A 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 soldier, you may be involved in a blast from an improvised explosive device (EID). When the brain moves back and forth within the skull, it can cause contusions or bruises at the impact sites. Like any kind of bruise you sustain on your body, it takes time to heal. If there are multiple bruises on the brain, it can take longer for the swelling to decrease. When you experience a TBI, it’s possible that you are eligible for Social Security disability benefits.
How the Social Security Administration Evaluates a TBI
If you want to apply for Social Security benefits for a TBI, you need medical evidence that your brain injury has caused serious functional limitations that prevent you from working. Mental and physical impairments and conditions are listed in the Social Security Blue Book, and under the Neurological portion, criteria for evaluating a TBI is cited in section 11.18.. Sections 11.02, 11.03, 11.04, and 12.02 outline the criteria specifically. Here are some of the physical, behavioral, and psychological disruptive changes that are defined as part of that criteria:
To be eligible for disability under the Epilepsy classification, your TBI must produce a certain type of seizure according to a specific frequency. Because epilepsy can be controlled and isn’t always disabling, you need evidence that shows you’ve taken anticonvulsant medications for at least three months, but your condition still interferes with your daily life, activities, and work.
After you file, a claims examiner and/or medical consultant hired by the Social Security Administration (SSA) will review your medical records. He will look for the following evidence in your records:
- A doctor has diagnosed you with epilepsy
- The detailed information about your type of seizure and all of your symptoms
- A statement from your doctor that substantiates your own personal record of the frequency and nature of your seizures
- A description by a third-party witness who has observed your seizures
- A record that documents how often you’ve experienced seizures in the past
- The results of appropriate tests, including an EEG
- A record of your treatment history—medications and treatments and how you responded
- Medical evidence that you’ve taken prescribed medications for at least three months—this may include blood tests indicating the medication in your system
Central Nervous System Vascular Accident
If you’ve suffered a stroke due to your TBI, you may be eligible for disability under the impairment listing for central nervous system vascular accidents. The listing for this section is very clear and states that due to the stroke, you’re unable to do the following:
- Speak or write in an effective and successful way. This means you have difficulty with language that results in inadequate communication or speech.
- Control the movements of your extremities. This may be reflected by a serious disruption in the ability to use your arms, legs, hands, and fingers.
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:
- Medical documentation of a significant cognitive decline from a prior level of functioning in one or more of the cognitive areas:
- Complex attention
- Executive function
- Learning and memory
- Social cognition.
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
- Understand, remember, or apply information
- Interact with others
- Concentrate, persist, or maintain pace
- Adapt or manage oneself
- 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:
- 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
- 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
Using Your RFC to Determine Eligibility for Benefits
Even if you don’t meet the Blue Book impairment criteria for evaluating a TBI, it’s still possible to receive disability benefits. The SSA typically looks at residual functional capacity (RFC) rather than certain conditions. Your RFC is an assessment of what you are still able to do with regard to work and daily activities after evaluating your condition. A disability claims examiner wants to understand how your TBI has restricted, limited, or interfered with your ability to perform at your current job, perform at jobs you’ve had in the past, or perform other types of work you might be capable of.
At Cuddigan Law, we understand Social Security benefits and the rules and restrictions that govern disability for TBIs. We know that TBI disability cases are challenging, but we also know it’s possible to win them. Call us at (402) 933-5405 for a free evaluation of your case.