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GAF scores and Disability Compensation from SSA and DVA

Does Your GAF Score Support Your Disability Application?

When the Social Security Administration (SSA) or the Department of Veterans Affairs(VA) considers your disability application, they try to understand how your illness or injury affects your day-to-day life and ability to work. In cases with a psychological component, a Global Assessment of Functioning (GAF) score is used to help the SSA or VA better understand the challenges you face.

What is My Global Assessment of Functioning (GAF) Score?

If you’ve consulted with a psychiatrist or psychologist, he or she will assess your ability to function in every day family, personal business, and work situations – as well as your ability to care for yourself. This assessment is your GAF score.

Possible scores range from 1 to 100 with 1 being the potential to harm yourself or someone else and 100 being normal.

Why is the GAF Score Used?

GAF scoring is used to standardize psychological assessment. Both the Social Security and Department of Veterans Affairs recognize that not all injuries and illnesses are solely physical.

Psychological problems such as anxiety and panic attacks, depression, post-traumatic stress syndrome, or other diagnoses are very real and very disabling.

Why Your GAF Score Matters

The SSA and the VA use your GAF score to help them determine whether you meet their definition of disability.

If your disability application has any psychological component (even if based on a physical cause), your GAF score will be considered. Your score identifies your level of disability.

Here is the Actual GAF Score Chart

This is the standard used to quantify your limitations so the SSA or the VA understands what you go through every day.

• 91 – 100 No symptoms. Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities.

• 81 – 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

• 71 – 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

• 61 – 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

• 51 – 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

• 41 – 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

• 31 – 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed adult avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

• 21 – 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)

• 11 – 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

• 1 – 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

• 0 Inadequate information

Where to Get Help with Your Disability Application

We are proud to help those who are too injured or too ill to work get the disability benefits they’ve earned – and – we invite you to contact us for a free case evaluation so you can find out whether a Global Assessment of Functioning (GAF) score is needed in your disability case. While our disability law offices are physically located throughout Central Florida, we represent clients nationwide. We welcome you to contact us toll free at 1-888-477-2363 or email our disability attorneys here.

For Questions About Your Disability Claim... Contact Us



by Matthew Hill
January 24, 2013

Best evidence for IU and how to appeal an IU denial

In the previous blog post, we looked at what Total Disability Due to Individual Unemployability (TDIU or IU) is and how to apply for it. In this post, we will review the factors considered in making a decision on IU, the best evidence for an IU claim and how to appeal the denial of an IU claim.

FACTORS THE VA CONSIDERS IN DETERMINING IU

The VA determines whether the individual veteran is prevented from securing or maintaining a substantially gainful occupation because of service-connected disabilities. There are three important caveats to understand about this determination.

First, the age of the veteran is not a factor when qualifying for individual unemployability. So the VA cannot say that because the veteran is a certain age he or she would not be able to work due to the veteran’s age alone.

Second, the VA cannot consider non service connected disabilities when making a determination on individual unemployability. For example, if a veteran has a 70% service connected rating for PTSD and a non service connected back disability the VA must review the veteran’s ability to work solely as it pertains to the service connected PTSD. Even if the veteran is receiving worker’s compensation or Social Security Disability for the back injury, which would indicate that another governmental organization recognized that the veteran could not work due to his back, the VA cannot use this information against the veteran. After all, the veteran may not be able to work for more than one reason.

Third, having a job does not automatically disqualify a veteran from individual unemployability. The Court has held that substantially gainful occupation means an occupation that provides the veteran with an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the veteran actually works. The poverty threshold established by U.S. Department of Commerce, Bureau of the Census, for 2011 was $11,484.00. Under the current poverty threshold established by the U.S. Department Health and Human Services, marginal income for the year 2012 is $11,170.00 (2012 Poverty Guidelines for the 48 Contiguous States and the District of Columbia). Therefore, a veteran who is working, but whose income does not exceed the poverty threshold, may still qualify for individual unemployability.

Furthermore, marginal and sheltered employment is not considered substantially gainful employment. A job with a salary below the poverty level is called marginal employment. Sheltered employment includes, but is not limited to, employment in a protected or sheltered environment, such as working for a family business. Working in a sheltered workshop is also not considered substantially gainful employment, even if the veteran’s annual earnings exceed the poverty threshold. Basically, if a veteran is working in an environment where the veteran is protected from job requirements that someone else in that position would be expected to satisfy, the VA will not necessarily consider that veteran to be gainfully employed.

BEST EVIDENCE TO PROVE INDIVIDUAL UNEMPLOYABILITY

When it comes to proving to the VA that the veteran is eligible for individual unemployability, that is if the veteran is found to have met the rating threshold and employment criteria mentioned above, the best evidence is a professional opinion from a vocational expert or competent medical doctor concerning the veteran’s ability to secure or follow a substantially gainful occupation. The VA often times schedules a veteran for a C&P exam to get an opinion on IU. This report should include a rationale as to whether it is as likely as not (50/50 chance) that the service-connected disability or combined disabilities render the veteran unable to secure and maintain substantially gainful employment. Additionally, the report should also include and describe the functional impairment caused by the veteran’s disabilities and how that impairment impacts on physical and sedentary employment. Other evidence to support unemployability may include employment history, employer records, and any medical evidence that indicates that the veteran is totally disabled and unemployable.

HOW TO APPEAL A DENIAL FOR INDIVIDUAL UNEMPLOYABILITY

Rating decisions granting or denying entitlement to IU must provide enough explanation so that the veteran can understand the reasons and bases for the decision. As with any decision, the rating must list the evidence considered, a clear explanation of the basis of the decision, and an explanation of the effective date of entitlement.

To appeal the rating decision, the veteran must file a Notice of Disagreement (NOD) within one year of the date on the letter that accompanied the rating decision. If the veteran fails to file a NOD within one year, that decision becomes final and can only be “reopened” by submitting “new and material evidence,” or by demonstrating that the decision was the product of “clear and unmistakable error.”

The Notice of Disagreement can be submitted to the regional office in any format – on a Statement in Support of Claim (VA Form 21-4138) or in a letter. The NOD must state that the veteran seeks appellate review and should identify the issues that are in dispute. It is best to keep the NOD short and simple.

For Questions About Your Disability Claim... Contact Us



by Matthew Hill
January 23, 2013

TOTAL DISABILITY RATING BASED ON INDIVIDUAL UNEMPLOYABILITY (TDIU OR IU)

Many veterans suffer from service-connected disabilities which are severe enough to cause marked impairment to their ability to secure or follow a substantially gainful occupation. But these veterans might not have a combined service connected rating of 100%, after all a 100% combined rating is difficult to get from the VA. In these situations, the VA may consider the veteran 100% disabled even though the VA has not rated his or her disability or combined disabilities at 100%.

A veteran may be assigned a total rating when he or she is unable to secure substantially gainful occupation due to service-connected disabilities. This is known as a total disability rating based on individual unemployability (TDIU or IU). The veteran is granted the equivalent of a 100% rating even if his or her schedular rating is less than 100%.

There is a lot to consider in claims for individual unemployability. This blog post will review what IU is and how to apply for it.

For example, if a veteran is rated at 60% for a single service-connected disability and that disability prevents the veteran from performing substantial gainful employment, then the veteran may be entitled to individual unemployability and considered 100% disabled.

The VA regulation authorizing individual unemployability requires that the veteran’s service-connected disabilities satisfy certain percentage rating requirements. The disabilities must meet minimum rating thresholds:

• Schedular – The veteran must have at least one service-connected disability rated 60% or higher. If the veteran has two or more service-connected disabilities, at least one of those disabilities must be rated at 40% or higher, and, after factoring in the ratings for the other disabilities, the veteran’s combined disability rating must be 70% or higher.

• Extraschedular – Even when a veteran does not meet the schedular requirements, TDIU may be awarded on an extraschedular basis because of an unusual disability picture or due to marked interference with employment. The VA regional office and the Board of Veterans’ Appeals are not authorized to make these awards, but either may refer the claim to either the Director of the Compensation and Pension Service or the Under Secretary for Benefits for consideration of an extraschedular rating.

Hill & Ponton focuses on individual unemployability claims. The firm assists most of our veterans with reaching individual unemployability based on the schedular rating system. According to the U.S. Department of Commerce, Bureau of the Census, 3.5 million veterans have a service-connected disability rating. Of this number, 810,245 have a rating of 70% or higher.

HOW TO BEGIN A CLAIM FOR IU

Once a veteran meets the schedular requirements for individual unemployability and has submitted to the VA evidence of not being able to work, the VA must consider individual unemployability. However, for the VA to grant individual unemployability the veteran must submit a VA Form 21-8940, Application for Increased Compensation Based on Unemployability, the prescribed form for claiming individual unemployability (TDIU).

A veteran may initiate a claim for individual unemployability by submitting a Statement in Support of Claim (VA Form 21-4138) to the regional office indicating the benefit being sought. This is considered an informal claim. If the veteran files an informal claim, the regional office must send the veteran a VA Form 21-8940 with instructions to complete and return it within one year in order to preserve date of receipt of the earlier communication as the date of claim. A signed and dated letter, clearly indicate the benefits sought, can also be considered an informal claim.

Although claims for individual unemployability are generally submitted by the veteran, they may also be reasonably raised by the evidence of record, including statements or evidence submitted by the veteran indicating unemployability. For example, if a veteran submits information regarding an award for Social Security Disability Benefits the VA has a duty to assist by requesting both the SSA (Social Security Administration) decision granting benefits and any supporting medical records. Although VA is not obligated to follow a determination made by SSA, these records may be relevant to the issue of the level of impairment of the veteran’s service-connected disability. The veteran should keep in mind that individual unemployability can only be awarded for service-connected disabilities. Whereas the SSA award may be for any disability the veteran may have, service-connected or not.

Additionally, if a veteran files a claim for increased evaluation, even without a specific individual unemployability claim from the veteran, it may also give rise to a claim for individual unemployability when associated with evidence of a worsened service-connected condition. For example, if the veteran has a current service-connected disability rating of 40 percent but their condition has worsened to meet the threshold for 60 percent evaluation, and the veteran can show that he or she has stopped working or has marginal employment secondary to the service-connected disability, the VA has the duty to evaluate the claim for individual unemployability as well.

For Questions About Your Disability Claim... Contact Us



by Matthew Hill
January 23, 2013

Isn’t the VA Supposed to Assist Me With My Claim?

The VA has a duty to assist veterans in developing their claims.  The VA benefits system was designed to be a non-adversarial, veteran-friendly system.  Ideally, this would mean that veterans would never even need a lawyer to fight for their disability benefits.  Too many times, however, we find that the VA has not satisfied its responsibility to help veterans with their cases.  It can be a mistake to rely solely on the VA’s assistance to develop your claim.

One part of the VA’s duty to assist includes helping veterans obtain records, including service personnel and medical records as well as current VA and private medical records.  The VA’s duty to assist in gathering records arises from the simple fact that the government is often in a much better position to obtain certain evidence than is the veteran.  For instance, the government has knowledge about the whereabouts of certain records and has access to records that many veterans may not know how to obtain on their own.  That is not to say that veterans should not make the attempt to get their own records—we often use private researchers to obtain such records with great success.  While the VA is required to help veterans in obtaining their personnel and service medical records, all too often we see claims files where the VA either did not even bother to request the complete records or did not put forth the best efforts in following up on those records.  Ultimately, it is the veteran, and not the VA, who is hurt if his or her records are not found.

It is also very important to make sure that the VA has all of the necessary information so that VA can make the appropriate requests.  The veteran should provide the VA with all of the information he has available about his time and place of service as well as the in-service circumstances leading to the veteran’s disability.  The VA may use a veteran’s failure to provide such information as an excuse for not assisting that veteran any further with his or her claim.

The VA’s duty to assist also makes the VA responsible for providing veterans with medical examinations when such examinations are necessary for a veteran to prove his or her case.  In order for the VA’s duty to be triggered, the veteran must first satisfy a minimum standard consisting of showing that some event did happen to the veteran in service, that the veteran now has a current disability, and that there is at least some indication that the event in service is related to the current disability.  If a veteran can meet that threshold requirement, the VA is required to assist the veteran by providing an examination.

Again, however, it is not always a good idea to rely solely on the VA to provide supportive medical evidence.  We find that veterans often obtain better results when they are able to provide the VA with medical opinions from private doctors rather than relying on the medical opinions that the VA provides.

We are able to have the Court of Appeals for Veterans Claims overturn many of the VA’s decisions based on the VA’s failure to properly assist veterans.  You can save yourself the time and aggravation of an appeal to the Court, however, by making sure that the proper evidence gets into your claims file in the first place—with or without the VA’s assistance.

For Questions About Your Disability Claim... Contact Us



by Attorney Shannon Brewer
January 7, 2013

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