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Ethan'sGrandma

Requesting Evaluation For Tdiu After Ssdi

Question

Would like to ask for some help in understanding TDIU evaluations, please. If a vet does not meet the % requirements for TDIU, is it necessary to submit a request for a higher rating, also, or does the TDIU application presume that? Does the VA look at evidence for a higher rating before making any decisions for TDIU? I am aware that VA and SSA do not have to follow each other's decisions, but if the vet was awarded SSDI based solely on VA and military medical records, the vocational aspects, and the judge's decision that the vet is not able to obtain or maintain gainful employment according to their law, will that help with VA's decision, although the VA had only rated the vet @ 30% for mental disorder and 10% for physical disorder? The TDIU evaluation seems to be moving rather quickly considering the backlog as the vet has already been scheduled for two C&P's...one for psychiatric; other for physical reason. Another concern is that in the notice of receipt for TDIU claim, it seems like VA keeps hitting on the "unusual circumstances" necessary for an extra schedular TDIU...is that just protocol in their form letters, or is that something to worry about? What "unusual circumstances" do they look for? I looked but couldn't get any clear picture of what that entails. Thank you very much to anyone that may assist with these questions.

Edited by Ethan'sGrandma

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4 answers to this question

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My personal example might help.

Husband was 30% SC PTSD from 1983.

In 1992 he requested a higher rating for his PTSD and then a few months later he sent them a TDIU form.

In 1992 SSDI awarded sole for a NSC stroke (was SCed under 1151 this past January at 100%)

I asked SSDI to reconsider the award as his PTSD had not been considered by the SSA,although they had all of his PTSD records.

A few months later they changed his SSDI from a 1992 stroke solely to PTSD with a very favorable onset date of 1991.

I did a lot of work to support the reconsideration and the better EED.Both SSA and a SSA lawyer tried to discourage me but evidence is what it is.I had some very unusual evidence too. It was generated by an ADA EEOC complaint. My husband was the first disabled veteran in NY to win under those discrimination regulations.Also I used VA testimony from an EEOC case he had filed against the VA.

N one is confined to just 'medical' evidence on many issues they might have regarding SSA and the VA claims process.

This new SSA award info was sent to the VA to support Rod's claim for higher PTSD rating and the subsequent TDIU claim he filed.

But he died while his VA claims were pending ( including a 1151 claim too)and I re opened them as the widow of the veteran.

A few months prior to the 1151 DIC award, the VA awarded posthumously, retroactive 100% P & T for PTSD back to 1991,using the same date the SSDI reconsideration award had given him.

So, here was a vet at 30 % and DAV reps had told him he was not eligible for TDIU and certainly not 100%.

I read the TDIU form over carefully in 1993 and saw that it contained no specific SC percentage criteria at all.

Although 70 % SC triggers the VA to consider TDIU, there is no statement on the form saying a vet can't request TDIU regardless of their current SC.rating.

I think his death made the TDIU a moot issue and that is why the award was for 100% P & T and not TDIU P & T.

So your point is correct except for one thing:

"but if the vet was awarded SSDI based solely on VA and military medical records, the vocational aspects, and the judge's decision that the vet is not able to obtain or maintain gainful employment according to their law, will that help with VA's decision, although the VA had only rated the vet @ 30% for mental disorder and 10% for physical disorder? The TDIU evaluation seems to be moving rather quickly",

the SSA award must solely regard the exact same SC conditions claimed.Any NSC part of the SSDI determination can make the SSDI award very problematic and not the best evidence for TDIU.

Often SSA focuses the prime medical condition only. As in my husband's case, they considered his stroke as the prime problem he had.

However his SSA app specified his PTSD as well ,and by time of the VA decision on his claims, his med recs revealed it was catastrophic.

He too had Voc Rehab records and significant other VA medical documentation( and from other sources) to support the SSA and also the posthumous VA 100% PTSD award.

I think if he had lived the award would have been the same, but for TDIU P & T.

Then again his med evidence matched the 100% SC PTSD rating criteria.

Edited by Berta
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Berta, when you say you asked SSA to reconsider their decision based on the PTSD award and then they gave a favorable onset date of 1991... were you still in the reconsideration phase, appeal phase, or had the final decsion already been given and you submitted your request after SSA had closed the case?

That would be nice to know that the SSA can change their decision after they issue an official decsion based on a good argrument and evidence.

And did your attornies submit the motion or did you write to SSA yourself?

Thanks

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Sorry I almost missed this question....

Rod had just been awarded SSA for a 1151 stroke.late 1992 or early 1993 . (EED to AUg 1992)

I called the SSA office up right away because the SSA award said nothing about his PTSD.

The SSA woman told me that they never considered his PTSD because the 1151 stroke was awarded. (EED Aug 1992)

"And did your attornies submit the motion or did you write to SSA yourself?" That was a LOL for me.

I wrote a Reconsideration Request to SSA myself for Rod to sign. It was right after he got the initial SSA award.I have no idea if they have a time frame for Reconsideration.It might be at their web site.

Both SSA tried to talk him and me out of filing this recon request and we went all the way to Elmira to have a SSA attorney turn us down for support for it. Adversity makes me push harder.

I had found at the Corning SSA office their regulations as to disability determinations. They allowed me to go through their law books and allowed me a few xerox copies. I found a regulation that stated that they(SSA) must consider every disability claimed. Rod had claimed both the stroke and also his PTSD. I sent a copy of their regulation in with the Recon request.

A few months after filing the SSA recon ,SSA called him up but Rod was at the VA day treatment and they told me he had won the request, a new award letter was prepared and his got an EED of Nov 1991.(last day he could work due to PTSD)

I called the SSA lawyer up and told him he just lost about $4500 bucks because he would not take the case ( 25 % fee of the additional retro about 18 thousand)

He was stunned and told me he would never pass up any PTSD SSA claim again. He apologized and we ended up talking about PTSD for about an hour.If an SSA lawyer doesn't understand one's disability, they wont take the case, or if they do, they would probably lose the case. Hopefully he learned something that day.

I had accumulated significant evidence (mostly all from the VA) as well as the proof that SSA had broken their own regs to file the reconsideration request. There was more to this then I could possibly type about here.....evidence resulting from numerous DOL complaints against his last employer, etc etc .....

This was pre internet as we know it, with no SSA web site. These days I am sure they would have info and deadlines on reconsideration requests.at the SSDI web site.

It was instrumental in me obtaining an accrued benefit for PTSD, due to Rod's pending PTSD claim for higher rating (he was 30%) when he died.

VA awarded posthumously 100% P & T for SC PTSD as of Nov 1991 (the same SSA retro date)

The recon request was awarded on 2 basis:

1. I proved SSA had broken their own disability regulations.

2. The medical evidence I submitted (most of whivh they already ad anyhow due to the initial award)was overwhelming and proved Rod was totally unemployable due to PTSD for almost a year prior to having the 1151 stroke.

Edited by Berta

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