VA Disability Rating Does Not Confer Automatic SSDI Approval

A Disability Rating from the VA Does Not Guarantee Social Security Disability Benefits

There is little question that going to war as U.S. service member can have lifelong consequences for those who return home.  One major health condition that affects our veterans is known as post-traumatic stress disorder or “PTSD.”

SSDI Attorney Boston This is certainly not a new issue.  During WWI and WWII, they used the term “shell shock,” derived from the perception that returning soldiers were  “shaken up,” sometimes permanently, from having shells and other types of explosive ordinance blowing up all around them and watching friends suffer serious traumatic injury or death.

However, even though we have known about this issue for many decades, we have made little progress when it comes to ensuring these brave soldiers are adequately compensated when they return with these profound psychological traumas and are unable to re-enter the workforce.

As our Boston Social Security Disability Insurance (SSDI) attorneys can explain, the U.S. Department of Veterans Affairs (VA) was once very hesitant to declare a service member disabled for having PTSD, or even recognizing the condition.  In the years of the wars in Afghanistan and Iraq, soldiers and sailors who were clearly debilitated by PTSD were told they were fine and redeployed oversees even if that was the worst thing for them and others.

This changed as the years of war dragged on and now a separated service member can go to the VA and, if the doctors agree, he or she will likely be awarded a disability rating and granted medical benefits.  This makes sense since PTSD is not a only a recognized mental health disorder, but it is also one that makes it very difficult for those suffering to work.

Many of these disabled veterans who served our nation honorably, being unable to work, go the Social Security Administration (SSA) and fill out an application for Social Security Disability Benefits. They think it should be an easy decision to award them benefits since the VA has already found them to be disabled – and it should be.  This is not generally what happens.

Instead, more often than not, the SSA denies their initial application, as they do with the majority of all other applications.  This is just standard operating procedure for SSA.  One would think they would have to honor the VA’s determination since the U.S. government has already done the same, but SSA is not required to adhere to a VA disability finding since the definition of being disabled is not the same at SSA as it is at VA.

Garcia v. Berryhill

In Garcia v. Berryhill, a Social Security disability appeal heard in the U.S. Court of Appeals for the Fifth Circuit, a veteran who served in the War in Vietnam went to the VA in 2005 for treatment for what he called dizzy spells.  When talking with doctors at the VA, he was given a physical evaluation and a mental evaluation, and it was determined that he had service induced PTSD.  The doctor also stated in his opinion letter that claimant had normal cognitive functions, but his abnormal speech patterns, anger control issues, and other related symptoms of PTDS would make it very difficult for him to engage in gainful employment and it might not be safe as he had homicidal ideations. He was given a 100 percent disability rating by the VA. 

When he applied for SSDI benefits, his application was denied upon a finding that he was not disabled.  He then requested for reconsideration as is part of the normal process and this too was denied. He then filed a request for a hearing before an administration law judge (ALJ).

Prior to this hearing, claimant’s case was evaluated by two doctors hired by SSA for this purpose. As part of this evaluation, they reviewed the reports from his VA doctors and also met with claimant and performed their own assessment. As one would expect from SSA contracted doctors, they determined that while he had PTSD and his other medical issues, including hearing loss, this did not leave him unable to engage in substantial gainful activity. This is SSA’s way of saying a claimant was not disabled and should be denied SSDI benefits.

Following a hearing before the ALJ, he was denied benefits and the ALJ supported his determination with the opinions of the two doctors. At this point, claimant appealed to the U.S. District Court, and that court affirmed ALJ’s denial of benefits. Typically, it is somewhat difficult to overrule the treating physicians’ opinion without substantial evidence to the contrary. The argument here, however, was that the VA doctors also only saw claimant for the purpose of a disability evaluation and were not really his treating physicians.  The court agreed with this argument when deciding claimant was not disabled.

After being denied benefits before a U.S. District Court judge, the next, and probably final step, is to file an appeal with the U.S. Court of Appeals where jurisdiction is proper.  Unfortunately for claimant, the court of appeals also agreed with the ALJ and the lower court’s findings and affirmed the denial of benefits.

Finding a Treating Physician Not Credible

The standard of departing from a treating medical professional’s opinion is that the record must be established by substantial evidence to the contrary. This is pursuant to 42 U.S.C. Section 405(g). While this is not an easy burden to overcome, ALJ’s will often  such a finding, especially when the claimant is not represented by an experienced attorney. There is however, no reason that claimant should not be represented since there is no cost for representation unless claimant is successful in being awarded SSDI benefits.

One way to strengthen the chances of a successful outcome is to get an attorney as early in the process as possible so that the proper medical evidence can be gathered and submitted with the application. An experienced SSDI lawyer, who has dealt with many similar cases, will have a good idea at to how SSA’s doctors will testify and know how to cross-examine them and introduce necessary evidence to put on the strongest case the facts and evidence will allow. These are issues about which claimant should discuss during his or her free initial consultation with an experienced SSDI attorney in Boston.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Garcia v. Berryhill, November 30, 2017, U.S. Court of Appeals for the Fifth Circuit

More Blog Entries:

SSDI Appeal Results in Affirmation of Denial, Feb. 15, 2017, Boston SSDI Attorney Blog