
New Normal Big Life
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New Normal Big Life
From Denials To Approvals: How Objective Medical Evidence Wins VA, Social Security, and LTD Claims
Denied benefits don’t mean you’re not disabled — they usually mean your record isn’t saying what the system needs to hear. We sit down with disability law expert, Attorney Nancy Cavey to map a practical route through VA ratings, Social Security’s five-step test, and short- and long-term disability insurance, showing how objective medical evidence turns “I hurt” into “Here’s why I can’t work.” If you’re a veteran juggling C&P exams or a civilian facing an LTD cutoff, this conversation gives you the playbook to build a case that holds up.
Nancy breaks down the crucial differences between systems: VA pays by body-system ratings while Social Security asks whether you can sustain full-time work in the national economy. That shift makes function king — how long you can sit, stand, lift, focus, and show up reliably. We dig into residual functional capacity (RFC) forms, neuropsych testing for TBI, CPET and FCE for fatigue and pain conditions, and imaging like MRIs and CTs to anchor diagnoses.
You’ll learn why “I’m fine” in your chart is fatal, how to replace vague notes with a consistent, detailed history, and what to do when VA clinicians won’t complete forms.
We also cover timing and policy traps that quietly sink claims. From the Social Security date last insured window to LTD offsets and changing definitions of disability, the details matter. Nancy shares field-tested strategies for filing before termination to preserve coverage, coordinating multiple claims without tripping over contradictions, and navigating invisible illnesses like fibromyalgia or ME/CFS when others can’t see what you’re up against. Her three-part checklist—get a lawyer, know each system’s proof, make your records tell the story—turns confusion into a plan.
If you’re ready to stop guessing and start winning, listen now, take notes, and share this episode with someone who needs a clear path. Subscribe for more expert guides, leave a review to help others find the show, and tell us: what evidence do you still need to gather?
DISCLAIMER: The information is not medical advice and should not be treated as such. Always consult your physician or healthcare professional before pursuing any health-related procedure or activity.
Hi friends, welcome to the new normal, Big Life Podcast! We bring you natural news and stories about nature that we hope will inspire you to get outside and adventure, along with a step-by-step plan to help you practice what you’ve learned and create your own new normal and live the biggest life you can dream. I’m your host, Antoinette Lee, the Wellness Warrior.
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New normal big life.
SPEAKER_00:You know, people like you who understand the medical um understand that first off, um it is the history of the nature of their medical condition, the symptoms, nature, frequency, duration, impact on functionality. But just as important is the diagnosis. There has to be an objective basis of the diagnosis. So it doesn't matter if it's a social security case, a VA case, a short or long-term disorder case, the carrier, they're going to be looking for X-rays, MRIs, CT scans, um, whatever the objective evidence is that's going to establish the diagnosis. So we want objective evidence of the diagnosis. Number two, we want objective evidence of the restrictions and limitations.
SPEAKER_01:Imagine working hard for years, paying into an insurance plan and social security, or maybe you sacrifice your youth, health, and income earning potential to do what 93% of Americans have never done. Serve your country in the military. As a dedicated employee, a person with a long-term or short-term disability, a sick or injured veteran, you apply for the health benefits you were promised, only to be denied. Today's guest, our new normal big life, is disability law expert, attorney Nancy Kavey. Attorney Kavey will unpack how to cut through the red tape to get the benefits you need and deserve. Hi, friends, welcome to the New Normal Big Life podcast. We bring you natural news and stories about nature that we hope will inspire you to get outside in adventure, along with a step-by-step plan to help you practice what you've learned and create your own new normal and live the biggest life you can dream. I'm your host, Anthony Lee, the Wellness Warrior. Today I'm joined by Nancy Cavey. She spent her career working tirelessly on behalf of Floridians who haven't received fair treatment or promised benefits. In August of 2004, her legal peers selected her to serve as chair of the workers' compensation section of the Florida Bar. She's a member of the National Organization of Social Security claims representatives, the American Association for Justice, and the Employee Benefits Section of the American Bar Association, and the National Employment Lawyers Association, and the Florida Bar. Her firm, the Law Office of Nancy L. Kavey, has extensive experience in helping individuals with disability claims and has helped clients with medical conditions such as heart disease, hypertension, chronic fatigue syndrome, fibromyalgia, spinal injuries, post-traumatic stress, traumatic brain injury, and more. Today, she's going to help you understand how to improve your chances of getting the benefits you need. Attorney Nancy Kavey unpacks the labyrinth of disability advocacy from decoding short-term versus long-term insurance traps to leveraging VA law for service-connected health challenges. KV reveals how ironclad medical evidence turns no into yes. Let's meet our guest, Attorney Nancy Kavey. Attorney Kavey, welcome to New Normal Big Life. Thanks for having me. I look forward to speaking with you. I'm excited about this topic. As you know, I'm a veteran, but you may not know that I'm one of the moderators of a veteran supporting veterans group on X called Veterans United. And this topic comes up so often, where you have veterans from every era just about, from Vietnam to Iraqi freedom. We don't so much hear of any other era generations on social media. But they're all complaining that they're still experiencing delays with getting their benefits. Although I think uh Douglas Collins, the new Secretary of the Veterans Affairs, is doing a pretty good job and he's making progress. There's still so many obstacles to veterans seeking the benefits they need and deserve. So I'm very excited to have this conversation. So let's level the field with our discussion today and talk about your father's battle with leukemia and uh what your family went through and your path to becoming a disability advocate.
SPEAKER_00:Well, my father was a naval aviator during World War II and he fought off a Guam. And when he came back from the war, he uh attended Johns Hopkins under the GI Bill, joined the family insurance business in Baltimore, Maryland, got married, had kids, and when I was in junior high school, he was diagnosed with leukemia. So I watched him make that difficult decision until the day I graduated from high school to try to live with the leukemia and work with the leukemia because he was a John Wayne kind of guy. And he finally realized that he had to put his health first. And when he did that, he left the family business. We moved to Florida. He became a patient at Chann's. And unfortunately, he died three years after we moved. I graduated from college six weeks after he died. So I accelerated my college so that I could hopefully he could live to see me graduate. That didn't happen. But he knew I was going to law school to represent people who had disabilities, and he applied for his Social Security disability, and he had an individual disability insurance uh policy. And so he applied for that. So I watched him, you know, a proud man who who who fought in a very difficult circumstances and you know ultimately had to stop work and apply for benefits. And that was a change in his identity, and certainly it changed our family dynamic to have the breadwinner become disabled. And so that, you know, his journey and my experience with that journey is what inspired me to represent people in Social Security disability claims, ERISA disability claims. And we do do VA work, but that's not uh the primary focus of our of our work.
SPEAKER_01:Well, I'm so sorry to hear that your family had to go through this tragedy. And I know how it is when you lose your father, it's a it's a big deal for myself included. My father was also a veteran. Can you tell us what kinds of people come to you for help? What kinds of problems are they having? What types of insurance are they having trouble getting benefits from in terms of long-term and short-term? And then also what types of problems are people having with applying for social security benefits and also VA benefits?
SPEAKER_00:So that's a broad perspective. You know, we see people who have significant medical conditions that range from congenital conditions to degenerative conditions, conditions caused by injuries or you know, conditions that certainly just develop as a result of the aging process. So we'll see, particularly in my veterans population, normally what I see are people who have been airborne, if you will. And so we we've got a lot of knee injuries, a lot of shoulder injuries, a lot of back injuries. I see a fair number of cases that will also involve exposures to different substances, which result in a myriad of different types of medical conditions from rheumatological to immunological to you know, even conditions involving the pulmonary system. So we see the whole range, if you will, of those conditions. And then, of course, most of the veterans I represent also have psychological issues, be it post-traumatic stress disorder, depression, anxiety. So I see this kind of the whole gambit, if you will, when it is when we're with our veterans population. In terms of applying for Social Security benefits, I tell my veterans, and I just had this conversation about 30 minutes ago, this gentleman has 100% TDIU, and he is very frustrated that his the government said he couldn't, I mean, he was he's disabled with the Social Security system, says he isn't. So what I try to explain to my veteran clients is I want you to think about this like football and baseball. Different games. Yeah, that you had to have a ball in common, but beyond that, not so much. For veterans, they need to understand that in the VA system, benefits are paid based on ratings, based on body systems. Okay, we all went to high school, we all took biology, we learned about the cardiovascular system, the digestive system, the pulmonary system, the orthopaedic system. So, you know, VA uses ratings and they'll look at the medical records, and I'll talk about the VA records in a second. But normally you have a CMP exam where the doctor is doing the physical examination consistent with the rating, and then you get rated, and your benefits are based on the rating. Not so in Social Security. Social Security uses a five-step sequential evaluation test. And the first question is basically, have you been out of work for a year? Do you have a medical condition that would keep you out of work for a year? Is that condition severe? Do you meet what's called a medical listing? Now, medical listings sound like ratings based on body systems, but every listing has certain elements. So, you having come from the medical field, we look at the elements of the listing, we look at the records, and we start checking things off. And more often than not, people don't meet a listing. So it doesn't matter what your rating is because you're not going to meet a listing, different criteria. Where Social Security case is different also is at step four and five. At step four, the issue is can you go back to the lightest job you held in the five years before your claim has been adjudicated? Most of my veterans have just recently left the military. So the question is, can you go back to the role you had in the military? And obviously the answer to that is heck no. But everybody needs to understand it's step five where these cases are decided. And this is a crazy Kakamami test. And the test is is there other work in the mythical, hypothetical, not real-world national economy that you wouldn't want to do doesn't pay a living wage in view of your age, not a factor in VA, your education, not necessarily a factor, the skills you've learned, in other words, can you take those skills to other work in view of whatever your restrictions and limitations are? And that's in English means can you do a dumb job like surveillance system monitor, sort nuts and bolts, or address envelopes? But the problem that I have with my VA clients in my social security cases is that if you've ever read those VA records, you know they don't say a whole lot. Okay. You go in and you complain. That's part of the problem. A lot of veterans are, you know, and I have to tell them the story of my dad. And I have to say, look, you need to go in and tell them what are your symptoms. How do those symptoms impact your ability to function? Because if you walk in and say you're fine, social security is going to say, well, why on earth is he applying for benefits?
SPEAKER_01:Right. Veterans can be very stoic at times.
SPEAKER_00:Oh God, you know, it's like I have to talk them down out of that mindset. But what's important here is that we social security lawyers use forms called residual functional capacity forms. We I think we've developed about 70 of them for 70 different medical conditions. Now, under the VA regs, the VA doctors are supposed to fill out these forms, but they don't. And that's a huge problem because those forms will address how long can you sit, stand, walk, stoop, bend, how much can you lift? Do you need breaks? Are you going to be off task? Are you going to be absent from a psychological standpoint? Do you have problems getting along with others? Are you irritable? Do you have problems with hypervigilance? Do you have problems staying on task? You know, all sorts of psychological issues. Now, the only way I can, with my VA clients, address that is to say, look, maybe we need to have you treat outside of the VA for a while and get these forms filled out. Maybe you can convince your VA doctor to fill out the forms, but it's going to be a hard, harder case because other than the CNP exam or even the TDIU, there's not a lot of discussion about what your functional restrictions and limitations are. So that leaves the Celsius Security administration and the judge to kind of figure it out, which doesn't always help the benefit, the veteran.
SPEAKER_01:That's very complicated.
SPEAKER_00:Well, you know, VA is siloed, okay? You know, every little medical condition is in their little silo, which drives me nuts because nothing is moving along at the same time, if you will. Social Security, we can develop all the different medical conditions and it all moves along. Doesn't move necessarily any faster than VA. And I will tell you that the claims examiners at Social Security and the VA, I think came from the same mold, uh, if you will. I think one of the other things that the veterans need to understand is yeah, if you get 100% rating, it does have some applicability in a social security case. It gets you fast-tracked to a denial, in my view. So in the discussion I just had with the veteran, I said, look, your records are awful. I, you know, you're getting psych treatment outside of the VA. I want you to give a better history of your symptoms and functionality. Here's the RFC form I want you to take to the doctor. But we've got to talk about what's in those VA records or what's not in those VA records about your physical problems because he was airborne. Okay. And I know he's got back problems, hip problems, knee problems. The doctor or the VA is not going to fill out the forms that would document how long he can sit, stand stoop, and wet and bend. Remember, I told you step five, those jobs they have in common the requirement that you sit. Okay. And generally bilateral manual dexterity. So we want something in those records that document you can't sit six out of eight hours. You got to alternate sitting and standing. You have to, or because of your knee or your back or whatever, because of your shoulders. You may have trouble manipulating things or holding your arms out in front of you. So it, you know, veterans will come and say, Well, I got the 100%. And I'll say, No, fast track to denial. We've got to clean this all up. We'll file the application because it's going to take at least a year and a half to get in front of a claims examiner on the first application. So let's use this time wisely. Drop that John Wayne and go in and tell them what your complaints are and your and your your symptoms and functionality. Let's see if we can find a new doctor. Let's see if we can get some forms. Because the the the the game here, if you will, is to basically give them on a silver platter what they need to say, uh, either meets a listing, probably doesn't. At four, he can't go back or she can't go back to her past work. And at five, they can't do these other dumb jobs I just identified. So that's the game that needs to be played, which is a different game than the game you play when you're seeking VA benefit.
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SPEAKER_01:Another challenge that I've heard veterans talk about when they're seeking social security benefits is that there was some qualification that it had to do with when was the last time that you collected a paycheck into Social Security. Can you explain that?
SPEAKER_00:Yeah, okay. That's called date last insured. And that's one of the first questions that we ask. And normally for Social Security purposes, you become insured when you've worked 20 out of the last 40 quarters. But when you stop working, you lose your insured status roughly in about five years. So I tell my veterans, apply now. Don't wait. Because if you wait until your insured status has ended, your only option is to potentially file an SSI claim, supplemental security income, which is asset-based. Now, some of my veterans who are homeless are going to meet that asset test, but a lot of them don't because it's it's if you're married, it's your assets and your spouse's assets. So we need to make sure that we are getting this application filed as quickly as possible so that we don't have a date last insured. Because if you're not insured and you're not eligible for SSSI, I'm going to use a legal term. You're screwed.
SPEAKER_01:About long-term and short-term disability. Tell us when someone would be considered on long-term and short-term disability, what kind of situations, and then what type of benefits would they apply for?
SPEAKER_00:Okay, so I'll I'll tell you the answer that question in the form of a story. I represented a female Marine uh colonel who retired, and she had some significant cognitive issues as a result of her service, as a result of a TBI. And she went to work for a defense contractor in DC. And that defense contractor offered, as part of her employee benefit package, short and long-term disability benefits. There is no uniform short or long-term disability policy or plan. Everyone is different, and the definition of occupation and disability is different. And in this case, she began to have very serious cognitive issues that impacted her ability to work basically as a compliance officer. She stopped work and she applied for her short and long-term disability benefits. The carrier paid her short-term disability benefits. But when it transitioned to long-term disability, the carrier said it's all in your head, and you don't meet the definition of disability. Well, of course, it was all in her head. Okay. And so we ultimately file a claim. But normally it'll pay a percentage of your income for a specific period of time. So it might be 60% of your before monthly earnings, as that term is defined in the policy, to mage age 65 or 67. And you know, we we had a mediation, and she came to that mediation at my request in her uniform. And I basically said, this woman has honorably served her country. She was injured in the course of serving her country. It is in her head. And here are the records that support this particular claim. And she has devoted her life and her country, her life to this country. She kept the promises made when she, you know, enlisted and in the course of her military service. But you, the disability carrier, are not keeping the promise that you made to her. That's all I think. And that's all I said. And she was put back on claim.
SPEAKER_01:You are demonstrating the importance of having an advocate because an ordinary family member would not know how to do this. Can you tell us what role does medical evidence play in winning any type of disability claim? Crucial.
SPEAKER_00:Can't win without it. It's as simple as that. You know, people like you who understand the medical understand that, first off, it is the history of the nature of their medical condition, the symptoms, nature, frequency, duration, impact on functionality. But just as important is the diagnosis. There has to be an objective basis of the diagnosis. So it doesn't matter if it's a social security case, a VA case, a shorter long-term dislike case, the carrier they're going to be looking for X-rays, MRIs, CT scans, whatever the objective evidence is that's going to establish the diagnosis. So we want objective evidence of the diagnosis. Number two, we want objective evidence of the restrictions and limitations. So you say you can't do it. Well, who gives a rat ass if you say you can't do it? Again, that's military talk. You know, it's it's what's what objectively about your physical exam or your diagnostic studies show that you can't sit for 45 minutes. Okay. Or if you have MECFS or fibromyalgia, they're going to want to see objective basis of the diagnosis, which can be hard, but they're really looking for objective evidence of the restrictions and limitations. So they're going to be saying, have you had a CPET exam? Have you had a functional capacity evaluation test? So when I'm looking at a case, I'm always looking at the records. Are they strong? Are they weak? Where are they strong? Where are they weak? What do I need to do to develop this evidence? Do I need to have my client see another doctor? Do I need to go get an independent medical exam? Do I need to send them out for these tests to prove the diagnosis and the restrictions and limitations? But then the carrier is going to look at consistency. In other words, they're going to look for that history of symptoms and complaints. So think of this as an after-action report. Okay. That's what I tell my veterans. Look, I want you to summarize what happened, like you have to do symptoms, functionality. And I want you to give the detail that you would give if you're doing an after-action report. Okay? Because this is what it is. So they're looking for consistency because if you say that you have these problems, let's say that you say you're fine, they're going to look at the records and say, well, he says he's fine, so why is he here? Okay. They're looking to see, okay, he's got the or she's got these levels of complaints, they're confirmed by objective studies and diagnosis and restrictions and limitations. I get this whole picture. Because, and this is true regardless of whether it's via medical treatment or not. Medical records have to tell the story. Okay. Most medical records will give you the medical jargon and crap. You know, it's necessary, but it doesn't tell the story of your journey. And that's where you need to, you know, not be the John Wayne, but be the officer who's giving or the person who's giving the after-action report. That's the story in medical records that will make a difference.
SPEAKER_01:Before we cover the next topic in this episode, I want to introduce you to the Adventure Sports Lifestyle with what I call a micro story about an adventure that I've had. The Adventure Sports Lifestyle and my deep connection to nature is essential to my good health. So here's the story. September was disaster preparedness month. And it made me think of helping you to get ready for whatever disasters might come into your life in the future. So let's plan for life's curveballs. Survival isn't just about supplies, it's about neighbors you can count on. My neighbor just hiked to my house and delivered warm homemade pumpkin cake. She left with our vine ripened tomatoes for her Capre salad. That exchange built trust, a bond for emergencies. Being neighborly is a life skill. It's coffee and barbecues, tools lit freely, or a check-in during a blackout. These acts weave friendships that become your lifeline when disaster strikes. Who will watch your pets? Who will share a generator with you, your neighbors? This year, listen to 18 Topics for Survival and our upcoming series on preparedness, a new normal big life wherever you get your podcast. I hope this inspires you to get outside in a venture alone with friends or the people you love most. Now, back to the show where we're talking with attorney Nancy Kavey. Often when we leave the military or even if you're out on some form of short-term or long-term disability from your work, if you're not a veteran, but just ordinary civilian employee, often when you are recovering from something like a traumatic brain injury, like in my case, they will tell you to ask for workplace accommodations and get them in writing and negotiate them into your contract. And I've done all of those things. And the employer is very happy with my work, except for one thing. I have too many medical appointments. And then the first thing they do to try to get you to quit because they don't want you to fire you, even if you are doing a stellar job and your evaluations are exceptional. The fact that you have to leave sometimes to go for appointments because you have a number of medical challenges, that becomes a problem. And then they don't want to continue to give you the workplace accommodations that you've negotiated. And that can be one of the major reasons for unemployability for many veterans. So that's one piece of it. But the second piece of it is what can we do, especially when you have a hidden, hidden disability, a disability that people cannot see. They're less compassionate, they often don't believe you.
SPEAKER_00:There's no good answer to that. That in part is an employment law question, and I'm not an employment lawyer, so I won't, you know, my comments to that will be limited. But to the extent to which you can get the employer to acknowledge accommodations, that certainly will be helpful. And again, this is sort of a case-by-case answer. If the client is having medical problems that will result in them missing time from work and they have a shorter long-term disability claim, I'm sitting down with them and saying, look, we need to do some planning. Is this really working? Because in the world of short and long term disability benefits, there's the concept of working while disabled. Okay. But if you're working full time and you're not losing wages and they decide that they don't like the color of your shirt today, but that's really an excuse for terminating you, you will have lost the employee. Benefits that you have, the short and the long-term disability benefits. So when I have a situation where someone is having difficulty with the employer, difficulty with appointments, perhaps a progression of their symptoms, we're talking about maybe we need to plan on filing a disability claim before they terminate you. Now, if you're not having medical problems and it's just appointments, I don't have a good answer for you.
SPEAKER_01:That's that's a good enough answer for today. So how can we navigate multiple benefit systems at the same time? So VA, SSD, and LCD all at the same time.
SPEAKER_00:Well, to be frank, it's very difficult to find a lawyer who does all three of them. Normally you're gonna find one person who does one thing and they don't always talk to each other. And the elements of proof are completely different, and the interaction are completely different. So, for example, in long-term disability, there's an offset generally for Social Security benefits. So they'll reduce your benefits by what you get and your children are getting. So I'm sitting down saying, okay, we've got three cases. Okay, we've got the VA case, it's siloed. Here you're at, here's where you're at, you know. We're off doing that, okay. Here's Social Security, five-step sequential evaluation tests completely different than the VA, but here's the proof, and here's the problems with your VA records, and here's how we have to go fix that. By the way, here's your short and long-term disability uh policy or plan. We gotta go get it. Why? Well, there's an offset generally for social security benefits, and depending on what circuit you're in, there's an offset for your VA benefits. That stinks, but you gotta understand that. And that standard of disability is different than VA, that's different than social security. So, literally, if you will, I'm siloing each one of these cases, saying, Today we're talking about this one, here's what we gotta do. Tomorrow we're gonna talk about this one, and here's what we're gonna do. Next day we're gonna talk about this one, and here's what we're gonna do, and here's the interaction between all those.
SPEAKER_01:So, if you were going to sum up maybe three tips for someone who's just getting started with their claim of any sort, what would you tell them to do?
SPEAKER_00:Get a lawyer. Number one. You cannot. I mean, I know you think you can do this, and some of you may have done it, but you really at the end of the day are learning the hard way, and that's not what you learned in the military. That's not how you were taught to do things. So, one, get a lawyer. Number two, I think if you have multiple claims, you need to understand the elements of proof. Okay. What do I have to prove in this case? What do I have to prove in this case? What do I have to prove in the third case? Is there a conflict? If there is, how are we going to work this out? Number three, the medical history, symptoms and functionality. I feel like I should give my clients a t-shirt that says symptoms on the front, functionality on the back, because that's what I harp on. Your medical records have to tell the story of your of your journey, of your case, of your symptoms, of your functionality, how it impacts your ability to work. So those are my three tips.
SPEAKER_01:The last question that I have for you today is what more do you want to leave listeners with?
SPEAKER_00:Um I think that they need to understand that not everyone appreciates the nature of their problems, particularly if it's an invisible condition. So I represent a lot of people who have um invisible conditions, primarily fibromyalgia, MECFS. Um, I have a lot of clients whose conditions are not necessarily diagnosed. And so people will not really appreciate the fact that you have a disability because you don't look like you are disabled. And to that I say, I don't really care what they think, and you shouldn't care what they think. The only people that should care are you, your family, and ultimately, if we're in front of a judge, the judge. Everybody else is irrelevant. Okay. You need to focus on what you need to focus on and let all of the distraction fall away.
SPEAKER_01:Thank you so much, Attorney Kavey. This has been so insightful, and I really believe you're going to help a lot of people uh get to the right person to help them with their biggest disability claim challenges.
SPEAKER_00:Well, thank you, and thank you for what you do, because it's not very often that we find an advocate of with your expertise and your passion also. So thank you.
SPEAKER_01:Thank you so much for being here today. Until next time, friends, I'm Antoinette Lee, your wellness warrior here at the New Normal Big Life Podcast. I hope one day to see you on the river, in the backcountry, or in the horse barn living your best life. Struggling with health problems or seeking natural health solutions, don't miss our latest podcast episodes, exclusive blog posts, and free ebooks packed with life-changing wellness tips. Join our newsletter at nnbl.blog to unpack this content and start living your biggest life today.
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