Social Security Disability & SSI for Traumatic Brain Injury (TBI)
The Social Security listing of impairments includes traumatic brain injury as a disabling impairment.
Updated March 2, 2017
Traumatic brain injury (TBI) is an acute injury suffered by the brain and can be caused by various events, the most common causes being falls, car accidents, and firearms. Soldiers also suffer inordinately from TBIs caused by roadside bombs known as IEDs. The injuries sustained from a TBI vary from a concussion with mild temporary amnesia to permanent coma.
It is not uncommon for those who have suffered a traumatic brain injury to experience a change in cognitive abilities, the ability to concentrate, personality, mood changes, or social functioning. Others also have trouble with language, which can result in ineffective speech or communication. Some impairments may heal over time, and some functions may be regained some through therapy, while other impairments will not improve—or they may actually get worse over time.
Social Security Disability Benefits for TBI
Before October 2016, Social Security evaluated traumatic brain injury under disability listings for other types of medical conditions: stroke, epilepsy, or organic mental disorders. Now, TBI is specifically listed in Social Security's listing of impairments (called the "blue book"). Social Security considers TBI to be brain damage caused by skull fracture, a closed head injury, or penetration by an object into the brain tissue. To qualify for benefits under the listing for TBI, 11.18, your medical records must document one of the following:
- The inability to control the movement of at least two extremities (either an arm and a leg or two arms or two legs), for at least three consecutive months after the injury. This must result in extreme difficulty in the ability to balance while standing or walking, to stand up from a seated position, or to use the arms. (These criteria used to be referred to as “a sustained disturbance of gross and dexterous movements or gait and station.”)
- “Marked” physical problems along with a "marked" limitation (for at least three months post-injury) in any one of the following:
- thinking (problems understanding, remembering, or applying information)
- interacting with others (social problems)
- finishing tasks (problems with concentration, persistence, or speed), or
- regulating emotions and controling behavior (such as problems with responding to demands, adapting to changes, and being aware of normal hazards).
Note that marked means problems that are worse than moderate, but not extreme. A marked limitation can be considered seriously limiting. Also note that a drop in I.Q. of at least 15 points that results in marked limitations is no longer is method of qualifying for benefits for cerebral trauma.
Moderate Limitations Caused by TBI and Your Ability to Work
If Social Security does not find that your limitations are so severe that you are disabled under one of the above listings, Social Security then must evaluate whether your limitations are legitimately keeping you from working. Social Security will assess your physical and mental limitations using a physical residual functional capacity (RFC) form and a mental residual functional capacity (MRFC) form. These forms note a wide variety of limitations that can affect your ability to work, such as problems concentrating, standing, walking, and so on.
Multiple moderate limitations across several areas may make you unable to work, even though you don't have marked or extreme limitations in any one area. An inability to return to your previous job, however, is not enough to get you approved for Social Security disability benefits. You must not be able to work any job, even one like "surveillance system monitor." Social Security will also look at your age, education, and work experience when assessing your ability to do any work.
Timing of a Social Security Decision on TBI
TBIs are different than most other illnesses or diseases in that it can be difficult to make a long-term prognosis about an individual's prospects. Social Security has taken into account the high variability associated with TBIs. With many other disabilities, applicants can not receive disability benefits until they have been disabled for over twelve months. However, with TBIs, an individual who sustains profound neurological impairment may be found disabled within three months post injury. If a finding of disability is not possible three months post injury, the applicant can be reassessed when evidence of neurological or mental impairments is received by Social Security. If there is still not finding of disability, an individual may be reassessed again at least six months post injury, if Social Security receives new medical evidence about your TBI.