Information for Wounded Warriors and Veterans Who Have a Compensation Rating of 100% Permanent & Total (P&T)

Military service members can receive expedited processing of disability claims from Social Security. Benefits available through Social Security are different than those from the Department of Veterans Affairs and require a separate application.

The expedited process is used for military service members who become disabled while on active military service on or after October 1, 2001, regardless of where the disability occurs.
Below are the answers to the questions most people ask about applying for disability benefits. Knowing the answers to these questions will help you understand the process.

What types of benefits can I receive?
Social Security pays disability benefits through two programs: the Social Security disability insurance program, which pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes; and the Supplemental Security Income (SSI) program, which pays benefits based on financial need.

What is Social Security's definition of disability?

By law, Social Security has a very strict definition. To be found disabled:

• You must be unable to do substantial work because of your medical condition(s); and
• Your medical condition(s) must have lasted, or be expected to last, at least one year or to result in death.

While some programs give money to people with partial disability or short-term disability, Social Security does not.

Can I receive benefits for a past disability if my health has improved?

That depends. If we find that you are disabled under our rules and your application was filed within a specified time frame, we will consider whether you qualify for a closed period of disability. There are specific requirements for a closed period of disability:

• The medical evidence must establish that you were unable to engage in substantial work for a continuous period of 12 months, but by the time the disability decision is made, your condition has improved to the point where we find you are no longer disabled.
• You also must file an application within 14 months after the disability ended.
• If you meet the requirements for disability benefits, there is a five-month waiting period before your first monthly benefit can be paid. You can receive up to 12 months of retroactive benefits from the date you file an application with Social Security.

Example: You file an application for Social Security disability benefits in December 2011. After reviewing your claim, we find that your disability started on April 15, 2010, and that your condition improved to the point that you were no longer considered disabled as of September 2011. We refer to this as a closed period of disability.
Your five-month waiting period begins May 2010, the first full month you are disabled. The months in your waiting period are May, June, July, August, and September. Thus, the first month for which you are entitled to disability benefits is October 2010.
You could potentially receive benefits for October 2010 until September 2011, the month your disability ended. Based on the application you filed in December 2011, you would receive 10 months of retroactive benefits for December 2010 through September 2011.

How does military pay affect eligibility for disability benefits?

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.

How do I apply?

You may apply for disability benefits at any time while in military status or after discharge, whether you are still hospitalized, in a rehabilitation program, or undergoing out-patient treatment in a military or civilian medical facility. You may apply online at www.socialsecurity.gov/woundedwarriors, in person at the nearest Social Security office, by mail, or by telephone.

You may call 1-800-772-1213 to schedule an appointment. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. We also have a “disability starter kit” available online to help you complete your application.

What information do I need?

To apply for benefits, you or your representative must provide information and documentation about your age, employment, proof of citizenship, and information regarding all impairments and related treatment. Social Security will make every reasonable effort to help you get the necessary medical evidence.
Important: You should file the application for disability benefits as soon as possible with any documents readily available. Do not delay filing, even if you do not have all the documents mentioned below.

• Original or certified copy of your birth certificate or proof of U.S. citizenship or legal residency if foreign born;
• Form DD 214, if discharged from military service;
• W-2 form or income tax return from last year;
• Proof of military pay or workers' compensation;
• Social Security numbers of your spouse and minor children;
• Checking or savings account number, if you have one;
• Name, address, and phone number of a contact person, in case you are unavailable; and
• Medical records that you have or that you can easily obtain from all military and civilian sources.

How does Social Security make the decision?
Your claim is sent to a State Disability Determination Services (DDS) office that makes disability decisions. The State has medical and vocational experts who will contact your doctors and other places where you received treatment to get your medical records. The State agency may ask you to have an examination or medical test. You will not have to pay the costs of any additional exams or tests you are asked to take. If the State does request an examination, make sure you keep the appointment.

How long does it take?

The length of time it takes to receive a decision on your disability claim can vary, depending on several factors, but primarily on:

• The nature of your disability;
• How quickly we obtain medical evidence from your doctor or other medical source; and
• Whether it is necessary to send you for a medical examination in order to obtain evidence to support your claim.

What can I do to speed the decision?

You can speed the decision on your application for benefits by being prepared for your interview. We can take prompt action on your claim if you:

• Let us know right away that your disability occurred while on active military duty;
• Have information available regarding all the doctors you have seen and the address of the military site where your records are kept;
• Notify us of any address changes you have while we are working on your claim; and
• Inform us about any changes in doctors, hospitals, or outpatient clinics where you are receiving treatment.

After we receive your application for Social Security disability benefits, we will identify it as a military service member claim and expedite it through all phases of processing, both at Social Security and the DDS. We also expedite disability claims filed online.

Can my family get benefits?

Certain members of your family may qualify for benefits based on your work. They include:

• Your spouse, if he or she is age 62 or older;
• Your spouse, at any age, if he or she is caring for a child of yours who is younger than age 16 or disabled;
• Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be younger than age 18 or younger than age 19 if in elementary or secondary school full time; and
• Your unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child's disability also must meet the definition of disability for adults.)

NOTE: In some situations, a divorced spouse may qualify for benefits based on your earnings if he or she was married to you for at least 10 years, is not currently married, and is at least age 62. The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children.

When do I get Medicare coverage?
You will get Medicare coverage automatically after you have received disability benefits for 24 months.

How does Medicare affect my TRICARE?

For service members who are entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance), TRICARE provides Medicare “wraparound” coverage. Medicare is the primary payer for these beneficiaries, and TRICARE serves as a supplement, paying the Medicare deductible and patient cost share.

If you are entitled to Medicare Part A based on disability or permanent kidney failure, contact the Department of Defense to find out how this may affect your TRICARE benefits. You may need to be enrolled in Medicare Part B to keep your TRICARE coverage. For general information about TRICARE, please visit http://www.tricare.mil/welcome/eligibility/medicareeligible.aspx.
Individuals who are awarded retroactive Social Security disability benefits also may become entitled to Medicare Part A for months before they receive the disability award notice. Effective October 2009, TRICARE beneficiaries who are awarded retroactive benefits based on disability or permanent kidney failure do not have to enroll in Part B for those months in the past and can keep their TRICARE coverage as long as they enroll in Part B currently. You should contact the Department of Defense to find out whether you need to enroll in Medicare Part B so you can keep your TRICARE.
The Patient Protection and Affordable Care Act of 2010 provides for a 12-month Medicare Part B special enrollment period for TRICARE beneficiaries who are entitled to Medicare Part A, but did not enroll in Medicare Part B during their initial enrollment period. The Department of Defense will notify eligible individuals about this period.

For more information about TRICARE and recent changes in the law, please visit www.socialsecurity.gov/legislation/tricareinfo.html.

What if I remain on active duty?

You may receive Social Security disability benefits and remain on active duty. It is important that you immediately contact Social Security if there is a change in your --

• Military Occupational Specialty code (MOS);
• Air Force Specialty Codes (AFSC); or
• Navy Enlisted Classification (NEC).

A permanent change of station (PCS) move from one duty station to another is also a potential indicator that you may be going back to work and should contact Social Security
Changes in your work status may affect your Social Security benefits. Tell us right away about any changes in your work or active duty status.

If you are planning to change your PCS, MOS, AFSC, or NEC, you can request a Benefits Planning Query from Social Security. This query contains information about the status of your disability benefits, work history and current work status, health insurance, scheduled medical reviews, and representative payee data.

You can use the Benefits Planning Query as a tool to help you plan your return to work. Request your query by calling 1-800-772-1213 or visiting your local field office.

What should I know about working?

Social Security has special rules called work incentives that allow you to test your ability to return to work and still receive monthly Social Security disability benefits.
You also can get help with the education, training, and rehabilitation you need in order to work. You will find a description of the work incentives and other programs that can help you return to the work force below. For more information, ask us for Working While Disabled -- How We Can Help (Publication No. 05-10095) or visit www.socialsecurity.gov/work.

Do I need to report my work activity?

Yes. If you take a job, it is important that you let us know about it as soon as possible. You should tell us:

• When you start or stop work; and
• If there is a change in your job duties, hours or work, or rate of pay.

Even if you are receiving full pay, you still may qualify for Social Security disability benefits.
You may visit your local field office to report your current work activity. You can find the closest offfice on our website at www.socialsecurity.gov.
Ask the Social Security representative to give you a receipt showing that you reported your work activity. The work report receipt is for your records and serves as proof that you told us about your current work situation.

What happens next?

When we receive notification that you have returned to work, we perform a work continuing disability review (CDR). During this review, we look to see whether you are doing substantial work. For 2013, we consider you to be doing substantial work if your monthly earnings are over $1,040 ($1,740 if you are blind).

That amount may change each year. When we conduct a work CDR, we ask you to complete an SSA-821-BK (Work Activity Report-Employee). You should complete the form and provide as much detail as possible about your job duties.

It is important that you tell us whether you are in a designated work therapy program or whether you are assigned limited duty because of your disability. You may be receiving full military pay, but not performing work duties. Without this information, we cannot properly evaluate your work, and your Social Security benefits may be suspended or terminated.

What are the work incentives?

Trial Work Period (TWP)
The TWP allows you to test your ability to work for at least nine months. The months do not need to be consecutive. During your TWP, you will receive your full Social Security benefits, regardless of how much you earn, as long as you report your work activity and you continue to have a disabling impairment.

In 2013, a trial work month is any month in which your total earnings are more than $750 or, if you are self-employed, you earn more than $750 or you spend more than 80 hours in your own business. The TWP continues until you have worked nine trial work months within a 60-month period.
Extended Period of Eligibility (EPE)

After the TWP ends, you have 36 months during which you can work and still receive benefits for any month that your earnings are not "substantial."
During the EPE, your benefits are suspended for any month that you have substantial earnings. However, you will receive a benefit for any month your earnings fall below the substantial level. You do not need a new application or disability determination to receive a Social Security disability benefit during the EPE.

More information on work incentives is available at www.socialsecurity.gov/redbook.

Ticket to Work Program
Social Security's Ticket to Work program offers many supports that can help you return to work. Under the Ticket program, you can obtain vocational rehabilitation, training, job referrals, and other employment support services free of charge. These services are provided by Employment Networks, which are private organizations or government agencies (state or local) that have contracts with Social Security to provide employment services and other supports to beneficiaries with disabilities.
If you are interested in using the Ticket program to go to work or get vocational services, please call 1-866-968-7842, toll-free.

Work Incentives Planning and Assistance (WIPA) program
The WIPA program is a nationwide network of community-based organizations with experts who can answer questions about Social Security's work incentives and help you make a decision about working.

WIPA experts, called Community Work Incentive Coordinators, provide information and work incentives planning and assistance to people who are receiving Social Security disability benefits and who are currently working or considering work. They can help you understand how work affects your disability benefits and explain what other federal, state, and local supports there are for people with disabilities who want to work.

To locate the WIPA project nearest you, call 1-866-968-7842, toll-free.

TOP 5 REASONS SOCIAL SECURITY DISABILITY BENEFITS ARE DENIED

There are many reasons for the Social Security Administration to deny your claim for disability benefits. These are just a few common reasons for denials:

• Your disability is due to drug or alcohol addiction. If your condition would likely improve if you stopped using drugs or alcohol, the Social Security Administration will likely deny your claim. 
• Your condition is not expected to last long enough. If your condition is not expected to last for 12 or more months, the Social Security Administration will deny your claim.
• Your condition is not severe. If your condition does not interfere with your ability to perform work-like functions, your claim will be denied.
• You did not provide enough medical documentation to support the severity of your disability. The Social Security Administration cannot approve your claim if you do not have medical evidence from medical providers to substantiate your symptoms. 

• You did not follow your doctor's recommendations. If you did not follow thru with recommended medical treatment, the Social Security Administration will deny your claim. 

If you are unable to work due to your medical condition(s) and were denied by the Social Security Administration, contact us for a free evaluation. We offer free case evaluations and can oftentimes assist you in navigating the complex system established by the Social Security Administration. Call or text me anytime at: 407-738-3718 or visit my website at www.rickgach.com

FORT LAUDERDALE HEARING OFFICE STATISTICS

Office	Judges	Avg. Hearing Wait Time	Average Processing Time	Dispositions Per Day Per ALJ	Cases Dismissed	Cases Approved	Cases Denied
Ft Lauderdale	14	16.0 months	558 days	1.6	23%	44%	34%
Florida		16.8 months	559 days	1.8	20%	44%	36%
National Average:		12.8 months	432 days	2.0	18%	44%	38%

ORLANDO HEARING OFFICE STATISTICS

Office	Judges	Avg. Hearing Wait Time	Average Processing Time	Dispositions Per Day Per ALJ	Cases Dismissed	Cases Approved	Cases Denied
Orlando	14	14.0 months	473 days	2.1	16%	50%	34%
Florida		16.8 months	559 days	1.8	20%	44%	36%
National Average:		12.8 months	432 days	2.0	18%	44%	38%

IMPORTANT DATES THAT YOU MUST KNOW WHEN FILING A CLAIM

If you are applying for disability benefits or if you have already filed a claim, it is important that you understand these terms: Protective Filing Date (PFD), Alleged Onset Date (AOD), and Date Last Insured (DLI).

Protective Filing Date (PFD)
When you initially contact SSA to file a claim, this is your PFD.  If you are awarded benefits, this date determines how far back SSA can go when paying your past due benefits.  For SSI claims, you can only be paid from this date forward.  For Disability Insurance Benefits (DIB), you can be paid a maximum of 12 months prior to your PFD.


Alleged Onset Date (AOD)
This the date that your disability began.  When you file our application for benefits, SSA will ask you when your disability began.  Giving SSA the wrong date can end up costing you money or a significant delay in your decision.  There are many factors to consider when you tell SSA when your disability began.  Probably the most important thing to remember when alleging an onset date is to determine when your condition was severe enough to interfere with your ability to do your job on a full-time basis.  If you had to reduce the number of hours that you worked or if you had to switch to a different less strenuous job, this will more likely be the date of your onset of disability.


Date Last Insured (DLI)
This is one of the most important considerations in your claim for disability benefits.  In order to qualify for DIB, you have to earn sufficient credits to become "insured."  Typically, you must have 22 credits in order to qualify for DIB.  You can earn 4 credits per year, so you must work at least 5 1/2 years to earn 22 credits.  Your Earnings Statement will tell you the last date that you could qualify for DIB based on your earnings.  This date is your DLI.

If you have questions about when to file a claim, what date to allege or how your DLI effects your claim, give me a call at 407-738-3718.

SSA Changes ALJ Job Description

Social Security Disability case judges have had rigorous caseloads for years, with many creating a significant backlog as a consequence. According to The Wall Street Journal, the Social Security Administration (SSA) is conducting a comprehensive reexamination of how judges reward disability benefits. The changes include altering job descriptions to give officials increased authority to oversee judges. Job descriptions currently contain the terminology “complete individual independence,” which creates challenges for the SSA. The Journal reports the phrase will no longer be included in job descriptions and new wording will make it clear that judges are subject to supervision by the agency. Approximately 1,500 administrative judges may be affected by the alterations.
 
This isn’t the first time disability judges have come under scrutiny. The changes came after wide disparities in judge rulings were revealed. The Journal reported that in 2011 it was found that dozens of judges ruled for benefits in 90 percent of their cases, while others denied benefits in more than 80 percent of their cases. These disparities between judges caused the agency to tighten enforcement at the time. Judges only awarded benefits in 67 percent of their cases in 2010, the Journal reported. That number fell to 56 percent last year.

“The allowance rate right now is probably at a 40-year historic low,” Glenn Sklar, deputy commissioner for the SSA, said at a congressional hearing in November, according to the Journal.
The LegalTimes blog noted two congressional committees examined how SSA judges rule on disability claims and how SSA leadership disciplines judges in mid-2011. During the hearing, the case was made that some judges didn’t take accountability for their actions, while others kept within the rules and were hardworking. According to the blog, 58 disability judges were disciplined by the administration between 2007 and 2011 for numerous reasons, the most common being failing to rule on enough cases.

For disability applicants, increased scrutiny of judges may be both positive and negative. While improving judge discipline can ensure disabled people receive benefits, it may also cause more judges to be terminated. The number of judges has been declining in recent years, which has created a backlog of cases. According to the Journal, the recession increased demand for SSD benefits, with the program now having approximately 11 million beneficiaries. In fact, the number of people in the program is set to continue increasing.
In an interview with the Center for Public Integrity, Russell Pulver, a former California-based administrative law judge for the U.S. Department of Labor, said it was increasingly difficult for him to handle his caseload.

“Each year I seemed to hear more cases and be given less help,” Pulver said. “I said, ‘I’m getting no love. I’m not staying around for this.’”

According to the Center for Public Integrity, Pulver voluntarily left his position with the Labor Department and now runs a mediation service. The dwindling number of judges is causing many department offices to be understaffed, which is only growing the problem of hearing and properly ruling on cases.

The changes to judge job descriptions and possibility of increased scrutiny may allow more applicants to be awarded benefits, but it may also increase case wait times.

---

What to Look for When Hiring a Representative?

I'm often asked this question by prospective clients and the answer is complicated.  Most representatives do a great job working on behalf of their clients.  But, there are representatives that actually do harm to their client's cases.  Sometimes this is through no fault of their own.  A perfect example is the representative that works for a large firm or so-called "national firm."  These firms spend millions of dollars advertising on television, radio and on the internet.  Their sole purpose is to bring in as many clients as possible.  And, unfortunately, they are doing this in record numbers.  However, when it comes to putting resources into providing representation for their clients, they fall short.  Here are some questions that I recommend every client ask their representative:

• How many cases do you handle?  You may be surprised to learn that your representative has several hundred cases in his/her inventory.  Is it possible for one person to handle this many cases and still be prepared to represent you in your claim?  Often, the tell-tale sign that they are overloaded with work is whether they keep in close contact with you, return your phone calls timely, and are willing to meet with you if necessary.  If you have questions that are not being answered appropriately or timely, this may be a sign that your representative is overloaded and has too many cases to manage.  Or, it could mean that he/she does not have the necessary resources and staffing to handle their caseload.
• Will you provide SSA with updated medical records at every level of the appeals process?  Believe it or not, there are many representatives that will tell you that getting your records before the hearing is scheduled is a waste of time.  But, the fact is without documentation to support your claim for disability, SSA cannot approve your case.  If your representative updates your medical evidence consistently and requests SSA to review these records, oftentimes cases will get approved without having to go before a judge.  Sitting on your case and not updating your records is another sure sign that your representative is either too busy with his/her caseload, or he/she just isn't concerned about your case.
• Does your representative listen to you?  It is important that your representative understands why you are unable to work.  This seems like an obvious consideration, but all too often representatives do not understand your case or the reasons that you are not able to work.  You should have a good rapport with your representative and you should feel like they are on your side.  Many representatives become "jaded" after representing claimants.  They don't listen to you and are going through the motions hoping they get a good judge.
• Will your representative adequately prepare you to testify at your hearing?  Again, this seems like a simple thing to expect.  Will your representative meet with you or call you well in advance of your hearing in order to prepare you to testify?  If not, will SSA have all of the facts?  Probably not.  Representatives are paid a fee out of the benefits that are awarded to you on your claim.  The representative should be willing to spend time with you and be prepared to represent you at your hearing.  

Of course, there are many other questions to ask your representative before you hire him/her.  These are the most obvious.  Your relationship with the representative should be a good "fit" for you.  And you should feel confident that he/she is doing everything possible to get your claim approved.

If you need assistance or have questions about a social security disability claim, please don't hesitate to contact me directly on my cell phone at 407-738-3718.