In a recent case from the United States Court of Appeals for the Seventh Circuit, claimant had applied for Social Security Disability Insurance (SSDI) benefits, and his initial application was denied. He then applied for reconsideration of his application for Social Security benefits, and that was also denied. At that point, he applied for, and was granted, a hearing before an administrative law judge (ALJ), and the ALJ also denied benefits.
After being denied for benefits, the claimant appealed to the Social Security Administration (SSA) review commission, and the commissioner agreed that the denial was not supported by adequate evidence and remanded the case for further proceedings to determine if claimant was entitled to benefits. However, claimant was not satisfied with a remand for further proceedings and instead argued to the U.S. District Court to not only overturn the ALJ’s denial, but to also make an affirmative finding that claimant is entitled to benefits.
As our Boston disability benefits attorneys can explain, appellate courts typically review cases for mistakes of law and look for evidence that the ALJ or a low judge committed what is known as a reversible error. However, in SSA appeals, the appellate courts will sometimes review the facts of the case and make an actual determination as to the ultimate question as to whether or not claimant is actually disabled and thus entitled to benefits.
In this case, the district court declined to make a factual finding on whether or not the claimant was entitled to disability benefits, and the claimant then appealed to the U.S. Court of Appeals for the Seventh Circuit. As for the complaint’s actual medical conditions, he alleged that he was unable to work since 2006 due to post-traumatic stress disorder (PTSD), migraines, tendonitis, hearing loss and back pain. His tendon pain began when he injured his right shoulder while working in the Army National Guard.
Since his first injury was service-related, he first applied for benefits with the Department of Veterans Affairs (VA), and their doctors operated on his right shoulder. He testified that he told doctors he had a great deal of pain and could not grip objects properly with his hand, but as noted by the ALJ, the written medical records from the VA seemed to contradict his testimony.
However, when he applied for disability benefits through the VA, he was assigned a 70 percent disability rating, but he was paid benefits on a 100 percent disability rating, because they agreed that he was unable to work. This situation creates a lot of confusion, as our Boston disability benefits attorneys have seen in far too many cases. The confusion arises when someone is found to be 100 percent disabled by the VA and then, when that service member applies for disability benefits with the SSA, there is finding that the claimant is not disabled.
The reason for this is because, as SSA claims, the two federal agencies have different definitions of what it means to be disabled, and each agency has the right to use their own agency’s definition, even if that means that a claimant will be found disabled under VA guidelines and not under SSA guidelines. The appeals court ultimately affirmed the district court’s findings, noting that the VA has a pro-claimant review process and the SSA has a claimant neutral model that makes it harder to get benefits.
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.
Vallejo v. Berryhill, February 10, 2017, United States Court of Appeals for the Seventh Circuit
More Blog Entries:
Over 1 Million Wait for Social Security Disability Benefits, Feb. 9, 2017, Boston SSDI Lawyer Blog