To Appeal again or just forget it?

[ErinNick]

My husband is rated 70% for PTSD.  In January of 2020, he was finally marked unemployable and paid at the 100% rate.  A couple months later, he applied for SSI disability since the VA has said that he isn't employable.  He was instantly denied, so he sought out the advice of an attorney that specializes in SSI.  The lawyer told him his case was a no brainer and he would be awarded social security disability.  He had his telephone appeal at the beginning of this month and we just received the denial (attached here) in the mail.  Based on what he received in the mail, should he even try to appeal again?  The military says he cannot work.  Shouldn't SSI take that into account?  He's been working on this for almost a year and I would hate for all that hard work to go out the window.  His lawyer mentioned trying again in a year, but that doesn't make sense to me.  Has anyone been in this position?  Should he appeal again?

SSA Decision.pdf

[deedub75]

Unfortunately, SSA doesn't really care what the VA says about a veteran's disability because they each have different rules. Back in 2017, SSA changed their rules so they didn't have to take into account decisions made by other agencies. Before then, SSA was not bound to follow the decisions of other agencies but it generally did give weight to VA approvals of veterans with high disability ratings. SSA doesn't even have to explain whether it took VA decisions into account or not.

I have my with the ALJ on this coming Tuesday. I filed for SSDI in September 2019 when I forced to retire on disability from a federal job. I'm also 100% P&T through the VA. SSA disregarded the fact that I was retired on disability from a desk and my 100% P&T VA rating. My initial claim was denied so I hired an attorney for the reconsideration at it was denied. Since then I've been seeing a psychiatrist and he's made it clear in the records that I'm really messed up and can't work. I hope the ALJ gives this some weight. My primary care doctor and my neurologist both wrote letters and provided evidence that I couldn't work when I applied for the disability through my job but it sees SSA didn't give these any weight either.  

As far as what to do next, what is your attorney saying? I can't believe your attorney told you the case was a no brainer. My attorney hasn't promised me anything. I'm not confident that the ALJ will approve my claim so I'm not going in with my hopes up.  

[pacmanx1]

2 hours ago, ErinNick said:

My husband is rated 70% for PTSD.  In January of 2020, he was finally marked unemployable and paid at the 100% rate.  A couple months later, he applied for SSI disability since the VA has said that he isn't employable.  He was instantly denied, so he sought out the advice of an attorney that specializes in SSI.  The lawyer told him his case was a no brainer and he would be awarded social security disability.  He had his telephone appeal at the beginning of this month and we just received the denial (attached here) in the mail.  Based on what he received in the mail, should he even try to appeal again?  The military says he cannot work.  Shouldn't SSI take that into account?  He's been working on this for almost a year and I would hate for all that hard work to go out the window.  His lawyer mentioned trying again in a year, but that doesn't make sense to me.  Has anyone been in this position?  Should he appeal again?

My apologies for any misunderstanding but I must make things clear in my brain. There is a major difference between filing a claim for SSI compared to SSDI. As to SSI which is based on low or no work credits and your husband would not qualify for and the claim would be denied and SSDI which is based on work credit which your husband would qualify for. Does your husband have any other disabilities other than PTSD and Sleep Apnea? I know these are minor things, but they are important. When filing a claim for SSDI, you should list any and all disabilities that would/could create a problem for maintaining  work.  Not sure who your attorney was but you may want to try one of the bigger named SSA attorneys. They have an if you do not win you do not pay clause. Your husband may need a new medical opinion and an opinion of a Voc Rehab Specialist that states that he cannot work. You should start shopping around you have sixty (60) days to appeal to the Appeals Council. Most SSDI Attorney’s work with Voc Rehab Specialist and maybe able to get you an opinion. A lot of claimant gets denied and must file a request for review at the Appeals Council.  It is only over if you let it go.  Keep in mind that you do not have to choose a local attorney. The more experienced your attorneys are the better chance you have to win. 

Edited January 27, 2021 by pacmanx1 (see edit history)

[broncovet]

Appeal or lose out.  I had to appeal my SSD denial.  Its sort of like VA, somewhat in that they mostly deny everyone the first time, and the only ones who get it are those who persue appeals.  (Yes, I won my SSD upon appeal).  

I agree that, if the VA says you are disabled, then so should the Social Security (but the reverse is not necessarily true).   With VA you have to show you are unemployable DUE TO SC CONDITIONS, while at Social secuity, you need only show you are unemployable due to any condition, SC or not.  

[Banned]

If posted this a couple times, but appropriate,

I've posted this before, but here it is in a nut shell. 

VA comp and SSDI are two totally different things.  VA comps you on your chronic injuries while on active duty.  SSDI pays you not to work, because you can't, (some exceptions).

VA is not age based.  SSDI is age based.

With SSDI, under 50, if you can be retrained to do ANYTHING (answer the phone), you get denied.  50-59, if  you can be retrained in your field, you get denied.  60+, no retraining required, if you can work your current job, denied.

VA has no time periods, except for appeals and EED's etc.  SSDI, you must have worked within the last 5 years.  There is a 40 quarters (10 year) requirement for SSI, not sure if there is a minimum for SSDI.

VA has an appeals process.  SSDI has three stages.  You initial claim will be seen by a clerk, who, if he/she dose not see your malady on the list you get denied.  Your appeal gets seen by his/her supervisor and then a doctor who will approve or deny.  Then off to the Judge, with a wait date.  When we did my wife's, the wait in WI was 18 months for a date with the Judge.

As an aside, we got denied twice, which is common when the malady is not on the list, such as Multiple Sclerosis, and we got a date with a Judge.  At that time, we contacted a pro-bono site that helped us.  As of note, they (lawyers, etc.) have the ability to meet with the Judges staff at anytime and go over what they have so far.  My wife got approved three months after the Judge letter.  And they can and do make deals.  Part of the approval was, SSDI immediately, but a 23 month wait for Medicare (which normally comes with SSDI).  I had her covered with my work health insurance, so that was not a concern.

We lost 20% of our back-pay, around $1800.00, to the law firm, but it was infidelity worth it.

FWIW,

Hamslice

[El Train]

2 hours ago, Hamslice said:

If posted this a couple times, but appropriate,

I've posted this before, but here it is in a nut shell. 

VA comp and SSDI are two totally different things.  VA comps you on your chronic injuries while on active duty.  SSDI pays you not to work, because you can't, (some exceptions).

VA is not age based.  SSDI is age based.

With SSDI, under 50, if you can be retrained to do ANYTHING (answer the phone), you get denied.  50-59, if  you can be retrained in your field, you get denied.  60+, no retraining required, if you can work your current job, denied.

VA has no time periods, except for appeals and EED's etc.  SSDI, you must have worked within the last 5 years.  There is a 40 quarters (10 year) requirement for SSI, not sure if there is a minimum for SSDI.

VA has an appeals process.  SSDI has three stages.  You initial claim will be seen by a clerk, who, if he/she dose not see your malady on the list you get denied.  Your appeal gets seen by his/her supervisor and then a doctor who will approve or deny.  Then off to the Judge, with a wait date.  When we did my wife's, the wait in WI was 18 months for a date with the Judge.

As an aside, we got denied twice, which is common when the malady is not on the list, such as Multiple Sclerosis, and we got a date with a Judge.  At that time, we contacted a pro-bono site that helped us.  As of note, they (lawyers, etc.) have the ability to meet with the Judges staff at anytime and go over what they have so far.  My wife got approved three months after the Judge letter.  And they can and do make deals.  Part of the approval was, SSDI immediately, but a 23 month wait for Medicare (which normally comes with SSDI).  I had her covered with my work health insurance, so that was not a concern.

We lost 20% of our back-pay, around $1800.00, to the law firm, but it was infidelity worth it.

FWIW,

Hamslice

Sounds like you did it right.  Only hire a lawyer after the second denial, is what I am told.  Not before.

[Buck52]

Yes Mam  Appeal Again , if this was his 2nd denial   then this next go round he will see the SSA disability Judge, and he can show the Judge his disability, or let the Judge know  why he can't work and the medical records will be his evidence if he sees the Judge by virtual meeting on the computer  if they offer a in person hearing ? due to covid

I'd do the in person meeting  if the offer it?

 something might be missed or not  brought up  in the virtual but in person that's stressful to but he has a better chance in my opinion to see the judge up close.

Just keep Appealing  he will get it  never give up.

(jmo)

[deedub75]

They are having hearings by phone due to Covid. I have a hearing with the ALJ next week. The OP's husband already had a hearing with the ALJ and it was denied. The next step is request a review from the Appeals Council. The Appeals Council can just rubber stamp the ALJ's decision if they agree with it and deny the request for a review. If they do decide to review they can decide the case or return it to the ALJ. 

[pacmanx1]

Think of it like the VA process, a veteran has a better chance of getting his/her claim granted at the review level because they will most likely consider his/her military time.  Of course they want to make it somewhat difficult to weed out some claims but if you continue to claim benefit he should win.

[ErinNick]

Thanks for all the opinions!  I do believe we are looking into hiring an occupational expert on our end to have my husband evaluated.  His lawyer told him not to appeal if there was no new evidence to present, so we'll have that report to present.

[pacmanx1]

15 minutes ago, ErinNick said:

Thanks for all the opinions!  I do believe we are looking into hiring an occupational expert on our end to have my husband evaluated.  His lawyer told him not to appeal if there was no new evidence to present, so we'll have that report to present.

keep in mind that one of the best benefits of being awarded SSDI is they will also pay for minor children.  In this day and age every little bit helps.

Benefits for Children (ssa.gov)

Who can get child’s benefits?

Your unmarried child can get benefits if they’re:

• Younger than age 18;

• 18-19 years old and a full-time student (no higher than grade 12); or

• 18 or older with a disability that began before age 22.

Under certain circumstances, we can also pay benefits to a stepchild, grandchild, step-grandchild, or adopted child.

To get benefits, a child must have:

• A parent who’s disabled or retired and entitled to Social Security benefits; or

• A parent who died after having worked long enough in a job where they paid Social Security taxes.