Military Post Traumatic Stress Claims and Social Security Disability

By Pitt Dickey

This column will examine how the Social Security Administration (SSA) evaluates claims from individuals diagnosed with military related Post Traumatic Stress Disorder (PTSD). PTSD can affect non-military as well as military individuals. In the Fayetteville area, due to the Viet Nam, Iraq and Afghanistan wars we have a substantial number of veterans who have been diagnosed with this condition as a result of their wartime service to our country. These veterans may also be awarded a disability rating by the Department of Veterans’ Affairs (VA).

There are many differences in the evaluation of PTSD claims for disability between the VA and the SSA. In a nutshell, the SSA’s medical/legal test for awarding disability benefits is whether the claimant has a medical condition that can be expected to last for a period of at least 12 months or result sooner in death, that prevents the claimant from being able to perform his past relevant work or any other type of work that exists in substantial numbers in the U.S. economy. The SSA test requires that the claimant be unable to perform work on a 40 hour a week basis. Under the SSA system, a claimant is either totally disabled and thus entitled to benefits or if he is not totally disabled then he is not entitled to SSA benefits.

Unlike the SSA test for disability benefits, the VA’s disability test is not either all or nothing in terms of disability. The VA’s service connected disability claims allows the award of partial disability benefits. A claimant receiving partial VA disability benefits can still be employed and receive VA benefits. Neither the SSA nor the VA is bound by the disability decision of the other federal agency in making its own decision. The SSA is required to consider a decision by the VA as to disability but will make its own decision about whether the claimant meets the SSA disability criteria. A person with a 100% VA disability rating can still be denied SSA disability benefits.

The SSA uses two broad areas to evaluate PTSD claims - anxiety related disorders and affective disorders. Due to space limitations this column will only examine anxiety related disorders. Under anxiety related disorders, the SSA test requires medical documentation of at least one of the following conditions: 1. "Generalized persistent anxiety with three out of the following four symptoms: motor tension; autonomic hyperactivity, apprehensive expectation, or vigilance and scanning". Or 2. a "persistent irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the dreaded object, activity or situation." Or 3. "Recurrent severe panic attacks manifested by a sudden unpredictable onset of intense apprehension, fear, terror and sense of impending doom occurring on the average of at least once a week." Or, 4. "Recurrent obsessions or compulsions which are a source of marked distress." Or 5. "Recurrent and intrusive recollections of a traumatic experience , which are a source of marked distress; - And resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence or pace," or 4. Repeated episodes of decompensation, each of extended duration. Or resulting in complete inability to function outside the area of one’s home."

The VA rating schedule for PTSD has levels of disability ratings at 0%, 30%, 50%, 70% and 100%. At 0% the vet has been diagnosed with but the symptoms are not severe enough to interfere with occupational or social functioning and do not require continuous medication. A 30% rating is assigned when there is "occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events." A 50% rating is assigned when there is "occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in maintaining effective work and social relationships."

A 70% rating is assigned when there is "occupational and social impairment, with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to such symptoms as suicidal ideation; obsessional rituals with interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work and work-like setting); inability to establish and maintain effective relationships." A 100% rating is assigned when there is "total occupational and social impairment due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior , persistent danger or hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place, memory loss for names of close relatives, own occupation or own name."

A claimant applying for Social Security disability benefits should always submit a copy of his or her VA rating decisions to the SSA. The VA rating decisions frequently provide excellent medical summaries of the claimant’s condition which can help the claimant obtain SSA disability benefits.