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

Traumatic brain injury (TBI) occurs when a sudden blow to the head jostles the brain around in the skull, resulting in internal bleeding, bruising, or swelling. Traffic accidents, falls, assaults, and sports injuries are some of the most common causes of TBI.

Around 80% of all TBI cases are considered mild head injuries. According to the National Institutes of Health, however, moderate to severe TBI is disabling or fatal for 500 out of every 100,000 people diagnosed annually. The more severe your TBI symptoms are, the more likely you are to qualify for disability benefits.

What Are Severe TBI Symptoms?

Traumatic brain injuries are classified as mild, moderate, or severe. A mild TBI ("concussion") occurs when the injured person experiences less than 30 minutes of confusion or loss of consciousness. Even though TBIs of this kind are classified as "mild," they're frequently accompanied by serious cognitive symptoms like memory loss, headaches, dizziness, and fatigue.

Moderate and severe TBIs cause loss of consciousness for more than 30 minutes, along with symptoms such as speech and language abnormalities, poor abstract thinking skills, and loss of motor function. People who have sustained a moderate or severe TBI often experience related symptoms for months or even years afterward—such as sleep disturbances, persistent headaches, poor memory, shortened attention span, and depression.

Is TBI Considered a Disability?

Social Security can award disability benefits to people who have a medical condition that keeps them from working full-time for at least one year. If, following your TBI, your symptoms persist to the extent that you haven't returned to work and you struggle to complete your daily routine, you may qualify for disability.

Military service members in particular are at risk of traumatic brain injury. Veterans who've experienced a TBI that's related to their time on active duty may qualify for disability compensation from the VA.

Qualifying for Disability Benefits for a Traumatic Brain Injury

You can qualify for Social Security disability benefits due to brain damage in one of two ways: by meeting the criteria of a disability listing or by showing that your TBI symptoms rule out all work.

Meeting a Disability Listing for TBI

A "listed impairment" is a medical condition that Social Security considers especially severe. These conditions are categorized and numbered according to which body system is affected. Each "listing" has a set of requirements that must be present in your medical record for the agency to determine that you "meet the listing." If you meet the listing requirements, Social Security will award you disability benefits.

Two listings are relevant for people with a TBI. Listing 11.18, Traumatic brain injury, addresses TBIs that result in difficulties physically moving around, in addition to trouble thinking and concentrating. Listing 12.02, Neurocognitive disorders, addresses cognitive difficulties only. Social Security can evaluate your disability application under both listings to see which one may fit better—you don't have to pick one.

To meet the requirements of listing 11.18 for traumatic brain injury, you'll need medical documentation of either one of the following two scenarios:

• It's been at least three months after your TBI and you still haven't regained full control over of at least two of your extremities (arms, legs, hands, fingers, wrists, or shoulders), resulting in an inability to perform basic movements such as standing up from a seated position, maintaining balance while upright, and holding on to objects.
• You can perform basic movements with significant ("marked") difficulty, and in addition you have marked limitations in areas of mental functioning concerned with understanding instructions, getting along with others, finishing tasks, and behaving appropriately.

If you don't have any lasting physical problems following your TBI, Social Security will evaluate your application under listing 12.02 for neurocognitive disorders. You can meet the requirements of listing 12.02 with medical documentation of both of the following:

• You have a significant decline from a prior level of functioning in at least one cognitive area (complex attention, executive functioning, learning and memory, language, perceptual-motor, or social cognition).
• Because of your cognitive decline, you now have an "extreme" limitation in one, or a "marked" limitation in two, areas of mental functioning concerned with understanding instructions, getting along with others, finishing tasks, and behaving appropriately.

Having an extreme functional limitation is worse than having a marked limitation. That's why you can meet the listing with an extreme limitation in only one area, but you'll need two areas where you have marked limitations. You can also meet the listing criteria if you would have extreme or marked limitations, but you live in a highly structured setting (such as a group home) that keeps your symptoms under control—and your symptoms would come back outside of that environment.

Getting a Medical-Vocational Allowance for a TBI

You can still qualify for disability benefits without having to satisfy the listing requirements. Under the agency's five-step sequential evaluation process, if you don't meet a listing, Social Security will need to assess your residual functional capacity (RFC) to determine whether any jobs exist that you can do despite your symptoms.

Your RFC is a short paragraph describing the most that you're capable of doing, physically and mentally, in a work environment. Because many brain injuries result in cognitive impairments, your RFC will likely contain a restriction against performing skilled work. And if you have trouble with motor functions following your brain injury, your RFC should contain restrictions on how much weight you can lift, how far you can walk, or how long you can use your hands.

The more limitations you have in your RFC, the more likely it is that Social Security will find that you can't do any work. For example, you might have a psychological evaluation performed that says you'd be unable to keep up with job tasks, communicate productively with others, or maintain regular attendance. If Social Security agrees that these limitations—which effectively rule out all full-time competitive employment—are supported by your medical record, you'll receive disability benefits by way of a medical-vocational allowance.

Medical Evidence You Need to Support Your TBI Claim

Whether you're looking to prove that you meet a listing or to show that you can't perform any work, it's crucial that you provide documentation of all your medical treatment and functional limitations arising from your TBI. Social Security will be reviewing your application for the following information:

• emergency room records
• clinic notes from doctors' visits
• counselor or caseworker notes
• medical source statements from your doctors, preferably neurologists
• results of X-rays, MRIs, CAT scans, and other objective testing
• neuropsychological or IQ testing, and
• written statements from friends, family members, or former employers.

People dealing with symptoms of traumatic brain injuries often report other mental health disorders such as depression, anxiety, or PTSD. Be sure to submit evidence for those conditions as well. Social Security is required to consider the combined effect of all your impairments on your ability to work. The more evidence you can provide about your limitations, the better your chances of getting approved.

Applying for Disability Benefits With a Traumatic Brain Injury

Social Security offers several ways you can start your application for disability benefits.

• File online using Social Security's disability application portal.
• Call the Social Security hotline at 800-772-1213 (TTY 800-325-0778 for people who are deaf or hard of hearing) between 8:00 a.m. and 7:00 p.m., Monday through Friday.
• Go in person to your local Social Security field office.

Some people choose to bring a disability lawyer on board for help with the initial application. While you don't need to have an attorney at any stage of the disability determination process, there are a lot of advantages with this approach. Hiring an experienced disability lawyer early on can help you avoid missed deadlines and increase your odds of getting benefits, without any up-front legal fees.

_{Updated April 12, 2024}