extension, showing good cause as outline in 20 CFR 404.911(a). (The request MUST be one of the reasons listed in the CFR just quoted).

Two things are going to be happening at the same time. Your appeal will be going to OHA and you may apply to "Reopen" your claim immediately. Be aware that if you apply to reopen and you are finally awarded your claim your back pay will only go back to the date when you applied for the reopening. You can still receive payment from the date you first initiated your claim but that will be handled by the OHA, if they overturn the ALJ. Your case could be remanded back to the ALJ or the OHA may flat deny your claim.

If you reach this stage and have to appeal your case to OHA you are in for a lengthy and frustrating experience. I advise you to contact your State Senator or Congressman for help. It took me over 3 years to get my claim overturned by the OHA (See OHA Final Decision)

Reopening Your Claim.

Conditions for reopening. (20 CFR 404.988)

A determination, revised determination, decision, or revised decision may be reopened--

(a) Within 12 months of the date of the notice of the initial determination, for any reason;

(b) Within four years of the date of the notice of the initial determination if we find good cause, as defined in §404.989, to reopen the case;

§404.989 Good cause for reopening.

(a) We will find that there is good cause to reopen a determination or decision if--

(1) New and material evidence is furnished;

(2) A clerical error in the computation or re computation of benefits was made; or

(3) The evidence that was considered in making the determination or decision clearly shows on its face that an error was made.

(b) We will not find good cause to reopen your case if the only reason for reopening is a change of legal interpretation or administrative ruling upon which the determination or decision was made.

If you decide to Reopen Your Claim.

The entire process begins over again. Call the national phone number or you local SSA office and state that you wish to "Re-Open" your claim. Make certain the representative knows that you are NOT filing a NEW claim. The same things are about to happen as when you started your original claim. You will receive a new application packet within a few day which will contain the following:

a. Cover letter - They may request items such as Birth certificate or DD 214

b. SF-SSA-16 Form - This contains the information you gave to the SSA Interviewer such as date of birth, etc.

c. SSA-827 Form - Authorization for source to Release Information to the Social Security Administration (SSA) - You will sign and return these.

d. Personal Data Questionnaire (Unnumbered form)

e. SSA-3369-BK Work History Report - You filled out this form for your first application.

You are required to return the package within 10 days. These are the same forms you filled out for your original claim. Make certain all of the data matches other than what may have changed since you first filed.

<li>E-MAIL Bub Parrish at iparrish@ptsdmanual.com

Referenced from link ; http://www.ptsdmanual.com/SSArev.htm

Edited November 10, 2011 by usmcgirl

[Notorious Kelly]

Good info, USMCgirl.

Thanks!