Expediting Disability Applications For Wounded Warriors

Military service members can receive expedited processing of disability claims from Social Security. Benefits available through Social Security are different than those from the Department of Veterans Affairs and require a separate application.

The expedited process is used for military service members who become disabled while on active military service on or after October 1, 2001, regardless of where the disability occurs.
 

Questions

What types of benefits can I receive?

What is Social Security’s definition of disability?

If I was disabled a while ago and my health is improved, can I receive disability benefits for the time that I was disabled?

How does military pay affect eligibility for disability benefits?

How do I apply?

What do I need to apply?

How does Social Security make the decision?

How long does it take for a decision?

Can I do anything to speed the decision?

Can my family get benefits?

How does Medicare affect my TRICARE?

Contacting Social Security

The following are answers to questions most people ask about applying for disability benefits. Knowing the answers to these questions will help you understand the process.
 

What types of benefits can I receive?

Social Security pays disability benefits through two programs: the Social Security disability insurance program, which pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes; and the Supplemental Security Income (SSI) program, which pays benefits based on financial need.

This leaflet is about the Social Security disability program. For more information about the Social Security disability program, ask for Disability Benefits (Publication No. 05-10029). For information about the SSI disability program for adults, ask for Supplemental Security Income (Publication No. 05-11000).

What is Social Security’s definition of disability?

By law, Social Security has a very strict definition. To be found disabled:

• You must be unable to do substantial work because of your medical condition(s); and
• Your medical condition(s) must have lasted, or be expected to last, at least one year or be expected to result in death.

While some programs give money to people with partial disability or short-term disability, Social Security does not.

If I was disabled a while ago and my health is improved, can I receive disability benefits for the time that I was disabled?

That depends. If we find that you are disabled under our rules and your application was filed within a specified time frame, we will consider whether you qualify for a closed period of disability. There are specific requirements for a closed period of disability:

• The medical evidence must establish that you were unable to engage in substantial gainful work for a continuous period of 12 months, but by the time the disability decision is made, your condition has improved to the point where we find you are no longer disabled.
• You also must file an application within 14 months after the disability ended.
• If you meet the requirements for disability benefits, there is a five-month waiting period before your first monthly benefit can be paid. You can receive up to 12 months of retroactive benefits from the date you file an application with Social Security.

Example: You file an application for Social Security disability benefits in December 2007. After reviewing your claim, we find that your disability started on April 15, 2006 and that your condition improved to the point that you were no longer considered disabled as of September 2007. We refer to this as a closed period of disability.
Your five-month waiting period begins May 2006, the first full month you are disabled. The months in your waiting period are May, June, July, August and September. Thus, the first month for which you are due disability benefits is October 2006.

Your disability ended in September 2007. SSA pays benefits for October 2006 until September 2007, the month your disability ended. Based on your application of December 2007, you could receive 10 months of retroactive benefits for December 2006 through September 2007.

How does military pay affect eligibility for disability benefits?

Active duty status and receipt of military pay does not, in itself, necessarily prevent payment of Social Security disability benefits. Receipt of military payments should never stop you from applying for disability benefits from Social Security. If you are receiving treatment at a military medical facility and working in a designated therapy program or on limited duty, we will evaluate your work activity to determine your eligibility for benefits.

You cannot receive Social Security disability benefits if you engage in substantial work activity for pay or profit, also known as substantial gainful activity. However, the actual work activity is the controlling factor and not the amount of pay you receive or your military duty status.

How do I apply?

You may apply for disability benefits at any time while in military status or after discharge, whether you are still hospitalized, in a rehabilitation program or undergoing out-patient treatment in a military or civilian medical facility. You may apply online at www.socialsecurity.gov/woundedwarriors, in person at the nearest Social Security office or by telephone.

You may call 1-800-772-1213 to schedule an appointment. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. We also have a “disability starter kit” available to help you complete your application.

What do I need to apply?

To apply for benefits, you or your representative must provide information and documentation about your age, employment, proof of citizenship and information regarding all impairments and related treatment. Social Security will make every reasonable effort to help you get the necessary medical evidence .

Important: You should file the application for disability benefits as soon as possible with any documents readily available. Do not delay filing, even if you do not have all the documents mentioned below.

• Original or certified copy of your birth certificate or proof of U.S. citizenship or legal residency if foreign born;
• Form DD 214, if discharged from military service;
• W-2 form or income tax return from last year;
• Proof of military pay or workers’ compensation;
• Social Security numbers of your spouse and minor children;
• Checking or savings account number, if you have one;
• Name, address and phone number of a contact person, in case you are unavailable; and
• Medical records that you have and/or that you can easily obtain from all military and civilian sources.

How does Social Security make the decision?

Your claim is sent to a state Disability Determination Services (DDS) office that makes disability decisions. The state has medical and vocational experts who will contact your doctors and other places where you received treatment to get your medical records. The state agency may ask you to have an examination or medical test. You will not have to pay the costs of any additional exams or tests you are asked to take. If the state does request an examination, make sure you keep the appointment.

How long does it take for a decision?

The length of time it takes to receive a decision on your disability claim can vary, depending on several factors, but primarily on:

• The nature of your disability;
• How quickly we obtain medical evidence from your doctor or other medical source; and
• Whether it is necessary to send you for a medical examination in order to obtain evidence to support your claim.

Can I do anything to speed the decision?

You can speed the decision on your application for benefits by being prepared for your interview. We can take prompt action on your claim if you:

• Let us know right away that your disability occurred while on active military duty;
• Have information available regarding all the doctors you have seen and the address of the military site where your records are kept;
• Notify us of any address changes you have while we are working on your claim; and
• Inform us about any changes in doctors, hospitals or outpatient clinics where you are receiving treatment.

After we receive your application for Social Security disability benefits, we will identify it as a military service member claim and expedite it through all phases of processing, both at Social Security and the DDS. Disability claims filed online also are expedited.

Can my family get benefits?

Certain members of your family may qualify for benefits based on your work. They include:

• Your spouse, if he or she is age 62 or older;
• Your spouse, at any age, if he or she is caring for a child of yours who is younger than age 16 or disabled;
• Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be younger than age 18 or younger than age 19 if in elementary or secondary school full time; and
• Your unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of disability for adults.)

NOTE:In some situations, a divorced spouse may qualify for benefits based on your earnings if he or she was married to you for at least 10 years, is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children.

How does Medicare affect my TRICARE?

If you are entitled to Medicare, you should contact the Department of Defense to find out how this may affect your TRICARE benefits. You may need to be enrolled in Medicare Part B (medical insurance) to keep your TRICARE coverage. For general information about this coverage, please visit www.tricare.mil/mybenefit/ProfileFilter.do.

If you have been awarded retroactive disability benefits, you should contact the Department of Defense to find out whether you need to elect retroactive Medicare Part B so you can keep your TRICARE.

The Patient Protection and Affordable Care Act of 2010 provides for a 12-month Medicare Part B special enrollment period for TRICARE beneficiaries who are entitled to Medicare Part A. The Department of Defense will notify eligible individuals about this period.