Understanding a TBI and How to Obtain Disability Benefits After Your Diagnosis

 A Red Stethoscope Formed Into the Shape of HeadA traumatic brain injury (TBI) can be caused in many different ways. You may experience a fall, an assault, an automobile accident, or a sports-related injury; or if you’re a combat solider, you may be involved in a blast from an improvised explosive device (IED). When you suffer a brain injury, you may experience a change in consciousness, feel confused and disoriented, temporarily lose your memory, or go into a coma. A TBI can be mild to severe, and not all head injuries cause a TBI. Here are some additional ways you can suffer a brain injury:

  • Whiplash. Even if there’s no direct blow to the head, it’s possible to sustain a brain injury. When any outside force creates a rapid acceleration and deceleration of the head, causing the brain to move back and forth within the skull, the force of the twisting or rotation can stretch and sometimes sever the long-range fibers that connect to the brain. This is seen in cases of whiplash. When there is damage to these fibers, it reduces the efficiency of the brain networks because the communication between the nerve cells is disrupted.
  • Damage to blood vessels. Brain injury can occur if there is damage to the blood vessels that surround the brain. This can cause bleeding between the skull and the brain. Typically, the bleeding stops by itself and the blood vessels heal.
  • Rapid pressure changes. If you’re exposed to sudden changes in pressure such as under pressurization or over pressurization waves that happen when there’s an explosion, you can sustain a brain injury. These shifts in pressure can cause air bubbles to form in your blood and travel to the brain, interrupting the blood supply there.

How TBIs Are Evaluated

When you apply for Social Security disability benefits, you need to provide medical evidence that your TBI has caused significant functional limitations that prevent you from working. Mental and physical impairments are listed in the SS Blue Book, and in section 11.18 of the neurological section—the listing refers you to other mental and neurological listings for evaluation criteria. The criteria for evaluating a TBI is listed in:

  • 11.02 and 11.03 under convulsive and nonconvulsive epilepsy. To meet the criteria for 11.02, you must have convulsive seizures and loss of consciousness or episodes that occur at night that severely disrupt your activities in the daytime. For 11.03, you must have medical documentation that shows that your awareness is altered in some way, you have odd or unusual behavior, there is a disruption in the way you perform day-to-day activities, and there’s a change in your awareness level after experiencing a seizure.
  • 11.04 for central nervous system vascular (CVA) accident or stroke. Even if your TBI doesn’t produce seizures, the symptoms you exhibit may still meet the criteria for seizures, including loss of coordination, speech, ability to communicate, or motor function. Additionally, post-traumatic stress disorder (PTSD) may be evaluated under 11.04.
  • 12.02 for neurocognitive disorders. If your TBI results in behavioral or psychological abnormalities, your condition might be evaluated in listing 12.02. To be eligible for disability under this category, you need to show significant changes in your cognitive abilities due to your brain injury. This may include providing evidence of changes that limit your ability to concentrate, perform daily activities, or engage in social functioning. You must satisfy parts “A” and “B,” or “A” and “C” to meet the requirements of this category:

A. Medical documentation of a significant cognitive decline from a prior level of functioning in one or more of the cognitive areas:

  1. Complex attention
  2. Executive function
  3. Learning and memory
  4. Language
  5. Perceptual-motor
  6. Social cognition

AND

B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:

  1. Understand, remember, or apply information
  2. Interact with others
  3. Concentrate, persist, or maintain pace
  4. Adapt or manage oneself

OR

C. Your mental disorder in this listing category is “serious and persistent”; that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:

  1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder
  2. Marginal adjustment—that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life

If you’ve experienced a brain injury or a family member shows signs of a TBI, the attorneys at Cuddigan Law can help you coordinate the testing needed to verify the diagnosis. This is a critical step in getting compensation from the Social Security Administration for your condition. Call us today at 402-933-5405 to discuss your disability case.

 

Sean D. Cuddigan
SSA and VA Disability Attorney in Omaha, Nebraska