If you've suffered a traumatic brain injury that prevents you from working, you may be eligible for Social Security disability benefits.
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.
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 afterward, including sleep disturbances, persistent headaches, poor memory, shortened attention span, and depression.
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.
In late 2016, Social Security added a new disability listing for TBI under neurological disorders (listing 11.18). Previously, Social Security evaluated traumatic brain injury under disability listings for other types of medical conditions: stroke, epilepsy, or organic mental disorders (also known as neurocognitive disorders).
If you suffered a TBI but don't have lasting physical problems, your condition will still be evaluated under another listing: listing 12.02 for neurocognitive disorders. Note that a drop in I.Q. of at least 15 points that results in serious limitations is no longer a method of qualifying for benefits for cerebral trauma under that listing. (For more information, see our article on getting disability for a neurocognitive disorder.)
In its listing, Social Security considers TBI to be brain damage caused by a closed head injury, penetration by an object into the brain tissue, or a skull fracture. To qualify for benefits under the listing, your medical records must document that you either:
What does "marked" mean? It can be considered as seriously limiting—worse than moderate, less than extreme. 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.
If you don't meet the TBI listing, Social Security will measure 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 or physically taxing given your limitations, Social Security will use your age, education, work history, and RFC to determine whether other, less mentally or physically demanding jobs exist that you can perform. If Social Security agrees that your RFC doesn't 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 condition. This may include:
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 of getting approved.