How VA TDIU Claims work – Total Disability based on Individual Unemployability

Total Disability based on Individual Unemployability

(TDIU or IU)

TDIU (IU) is a part of VA’s disability compensation program that allows VA to pay certain Veterans compensation at the 100% rate with all the benefits, even though VA has not rated their service-connected disabilities at the 100% level.

A Veteran must be unable to maintain substantially gainful employment as a result of his/her service connected disabilities. (marginal employment -about $14,079/year (2022), such as odd jobs, is not considered substantial gainful employment for VA purposes). This is the Veteran’s earned income from employment. Not household income. This is the same whether the veteran has zero dependents or multiple dependents.

Additionally, a Veteran must have:

  • One service-connected disability ratable at 60 percent or more, OR
  • Two or more service-connected disabilities, at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.

Extra schedular TDIU is possible with less than the above percentages in certain circumstances. In order to support a claim for an extra-schedular evaluation based on exceptional circumstances, the evidence must show that your service-connected disability or disabilities present such an exceptional or unusual disability picture, due to such factors as marked interference with employment or frequent periods of hospitalization, that application of the regular schedular standards is impractical. If you do not meet either of the two criteria above, make sure you include in the REMARKS section or on a separate VBA Form 21-4138 that you are filing for EXTRA SCHEDULAR CONSIDERATION BASED ON 38 CFR § 4.16(b).

NOTE: If already rated at 100%, the VBA will generally not award IU and will deny based on the claim being ‘moot’ as there are no additional benefits.

NOTE: The VBA CANNOT use age as a reason for denial. You can be 21 or 98 or any age.

To start a TDIU (Total Disability based on Individual Unemployability) claim, you have to start the claim by either filing a VA Form 21-526EZ or starting a new claim on https://www.va.gov. If you have a claim in process, you do not need to start a new claim as the IU claim will become part of that claim. IU is a claim for increase and is not a stand alone claim.

In addition to one of the options above, you would need both VA Form 21-8940 & VA Form 21-4192 (for the last year you worked)

If you can, get your doctor to state in writing that you are unemployable due to a SC condition.

Two things to help your IU or SSDI claim:

An unemployability determination from Voc Rehab (VR&E) or state or civilian vocational evaluation services.

“It does not appear feasible for you to obtain suitable employment through your Vocational Rehabilitation services at this point in time because of the severity of your service connected disabilities that make you unemployable and unable to maintain gainful employment.”

-AND/OR-

A statement like this will help if you can get a doctor to write it out for you.

“After examining Mr/Ms Veteran, his/her chart and medical records it is my opinion that Mr/Mrs Veteran is totally and permanently disabled due to the above discussed ______ condition. The veteran cannot hold gainful employment (manual or sedentary) as a result of the injury he/she sustained while in the military. It is also my opinion that it is more likely than not the that the physical traumas suffered during the veteran’s military service as noted in his/her record (description of events and dates) caused, contributed to and aggravated the totally disabling ______ condition(s). “

A VA Form 21-8940 must be signed by the Veteran and not a third-party source such as a power of attorney.

Add a VBA Form 21-4138 as a personal statement and another each as a spouse’s, family and co-worker statement on how the condition(s) affected your work.

https://www.vba.va.gov/pubs/forms/VBA-21-8940-ARE.pdf
https://www.vba.va.gov/pubs/forms/VBA-21-4192-ARE.pdf

Tips to Filling out the VBA Form 21-8940 (5/11/2022)

The VA’s application for Total Disability due to Individual Unemployability (TDIU or just IU) seems to be one of the hardest VA forms to fill out. The first page is the worst part. It seems like the VA is asking you for more information than you can squeeze into the tiny fields. How are you supposed to fit all your disabilities or all your medical treatment information into those small boxes? Luckily, there is an easier way to approach this. If you need more room, add a VBA Form 21-4138 and reference that in the comments.

SECTION I – VETERAN IDENTIFICATION INFORMATION

Box 3: VA FILE NUMBER

Answer: The VA file number is written at the top of all letters, statements and explanation of benefits, otherwise it is the Veteran’s SSN.

SECTION II – DISABILITY AND MEDICAL TREATMENT

Box 8: WHAT SERVICE-CONNECTED DISABILITY PREVENTS YOU FROM SECURING OR FOLLOWING ANY SUBSTANTIALLY GAINFUL OCCUPATION?

Answer: This is tricky. The VA is specifically asking what service-connected disability prevents you from working. If you are service connected for a disability that prevents you from working, list the disability here. If, however, you are service connected for Tinnitus (for example) but stopped working due to your bad back (which has not been service connected), then it makes no sense to put Tinnitus in this box. In this case, it is recommended that you put your back condition in this box (provided that you are pursuing a claim for this). That way, if/when your back condition is granted service connection, your claim for IU will already be on file. Substantially Gainful Employment is currently (2022) $14,079/year gross income as reported on your IRS tax forms and may go up slightly every year. NOTE: This is the veteran’s income, not household income and is from employment, not passive income. Other considerations: If you have multiple conditions that prevent you from working, limit the answer to the top 2 (such as back and PTSD). Ideally, there should be one condition.

Box 9: HAVE YOU BEEN UNDER A DOCTOR’S CARE AND/OR HOSPITALIZED WITHIN THE PAST 12 MONTHS?

Answer: If you have received care from doctors and from a hospital, then answer “Yes”. If you are being treated by only one, then list which one. The next boxes will provide space to give facility/doctor information

Box 10. DATE(S) OF TREATMENT BY DOCTOR(S)

Answer: The best way to answer this question is to think in terms of frequency – not exact dates. How often do you receive treatment? Weekly? Monthly? Every two weeks? Twice a year?

Box 11: NAME AND ADDRESS OF DOCTOR(S)

Answer: If you are being treated by a private doctor, list the doctor’s name and address in this box. If you are being treated by more than 1 private doctor, you can include a separate attachment with the names and addresses. If you are being treated by VA doctors, then list the doctor’s name and the VA facility you go to. Remember: this information only applies the condition that you listed in Box 8

Box 12: NAME AND ADDRESS OF HOSPITAL

Answer: If you have been or are being treated by a private hospital, list the facility name and address in this box. If you are being treated at a VA facility, simply list the facility name, city and state Remember: this information only applies the condition that you listed in Box 8

Box 13: DATE(S) OF HOSPITALIZATION

Answer: Refer to Box 10

SECTION III – EMPLOYMENT STATEMENT

This next section refers to Boxes 14-22. When answering these questions, be mindful that the information you provide must be in the context of the disabling condition that you listed in Box 8.

Box 14: DATE YOUR DISABILITY AFFECTED FULL-TIME EMPLOYMENT

Answer: Consider the question like this: When did you condition start affecting your full-time employment? Or, when did your condition start affecting your work performance? If you are having trouble with a date, think about this: Was there a time when you started getting written up, missing work for doctor’s visits, calling out sick, getting your shift covered due to your service connected conditions? Generally, a month and year is sufficient for this question. This question is very important for your SSDI (Social Security Disability Insurance) claim, also. If you had sufficient work credits at this date, even if the SSA says you do not have the required work credits you may still be eligible. You CAN collect both VA Disability Compensation and SSDI.

Box 15: DATE YOU LAST WORKED FULL-TIME

Answer: This can be when you transitioned from full to part time, or from full time to not working at all.

Box 16: DATE YOU BECAME TOO DISABLED TO WORK

Answer: This is the date that you stopped working due to the condition listed in Box 8. If you cannot remember the exact date, a month and year will suffice.

Box 17A: WHAT IS THE MOST YOU EVER EARNED IN ONE YEAR

Answer: This is a comprehensive question. The VA wants to know how much you have ever earned in one year over your lifetime. If you cannot remember the exact amount, a ball-park figure will suffice. You can also look it up on the MY SS website here: http://www.ssa.gov/myaccount/

Box 17B: WHAT YEAR?

Answer: List the year during which you earned the amount that you listed in Box 17A.

Box 17C: OCCUPATION DURING THAT YEAR

Answer: List your occupation or job title for which you earned the amount listed in Box 17A.

Box 18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive duty for training)

Answer: While this seems fairly self-explanatory, many people miss the key phrase in the question: “for the last 5 years you worked”. The VA is looking for employment history for the last 5 years that you were employed, not in the past 5 years from today. For example, if you stopped working in 2017, the VA wants your employment history from 2012 – 2017. The VA wants names and addresses of the places/companies that you worked for. If this information is missing, the VA will send you a notice requesting the names and addresses and this will slow your claim down. If the company you worked for is no longer in business, fill in the information as best you can, and indicate in Box 17A that the company is out of business. If you were self-employed, indicate this in Box 17A, along with the name of your business (if applicable).

Box 18B. TYPE OF WORK

Answer: Give your job title or type of work. This could be supervisor, truck driver, salesman, refrigeration repair, etc.

Box 18C: HOURS PER WEEK

Answer: If the hours varied, give an average. You can also use a range (35-40).

Box 18D: DATES OF EMPLOYMENT

Answer: Use the month and year that you started and left the employer.

Box 18E: TIME LOST FROM ILLNESS

Answer: This question references the disabling condition(s) that you listed in Box 8. As with the first part of the form, think in terms of frequency. Did you call out monthly or weekly? Did you use all your vacation time? Were you out 2 weeks a year? Ten hours a week?

Box 18F: HIGHEST GROSS EARNINGS PER MONTH

Answer: The VA wants to know the most you made a month at that particular company. If you cannot remember the exact amount, but do remember what you were being paid hourly, multiply that number by the hours you worked in a week, and figure out your monthly pay that way.

Box G: IF YOU ARE CURRENTLY SERVING IN THE RESERVE OR NATIONAL GUARD, DOES YOUR SERVICE CONNECTED DISABILITY PREVENT YOU FROM PERFORMING YOUR MILITARY DUTIES?

Answer: Guard or Reserve duties typically require you to be deployable so if you answer “NO” you will have to have a separate sheet that explains how your duties are not similar to a comparable civilian occupation that is gainful employment.

Box 18H: INDICATE YOUR TOTAL EARNED INCOME FOR THE PAST 12 MONTHS

Answer: The key word here is “earned” income. This is money earned from physically working and receiving payment. This does NOT include: pensions, retirement, IRA’s, 401k’s, SSDI or SSI. Generally, this amount should be $0. However, if you stopped working within the past 12 months or are working part time, you will need to indicate how much you earned/are earning.

Box 18I: IF PRESENTLY EMPLOYED, INDICATE YOUR CURRENT MONTHLY EARNED INCOME

Answer: If you are not physically working, this amount should be $0. However, if you are working, give the amount that you earn per month.

Box 19: DID YOU LEAVE YOUR LAST JOB/SELF-EMPLOYMENT BECAUSE OF YOUR DISABILITY?

Answer: This question is reflective of the disabling condition(s) that you listed in Box 8. Check “Yes” if you were fired, laid off, or resigned from your last job because of the disabling condition(s). Check “No” if you left your last job due to outside circumstances, such as being laid off due to the economy. Please understand that TDIU is not unemployment insurance or retirement.

Box 20: DO YOU RECEIVE/EXPECT TO RECEIVE DISABILITY RETIREMENT BENEFITS?

Answer: In addition to Disability Retirement benefits, this also includes any Social Security benefits, such as SSDI and SSI. Since these are not considered earned income, they will not affect the outcome of the application.

Box 21: DO YOU RECEIVE/EXPECT TO RECEIVE WORKERS COMPENSATION BENEFITS?

Answer: Self-explanatory. Worker’s Compensation does not mean you cannot also qualify for IU.

Box 22: HAVE YOU TRIED TO OBTAIN EMPLOYMENT SINCE YOU BECAME TOO DISABLED TO WORK?

Answer: This only applies if you have applied anywhere since you stopped working. *If you cannot remember, answer “No” *If you have applied for work, list the name and address of the business/employer, the type of work and the date applied.

SECTION IV – SCHOOLING AND OTHER TRAINING

Box 23: EDUCATION

Answer: Self-explanatory. Education in and of itself does not bar you from eligibility for IU.

Box 24A: DID YOU HAVE ANY OTHER EDUCATION AND TRAINING BEFORE YOU WERE TOO DISABLED TO WORK?

Answer: This applies to any education or training before you stopped working. This could include trade schools or specialized training, such as truck driving school, welding school, mechanics, etc. If not, answer “No”, and leave Boxes 24B & 24C blank. Note: you may have used your GI Bill for this.

Box 25A: HAVE YOU HAD ANY EDUCATION AND TRAINING SINCE YOU BECAME TOO DISABLED TO WORK?

Answer: This applies to any education or training that you had in an attempt to get a job after you became too disabled to work. This could include vocational rehab. If not, answer “No”, and leave Boxes 25B & 25C blank.

SECTION V-REMARKS

Box 26: REMARKS

Answer: (If any) This section is usually left blank. However, you can use this to make additional notes on any of the previous sections.

SECTION IV – AUTHORIZATION, CERTIFICATION, AND SIGNATURE

Make sure you sign and date the form IN INK. If the claimant can only make an “X” mark, you will need two witnesses.

Once the VA receives this application, they will send you a notice indicating that they have received your application and will verify your employment history. They do this by sending your past employer(s) (which you listed in Box 18A) a form to fill out – the VA Form 21-4192. This form will ask the employer to verify the dates of employment and indicate why you stopped working for that employer.

If the VA is unsuccessful with obtaining completed copies of this form from your past employer(s), they will send you a second notice, requesting that you attempt to contact the past employer(s) to have them fill out the necessary form.

In order to speed up your IU claim, you can get these filled out yourself and send in with your claim.

NOTE: The VA Form 21-4192 is YOUR RESPONSIBILITY and if the employer is no longer in business you need to make that clear in a separate sheet. If the employer refuses to fill out the VA Form 21-4192, you need to indicate in a separate sheet your efforts to get it filled out and why the employer did not. In either of these two cases, you can fill out the form as much as possible and submit with the explanation. If you need to do this, do not sign as the employer.

NOTE: The VA cannot deny simply because a former employer refuses to fill out a form. It may delay your claim.

NOTE: Federal employment does not need a VBA Form 21-4192 as the VBA is required to get that information directly from them. A lay statement from your employer describing the employment issues you may have had is valid evidence.

NOTE: If self employed, add a VBA Form 21-4138 with the following information along with a VBA Form 21-4192 filled out by yourself:

Furnish a statement regarding the

  • types of work performed
  • number of hours worked per week, and
  • amount of time lost in the previous 12 months due to service connected disabilities.

When you file for TDIU, the VBA is required to review your current ratings listed in Box 8 to see if you can be increased to 100% scheduler versus IU. They may also review any other current ratings in that same effort. This is part of the ‘DUTY TO ASSIST’. To speed up your claim you can get new DBQs (Disability Benefits Questionnaires) filled out by your own doctors and submit with your IU claim.

With Disability Benefits Questionnaires (DBQs) Veterans now have more control over the disability claims process. Veterans have the option of visiting a private health care provider instead of a VA facility to complete their disability evaluation form. Veterans can have their providers fill out any of the more than 70 DBQs that are appropriate for their conditions and submit them to the VBA. It’s that easy! Here is the list on online DBQs you can take to your doctor.

How VA Disability Ratings Work – Disability Benefits Questionnaires (DBQ)

By adding a separate PERSONAL STATEMENT that indicates how your service connected conditions affect you on a daily basis you are adding your input directly to the RVSR (VA Rater) who decides your claim. A spouse’s statement will also help give a perspective the Veteran’s statement may not have.

A VA Form 21-8940 SHOULD be signed by the Veteran and not a third-party source such as a power of attorney.

ALWAYS USE THE MOST CURRENT FORMS ON THE WEBSITES HERE! If you get a form from your VSO, make sure the date matches the web forms above. If your forms are out of date, it will delay your claim.

https://www.vba.va.gov/pubs/forms/VBA-21-8940-ARE.pdf
https://www.vba.va.gov/pubs/forms/VBA-21-4192-ARE.pdf

SECTION V – WHERE TO SEND CORESPONDENCE

File through your accredited VSO (Recommended), through https://va.gov by starting a new claim or by REGISTERED mail or fax accompanied by a VA Form 21-526EZ here.

https://www.vba.va.gov/pubs/forms/VBA-21-526EZ-ARE.pdf

Send to: Janesville Intake Center:

Mail to:

DEPARTMENT OF VETERANS AFFAIRS

CLAIMS INTAKE CENTER

PO BOX 4444

JANESVILLE, WI 53547-4444

or Fax to:

TOLL FREE: 844-531-7818 & 248-524-4260

The Role of a Vocational Expert in a Disability VA –  TDIU Claim

The Role of a Vocational Expert in a Disability VA –  TDIU Claim

What are Vocational Assessments for a Veterans TDIU Claims?

Many people are unsure as to why they need a Vocational Evaluation/Assessment for their claim. A vocational assessment can provide valuable information for decision-makers regarding Total Disability Individual Unemployability cases, also known as TDIU/IU cases and help answer whether a veteran’s service-connected disabilities prevent him or her from securing substantially gainful employment (“SGE”).

Many people assume if they cannot do their Own Occupation that that means they are disabled but Any Occupation especially UnSkilled Sedentary Occupations have to be ruled out.

The Department of Veterans Affairs (“VA”) defines SGE as “employment that is ordinarily followed by the non-disabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.”

The Veterans Administration specifies that SGE cannot include sheltered or protected employment. Further, if a veteran’s annual wages are below the poverty level, this employment cannot be considered substantially gainful. If a veteran is unable to secure SGE as a result of a service-related disability, then he or she is entitled to receive 100% compensation for TDIU.

Why TDIU Vocational Evaluations are Essential?

Judges as well as other decision-makers in these types of cases often rely on the opinion of physicians and other medical providers to determine whether a veteran can still obtain SGE. However, these reports are done in medical terms and not vocational terms.

Therefore individuals, do not have specialized vocational experience or expertise and are not equipped to determine the feasibility of a veteran’s ability to work.

A vocational expert knows vocational terms, transferability of skills, and what the 72 factors of occupations that need to be looked at.  A vocational evaluation can help bridge the gap between any documented medical and psychological limitations and residual functional limitations within the context of jobs in the present labor market.

A vocational evaluation is a multi-step process and is prepared by a vocational expert. The vocational rehabilitation assessment must have a methodology that fulfills the VA requirements to address the critical questions in a TDIU matter. These questions include:

  • Is the veteran disabled?
  • What is the estimated date of TDIU?
  • Was past work sheltered or protected employment?

The analysis also includes a vocational opinion based on both objective and subjective evidence regarding the estimated date the veteran was unable to work at SGE.

Vocational assessments are structured by topic, starting with the reason for the referral. All records to be considered in the matter are summarized in a report. This records summary is critical because it outlines the objective and subjective evidence in the case, including a review of the medical, psychological, and other records contained in the file. Additionally, a thorough interview is conducted with the veteran regarding symptomology, limitations, educational history, and work history.

 Vocational Assessment

This information is synthesized, and the residual functional capacity (“RFC”) of the veteran is identified. RFC is the functional ability a person has after the effects of the disabling condition. RFC can relate to physical and/or mental abilities that result in restrictions on certain behaviors and/or exposure to specific environments. The RFC identified in the records are matched with the veteran’s past work as defined in the Dictionary of Occupational Titles and the functional demands of that job. If the functional limitations preclude past work, the VE will perform a transferable skills analysis. No more than the past fifteen years of work are analyzed as it is no longer realistic to expect skills to continue after fifteen years. For example, if a veteran had worked for the previous fifteen years in unskilled, but physically demanding jobs, no skills would transfer to other work. If the veteran has no past skilled work, or the RFC precludes skills from past work, the VE must consider other, unskilled jobs that both exist in the economy and that would fit within the RFC. In addition, the vocational expert will also provide an analysis regarding the labor market and the actual availability of jobs in the current economy. As part of the conclusion, specific records must be cited to support the RFC and the date the RFC was established. If the RFC precludes any unskilled work in the economy, the VE can conclude that the veteran could not work. This analysis also allows the VE to determine when the veteran became unable to work.

How TDIU Cases are Evaluated?

Decision-makers are often faced with challenges when evaluating TDIU case records without a vocational assessment. Information contained in a veteran’s records can be confusing and contradictory. Identifying the RFCs can be difficult if the records are unclear. The veteran may have unsuccessful work attempts or a history of accommodated work in the past. It is often difficult for TDIU decision-makers to thoroughly unpack and effectively analyze this information. Additionally, decision-makers may struggle to identify the date the veteran became unable to work. A VE has the skills to identify RFCs and past relevant work and to determine how the veteran’s service-connected disabilities may limit their ability to work and earn a substantially gainful income. If the veteran cannot earn a substantially gainful income as a result of his or her service-connected disabilities, the veteran may qualify for a 100% TDIU rating from the VA. Thus, a vocational evaluation from a vocational expert  is a invaluable in supporting a veteran’s TDIU claim.

References

Determining Disability, Unemployability, and Marginal Employment. M21-1MR, Part V, Subpart ii, Chapter 1, Section B (2018).

Havraneck, J. (2007). Advanced issues in forensic rehabilitation (199). Athens, GA: Elliott & Fitzpatrick.

Total Disability Ratings for Compensation Based on Unemployability of the Individual. 38 CFR § 4.16(a) (2011).

Weed, R. O., & Field, T. F. (2001). Transferable skills analysis. Rehabilitation Consultants  Handbook (pp. 101-103). Athens, GA: Elliott and Fitzpatrick, Inc.

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