TDIU and SSDI: What Do the Agencies’ Interaction Mean for Vocational Experts?

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Vocational experts

The Department of Veterans’ Affairs (VA) and the Social Security Administration (SSA) each maintain programs that pay disability benefits. The SSA pays disability benefits to people with a work history who qualify for Social Security Disability Insurance (SSDI) and to any individual, regardless of work history, who qualifies for Supplemental Security Income (SSI). The VA pays benefits to veterans for service-related disabilities, including benefits for veterans whose disability and inability to work qualifies them for Total Disability Individual Unemployability (TDIU).

Disability determinations made by the VA and SSA can sometimes be in conflict. Ideally, conflicts should not arise because both SSA and the VA are required to consider the other agency’s disability decisions when making their own determinations. Since VA and SSA each have their own methods of determining disability benefit eligibility, however, one agency might find that a disabled individual is disabled while the other reaches the opposite conclusion.

To minimize conflicts, the Government Accounting Office (GAO) recommended that the SSA collaborate more closely with the VA to improve the access of veterans to SSDI benefits. Casualties in Afghanistan and Iraq also prompted Congress to take action to improve interaction between the agencies. Still, the VA and SSA disability programs serve different purposes and do not always integrate well.

VA Disability Benefits

The VA disability compensation program addresses service-connected disabilities. Disabled veterans qualify for benefits when, because of their service, they were injured contracted a disease, or aggravated a pre-existing condition, that impairs their functionality. 

The VA rates service-connected disabilities on a scale of 0 to 100. Individuals may have more than one disabling condition, resulting in multiple disability ratings. Individual ratings are combined into a single combined rating and rounded to the nearest 10%. Disabled veterans with a combined rating of 10% or greater are entitled to compensation in the form of a cash benefit. For the most part, that benefit is unaffected by a veteran’s employment or employability.

A single- or combined-impairment rating of 100% constitutes total-disability status. However, few veterans receive that rating. Veterans who retain a degree of functionality will almost always have a rating of less than 100%. However, veterans who qualify for TDIU status can receive the same benefits as one who is 100% disabled.

To qualify for TDIU, a veteran must be at least 60% disabled (or have two disabilities that result in a combined disability rating of 70% if at least one disability is rated at 40% or higher) and be incapable of engaging in substantial gainful employment. Unlike other VA disability benefits, employment matters to TDIU status. All but meager earnings from employment will usually disqualify a veteran from TDIU benefits. Since veterans who receive TDIU benefits need to report their earnings every year, veterans can lose their TDIU benefits if the earn too much income.

SSA Disability Benefits

As a general rule, the same test of disability applies to adults who are insured under SSDI and who receive benefits under SSI. While the SSA refers to substantial gainful activity rather than substantial gainful employment, the focus remains on whether the applicant is capable of obtaining employment earnings above the current year’s earnings threshold.

To meet SSA’s definition of disability, an individual must be unable to perform substantial gainful activity because of an impairment that has lasted or can be expected to last 12 months or end in death. The SSA first asks whether the applicant’s earnings exceed the substantial gainful activity threshold. If so, the applicant is disqualified.

If the applicant’s earnings are below the threshold, the SSA examines the nature of the disability and determines whether it will likely last longer than 12 months. It also asks whether the disability appears on a list of very serious conditions (such as some forms of cancer) that are automatically qualifying.

The last two steps in the process require the SSA to ask whether the applicant can do his or her former work and, if not, whether the applicant can do any work. At this stage, the question of employability overlaps with the VA’s view of employability for the purpose of TDIU benefits.

Vocational Experts and Coordination Between VA and SSA

Veterans who apply for VA benefits typically apply for SSDI benefits if their disabilities affect their ability to earn substantial income. Since SSDI looks at earned income, the receipt of VA benefits does not usually affect the receipt of SSDI benefits. The same is not true of SSI, which is a needs-based program.

Generally, both the SSA and the VA are required to consider the other agency’s disability decision in making their own determinations, although neither agency’s decision is binding on the other. The VA and SSA are required to share information about medical evidence, hospital records, disability determinations, the receipt of benefits, and payment amounts.

The SSA will often employ a vocational expert when it holds a hearing that addresses the fifth step of its analysis — whether the applicant is employable. Vocational experts examine the disabled individual’s functional capacity, analyze jobs in the labor market that can be performed by someone with that functional capacity, and determine whether the applicant is capable of substantial gainful activity.

Vocational experts may not have complete information in either a VA or an SSA case unless they are able to conduct a complete file review from both agencies. Medical records may have been filed with one agency that were not filed with the other. Other evidence, such as information about why a client was terminated from a job, might also appear only in one file.

Differences between TDIU cases and SSA can also affect the contents of files, notwithstanding information sharing. A VA file should contain a chronology of service-connected conditions that have an impact on the veteran’s life and their ability to work. Age is not a factor in TDIU cases but it can be a factor in SSA determinations. Vocational experts must be mindful of the differences in eligibility for benefits in TDIU and SSA cases when reviewing data that will inform the expert’s employability opinion in either kind of case.