Obtaining Social Security Benefits for PTSD

 

Understanding the Ground Rules

 

The Social Security Administration (SSA) is government organization, ergo, waiting and frustration is in store for you. Knowing what to expect and what forms are required will help eliminate a great deal of frustration and will cut down on the time required to receive your benefits.

 

The SSA Internet web page is located at “www.ssa.gov” where you can download blank forms and find up-to-date information on rulings and regulations. The SSA falls under CFR (Code of Federal Regulation)  20 (Employee Benefits), Chapter III which can be found at “www.ssa.gov/OP_Home/cfr20/cfrdoc.htm”

 

 

Special note for Military Veterans

 

Duel Compensation. Under current regulations you can receive VA disability compensation and Social Security disability benefits at the same time.

 

 

 Qualifying for Benefits.  You are not eligible for SS benefits until you have been out of work at least 6 months and it may take an additional three months, after your claim is approved, before you actually begin receiving payments. It is even more likely that it will take over a year before you begin receiving any benefits, however, according to SSA Publication 05-10029, dated May 1996, "…. you will receive your first Social Security disability check dating back to the sixth full month from the date we decide your disability began (but no more than one year of back benefits can be paid)."

 

The SSA explains how they determine a disability in their Publication 05-10029. They state "It's a step-by-step process involving five questions. They are:

            1.  Are you working? If you are and your earnings average more than $500 a month (this amount may have changed. Check the SSA home page), you generally cannot be
considered disabled.  (Authors note: It is possible to earn more than $500 a month and retain your benefits under certain "work incentives", which will be explained in the booklet you will receive along with your first disability check.)


 

            2. Is your condition "severe"? Your impairment(s) must interfere with basic work-related activities for your claim to be considered. (Authors note: The SSA has a lot of control over what the word "severe" means. More on this later.)

            3. Is your condition found in the list of disabling impairments? We maintain a “List of Impairments" for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step. (Authors note: PTSD is NOT identified in the "List of Impairments" (Discussed in detail later), however, there is a "Mental Disorder" section (paragraph 12.00) and symptoms of PTSD may be found in the "Anxiety Related Disorders" section. If you have been diagnosed with PTSD I will provide you with a statement later that parallels their mental disorder section definition.)

 

Authors note: These last two questions are where the SSA attempts to identify every SS disability claim applicant. As you will see later, should you make it to the Administrative Law Judge appeals level, almost this entire hearing is aimed at proving that you are able to perform “previous” or “any other type of work”. I had not properly prepared my initial claim for SS based on PTSD. When I received my initial denial it stated "We have determined that your condition is not severe enough to keep you from working. We consider the medical and other information, your age, education, training, and work experience in determining how your condition affected your ability to work. We understand your condition concerns you and you may not have the ability to do your past work. However we find you retain the ability to do other types of work." They did not tell me what other types of work I am capable of performing. Note also the almost 'Word for Word' text from their regulations.




            4. Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.

 

            5. Can you do any other type of work? If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.

 

 

You also need to be aware of the following...."Section 404.1532(a) of such regulations (20 CFR 404.1532(a)) states:

 

1. If an individual performed work during any period in which he alleges that he was under a disability . . . the work performed may demonstrate that such individual has ability to engage in substantial gainful activity. . . .

 

And……section 404.1534(a) (20 CFR 404.1534(a)) of this regulation states, in pertinent part:

 

1. Where an individual who claims to be disabled engages in work activities, the amount of his earnings from such activities may establish that the individual has the ability to engage in substantial gainful activity. Generally, activities which result in substantial earnings would establish ability to engage in substantial gainful activity ……Where an individual is forced to discontinue his work activities after a short time because his impairment precludes continuing such activities, his earnings would not demonstrate ability to engage in substantial gainful activity.

 

Work to be done prior to the application

 

Before you begin the claims process obtain and submit a Form SSA-7050-F4 (Request for Social Security Earnings Information.) As part of your initial application packet you will be required to fill out two documents that require work history for the past 15 years. (Be certain to give the EXACT years you wish to have them provide, not "last 15 years". They will send it back to you.) Obtaining the information form the SSA insures that you do not submit incorrect data and also serves as a reminder of your work record in case you no longer have that information available in your own files. You will be required to pay approximately $50 for this information. (Be certain to enter the amount you expect to pay for this service (currently $43.75 for 15 years). If you leave the amount open they will return you application without action.)

See Appendix A for instructions on filling out this form. Go to the SSA Home page at www.ssa.gov or Appendix B of this book for a copy of the Form. Attach a copy of this to your disability application.

 

It will take approximately 3 weeks to receive the information you request but it is well worth the wait if you do not have past records showing your employment. The following is provided:

1. Name, address and Federal ID # of employer.

2. Years of employment with each employer and how much you received each year.

 

 

I also recommend that you have a “Medical Assessment of Ability to do Work-Related Activities - Mental” by your VA or civilian psychiatrist. There use to be a SSA-1152 Form for this exact purpose but it may or may not be available. See Appendix B for a copy of the original Form, which may no longer be an “official” form but can still be used for its intended purpose. Attach this completed form to your disability application.

 

 

Filing your Claim

 

 

Call 1-800-772-1213. You will normally be asked if you wish to go to the nearest SSA office for an interview or if you prefer to file your claim by telephone. Save yourself time and aggravation and take the phone interview (if they do not offer this option, ask for it).

 

You will be informed of the time and date of the telephonic interview and that you will receive a reminder in the mail. You should also be informed that you will need an ORIGINAL copy of your DD 214 (if you served in the military) and birth certificate to submit with your claim application. If you are not so informed obtain them anyway as they are required. The SSA will obtain these forms for you but it will slow down the claims process.

 

Authors note: I did not receive a reminder in the mail, so, mark your calendar just in case. Also be advised that the call can come anytime within an hours time, thirty minutes prior to or after, the agreed upon time.

Accomplish the claim interview. The phone interview will take approximately 30 minutes. Most of the interview will consists of questions about your work history with emphasis on unusual changes in your work habits (sharp increases or decreases in income). Having already obtained a copy of your Social Security Earnings Information, you will be prepared for these questions. You will be asked if you were ever self employed, or if you are currently drawing Workman’s Compensation.

 

You should be informed that it will take approximately 90 days to receive a determination and that you may appeal that determination if I did not agree with it. You should also be informed that you will receive a packet containing a medical questionnaire and a list of any documents that you will need to send in.

 

You will be informed that the disability claim evaluation would be done by a "local state agency" and the approximate amount you can expect to receive if your claim is approved.

 

Authors note: Approximately two weeks after I applied for benefits I received a letter from the "Department of Public Health and Human Services, Disability Determination Services, my home state. A representative from that office informed me by letter that they would process the medical portion of the disability application (this would be the local state agency the SSA spoke of). The letter also informed me that the process would take between 60-120 days, that my doctors would be contacted along with past employers, schools and other sources. This agency may also require that you be examined by a doctor of their choice, at state expense. I would like to point out paragraph (D) (4) of the introduction of section 12.00 of the "List of Impairments", which is for Mental Disorders, CFR 20. When you take your "Mental Status Examination" the doctor will be making notes on the following:

 

"....your appearance, behavior, and speech; your thought process (is your conversation rambling or disjointed); your thought content (are you expressing unusual beliefs such as people watching you or that the government is after you); are you seeing things that are not really there; do you seem depressed, excited, or nervous; do you know where you are and are you able to concentrate and remember things; do you show signs of normal intelligence?"

 

The letter also said that I might be contacted and that if I had additional treatment to contact them with that information or any information that I might have left off of my original claim.

 

Authors note: If you need to submit an appeal you will have to "update" your claim file at each level. I make this statement now because you will need to keep track of anything that happens that might concern your claim. If you have any change in medication, visit a doctor or hospital or are treated for anything related to your claim you will have to note this on required forms between each appeal. Get in the habit of noting these things in the beginning of the process.


 

Filing out The Forms.  Within three days after the phone interview you will received an envelope containing the following:.

 

a. Stamped return envelope (normally).

 

b. Cover letter. This letter will request that you mail them ORIGINAL copies of your birth certificate and DD Form 214, if required. There will normally be no Claim Number listed. Always reference your Social Security number when dealing with the SSA.

 

Authors note: If they ask for your DD 214 they mean ALL of your DD 214’s. If you served more than one hitch in the military you may have several.

 

c. Letter SG-SSA-16. This was a three page documents more or less containing the information covered in the telephone interview. Make certain the information presented is accurate or make corrections and initial where appropriate. You will also find several items you will be agreeing to when you sign the letter such as reporting any change in your medical condition and your work status. You will need to sign and date this letter.

 

d. Form SSA-3369-BK (Work History Report). See Appendix A for instructions and B for a blank form.

 

e. Form SSA-3368-BK (Disability Report - Adult). Again, see Appendix A and B.

Authors note: Both of the above SSA Forms are tedious and will require your patience to complete properly. Get someone to assist you if necessary, but do not submit incomplete or incorrect information.

 

f. Form SSA 827 (Authorization for Source to Release Information to the Social Security Administration (SSA). This is the SSA version of VA Form 10-5345 (Request for and Consent to Release of Medical Records). Do not do anything to these forms except sign them and have them witnessed. IMPORTANT - Have the form witnessed by a "competent adult", which the SSA states can be a spouse or social worker. Have them witnessed even if they do not ask for it. Make extra copies of the originals as you may need them again later in the process.

 

f. Personal Data Questionnaire. This appears to be a local questionnaire included in the packet for the benefit of the Department of Public Health and Human Services in my home state. You may or may not receive this questionnaire so I have not included it in Appendix A or B.

 

Within two weeks after you submit your claim you should  received a letter of acknowledgement and the return of the original documents you submitted with the application.

 

Attach your “Social Security Earnings Information”, “Medical Assessment of Ability to do Work-Related Activities – Mental” and the following statement to your claim:

 

 

Date

 

 

 

TO WHOM IT MAY CONCERN:

 

 

Request for Clarification

 

1. Your governing regulation, CFR 20, says in Paragraph 404.1525 (Listing of Impairments in appendix 1), item (c),”…..if the medical findings needed to support a diagnosis are not given in the introduction or elsewhere in the listing, the diagnosis must still be established on the basis of medically acceptable clinical and laboratory diagnostic techniques. Following the introduction in each section, the required level of severity of impairment is shown under “Category of Impairments” by one or more sets of medical findings. The medical findings consist of symptoms, signs, and laboratory findings.”

 

 

2. Within the “List of Impairments”, section 12.00 (Mental Disorders) part of the introduction, section (D)(11) says, “Anxiety disorders. In the cases involving acrophobia and other phobic disorders, panic disorders, and posttraumatic stress disorders……..”.

 

 

3. Under your “How We Determine Disability” section it says: “If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. IF IT IS, YOUR CLAIM IS APPROVED.”

 

 

4. I understand that the Social Security Administration uses (The Diagnostic and Statistical Manual of Mental Disorders) DSM-IV to determine if an applicant has a particular mental disability. (ADD THE FOLLOWING ONLY IF YOU ARE A VETERAN) I also understand that the reason that the SSA does not accept a disability determination by the Veterans Administration is that the VA uses the DSM-IV to make a Diagnosis, not a determination. You will find that in medical terms a Determination is the SAME as a Diagnosis. Can you clarify this please?

 

5. Under paragraph 12.06 (List of Impairments) Anxiety Related Disorders (the DSM-IV has PTSD listed under a “Stress Response” category, which comes under the SSA “anxiety disorder” category)  which says:

 

“A. Medically documented findings of at least one of the following, referring to items 1 through 5 under “A” (I have been diagnosed by VA psychiatrists and civilian psychiatrists with having PTSD):

 

1.      Your # 1(d) corresponds directly with item d (4) in section 309.81,  “Anxiety Disorders”, of DSM-IV.

2.      Your # 2 corresponds directly with item c (2) in section 309.81, “Anxiety Disorders”, of DSM-IV.

3.      Your # 5 corresponds directly with item b (1) in section 309.81,  “Anxiety Disorders”, of DSM-IV.”

 

***PTSD fulfills THREE of the requirements, not just ONE.***

 

AND

 

“B. Resulting in at lease two of the following:

 

1.      Your # 2 corresponds directly with item c (2) in section 309.81,  “Anxiety Disorders”, of DSM-IV.

2.      Your # 3 corresponds directly with item d (3) in section 309.81,  “Anxiety Disorders”, of DSM-IV.

3.      Your # 4 corresponds directly with item d (2) & d (3) in section 309.81,  “Anxiety Disorders”, of DSM-IV.

 

***PTSD fulfills THREE of these requirements, not just TWO.***

 

The “List of Impairments” states that “The required level of severity for these disorders is met when the requirements in both A and B are satisfied……”.

 

 

6. Taking into consideration CFR 20, paragraph 404.1525 (I have been DIAGONSED with PTSD), your acknowledging the existence of PTSD in the “List of Impairments”, section 12.00 (Mental Disorders) part of the introduction, section (D)(11), your implantation of how you determine disability (http://www.ssa.gov/disability.html), and my diagnosis fulfilling the requirements of SEVERITY under paragraph 12.06 (List of Impairments) Anxiety Related Disorders, please explain what objections you may have to approving my disability claim?

 

(End of attachment)

 

Authors note: The SSA does use the DSM in determining mental disability claims, however, they do not automatically accept disability rulings from the VA for mental disorders because the VA uses the DSM for DIAGNOSING mental problems where as the SSA uses it to DETERMINE mental disabilities. In my research of medical terminology I find that "to diagnose" means "to determine" and to "determine" is to "resolve or settle". I have not been able to find ANY medical person to tell me what the difference is.

 

 

 

Make copies of everything before you mail it. You may wish to return the packet back by Registered mail, particularly if it contains original copies of your birth certificate and/or DD 214.

 

 

 

Appeals

 

 

Types of Appeals

 

a. Reconsideration - This is accomplished at the same SS office where you initially applied for benefits but by a different person than the one who made the initial decision.

 

b. Hearing by Administrative Law Judge - This appeal is accomplished by an administrative law judge (this is a judge who presides over public hearings involving the promulgation (to post in public) of regulations and decides contested cases and appellate cases) within 75 miles of your home. You may request NOT to attend this hearing in person, however, this is not advisable unless you have a representative present. There is move information on the ALJ below.

 

c. Review by the Appeals Council - This is a SSA council which will make a decision based on the material presented or return your claim to the administrative law judge for further review.

 

d. Federal Court review - For this appeal you must file a lawsuit in a federal district court.

 

 

Filing Appeals on Time or Proving Cause for Being Tardy. Let me take a moment here and emphasize the importance of filing your appeals on time (within 60 days). If you do not file your appeal on time you may still file another application, BUT, you may lose some benefits, or not qualify for any benefits. This is because you are starting all over again.

 

 

 

If at first you don’t succeed…….

 

 

 

Personal Experience - First Denial.  Approximately 48 days after I submitted my claim I received a letter informing me that my claim had been denied. The letter was some 4 pages long and listed the material used to decide my case (you may view the entire denial letter in Appendix C) . The letter informed me that I must submit my appeal on a Form SSA-561-U2 (Request for Reconsideration), which they did not provide, (see Appendix B for a copy of this form), however, a pamphlet enclosed with my denial letter says you may also submit a signed letter requesting an appeal (I would not bother with this. They are going to have you fill out the Form SSA-561-U2 anyway). Instructions of filling out the SSA-561-U2 Form can be found in Appendix A

 

Filing the “Request for Reconsideration”. Before filing your RFR request that the SSA send you copies of any reports submitted by your doctors and the state agency Staff psychiatrist.

 

Authors note:  IMPORTANT. You can save yourself another couple of weeks by submitting a Form SSA-3441-F6 (Reconsideration Disability Report) along with the Form SSA-561-U2 and a half dozen SIGNED AND WITNESSED Forms SSA-827 (Authorization for Source of Release Information to the Social Security Administration). If you go to the SSA web site and then the "Forms" area you will find the following statement, "If you determine you need to complete an SSA-561-U2 and your disability claim was denied because we determined you do not meet our medical, or vocational, requirements, you need to complete the SSA-3441-F6. If you are uncertain whether this is the appropriate form, review the letter you received. It will tell you why we denied your application." Instructions for filling out the Form SSA-3441-F6 are provided  in Appendix A and a blank form can be found at Appendix B.

 

Once again you should submit the “Request for Clarification” I had you submit with your original claim, unless they have satisfactorily explained away the DSM/List of Impairments definitions of “severity”.



 

Determination of “Request for Reconsideration” (RFR).  Approximately 90 days after you submit your RFR you should receive a determination. You may be fortunate and win your award at this time. My RFR was denied and may be seen at Appendix C.

 

 

Legal Representation

 

 

If your original claim and RFR have been denied you may wish to hire a lawyer that specializes in SS benefits. You must file a Form SSA-1696-U4 (Appointment of Representative) with the SSA as soon as you have chosen your representative, see Appendix A and B for assistance with filling out the form and a blank form. The selected representative may not charge you without first receiving permission from the SSA. (SSA Publication 05-10075).

 

Authors note: A Form SSA 1696-U4 (Appointment of Representative) was filled out by the lawyer I selected and faxed to me for signature (I called the SSA and they said a faxed copy was acceptable). The lawyer also sent me a simple contract outlining the current allowable charges by the SSA. He is entitled to 25% of the recovery (this recovery only includes "back" benefits" owed to me by the SSA not future benefits) or a maximum of $4000.00.

 

If the lawyer does not win your case you will not be required to pay anything except possibly fees incurred for obtaining medical or other records. You will need to mailed a copy of the Form SSA 1696-U4 and the lawyers contract to the SSA and a copy of all the documents you have accumulated concerning the claim to the lawyer. Make certain he/she realizes that you are applying for a PTSD disability and that he/she is to concentrate on discounting the PHYSICAL jobs the SSA will say you are still able to perform.

 

 

 

More paperwork and lost time


Appealing to the Administrative Law Judge. Even though the RFR denial packet I received did not contain any blank forms you will need to submit the following  (instructions and blanks found at Appendix A and B):

 

a. Form HA-501 (Request for Hearing by Administrative Law Judge) - The instructions say you may write a letter instead of this form but you can bet the SSA will send you this form after you submit a letter because some required data will be missing.
           

b. Form HA-4486 (Claimant's Statement When Request for Hearing is Filed and the Issue is Disability).

 

c. Form SSA-827 (Authorization to Release Medical Information). Send in 5 of these forms, SIGNED and WITNESSES.

 

d. Form HA-4608 (Waiver of Your Right to Personal Appearance Before an Administrative

Law Judge). This form is required ONLY if you are unable to attend the hearing.

 

e. Form HA-4631 (Claimant's Recent Medical Treatment). If you have NOT had any medical treatment since your "Reconsideration" appeal submit this form anyway and check "NO" in section B (1).


f. Form HA-4632 (Claimant's Medications). This is another redundant form but fill it out anyway, making certain it is consistent with other forms asking for information on your medications.


g. Form HA-4633 (Claimant's Work Background) Fill out and return ONLY if you have worked since you filed your "Reconsideration" appeal.

 

 

You will receive a letter from the SSA approximately one week after submitting your appeal to go before an Administrative Law Judge. If you have a lawyer he/she will probably get the letter. The highlights are:

            "We will mail a Notice of Hearing to you and your client at least 20 days before the hearing to tell you its time and place."

            "At the hearing the ALJ will consider the issue(S) raised and the evidence now in the file and any additional evidence you provide."

            "The Notice of Hearing will state the issues the ALJ plans to consider at the hearing."

            "Because the hearing is the time to show the ALJ that the issues should be decided in your client's favor, we need to make sure that the file has everything you want the ALJ to consider. You and your client are responsible for submitting needed evidence. After the ALJ reviews the evidence in the file, he or she may request more evidence to consider at the hearing."

            "If you wish to see the evidence in your client's file, you may do so on the date of the hearing or before that date. If you wish to see the files before the date of the hearing, please call us."

            "The ALJ or the ALJ's designee may decide to meet with you before the hearing to review the case. If so, we will write to tell you about the conference."

 

 

Notice of the ALJ Hearing. It will take another 90 to 120 days before you receive notice of your ALJ hearing. The packet will normally contain the following:

 

a. Notice of Hearing - This document announces the place and time of the hearing. It states the issues in the case. It may or may not state that a Vocational Expert and/or psychiatrist will be present to testify.

 

b. Letter to Vocational Expert - A request for the Vocational Expert to appear at the hearing. (This might be for a psychiatrist.)

 

c. Acknowledgment of Notice of Hearing - A document with your name an SSN on it asking if you will or will not be present for the hearing. You must check the appropriate box, sign and date the form and provide your telephone #. Mail the form to the SSA in the postage free envelope provided.

 

A copy of these documents are available for viewing at Appendix C.

 

 

Here comes the Judge

 

 

The Hearing – What will happen.  (Authors notes: Had I know then what I know now I would not have gone to this level. The important thing is emphasizing that your disability claim is for PTSD and that it has been established as being “severe” by DSM definition and the SSA “List of Impairments” definition. If this has not been established get your lawyer to emphasize this fact at the beginning of the hearing and try and get the ALJ to answer why PTSD is not “severe” as defined by their regulations. This will totally eliminate the “past work” and “other work” angle the ALJ will seek to embellish upon, as happened to me).

 

There was a ALJ, my lawyer, a transcriber (the session was recorded and transcribed) and a Vocational Expert (contracted by the SSA) present.  The hearing was conducted in the following sequence:

 

a. The Judge started by asking me questions for about 20 minutes. He asked such questions as "Can you bend and lift items?, what do you do on a typical day? What my education was, and what my work history was for the last 10 years, and about my last job. He was setting the table for the Vocational Expert to tell what type of work I would be able to do.

 

b. He next let my lawyer ask me questions. My lawyer asked me clarification questions related to answers I had given the ALJ that would act in my favor.

 

c. The Judge next called on the Vocational Specialist to tell him what type of work I should be able to do.

 

d. My Lawyer was next permitted to ask the Vocational Specialists questions about other things I could not do because of my disability (unable to concentrate, unable to work for a supervisor, bad memory, etc.). After my lawyer asked his questions relating to my disability he asked the Vocational Specialist "considering the disabilities I have just listed, what jobs you have listed can my client perform?" The Vocational Specialist said, "NONE". (Authors note: As far as I can determine this answer of “none” by the Vocational Specialist had NO effect on the hearing. It was not mentioned in the denial handed down by the ALJ, see Chapter C.)

 

e. The Judge asked If I had anything else to add. 

 

f. The Judge closed the hearing by telling me that I would receive a letter advising me of his decision, usually in approximately 120 days.

 

 

Personal Experience - Third Denial. Almost four months after the ALJ hearing I received a letter with an UNFAVORABLE decision.

 

Authors note: It took 16 months to receive reach this point in the claims process.

 

You will find the ALJ “Notice of Decision” in Chapter C.

 

If you have reached this point and plan to go further submit a request for a copy of the exhibits you do not have and a copy of the recorded hearing as soon as possible. You MUST get these prior to the paperwork going to the Appeals Council or your chances or slim to know of ever seeing them. (Authors note: It was at this point that I initiated a Congressional Inquiry into my claim. I had not been able to get a copy of the hearing and had not received a reply to several letters asking for assistance. Hopefully you will not have to go this far.)

 

Further down the line ……

 

 

Appeals Council. Your claim will automatically be sent to the Appeals Council in Virginia. This council can overturn the ALJ decision or remand (send it back) to the ALJ.

 

You may file an appeal by submitting a SSA Form HA-520 (Request for Review of Hearing Decision/Order) (not furnished with the decision but available here at Appendix B with instructions at Appendix A). This appeal may be sent to your local SSA office, a hearing office or mailed directly to the Appeals Council (save time by sending it directly to the Appeals Council). If you have a lawyer it needs to go to him/her for signature. You have 60 days to file your appeal.

 

Go over the hearing transcript and the ALJ disapproval with your lawyer and pick out any discrepancies or information not included in the hearing and attach that to the appeal. The lawyer will lean towards sending in the SSA Form HA-520 without additional comment as otherwise creates more work for him/her. You can expect to wait up to two years, yes….two years, for a decision by the Appeals Council. When I filed an appeal on my 1999 claim the AC was still working on 1997 claims.

 

 

In the mean time ……

 

 

Reopening Your Claim. You need to immediately call and arrange to Re-open your claim. The SSA regulation, 20 CFR, states:

 

§404.988 Conditions for reopening.
A determination, revised determination, decision, or revised decision may be reopened--

(a) Within 12 months of the date of the notice of the initial determination, for any reason;

(b) Within four years of the date of the notice of the initial determination if we find good cause, as defined in §404.989, to reopen the case;

§404.989 Good cause for reopening.
(a) We will find that there is good cause to reopen a determination or decision if--

(1) New and material evidence is furnished;

(2) A clerical error in the computation or re computation of benefits was made; or

(3) The evidence that was considered in making the determination or decision clearly shows on its face that an error was made.

(b) We will not find good cause to reopen your case if the only reason for reopening is a change of legal interpretation or administrative ruling upon which the determination or decision was made.

 

 

Here we go again



If you Need to Reopen Your Claim. The entire process begins over again.

 

Call 1-800-772-1213or you local SSA office and state that you wish to “Re-Open” your claim. Make certain the representative knows that you are NOT filing a NEW claim.

 

The same things are about to happen as when you started your original claim. You will receive a new application packet within a few day which will contain the following:

 

a. Cover letter  - They may or may not request items such as Birth certificate or DD 214, since these are already on file.

 

b. SF-SSA-16 Form - This contains the information you gave to the SSA Interviewer such as date of birth, etc.

 

c. SSA-827 Form - Authorization for source to Release Information to the Social Security Administration (SSA) - You will sign and return these.

 

d. Personal Data Questionnaire (Un-numbered form) – You filled this form out the first time you applied. Do it again.

 

e. SSA-3369-BK Work History Report – You filled out this form on your first application.

 

You are required to return the package within 10 days. Make certain all of the data matches your first claim, other than what may have changed since you first filed.

 

If you receive benefits as the result of this claim process payment goes back to day after your disapproval date by the Administrative Law Judge. You may still receive back payment on your original claim at a later date, if the Appeals Council finds in your favor.