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 physical difficulties as well as 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.
Before October 2016, Social Security evaluated traumatic brain injury under disability listings for other types of medical conditions: stroke, epilepsy, or organic mental disorders (called neurocognitive disorders). Now, TBI has its own listing in Social Security's listing of impairments (called the "blue book").
In its listing, 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:
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.
If you suffered a TBI but don't have lasting physical problems, your condition would be evaluated under listing 12.02 for neurocognitive disorders. For more information, see our article on getting disability for a neurocognitive disorder.
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," which requires few skills and limited physical activity. Social Security will also look at your age, education, and work experience when assessing your ability to do any work. Social Security recognizes that the older one is, the harder it is learn a new job, particularly if an applicant has cognitive difficulties.
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 cannot 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.