Denied SSDI because of income

Jeep Freak

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They can and will request his medical records. From my understanding at my base it usually takes around 6 weeks to get them copied.
 

Warrior644

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They can and will request his medical records. From my understanding at my base it usually takes around 6 weeks to get them copied.
If the agreement between DoD and SSA is still binding, SSA can expeditiously request a military service member's medical records via the "electronic records express" joint initiative. Then, SSA may request any hard-copy follow-on medical requests if warranted.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

Warrior644

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He was never assigned to the WTU. He tried and tried, but everyone kept telling him good luck or that he would need to be near dead for them to consider it. He has not worked an actual job or done anything in his MOS since he was stabbed on May 8th, 2012. He came home at that time and went directly on con leave and didn't return to work for 2 months, still not able to use his arm/hand. His normal day consists of his going in for formation or just for accountability, coming home and changing then going to some appointment or OT. He's also been attending some behavioral health group counseling for months. I can't remember what he told me they are called, but they have been a series of group counselings. Right now he's in trauma resolution and he was meeting with behavioral health this morning to discuss going to some continued counseling they feel he will benefit from. So, at most he is at "work" about an hour or so every morning, doing no job. but just showing up to check in.
The WTU reference was just to demonstrate a possible scenario of no longer performing SGA. This is the key, from what you are describing, the last day your husband performed SGA was when his injury had occured. This needs to be relected on the application for SSDI. Even though it would cost your family 25% of his SSDI or $5000 (whichever is less), I recommend getting a SSDI lawyer to represent you and see this through. The benefits to getting the layyer are that they are familiar with the SSDI office, the Administrative Law Judges and they want to get PAID. They will do everything in thier power to ensure the paperwork is filed properly and all of the appeals are completed in a timely manner.
gsfowler is correct, SGA is the primary focus of interest to determine a SSDI applicant's current work status.

Unfortunately, the SSDI lawyer avenue of approach is probably your best option at this point in time since the SSA Field Office didn't properly perform the duties of their employment in reference to the Wounded Warriors applicant cases for SSDI.

Thus, possessing well-informed knowledge is truly a powerful equalizer; and I offer that you continue your pursuit efforts to obtain a favorable "disabled" SSA SSDI determination!

Best Wishes!
 

gsfowler

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gsfowler is correct, SGA is the primary focus of interest to determine a SSDI applicant's current work status.

Unfortunately, the SSDI lawyer avenue of approach is probably your best option at this point in time since the SSA Field Office didn't properly perform the duties of their employment in reference to the Wounded Warriors applicant cases for SSDI.

Thus, possessing well-informed knowledge is truly a powerful equalizer; and I offer that you continue your pursuit efforts to obtain a favorable "disabled" SSA SSDI determination!

Best Wishes!
The SSA field office has very little to do with the initial approval of the SSDI claim. Everything is submitted to your State disability determining office as the State is on the hook for the first six months of disability. The State office almost always denies the initial claim and outs you into an appeal status. Let a SSDI lawyer do the job, they are good at what they do and want to get paid.
 

Warrior644

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gsfowler is correct, SGA is the primary focus of interest to determine a SSDI applicant's current work status.

Unfortunately, the SSDI lawyer avenue of approach is probably your best option at this point in time since the SSA Field Office didn't properly perform the duties of their employment in reference to the Wounded Warriors applicant cases for SSDI.

Thus, possessing well-informed knowledge is truly a powerful equalizer; and I offer that you continue your pursuit efforts to obtain a favorable "disabled" SSA SSDI determination!

Best Wishes!
The SSA field office has very little to do with the initial approval of the SSDI claim. Everything is submitted to your State disability determining office as the State is on the hook for the first six months of disability. The State office almost always denies the initial claim and outs you into an appeal status. Let a SSDI lawyer do the job, they are good at what they do and want to get paid.
This is not a valid statement as highlighted in red above...

Social Security representatives in the field offices usually obtain applications for disability benefits in person, by telephone, by mail, or by filing online. The application and related forms ask for a description of the claimant's impairment(s), treatment sources, and other information that relates to the alleged disability. (The "claimant" is the person who is requesting disability benefits.)

The SSA Field Office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information.

That said, if the SSA Field Office doesn't properly adjudicate the SGA determination as based on an in person, by telephone, by mail, or by filing online information provided by the SSDI applicant, then the SSDI application will be disapproved.

Moreover, the SSA's State Disability Determination Services (DDS) function is to perform an evaluation of medical disability (i.e., claimant is found disabled or not disabled under SSA rules) only for the SSA SSDI case if it meets all regulatory SSA SSDI qualifications. If all SSDI qualifications are validated, then SSA Field Office forwards the SSDI case file to the applicable State DDS.

If reference to a SSDI Lawyer, that's a good option if an individual truly meets the SSA SSDI qualifications, but were denied for whatever reason(s). To that extent and in most cases, the SSDI applicant doesn't properly complete all the required SSA SSDI forms. They vaguely or not legibly complete the forms then expect the SSA & SSA DDS to interpret their feedback. Won't happen; it will ultimately result in a denial of SSDI benefits.

In addition, the SSA DDS won't receive the requested medical documentation upon request from the applicant's medical providers. It's not the fault of the SSDI applicant, but it will ultimately result in a denial of SSDI benefits.

So, if the aforementioned observations were a result in the SSA's denial of an individual’s SSDI application, then it's probably in the best interest of the individual to hire the assistance of a seasoned SSDI attorney for potential award of SSA SSDI benefits; let them get paid!

Thus, possessing well-informed knowledge is truly a powerful equalizer

Best Wishes!
 

MrsR

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If the agreement between DoD and SSA is still binding, SSA can expeditiously request a military service member's medical records via the "electronic records express" joint initiative. Then, SSA may request any hard-copy follow-on medical requests if warranted.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
This is correct in my husbands case. He did not have to supply them any medical records, they told him they had access to them.
 

MrsR

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Our appointment is in a couple of hours. It is my understanding that instead of requiring him to appeal at this point, they are starting his application over. I will be sure to stress when he last performed SGA in his interview. If it doesn't work this time, we will get a SSDI lawyer to assist us. I'll report back how the appointment went. Thank you all for your help and advice.
 

Warrior644

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If the agreement between DoD and SSA is still binding, SSA can expeditiously request a military service member's medical records via the "electronic records express" joint initiative. Then, SSA may request any hard-copy follow-on medical requests if warranted.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
This is correct in my husbands case. He did not have to supply them any medical records, they told him they had access to them.
Great! I appreciate the reply. :)

Thus, the DoD/SSA Joint Initiative is still a valid continuing process; that's awesome.

Best Wishes!
 

Warrior644

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Our appointment is in a couple of hours. It is my understanding that instead of requiring him to appeal at this point, they are starting his application over. I will be sure to stress when he last performed SGA in his interview. If it doesn't work this time, we will get a SSDI lawyer to assist us. I'll report back how the appointment went. Thank you all for your help and advice.
This is outstanding news! :D

Moreover, I am extending well wishes to you and your husband during the SSA SSDI appointment.

To that extent, we look forward to your feedback from the outcome of the SSA SSDI appointment.

Thus, possessing well-informed knowledge is truly a powerful equalizer.

Best Wishes!
 

MrsR

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Update on our appointment today. At Ft Carson, you go to an office(on base) with a computer monitor and the Wounded Warrior liaison speaks to you via computer. We spoke to the actual liaison today. Come to find out, when my husband went for his original appointment she was on vacation and he spoke to someone that was filling in for her. She restarted his entire application, took the time to go through every answer that was listed on the original application and corrected many things that were wrong. After speaking with her, seeing all the wrong information on the original application and finding out that he spoke to someone that was just filling in, I'm actually looking at his first denial as a blessing in disguise. It helped to see a lot of mistakes that were made.

We stressed to her that he has not worked since the date of his injury and his MEDEVAC home, which was not even noted in the original application. The type of injury listed was also incorrect. I also made it a point to ask if it was in fact noted on his new application that he should fall under the Wounded Warrior status, which is something else that was not listed on his original application. We also stressed to her that he has not worked since that date and the max amount he spends at the "office" a day is an hour at best, just for accountability. She did tell us that they don't care if he isn't doing his actual job listed for his MOS, they just want to know if he's doing any work. I was under the impression it was based on working his actual job. I obviously misunderstood that.

She told us we would hear something by July. The original application was denied and we received notification in 3 days time. Do I think we will get denied again? Probably. I like to be realistic about things. If that does happen, we will get a lawyer and appeal at that time. Thank you all again for your help, as well as sharing your knowledge and personal experiences. I will update this as things happen, so that hopefully it can help someone else in the future.
 

Warrior644

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Update on our appointment today. At Ft Carson, you go to an office(on base) with a computer monitor and the Wounded Warrior liaison speaks to you via computer. We spoke to the actual liaison today. Come to find out, when my husband went for his original appointment she was on vacation and he spoke to someone that was filling in for her. She restarted his entire application, took the time to go through every answer that was listed on the original application and corrected many things that were wrong. After speaking with her, seeing all the wrong information on the original application and finding out that he spoke to someone that was just filling in, I'm actually looking at his first denial as a blessing in disguise. It helped to see a lot of mistakes that were made.

We stressed to her that he has not worked since the date of his injury and his MEDEVAC home, which was not even noted in the original application. The type of injury listed was also incorrect. I also made it a point to ask if it was in fact noted on his new application that he should fall under the Wounded Warrior status, which is something else that was not listed on his original application. We also stressed to her that he has not worked since that date and the max amount he spends at the "office" a day is an hour at best, just for accountability. She did tell us that they don't care if he isn't doing his actual job listed for his MOS, they just want to know if he's doing any work. I was under the impression it was based on working his actual job. I obviously misunderstood that.

She told us we would hear something by July. The original application was denied and we received notification in 3 days time. Do I think we will get denied again? Probably. I like to be realistic about things. If that does happen, we will get a lawyer and appeal at that time. Thank you all again for your help, as well as sharing your knowledge and personal experiences. I will update this as things happen, so that hopefully it can help someone else in the future.
This is truly outstanding news! :) My internal assumptions concerning your situation were just validated from experience and sound insight.

In my opinion, your husband's chance of receiving a “disabled” SSDI determination has increased significantly. By SSA guidelines, they are supposed to "determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force...do not evaluate the claimant’s work activity based solely on military wages."

Moreover, the SSA's GRID of Rules implemented by the State DDS is the next stage in the SSDI determination process. This is a very difficult process if a disability applicant doesn't meet a medical impairment listing by the SSA. Remember, it's very difficult to obtain a "disabled" SSDI determination, but it's not impossible to obtain a "disabled" SSDI determination if all medical conditions are well documented by military and civilian healthcare providers.

Thus, possessing well-informed information is truly a powerful equalizer.

Best Wishes!
 

jwbad82

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your th
The following advice is offered as historical information to potentially assist your SSDI efforts:

SSA's SSDI is an "all" or "none" based total disability program, unlike the DoVA which compensates for numerous medical conditions which may not be totally disabling.

Upon submitting your application, did you annotate in the “remarks section” that you are a “Wounded Warrior still on Active Duty” since 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.

Unfortunately, yes, it's very common to be denied SSDI benefits because of income. But, that usually applies to non-Wounded Warriors on Active Duty applicants.

From what I have read, some SSA Field Offices are NOT following their instructions, policies and procedures in reference to Wounded Warrior applicant cases. They are having significant challenges with making the SGA determination for active duty service members since they usually continue to receive full military pay while receiving medical treatment.

Per SSA guidelines, SSA is supposed to "determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force...do not evaluate the claimant’s work activity based solely on military wages." Based upon the statement "Looking at your base pay and hourly pay rate, you will have to work less that two days a week," the SSA didn't properly make the SGA determination. Did you inform the SSA that your husband is "no longer working" in his MOS and he stopped working on __________ (you fill in that date)?

The SSA uses a GRID of Rules if a disability applicant doesn't meet a medical impairment listing.
The GRIDs are set up as a series of charts which can be confusing. SSA will make a determination on what level of exertion you can perform at in a work environment. The categories are from least level of exertion to most: sedentary, light, medium, and heavy.

Moreover, the GRID of rules calculate when an applicant is disabled as based on age, RFC level (sedentary, light, medium, or heavy work), education level, and work history and skills. If the applicant's impairment(s) does not met or equal a listing, the GRID rules come into play when an individual has a severe medically determinable physical or mental impairment, is not working at SGA level, and the impairment prevents an individual from performing any of their past relevant work (PRW).

With that all said, it's a good idea to request a complete copy of your SSA case file (for a nominal fee) upon availability. The "disability determination explanation" packet will include at a minimum "findings of fact and analysis of evidence" and an "assessment of vocational factors" write-ups which are very detailed to yield better explanations of any potential SSDI denial.

At your leisure, I suggest that you again visit the follows resources to obtain detailed information about the SSA disability evaluations and SSA SSDI GRID of rules:

1. http://www.ssa.gov/OP_Home/cfr20/404/404-app-p02.htm
2. http://www.ultimatedisabilityguide.com/grid_rules.html
3. http://www.ssa.gov/disability/professionals/bluebook/

Thus, possessing well-informed knowledge is truly a powerful equalizer.

Best wishes in your pursuit to obtain a favorable "disabled" SSA SSDI determination!

you are the man thanks!
 

turion1973

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The key with SSDI is Gainful Employment, I myself have applied for SSDI and like most everybody have been denied. I catch a lot of talk about you have a better shot if your in WTU and so on and so on. SSDI does not care if you in WTU or not it means nothing to them at all. My attorney says it can be difficult for military to get it since you regardless of what status SSDI still likes to consider us in a work for pay status. The key to SSDI it to prove you can not get gainful employment of 1040 a month. There is no explination on how SSDI looks at one injury to the next. you have to consider many things Age, Education, Injury many factors. Your could take to identical people on 19 yrs old and a 35 yr old with the very same injury, and the 19yr old may get SSDI before the 35 yr old just because the 35 yr old has a degree in college versus the 19 yr old only have a HS Diploma. The 35yr old has a better chance of getting a gainful wage job as to were a 55 yr old may get it just because of being considered a worn out worker hands down. There is a lot of science that goes into SSDI.
 

Warrior644

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The key with SSDI is Gainful Employment, I myself have applied for SSDI and like most everybody have been denied. I catch a lot of talk about you have a better shot if your in WTU and so on and so on. SSDI does not care if you in WTU or not it means nothing to them at all. My attorney says it can be difficult for military to get it since you regardless of what status SSDI still likes to consider us in a work for pay status. The key to SSDI it to prove you can not get gainful employment of 1040 a month. There is no explination on how SSDI looks at one injury to the next. you have to consider many things Age, Education, Injury many factors. Your could take to identical people on 19 yrs old and a 35 yr old with the very same injury, and the 19yr old may get SSDI before the 35 yr old just because the 35 yr old has a degree in college versus the 19 yr old only have a HS Diploma. The 35yr old has a better chance of getting a gainful wage job as to were a 55 yr old may get it just because of being considered a worn out worker hands down. There is a lot of science that goes into SSDI.
Yes; it's called the SSA's GRID of Rules implemented by the State DDS.

Thus, possessing well-informed information is truly a powerful equalizer.

Best Wishes!
 

Warrior644

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I was approved even though I was never at a WTU; they called my supervisor to check on my ability to work.
Congratulations on your award of SSA SSDI! :)

Yes, I concur. WTU assignment isn't a requirement for SSA SSDI award, but it significantly helps to validate the SGA criteria within the SSA SSDI. ;)

In retrospect and in most cases, the SSDI applicant doesn't properly complete all the required SSA SSDI forms. The SSDI applicant may vaguely, not legibly and/or don't descriptively annotate their symptoms on all mandatory forms then expect the SSA & SSA DDS to properly interpret their feedback. Won't happen; it will ultimately result in a denial of SSDI benefits.

In addition, the SSA DDS on occasion won't receive the necessary medical documentation upon request from the applicant's medical providers. Unfortunately, it's not the fault of the SSDI applicant that the SSA DDS didn't receive the mandatory supporting medical documentation, but it will ultimately result in a denial of SSDI benefits.

To that extent, it's probably in the best interest of the SSDI denied applicants to consult the services of a seasoned SSDI attorney for potential award of any SSA SSDI benefits; if the individual feels that they truly meet the SSA SSDI qualifications.

Thus, possessing well-informed knowledge is truly a powerful equalizer.

Best Wishes!
 

smacinnes40

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I have a question about the SSDI, I a am at the final stages of the decision. Thankfully as a wounded warrior, they help expedite the case. Especially since I am under treatment still. My question is about the onset date.

Can any of you answer how it went for you as far as the onset date. I was once told when I was up at JBLM. They use the onset date when you are starting your MEB/PEB.

My date was Jan 2012 and I Medically retired March 2013.

So how does the Social Security set the date of benefits.

I got a call from the field office who was very confusing about my case. I also have been in contact with the gentleman that does reviews of the whole case, reviewed all my medical records. He called me today and said we got the most important paperwork and had sent the case to the DR for final verifications. He kept saying everything looks good. Nothing more than that, also he sent to my field office a pre-assumptive approval but the field office could not give me benefits since my wife is in the military so I have to wait for my SSDI. The field rep also told me that my kids will get paid also once I am approved.
 

Warrior644

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I have a question about the SSDI, I a am at the final stages of the decision. Thankfully as a wounded warrior, they help expedite the case. Especially since I am under treatment still. My question is about the onset date.

Can any of you answer how it went for you as far as the onset date. I was once told when I was up at JBLM. They use the onset date when you are starting your MEB/PEB.

My date was Jan 2012 and I Medically retired March 2013.

So how does the Social Security set the date of benefits.

I got a call from the field office who was very confusing about my case. I also have been in contact with the gentleman that does reviews of the whole case, reviewed all my medical records. He called me today and said we got the most important paperwork and had sent the case to the DR for final verifications. He kept saying everything looks good. Nothing more than that, also he sent to my field office a pre-assumptive approval but the field office could not give me benefits since my wife is in the military so I have to wait for my SSDI. The field rep also told me that my kids will get paid also once I am approved.
Well, it sounds like an approved "disabled" determination for SSA Social Security Disability Insurance (SSDI). ;)

If this is the case, I extend my congratulations! :)
If not, then you shall have an opportunity to appeal the Social Security Administration (SSA) SSDI decision within a specific amount of days.

In reference to your inquiry, I offer the following Social Security Ruling (SSR) decision:

SSR 83-20: TITLES II AND XVI: ONSET OF DISABILITY

POLICY STATEMENT:
The onset date of disability is the first day an individual is disabled as defined in the Act and the regulations. Factors relevant to the determination of disability onset include the individual's allegation, the work history, and the medical evidence. These factors are often evaluated together to arrive at the onset date. However, the individual's allegation or the date of work stoppage is significant in determining onset only if it is consistent with the severity of the condition(s) shown by the medical evidence.

Moreover, with SSDI, you can get retroactive pay as far back as 12 months from the date you apply for benefits -- if you were disabled before that point. To get a full 12 months in backpay, you'd have to have become disabled at least 17 months before the date you applied, because there is a five-month waiting period after becoming disabled during which benefits are not paid or owed.

To that extent, your disability onset date determines how much in past due benefits, or backpay, you can get. For example, say that, when you applied for SSDI on 12/1/2010, you alleged that your disability began on 9/1/2010 and the SSA approved your benefits on 12/1/2011. If the SSA agreed with your onset date of 9/1/2010, you would be paid backpay benefits for 2/1/2011 to the present (five months after your alleged onset date (AOD) of 9/1/2010).

When individuals become eligible for SSDI benefits, there are circumstances in which the people who rely on their income (called dependents) are also eligible for benefits from Social Security. Whether a certain family member or relative is eligible for disability benefits for dependents depends on the type of Social Security Disability benefits the disabled individual receives and the dependent's relationship to the disabled individual.

Under certain circumstances Social Security will provide benefits to your children if you become disabled. Social Security considers biological children, adopted children, or dependent stepchildren to be children of the disabled individual.

A child may receive benefits if they are (1) unmarried, and (2) younger than 18 years old. Unmarried children who are 18 years old or older may receive benefits in two circumstances: (1) the child is under 19 years old and is enrolled full time as a student in a secondary school; or (2) the child is disabled and the disability occurred before the child turned 22 years old.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

smacinnes40

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Thanks, I did talk to the guy who put the whole packet together before it went to the DRs of Social security who make the final determination. He told me that the hard work is done and now we just have to wait for a few weeks. He mention that if my onset date was Sept 2011, then they only can go back 12 months but even that would help out. Crossing my fingers
 
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