I am now 100% P&T, what do I need to know to apply for Social Security Disability?

[traveler]

I have recently been raised up to 100% P & T for VA disability.

How do I find out about applying for Social Security?

Is there any source where I can learn about it, from being in my situation?

I don't know ANYTHING about it.  Please help!

[traveler]

Nope.  VA 100% P+T.  40 credits with Social Security.  3 months ago C+P with a shrink, it should be sufficient to get it done.

[traveler]

Okay, So I applied for SSDI online.

The process is, you fill it all out and submit it.

THEN they give you an address to submit any copies of evidence you have, which is a perfect time to send them copies that are highlighted so as to make the job easier for the reviewer.  From reading what the guys above have said, you have to make it so that it meets the "blue book" listings.  If your condition is in the  BLue Book Listings, it gets approved....at least that is what I am hearing and reading.

So, after applying, it stated the average submission takes 200+ days to complete.  I am thinking, if you have a blue book listing condition, and you have provided copies of medical records with those listings highlighted, it SHOULD be fairly straightforward.  The idea is to make the job EASY for the reviewer.  They are backlogged, and don't spend too much time on any record, as it is easier just to deny, deny, deny to get through their work stack.  If I make it easy, I think it MAY work out for me.

Sound good, or am I missing something?

Edited February 25, 2022 by traveler

[Rivet62]

On 2/11/2022 at 12:59 PM, El Train said:

I work damn near 40 hours a week.  I'm 100% ptsd/tbi P&T with SMC-S.  It's pretty rare, but doable.  It helps that I have sheltered employment.  I've told every C&P examiner this info.  This won't fly with SSDI, but maybe it will when I'm done working in a couple of years.  I can't take the stress much longer.

SSA administrative law judge and my SSDI attorney moved my effective date up, and called my working a 'work attempt,' becasue my work attempt didn't exceed a certain time frame (I can't recall what that limit is), so my work didn't disqualify me for SSDI, otherwise my working would have disqualified me for SSDI. I got less backpay as a result, but for me that was ok.

Edited February 25, 2022 by Rivet62

[Rivet62]

4 hours ago, traveler said:

The idea is to make the job EASY for the reviewer. 

You can make it easier for SSA and you by adhering to the SSA evidentiary rules which apply to the blue book listing of conditions and having your Residual Functional Capacity (RFC) already completed. It's what SSA reviewers go by. Hopefully then you won't have to have a hearing following a denial.

The only time things are straight forward is if your condition is in the Compassionate Allowances Conditions
https://www.ssa.gov/compassionateallowances/conditions.htm

 

Some advice concerning the blue book list:

To prove you are completely disabled, you will need to meet the Blue Book listing for the condition you are experiencing...Proving your complete disability, however, is often not so easy or straight forward.

It’s best to review the Blue Book with your doctor to make sure you have met the needed criteria. Your doctor can help orchestrate any tests that are needed to qualify. Keep in mind that this is just for qualifying and doesn't mean you will actually prove you are too disabled to work. You can prove the medical part of it, but the next consideration is the functional part of it.

https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

You should look over the evidentiary requirements, to hit this out of the park.
https://www.ssa.gov/disability/professionals/bluebook/evidentiary.htm

 

The functional part: Residual Functional Capacity (RFC)

The Social Security Administration uses residual functional capacity guidelines to define an individual’s work capability in the following categories: sedentary, light, medium and heavy work. 

A residential functional capacity form is often completed by a claimant's doctor and is reviewed by the SSA to determine if an individual qualifies for disability benefits.

https://www.disabilitybenefitscenter.org/glossary/residual-functional-capacity-RFC

The Social Security Administration (SSA) evaluates your residual functional capacity (RFC) when determining if you are disabled enough to qualify for Social Security Disability benefits.

A residential functional capacity form is often completed by a claimants doctor and is reviewed by the SSA to determine if an individual qualifies for disability benefits.

Let this be your guide for physical disability determination:
https://secure.ssa.gov/apps10/poms/images/SSA4/G-SSA-4734-U8-1.pdf

 

When you apply to Social Security for a mental health condition, a claims examiner who works at Social Security will fill out a mental residual functional capacity (RFC) form. This form says what types of tasks you can and cannot do.
If you can have your own doctor fill out a similar form and submit it to Social Security, the claims examiner needs to use it in developing your RFC

Mental Residual Functional Capacity Assessments:
DI 24510.060 Mental Residual Functional Capacity Assessment
https://secure.ssa.gov/poms.nsf/lnx/0424510060#:~:text=Because of the complexity of mental disorder evaluation%2C,despite his %2Fher impairment. 2. Medical Consultant Completion

An older official form: https://www.ssdfacts.com/forms/SSA-4734-F4-SUP.pdf

A worksheet: https://www.disabilitysecrets.com/sites/default/files/MENTAL_RFC.pdf

 

What SSA goes by:

Program Operations Manual System (POMS)
DI 24510.000 Residual Functional Capacity (RFC)
https://secure.ssa.gov/poms.nsf/lnx/0424510000

Code Of Federal Regulations
§ 416.945. Your residual functional capacity
https://www.ssa.gov/OP_Home/cfr20/416/416-0945.htm

 

It's important to realize the process:

"Most Social Security disability claims are initially processed through a network of local Social Security Administration (SSA) field offices and State agencies (usually called Disability Determination Services or DDSs). Subsequent appeals of unfavorable determinations may be decided in a DDS or by an administrative law judge in SSA's Office of Disability Adjudication and Review," source: https://www.ssa.gov/disability/determination.htm

Disability Determination Services (DDS) functions much like a VARO does to vets disability claims.  If your social security disability claim does not check off all the boxes according to POMS or the regulations, then you will get a denial because...  and you will have to appeal it at a SSA hearing with a SSA Administrative Law Judge (ALJ) and you will likely have a SSA vocational expert there at the hearing, and you, and your attorney, and the vocational expert, and the ALJ will hammer out how you qualify. They may resort to the SSA grid rules, which lower the threshold based on age, past work history, and education. https://secure.ssa.gov/apps10/poms.NSF/lnx/0425025035  That's where the vocational expert comes into the conversation. 

If you can make your SSA claim complete by seeing to it that your claim checks all the boxes that DDS considers then your claim should be approved with no need for a hearing. 

To make your claim complete, get your doctors to review what tests you need to solidly place your conditions in the blue book list (by the evidentiary requirements), and get your doctors to fill out the RFC forms, or something similar, that serves the functional part that SSA and DDS's look for. You can slam dunk this if you can get a vocational expert opinion, too.

Edited February 25, 2022 by Rivet62

[traveler]

The thing is, you never know WHAT it was that caused the denial, do you?

Edited February 26, 2022 by traveler

[Berta]

If you mean a SSDI denial, the links above should reveal the criteria for SSDI-

When my husband applied in 1992 they needed the proper work credits and he had to file with 5 years of attaining a 100% disability. or maybe it was within 5 years of his last employment-

I am guessing but their criteria is at the SSDI site.

He was awarded within a few months for a 1151 stroke but we filed for re consideration as he had told SSDI he had PTSD ( 30 % SC at that time,) and he considered it to be his most dehabilitating disability.

We asked a SSA lawyer to help us with the Recon request but he wouldn't.

I called him up a few months later and told him he lost over 4 thousand bucks-his fee he never got-as the new award was solely for SC PTSD and the retro was over 17 thousand.

We had a long talk about PTSD and he told me he would never look at a PTSD SSDI claim the same way again.

VA , after a battle raised my husband to 100% P & T SC PTSD. He had died and never knew how many claims he won with me as the claimant.The best one was for AO DMII undiagnosed and untreated , but I claimed it as direct SC death. Granted.

That award gave him and me Peace with Honor. There is no Peace with Honor  knowing the VA's malpractice killed him.

Some of the Best people I ever met work for the VA.

And some of the worst.

VA saves lives every day! I do believe that.

My whole church is praying that the H VAC passes my bill S 221- that will save lives too!

It passed the Senate unanimously. I will not be here much in March-I have a big VA fish to fry!

YUM YUM

 

 

 

 

Edited February 26, 2022 by Berta
CTS