The VA Says I’m Disabled– So Why Did Social Security Deny My Claim?

The VA Says I’m Disabled– So Why Did Social Security Deny My Claim?

Understanding Why a VA Disability Rating Does Not Automatically Qualify You for Social Security Disability Benefits

One of the most common questions we hear from veterans is: “The Department of Veterans Affairs found me disabled. Why did Social Security deny my disability claim?”

It’s an understandable question.

After all, both the Department of Veterans Affairs (VA) and the Social Security Administration (SSA) are federal agencies that evaluate disabilities. If one federal agency determines that you are disabled, many veterans naturally assume the other agency will reach the same conclusion.  Unfortunately, that is not how the law works.

While a favorable VA disability decision can provide valuable evidence in a Social Security Disability case, the two programs serve different purposes, apply different legal standards, and often reach different conclusions.

Understanding those differences can help explain why a veteran may qualify for one benefit program but not the other.

VA Disability Compensation and Social Security Disability Serve Different Purposes

Although both programs evaluate medical conditions, they were created for different reasons.

VA Disability Compensation

VA disability compensation is designed to compensate veterans for disabilities that are connected to their military service.  The VA asks questions such as:

• Is the condition service-connected?
• How severe is the condition?
• What percentage of disability should be assigned?

Veterans may receive disability ratings ranging from 0% to 100%, and they may receive compensation even while working full-time.

For example, a veteran with a 70% PTSD rating or a 60% back disability may continue working and still receive VA disability compensation.

Social Security Disability Benefits

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) ask a very different question:

Can you perform substantial gainful activity because of your medical impairments?

Unlike the VA, Social Security does not assign percentage disability ratings.

Instead, Social Security determines whether a claimant is disabled under a strict legal definition that generally requires an inability to perform substantial work on a sustained basis.

In other words, Social Security’s decision is essentially all or nothing.

Recommended Readings:  What is the difference in SSDI and SSI Claims?

Recommended Reading: SSA is Not Asking if you can do any Work, They are Asking if You can Maintain Steady Employment

Social Security Uses a Five-Step Evaluation Process

Every Social Security Disability claim is evaluated using a five-step sequential process.

The agency considers questions such as:

Step One

Are you currently performing substantial gainful activity?

Step Two

Do you have one or more severe medically determinable impairments?

Step Three

Does your condition meet or medically equal one of Social Security’s Listings of Impairments?

Step Four

Can you return to your past relevant work?

Step Five

If you cannot perform your past work, can you perform other work that exists in significant numbers in the national economy, considering your:

• Residual Functional Capacity (RFC);
• age;
• education;
• previous work experience; and
• transferable job skills?

It is often Steps Four and Five where veterans with high VA disability ratings encounter difficulties.

Recommended Reading: How Your Educational Level Affects Your Claim

Recommended Reading: How Your Age Affects Your Claim

Recommended Reading: What Does “Jobs Existing in Significant Numbers” Really Mean in a Social Security Disability Case?

Recommended Reading: Transferable Skills: Why Social Security Thinks You Can Do Another Job

Why a High VA Disability Rating Does Not Automatically Result in SSDI Benefits

Many veterans receive VA disability ratings of:

• 60%
• 70%
• 80%
• 90%
• or even 100%

Those ratings are certainly important, but they do not automatically satisfy Social Security’s legal definition of disability.  For claims filed on or after March 27, 2017, Social Security no longer gives any specific evidentiary weight to another agency’s disability determination, including a VA disability rating. Instead, SSA evaluates the claimant’s medical condition under its own rules and considers the medical evidence supporting the VA’s decision.

That means two veterans with identical VA ratings may receive different Social Security decisions depending upon their:

• functional limitations;
• ability to perform work-related activities;
• age;
• education;
• transferable skills; and
• vocational history.

Recommended Reading: How Postural Limitations Affects Your Claim

Recommended Reading: Why the Ability to Reach, Finger, Hold, Feel are so important

Residual Functional Capacity Often Determines the Outcome

One of the most important concepts in a Social Security Disability claim is your Residual Functional Capacity (RFC).  Your RFC is Social Security’s assessment of the most you can still do despite your medical impairments.

For example, SSA evaluates whether you can:

• sit for prolonged periods;
• stand and walk throughout a workday;
• lift and carry objects;
• use your hands effectively;
• reach overhead;
• stoop, crouch, kneel, or climb;
• concentrate and maintain pace;
• interact appropriately with supervisors, coworkers, and the public.

These functional limitations—not simply your diagnoses or VA disability percentage—often determine whether you qualify for benefits.

Recommended Reading: What Do Permanent Work Restrictions Mean in Workers’ Compensation and Social Security Disability Cases?

Recommended Reading: Why Work Classifications Matter in Alabama Workers’ Compensation and Social Security Disability Cases

Age Can Become Extremely Important

Many veterans are surprised to learn that age sometimes plays a significant role in Social Security Disability cases.  As workers become older, Social Security recognizes that changing careers becomes more difficult.

The Medical-Vocational Guidelines, commonly called the Grid Rules, consider:

• age;
• education;
• previous work experience;
• transferable job skills; and
• Residual Functional Capacity.

For example, under 20 C.F.R. Part 404, Subpart P, Appendix 2, Table No. 3, Rule 203.01, a claimant who is:

• limited to medium work;
• 60 through 66 years old (closely approaching retirement age);
• has a limited education or less; and
• spent a lifetime performing unskilled heavy or very heavy work

may be found disabled because Social Security recognizes that a lifetime heavy laborer is not realistically expected to transition to new medium-level work late in his or her working years.

This illustrates why vocational factors often become just as important as medical evidence.

Recommended Reading: Understanding the Grid Rules

Recommended Reading: Can You Really Perform Heavy Work?

Mental Health Conditions Are Evaluated Differently Too

Many veterans receive VA disability ratings for conditions such as:

• Post-Traumatic Stress Disorder (PTSD);
• depression;
• anxiety;
• traumatic brain injury (TBI); or
• other mental health disorders.

Social Security does not simply rely upon the VA’s percentage rating.

Instead, SSA evaluates how those conditions affect your ability to:

• understand and remember instructions;
• maintain concentration and persistence;
• interact appropriately with others;
• adapt to workplace changes; and
• maintain attendance and productivity on a sustained basis.

Again, the emphasis is on functional limitations, not disability percentages.

Recommended Reading: Chronic Pain and Psychologial Problems

The Medical Evidence Still Matters

Although Social Security is not bound by a VA disability determination, the medical records generated during your VA treatment often provide valuable evidence.

Those records may include:

• diagnostic imaging;
• specialist evaluations;
• mental health treatment notes;
• medication history;
• physical examinations;
• functional limitations; and
• longitudinal treatment records documenting the progression of your condition.

Well-documented medical evidence frequently strengthens both VA and Social Security claims.

Recommended Reading: Your Restrictions are More Important than your Diagnosis

The Bottom Line

Receiving a VA disability rating is an important accomplishment, and it often reflects serious medical impairments resulting from military service; however, a VA disability rating does not automatically qualify you for Social Security Disability benefits.

The two programs were created for different purposes and apply different legal standards.

If Social Security denied your claim despite your VA disability rating, that does not necessarily mean the denial was correct. In many cases, additional medical evidence, a better-developed Residual Functional Capacity assessment, vocational evidence, or an appeal may change the outcome.

At Powell & Denny, we have represented injured and disabled workers throughout Alabama for more than 30 years. We understand that serious claims are rarely decided by a diagnosis alone.  They are decided by how the injury affects the person’s ability to function, work, and earn a living.

If you have questions about an Alabama Workers’ Compensation claim, or a claim for Social Security Disability benefits, don’t hesitate to contact the experienced attorneys at Powell and Denny today a free consultation; remember. Virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live, and remember-there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Offices in Birmingham, Alabama and Huntsville, AL