The Veterans Administration disability compensation program pays benefits to veterans who contract a disease or incur an injury that is connected with their military service. Medical records review to develop medical evidence such as the degree of impairment, disability and functional limitation is an important step in the disability claims process. Usually a disability examination conducted by a medical contractor or VHA clinician is also included in the disability determination process. The other two steps are:
- The rating process: Here the medical evidence is compared with the criteria in the Rating Schedule and a percentage rating between 0 and 100 (according to a schedule established by regulation) is arrived at. In the case of veterans having more than one disabling condition, the individual ratings are combined to a single combined rating and rounded to the nearest 10%. Those who have a combined rating of 10% or more are entitled to compensation in the form of cash benefits. Total disability status is when one has a single or combined impairment rating of 100%.
- The appeal process: In this process, the meaning and adequacy of the medical evidence is the main consideration.
VA disability benefits are not income based and so a person can receive SSDI (social security disability insurance) and VA disability compensation at the same time. Another benefit veterans may be eligible for is VA pension, a needs-based program that is similar to Social Security’s SSI (Supplemental Security Income). This pension is paid to vets who have very low or no income, and are disabled based on non-service disabilities. A person can receive VA and SSI at the same time. The more advantageous option is to qualify for VA disability compensation and SSDI.
In what ways are SS benefits different from veterans disability benefits?
- Percentage rating of disability vs. total disability: To be eligible for VA benefits, a person need not be totally disabled. Most veterans who are awarded benefits do not receive a total disability rating. They can have a rating as low as 10% (or even 0%). A 0% rating is not compensable but it is significant because it means that the veteran has at least one proven service related disability that may develop into a more serious health issue that is compensable. On the other hand, under the social security disability benefits program you are either totally disabled or not disabled. The SSA does not compensate applicants on the basis of a partial loss of employability.
- The treating physician rule: The SSA defines a treating physician as a physician who provides medical treatment for the claimant on a regular basis, or has had in the past, an ongoing relationship with the claimant as his/her regular physician. Once the SSA has established that a claimant’s physician is a treating physician, they give credit and value to that provider’s opinion. This is important from the point of view of winning the disability claim. The VA does not give this deference to the opinion of the treating physician. The VA may consider the physician as biased; moreover, the treating physician rule is inconsistent with the vital VA standard that decisions must be based on the entire file, so that no particular evidence is given extra significance. Another thing is that it may prove difficult to extract a helpful opinion regarding disability for the purpose of VA benefits from a treating physician, especially if he/she works for the VA.
Since timely, accurate, and acceptable medical records are very important for a social security disability claim from the point of view of medical records review and medical evidence development, veterans applying for SSDI should ideally obtain all their medical records from the VA medical center or facility that has been their primary source of treatment. Once all the records are available, they can provide these to the SSA when they apply for disability or file an appeal. The VA and SS disability programs differ in that the former maintains a disability compensation program whereas the latter has an income replacement program. Many applicants are eligible for both programs simultaneously, though the differences in the decision criteria and the definition of disability may result in different application outcomes. Both the VA and SSA aim to give maximum support to disabled veterans and ensure that they receive the benefits they are entitled to.
