Receiving Social Security Disability Benefits After a Traumatic Brain Injury (TBI)

A disability applicant with lasting cognitive or mental difficulties from a severe TBI may be eligible for Social Security disability benefits.

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If you've suffered a traumatic brain injury that prevents you from working, you may be eligible for Social Security disability benefits.

Causes of TBIs

A traumatic brain injury (TBI) occurs when a sudden blow to the head causes damage to the brain, often in the form of internal bleeding, bruising, or swelling. The most common triggers of TBIs include traffic accidents, falls, assaults, and sports injuries. Many soldiers returning from Iraq and Afghanistan have suffered TBIs, often due to roadside bombs known as IEDs. (Also see Nolo's article on getting VA disability compensation for TBIs.)

In all, about 1.5 million people a year experience a TBI in the United States, with children, teenagers, and military personnel having more than their share of TBIs.

Mild vs. Severe TBIs

TBIs can be classified from mild to severe. A "mild" TBI, also called a concussion, occurs when a person suffers confusion or loss of consciousness for less than thirty minutes. Despite being classified as "mild," they're frequently accompanied by serious cognitive impairments such as memory loss, headaches, dizziness, and fatigue. Mild TBIs account for 80% of all brain injuries. "Severe" brain injuries are those that cause loss of consciousness for more than 30 minutes, along with cognitive impairments such as speech and language abnormalities, poor abstract thinking skills, and loss of motor function. Those who have sustained a TBI often experience related symptoms for months or even years afterwards, including sleep disturbances, persistent headaches, poor memory, shortened attention span, and depression.

Diagnosis of Traumatic Brain Injury

The presence and severity of a TBI may be diagnosed with MRIs and CAT scans, although many mild TBIs will not appear on neuroimaging. For this reason, neuropsychological testing may be performed to assess the extent of any cognitive deficits.

Disability Benefits for TBI

You'll be approved for Social Security disability benefits on the basis of a TBI if you meet or equal one of the listed impairments in Social Security's "Blue Book" or if you're found unable to perform any job that exists in significant numbers in the United States.

The Blue Book Listing for Traumatic Brain Injuries

Social Security's listing 11.18 states that cerebral traumas are evaluated under the provisions of the epilepsy listings, the stroke listing, or the listing for organic mental disorders, as applicable.

To meet the requirements of listing 11.02 for convulsive epilepsy, you must:

  • have grand mal or psychomotor seizures (despite three months of treatment)
  • more than once a month
  • with daytime seizure episodes OR nighttime episodes that interfere with your daytime activities.

Listing 11.03 for non-convulsive epilepsy is met when an individual experiences petit mal, psychomotor, or focal seizures more than once a week despite three months of treatment, with alteration of awareness, loss of consciousness, or other symptoms causing significant interference with daily activities.

The listing for strokes, 11.04, will be met if an individual continues to experience difficulty speaking or understanding speech or using his or her arms and legs three months after the stroke occurred.

Finally, listing 12.02 for organic mental disorders is rather complex but can be met when an individual has experienced a substantial loss of certain cognitive abilities, including the loss of 15 or more IQ points as measured by neuropsychological testing.

Even if your condition doesn't meet the exact requirements of these listed impairments, you can still get approved based on the listings if the severity of your condition equals the severity of the symptoms described in the listings.

In practice, a mild TBI usually does not qualify a person for benefits based on the listings, but many people who have suffered mild TBIs are approved for disability under a medical-vocational allowance.

How to Receive a Medical-Vocational Allowance for a TBI

Social Security uses your Residual Functional Capacity (RFC) to determine whether you can do your current job despite your physical and mental limitations. Your RFC is a description of your maximum work-related capabilities and your limitations.

If your current (or most recent) job is too mentally taxing, Social Security will use your age, education, work history, and RFC to determine whether other, less mentally demanding jobs exist that you can perform. If your RFC doesn't not allow for any gainful employment, you'll receive a medical-vocational allowance.

It is crucial that you provide documentation of all your medical treatment and functional limitations arising from your TBI so that Social Security can accurately assess your RFC. This may include:

  • emergency room records
  • clinic notes from doctors' visits
  • counselor or caseworker notes
  • results of x-rays, MRIs, and other objective testing
  • neuropsychological testing or IQ testing, and
  • written statements from friends, family members, or former employers.

If you suffer from impairments other than a TBI, such as depression, PTSD, or anxiety, be sure to submit documentation for those conditions as well. Social Security will consider the total effect of all your impairments on your ability to work. The more evidence you can provide about your limitations, the better your chances for getting approved.

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