It is a well-known fact that serving in the military can have a lifelong impact on the mental and physical well-being of individuals. Veterans who become disabled may be eligible for disability benefits provided by the Social Security Administration.
However, one question that often arises is whether a Veterans Affairs (VA) rating can affect Social Security Disability Insurance (SSDI).
A VA disability rating will not affect your SSDI benefits, as VA Disability Compensation and SSDI are different programs. However, if you have a 100% VA disability rating, it may help expedite your SSDI claim.
For more information on how a VA rating can affect SSDI, please read below.
How Does the VA Rate Disability?
There is a widespread misunderstanding that the term “combined” implies the addition of different factors. However, when it comes to determining a person’s ability, the VA uses a combined rating table which considers multiple factors in a systematic way.
This rating system assesses the most disabling condition or the condition with the highest rating first, followed by less severe conditions in order of their severity. By following this approach, the VA can accurately determine an individual’s overall efficiency.
For instance, a veteran may receive a letter from the VA informing them of two service-connected disabilities, each rated at 50%. One disability is caused by a traumatic brain injury (TBI) and the other by a back injury. Normally, the sum of 50% and 50% would equal 100%, but the overall disability rating for this veteran would be 80%.
In this scenario, the VA considers a fully efficient person as 100% and subtracts the highest-rated condition (TBI at 50%). Therefore, the veteran is presumed to be 50% impaired and 50% functional.
The back injury, which is also rated at 50%, is then subtracted from the remaining efficiency. This leaves only 25% (for the back injury) to be added to the initial 50% (for the TBI). The combined 75% disability rating is the result of a 50% TBI estimate and a 25% back injury estimate.
To obtain the overall disability rating, the VA rounds up to the nearest ten. Therefore, a total disability rating of 75% would be rounded up to 80%.
How a VA Rating Affects SSDI Care
The regulations of Social Security Administration clearly state that VA ratings do not bind them. Just because an individual has a 100% Permanent and Total (P&T) disability rating from the VA, it doesn’t necessarily make them eligible for SSDI benefits.
This is due to the eligibility criteria for disability benefits being different for the VA and the Social Security Administration. However, an ALJ usually must give great weight to a VA assessment of disability as established by the Ninth Circuit in McCartey v. Massanari.
If an administrative law judge (ALJ) decides to give less weight to a VA disability determination, they must provide “persuasive, specific, valid reasons” backed by the record as to their decision.
Although ALJs are not required to give the claimant’s VA rating decisions a great deal of weight or deference, the medical proof supporting the VA rating is the most crucial component. If a veteran has a 100% P&T disability rating from the VA, it is a strong sign that their medical records support the decision that they can’t work full-time.
Lastly, treating physicians’ opinions on disability are still crucial in Social Security cases due to the importance of “supportability” and “consistency” considerations.
Differences Between SSDI and VA Disability Benefits
There are many differences between these two disability benefits. Some of the main differences between the programs include the benefit amount, eligibility criteria, and the qualifying conditions.
Qualification
If you are a military veteran and have suffered a physical or mental injury while serving in the military, you may be eligible for disability benefits from the VA. It is also possible to qualify for these benefits if your conditions have worsened due to your military duty.
On the other hand, the Social Security Administration’s eligibility criteria for SSDI is determined by your employment history rather than the cause of your disability. You must have worked in jobs covered by the Social Security system for a specific amount of time to be eligible for SSDI.
Medical Qualification
To be eligible for SSDI benefits, your medical condition must be severe enough to last or be expected to last for at least 12 months or result in your death, as per the Social Security Administration. The Social Security Administration has an all-or-nothing approach to disability. Under Social Security Administration, a claimant is either disabled or not disabled; there are no varying degrees of disability or partial disability.
In contrast, the VA uses a percentage scale to provide a disability rating. The rating is based on how much a particular condition impacts a person’s health and capacity to work.
The VA assigns various percentages to different injuries like the number of fingers that were severed or how much of the leg was lost. The VA calculates a single rating using a complex formula if you have more than one disability as a result of your service.
Even if none of your conditions are very disabling on their own, you can earn a 100% disability rating if you have multiple conditions. Alternatively, if the VA believes your condition may improve over time, you may be granted a total but not permanent 100 rating.
Benefits
Your monthly benefit amount for SSDI is determined by your lifetime average earnings from Social Security-covered jobs. The Social Security Administration does not use a sliding scale to determine if an individual is disabled or not, regardless of the severity of their condition. In 2023, the average monthly payout from SSDI was $1,489.
On the other hand, the VA provides disability payments based on the rating that the department assigns to your condition. In 2023, monthly benefits for a veteran without a dependent varied from $165.92 for 10% disability to $3,621.95 for 100% disability.
There is an important exception from the standard procedure that the VA follows when determining payments by using your disability rating.
You may be eligible for the VA’s Individual Unemployability benefit, which pays at the 100% rate if you do not have a 100% rating but cannot retain consistent work that supports you financially due to your service-related disability.
Can SSDI and the VA Work Together?
If you are a disabled individual, you may be eligible to receive benefits from both SSDI and the VA. By understanding how these two programs can work together, you can maximize your benefits and receive the financial support you need to manage your disability.
Expedited Application Process
If you are a veteran with a 100% P&T rating from the VA and you are applying for SSDI, you may be eligible for expedited processing of your claim.
To request expedited processing, you can use the phrase “veteran 100% P&T” in the online application’s “remarks” area and submit a copy of the rating notification letter you received from the VA.
Additionally, if you were disabled on or after October 1, 2001, you may be eligible for the Wounded Warrior Project, which gives priority to claims and can help you get your claim processed more quickly, regardless of your P&T grade.
Exemption From Offsets
The Social Security Administration uses the term “offset” to describe the reduction in SSDI payments that can occur when you receive workers’ compensation or other public disability benefits.
Your SSDI benefits will not be affected by your VA disability benefits, and vice versa; if you are eligible for both programs, each will pay the total amount to which you are entitled.
Medical Coverage
It is possible to obtain medical coverage through both SSDI and the VA if you receive disability benefits from both programs.
SSDI beneficiaries are eligible to enroll in Medicare, but usually, there is a two-year waiting period before coverage can begin. Veterans can enroll in the military’s Tricare program.
If you receive both benefits, Medicare will serve as your primary payer, and your medical providers will bill it first. Tricare will act as a supplement, paying a portion of the cost-sharing that you are responsible for, such as copayments and deductibles.
How the VA Sees the Social Security Administration’s Disability Decision
If you are a veteran and are also receiving benefits from the Social Security Administration, it’s important to understand how the VA and Social Security Administration differ in their approach to determining eligibility for benefits.
The Social Security Administration evaluates claims based on whether an individual is medically disabled and unable to work, without considering the cause of the disability. On the other hand, the VA must determine if a disability is related to military service, as it only provides benefits for service-connected disabilities.
As a result, the VA might not consider the decision made by the Social Security Administration regarding your eligibility for benefits. However, the VA will examine the medical records provided by the Social Security Administration, so it’s crucial to include your complete Social Security Administration medical record when applying for VA benefits.
Your Social Security Administration medical record may contain evidence that can support your VA claim, including documentation from the judge’s rulings. Therefore, it’s essential to provide the VA with all relevant information, including the Social Security Administration’s medical evidence, to ensure that your claim is fully evaluated.
What To Do When Denied SSDI With 100% VA Disability
It’s important to note that receiving a 100% disability rating from the VA does not guarantee that you will also be eligible for SSDI benefits. This is because SSDI is a separate organization with its own set of requirements.
If you continue working and earn more than the substantial gainful activity (SGA) limit, your application for SSDI benefits may be declined by the Social Security Administration. If you disagree with the decision, you have 60 days from the date of the denial letter to file an appeal. It may also be helpful to consult with a lawyer who specializes in SSDI claims.
What To Consider When Applying for SSDI as a Veteran
The Social Security Administration handles your case differently than the VA does since they are separate programs.
Here are some additional factors to think about when applying for SSDI benefits as a veteran:
Substance Abuse
The VA generally does not penalize substance use disorders. This is largely due to the recognition that a significant proportion of veterans, especially those grappling with trauma-related disorders, may resort to self-medication with substances such as alcohol and drugs.
On the other hand, the Social Security Administration may adopt a different stance if your disabilities are directly or indirectly related to substance use. There are instances where the Social Security Administration may view evidence of self-medication through the use of alcohol and drugs in a less favorable light, particularly if it’s linked to mental health issues.
However, it’s important to note that the VA tends to adopt a more understanding approach towards veterans who self-medicate, given the prevalence of mental health issues among this population.
While this could potentially make it more challenging to receive Social Security payments, it would not prevent you from receiving VA individual unemployability benefits or a total occupational and social impairment rating.
It’s always recommended to seek professional help for substance use disorders, as there are numerous treatment options available.
Doctor Notes
When making claims with the Social Security Administration or the VA, medical reports from doctors are required to verify your claims. However, if you are applying for SSDI, you can support your claim by providing opinions from other doctors and different medical conditions.
There is no need for you to address service connection in your report when applying for SSDI because it is not taken into account.
Age
Age is not a factor when it comes to VA benefits. However, if you are filing for SSDI claims, your age will be taken into account.
The benefit amount you receive will be determined based on your age at the time of filing the claim. As a general rule, individuals in their senior years are entitled to more benefits since they have likely contributed more to the system over a longer period of time.
Employment History
The VA and the Social Security Administration assess your ability to work based on your past employment history and contributions to the system. They consider the types of jobs you have held in the past and your former employment status to determine your capacity to work.
Taxes
Your SSDI benefits may be subject to taxation, depending on the benefit amount that you receive. However, benefits received from the VA are exempt from federal income tax.
Conclusion
While the VA and SSDI offer two separate disability programs, they work together remarkably well, providing disabled veterans with the financial assistance they need. Make sure to check the requirements thoroughly before you apply for either program.
