Since 2014, the Social Security Administration has expedited disability applications for veterans who have 100 percent, permanent and total disability directly related to military service. This means that claimants can often get a decision on their claim or appeal much sooner.
A disabled veteran may be able to file for Social Security disability while he or she is still getting full military pay. Social Security's policy is stated below:
"Active duty status and receipt of military pay does not, in itself,
necessarily prevent payment of Social Security
disability benefits. Receipt of military payments should
never stop you from applying for disability benefits
from Social Security. If you are receiving treatment at a
military medical facility and working in a designated
therapy program or on limited duty, we will evaluate your
work activity to determine your eligibility for benefits.
You cannot receive Social Security disability benefits if you engage in substantial work for pay or profit. However,
the actual work activity is the controlling factor and not the amount of pay you receive or your military duty
status"
The Forsythe Firm works with many disabled veterans each year to navigate the complex application and appeals process with Social Security. We are proud to have an excellent success rate.
We are also proud to offer our services without any upfront cost. If we represent a claimant (veteran or otherwise), we never ask for any money upfront. If the case is successful, and if back payments are awarded, Social Security will deduct our approved fee and pay us directly. We never ask the claimant for money, and the claimant never owes us money unless their claim is successful.
I should point out that SSDI benefits are in addition to any benefits awarded by the military or Veterans Administration. The two programs are entirely separate and one does not interfere or reduce the other.
What Are the Requirements to Get SSDI Benefits?
- You must have an impairment that has lasted or is expected to last at least 12 straight months--called the "duration requirement."
- You must be medically unable to perform any substantial work due to a medical condition or conditions, and this must be supported by evidence.
Usually, an appeal process is required before you can get SSDI benefits. Veterans are often denied, then paid on appeal--especially at the hearing level.
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
CALL US: (256) 799-0297
Email us: forsythefirm@gmail.com
CHECK OUT OUR WEB PAGE
I spend my days (and some nights) helping individuals get Social Security Disability Insurance (SSDI) benefits. I want to help you understand what's involved in getting a benefit and what to expect from the process.
The first step is to file an application. This complicated process can be done by the claimant or by a representative, such as myself. Once the forms and questionnaires have all be sent in, it takes 4 or 5 months to get a decision. Up to 80 percent of decisions will be denials. The reason is usually: "You are not disabled according to our rules." Social Security has the strictest definition of "disability" of anyone. It is simply hard to meet their definition, so most applicants get denied. So, this completes the first step.
The first appeal is the next step. You must appeal within 60 days of denial. This first appeal is called "Reconsideration." In my experience, it is a waste of time but it is required. Your appeal goes back to the same state agency that denied your claim in the first place. The same agency, but a different person, will "reconsider" their decision. In over 90 percent of cases, they will deny again--so, usually a waste of time. But it sets up the next appeal.
The second appeal is a hearing before an Administrative Law Judge (ALJ). This is where you have some reasonable chance of getting approved and paid. The ALJ will hear your testimony, listen to the arguments of your attorney/representative, and review all the evidence (including new evidence). He or she will render a new decision within 3 months of the hearing. This is the best chance in the entire process of being approved.
If the hearing decision is not favorable, there are other appeals available which I will not discuss here.
I want you to understand that denials are very common (almost expected) at the first two levels. The second appeal is your best bet. Each appeal only allows you 60 days to file and you cannot miss this deadline. You would not believe how many cases get dismissed because the appeal was filed a few days late. That requires you to start all over with a new application. Don't miss the 60 day deadline!
I have some other postings dealing with appeals, benefits and the hearing process. Hopefully, these will help with information about the Social Security disability programs and processes.
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If you look at your pay stub you will see a deduction for FICA. This stands for Federal Insurance Contribution Act. It's the federal law that requires payroll deductions for Social Security and Medicare taxes.
You pay approximately 7.5% of each dollar you earn to this tax. Your employer matches it. These taxes are sent to the government quarterly. They pay for the massive Social Security and Medicare programs.
What is this important to you? Because, if you haven't worked long enough and paid FICA long enough, you don't have any coverage for Social Security disability. In other words, you may become disabled but not be able to get any benefits because you haven't paid enough FICA tax into Social Security.
No money in, no money out.
Also, the amount of your monthly disability benefit is calculated by the amount of your wages and the amount of FICA tax you have paid over your working lifetime. The higher your wages, the more FICA tax you paid, the higher your benefit will be. In 2019, the average SSDI benefit is about $1,235 per month but the maximum is $2,861 for higher wage earners (non-blind).
We often run into problems when an individual hasn't worked enough, or recently enough to have SSDI coverage. For most people, they need to have worked about 5 years out of the most recent 10-year period to be covered for Social Security Disability Insurance (SSDI). In other words, SSDI coverage can expire if you stop working for a few years.
As a rule of thumb, if you haven't worked in about 5 years, your SSDI (disability) coverage has probably expired. Each worker has a Date Last Insured (DLI) which is the date his/her Social Security disability coverage expires. It is important that you think of SSDI as "insurance," because that's exactly what it is.
What happens when you don't pay your insurance premium? Your coverage expires. And you can't file a new claim on an expired policy.
So, there are two important considerations when trying to get a Social Security disability (SSDI) benefit:
1. Are you disabled according to Social Security's rules?
2. Have you worked enough, and recently enough, to be covered by SSDI? (At least 5 years out of the past 10)?
Finding out your Date Last Insured is simple. Call the local Social Security office and ask what your DLI is. The Huntsville, AL office number is 1-866-593-0663 (option 0).
What if your DLI is in the past and your SSDI coverage has expired? Can you still file a new claim? Maybe, but you will have to prove that your disability began before the DLI. And you can usually file only ONE disability claim after the DLI has expired, so you get one chance.
I use the illustration of my car insurance. Let's say my automobile insurance is with the XYZ Insurance Co. and I forgot to pay my premium. My insurance at XYZ expired on February 1, 2019. If I had an accident before February 1, 2019 it would be covered. But an accident occurring after February 1, 2019 would not be covered (expired policy). Social Security works much the same way.
One final footnote: There is a totally separate program called SSI. This stands for "Supplemental Security Income," which does not require any work or any FICA tax to be paid. SSI has no expiration date, since you don't pay into it. It does have income/resource restrictions to qualify. So, even if your SSDI coverage has expired, it may be possible to file for Supplemental Security Income or SSI, if your household income is low enough and you meet all the other requirements. This is also a question for your local Social Security office.
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THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL US (256) 799-0297
SEND US AN EMAIL: forsythefirm@gmail.com
CHECK OUT OUR WEBSITE
"Representing with Respect"
Your doctor can be of great value in getting disability benefits approved. However, many doctors just won't get involved. The basic reasons, I think are: they are busy, their time is limited and valuable and there is nothing in it for the doctor.
Another problem is getting to the doctor. Doctors have staff that are trained to keep patients away from the doctor except during paying medical appointments. That's why you can't just walk in and talk to your doctor or get him on the phone. So, you may not be able to get past the receptionist or front office staff to present forms to your doctor. You might solve this problem by approaching your doctor during a regular, scheduled medical appointment.
What Do You Need from Your Doctor?
You need a form called a "Medical Source Statement" (MSS), sometimes called a Residual Functional Capacity (RFC) form.
This form lists your maximum functional capacity: how long you can sit, stand, walk. Maximum weight you can lift; what your limits are for reaching, handling, grasping, kneeling, bending, kneeling, crawling, etc.
Does the MSS Form Require a Special Examination?
No. You want an estimate of function based on your doctor's history with you, not a special set of measurements. You do not want your doctor to refer you to a rehabilitation specialist or other doctor to get tested, as this defeats the purpose of getting the information from your treating doctor.
Will a Letter From My Doctor Do Just as Well?
No. First, I have never seen a doctor's letter that wasn't far to general and vague. It isn't enough for a doctor to say you can't work. It isn't sufficient to say that you can't sit or stand very long. We need to know how long you can sit or stand: an hour, half an hour, less than half an hour? Second, doctors usually will not know the language that Social Security wants. For example, Social Security has specific definitions in their regulations for words like rarely, occasionally, frequently, etc.
Can My Doctor Decide If I Qualify for SSDI or SSI Benefits?
No. That decision belongs to Social Security. But your doctor may provide detailed evidence to help Social Security reach a favorable decision, based on the medical data in your file, including his or her opinions concerning how much work-related activity you can do.
Are Medical Records Enough?
We always get medical records, of course. Often, we like to have more than the routine medical records--which simply do not detail the patient's functional abilities. Medical records will not state how long a patient can sit, stand, walk or how much he/she can lift, for example. Routine records will not tell us, for example, that the patient will need to sit down or lie down 3 times during an 8-hour workday. This specific type of information comes from the Medical Source Statement or Residual Functional Capacity forms.
Which Doctor is Best for Providing an MSS/RFC?
- It should be a treating doctor you have seen for a while.
- A specialist is more helpful in some cases
- The longer you have been treated by the doctor, the more influence his or her MSS/RFC will have.
- The form must be signed by a Medical Doctor (MD), a licensed Physician's Assistant (PA), or in the case of mental impairments by a licensed Psychologist (Ph.D, Psy.D). A licensed Optometrist may testify about diseases of the eye or vision; a licensed Podiatrist can testify about problems with the feet or ankles (only).
- Social Security will not recognize a statement from a chiropractor, nurse practitioner, licensed counselor (LPC), diet or nutrition expert, or most other practitioners.
Where Do I Get the Form Required?
The best place to get RFC/MSS forms is from your attorney. Most doctors do not keep these forms at their office. The claimant will need to obtain the form and take it to the doctor, or the attorney/representative can send to the doctor's office. Once the form has been completed by the medical professional, you should return it to your attorney/representative. Be sure to keep a copy for yourself.
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THE FORSYTHE FIRM
Social Security Disability Counselors
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
CALL US (256) 799-0297
Email Us: forsythefirm@gmail.com
CHECK US OUT
When an adult claimant is approved for Social Security disability (SSDI) benefits, he or she is called the "primary beneficiary." However, there may be auxiliary beneficiaries, such as dependent children of the claimant.
Children who are dependent on the primary beneficiary may also receive a cash benefit as long as they are:
Age 18 or below, OR
Age 19 or below and have not completed high school
Social Security will terminate dependent children's benefits at age 19 or upon graduation from high school, whichever occurs first.
Can dependent children also be eligible for back payments? Yes. Dependents will usually qualify for back payments during the same period as the primary beneficiary. For example, If Ms. Joan Claimant receives benefits back to 6/1/17, her dependents could receive back payments for that same period.
The maximum that all dependents can receive is usually 50 percent of the amount the primary beneficiary (claimant) receives. This is called the "family maximum." Dependent's benefits would be divided among all eligible dependents on the claim.
Whenever we file a new claim or appeal a denied SSDI claim, we always look for ways to include eligible dependents.
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The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL US (256) 799-0297
Send Us An E-Mail: forsythefirm@gmail.com
CHECK OUT OUR WEBSITE
There are always at least two parties in every legal proceeding. One of those parties has the "burden of proof." In other words, one party must prove the case, the other party doesn't have to prove anything.
In a Social Security disability hearing, there are two parties:
A. The claimant, who is trying to get a benefit--
B. The Social Security Administration who may pay a benefit--
The Social Security Administration has no burden of proof. They don't have to prove that a claimant is not disabled. They don't have to prove anything. If nothing is proven during the hearing, Social Security wins and pays nothing. The claimant loses.
It is the claimant, the person trying to get benefits, who must prove something. The claimant must present evidence proving that he or she is medically disabled, according to the rules and regulations of the Social Security Administration. If the claimant cannot prove this, he or she loses and gets no benefits.
So, you have to ask yourself, who is best qualified to prove the facts that are favorable to the claimant? Of course, it will be an attorney or disability advocate who knows the rule and regulations of the Social Security Administration.
You must know what you have to prove before you can prove it.
How can you get an attorney/advocate and what will it cost?
Disability attorneys who work on Social Security cases work on a Contingency Fee. This means they only get paid if the claimant wins the claim and collects back pay from Social Security. Otherwise, the legal work is all free to the claimant. Attorneys usually do not charge any upfront fees, deposits, expenses or other costs.
This allows the claimant, who has everything riding on the Social Security case, to hire the best representation money can buy--without paying a penny until after the case is decided favorably and Social Security pays the back payments due. In that case, Social Security will withhold the agreed upon attorney's fee and pay it directly.
If you have a Social Security disability hearing in your future, think about this: Do you know what you must prove? Do you have a plan to prove that you meet all of the federal regulations?
Disability hearings are much more complicated than most claimants imagine. They are much more "legal" than most people imagine. It's easy for claimants to get in over their heads, legally speaking.
"Wow! That hearing was nothing like I thought it would be!" is something we hear a lot from clients walking out of a hearing.
If your case is important to you, if you really need the benefits, be prepared to meet your burden of proof. The hearing is your very best chance to do so. There will never be a better opportunity to win your case.
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The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
E-mail Address: forsythefirm@gmail.com
SOCIAL SECURITY JUSTICE (WEBSITE)
When Social Security denies your application for disability benefits, the claimant must appeal with the 60 day deadline. The appeal will take you before a federal Administrative Law Judge (ALJ) for a hearing. The ALJ must listen to your testimony, look at all evidence, and decide if the claimant meets all of the federal regulations for a disability benefit.
The hearing is the absolute best chance the claimant will ever have to be approved. This hearing is so important, you can't take a chance on failure. Fail here and there are no more good opportunities to win the case and get paid!
So, who testifies at a disability hearing? First, the claimant will answer a barrage of questions from the judge. You will be asked about your medical conditions, what kind of activities you can and can't do, what your physical and mental limitations are; what your past jobs were like, your education and your daily activities.
The government will always call in a vocational expert (job expert) to provide testimony. The testimony provided by this expert can totally kill your case and get you denied if you (the claimant) don't handle it correctly. Since you are not familiar with all of the technical rules and regulations, you will want your attorney/advocate present to protect you.
Sometimes, Social Security will also call in a doctor (medical expert) to provide testimony. I recently attended a hearing where a retired medical doctor testified. The doctor stated that my client could perform any job at the light exertion level. That opened up thousands of jobs that Social Security believed the claimant could still perform and would have denied the claim if the testimony had been allowed to stand unchallenged. My job was to challenge the doctor's testimony, which I did.
Ultimately, the judge's decision will be based on what is in the claimant's medical record. Your attorney's job is to know the medical record and use it to PROVE your case and get you paid.
Keep in mind that the federal regulations will be used by the judge and it is the rules and regulations that must be satisfied. For a claimant who doesn't understand the rules and regulations, this is an impossible chore. So, take somebody with you to the hearing who knows the regulations and how to use them.
The judge is an expert on the regulations. The vocational witness is an expert. The medical doctor is an expert. Do you want to be the only person in the hearing who is not an expert?
I'm afraid many claimants believe that all they have to do is walk into a hearing and tell the judge their story and everything will be OK. This is not the case. The judge cannot and will not pay your claim unless you PROVE that you meet all of the federal regulations for a benefit. The law will prevail. For that to happen, all of the expert testimony must be dealt with.
The burden of proof is on the claimant, not on the government. In other words, the government doesn't have to prove that you are not disabled. You must prove with admissible, objective evidence that you are disabled.
Fail to prove your case and you walk out denied, without benefits.
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The Forsythe Firm
Social Security Disability Advocates
"Disability Is All We Do"
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
(256) 799-0297
Military personnel who have become unable to continue their military career may face a medical retirement board or mandatory retirement. Many of these veterans qualify for Social Security disability, if they persist with the process to get approved--which can be long and difficult.
SSDI benefits will be in addition to any VA or military benefits. Here are some facts you should know about Social Security Disability Insurance (SSDI) and the military:
FACT 1: Military personnel in all branches of the US Armed Forces pay into Social Security and have since 1954. This makes them eligible for benefits if they become disabled.
FACT 2: It may be possible to get benefits before the individual is discharged. The key with Social Security is, "Are you able to perform your duties?" It may not matter that you are still receiving military pay while awaiting discharge.
FACT 3: Social Security has a different definition of disability than the VA uses. With Social Security, most claimants need to be totally disabled (meaning, unable to work any full-time job). Just because an individual qualifies for 100 percent VA disability doesn't automatically mean that Social Security will find them "disabled." The process and requirements are different.
FACT 4: Social Security frequently denies cases before they pay them. That's true with veterans, as well. Expect your application to be denied. You will file an appeal and attend a hearing before you can be approved.
FACT 5: Professional representation is valuable when battling for your SSDI benefits. Having an advocate who understands the law and Social Security procedures gives you a great advantage. Best of all, you cannot be charged any legal fees or expenses unless your case is successful and you are awarded back pay from the government.
Our firm has been assisting veterans for decades right here in Huntsville. We would be pleased to provide a free consultation at no obligation. By the way, we are highly experienced in handling veterans' claims and we have a high success ratio.
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THE FORSYTHE FIRM
7027 Old Madison Pike NW
Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
Our email address: forsythefirm@gmail.com