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SSDI - Reconsideration Phase



Hi, I’m going through the appeal/reconsideration process now (filed 8/23/23) on step 3 of 5 as I was denied on my initial filing in which I filled 9/16/2022). Just to give you a brief medical background, I have depression, PTSD, anxiety, insomnia, hypersomnia, sleep apnea w/CPAP, migraines, headaches, tinnitus, cubital tunnel syndrome in both arms, and I am going through the process now with my Orthopedic doctor to diagnose cervical spine and neck pain and stiffness. I am a disabled veteran rated at 90% currently going through the process of being rated at 100%. It looks like I will be going the TDIU (Total Disability Individual Unemployability) route as I have not worked F/T since 9/2022. I only recently picked up roughly 15 hours per week as I became strapped for money and needed income to help out with bills. I do have legal representation as well. With the appeal/reconsideration I was able to submit a personal appeal letter I typed and documentation from one of my Psychiatrist citing PSTD diagnoses, mental fitness report, an appeal letter from her on my behalf as well. What are your thoughts on just this information I have shared with you this far of my chances of being approved at this stage?

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Welcome to hadit.  

Social Security and VA have some differences, but you have the right idea in apply for and appealing both.  

In reference to tdiu "its not enough" to "just" be not working.  To get tdiu, you have to demonstrate that "you are UNABLE to obtain and maintain SGE due to sc conditions". 

Lots of people dont work for a variety of reasons, some dont need the money, others really dont want to work, some are looking for a better job.  

The VA will likely be looking for evidence that one or more of your doctors stated you were unable to work (due to sc conditions).  

It gets worse.  Often the VA requires a voc rehab assessment.  Its one thing to not be able to do your present job, still another not to be able to do any job.  

Yes.  I get it.  You have ptsd so you are not able to do your current job.  But can you be retrained in another line of work?  

Yes, I get that if you cant work in the warehouse with ptsd, then you probably can not also work a McDonalds with PTSD because they dont want people who cant get along well with others either.  But, VA wont connect those dots.  Your doc is probably not qualifed to make a vocational assesment to see if you are a good candidate to be retrained if you cant do your present job.  Perhaps, if you work in a warehouse, and cant lift over 10 pounds due to a back injury, you may be able to be retrained as a computer programmer where the heaviest thing you need to lift is a pencil.  

If you have not had a vocational assessment, you may consider seeking one.  You can get voc assessments likely from your local Voc and rehab, (VA), often through your state, or you can hire your own assesment.  

I had to hire a voc rehab assessment in order to get my tdiu...after it was denied several times, appealed, and remanded by the courts to the board.  My attorney suggested a voc rehab assesment would be enough to get the board to award tdiu, after remand by the cavc.  He was spot on, and the board awarded tdiu.  The voc rehab counseler explained that, given my medical and work history, I was not a good candidate for retraining, also that it was at least as likely as not I was unemployable in any kind of work.  Of course he said this in language the VA can understand.  

Some VEts get tdiu without a voc rehab assessment, but the safe way is for you to get one, unless you want to delay being awarded tdiu another 5 years or more.  

To reiterate, a psychologist, your doctor, or Tom Hanks, are probably not competent in the VA's eyes to determine if you can work any job or not.  Only someone trained or experienced in voc rehab, is qualifed to make that assessment.  Your doctor or psychologist can determine if you cant work YOUR job, but not necessarily any job, because its not within a psychitrists or doctors knowledge to know if you would be suitable for work in another type of work.  

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Once you get p and t with va, you should have no trouble getting social security.  But it does ot always follow that if you get social security you should also get va disablity.  You still have to show you cant get work due to conditions which are service connected.  With social security its enough that your doc says you cant work, with va you still have to show the reason you cant work is from service connected conditions.  

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Vocational experts carry a lot of weight when determining substantial gainful employment. Any news on where you are at?

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The average time for an SSA Appeal (Reconsideration) is twenty-four (24) months. This was several years ago, and I think it is about the same now. SSA is a little different then the VA, you do not have to take my word for it but working while appealing your SSA benefits can cause a negative decision. I know and I understand, been there and done that. How can you support your family and stay alive without working? It seems that the SSA does this to weed out the individuals that say that it is not worth it and return to some type of work which could cause them problems later.

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