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Appealing the Decision When Your Disability Claim for PTSD Is Denied


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11/23/2016
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Post-Traumatic Stress Disorder (PTSD) is a very real, but often misunderstood, mental condition. Although many believe that it only affects veterans, this isn’t the case. Anyone who has lived through a traumatic experience can be affected by PTSD, and the effects can be debilitating. Consequently, the Social Security Administration (SSA) recognizes severe cases of PTSD as eligible for disability benefits.

Unfortunately, just because you may be eligible for benefits, does not guarantee that your claim will be approved. In fact, the SSA denies many PTSD cases due to lack of evidence of severity. If your claim isn’t properly constructed to clearly show your need for benefits, your claim will most likely be one of the hundreds returned with a denial letter.

However, there’s still hope. If you believe your denied claim is unjustified, you have the option to appeal the decision. 

Appealing Your Case

A disability appeal can require four separate steps, each one more difficult than the previous. These steps include the following:  

  1. Requesting reconsideration. Once your claim has been denied, you can request a reconsideration. If approved, this reconsideration will take place at the Disability Determination Services (DDS) level, and will be performed by a medical consultant and examiner who were not present at the initial decision. Furthermore, your claim doesn’t have to include the exact information included in your original claim. If the request for the review is accepted, you can present a revised and hopefully improved claim for consideration. If your request for reconsideration is denied or your secondary claim is rejected, you’ll receive a denial notice and an explanation similar to the one you received with your previously denied claim, but may still be able to appeal.
  2. Requesting review by an administrative law judge (ALJ). The next level of appeal requires a request for a hearing before an administrative law judge not more than 60 days following your second denial. ALJs are attorneys who work for the SSA's Office of Disability Adjudication and Review. On average, ALJs grant appeals for about 67% of the claims that reach them.
  3. Requesting a review by the Appeals Council. If the ALJ denies your claim a third time, you can request that the Appeals Council review the case. The Appeals Council is different from the disability board, the reconsideration board, and the ALJ, because it doesn’t review your claim for eligibility, it reviews the judgment of the ALJ. It evaluates your claim’s merit solely to determine if the ALJ who denied the claim made an error. Furthermore, the Appeals Council has the right to deny your request or dismiss your claim for a variety of reasons. If you’re lucky enough to be granted a review, your chance of winning the appeal is less than five percent. However, pursuing the review is a means to an end as you must complete this step before you’re allowed to advance to the fourth and final appeals level—suing the SSA in federal court.
  4. Requesting a review by the Federal Court. Your final option for a PTSD disability appeal is to file a lawsuit in U.S. district court, arguing the SSA decision to deny you benefits. If you’ve made it this far without legal representation, you’ll most definitely need an experienced attorney for this step. Litigation for disability cases requires a federal judge to review the case for legal errors, while also weighing any new evidence against the basis for the original denial. In many cases, the federal judge will overturn the ruling, citing that the SSA board failed to account for doctors’ evaluations and functional limitations.

Starting an Appeal

We know how frustrating and complicated disability claims and denials can be, especially when you’re struggling to control your PTSD. Let our experience and knowledge work for you. Contact us today for a FREE consultation, and allow us to work with you to build a strong appeal and get you the benefits you and your family need to survive.



Category: I Was Denied

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