SOCIAL SECURITY DISABILITY SSI FOR TRAUMATIC BRAIN INJURY TBI

Social Security Disability SSI and Traumatic Brain Injury (TBI)

Social Security makes disability decisions based upon an individual's residual functional capacity (what you are able to perform despite the limitations caused by your disabling condition) rather than specific medical conditions.

Social Security defines disability as any medically determinable mental or physical impairment that prevents a person from performing substantial gainful activity for twelve months, or is expected to prevent them from performing SGA level work activity (current SGA earnings limit) for twelve continuous months, or is expected to result in their death. Social Security Disability examiners must have both medical evidence and work history information to make their disability decision.

This simply means that your traumatic brain injury must be supported by medical evidence (physical examinations, lab results, etc.) and you must have significant functional limitations as a result of your TBI that prevent you from performing any of your past work (work performed three months or longer in which your earnings were SGA), or any other type of work that your age, education, and skills might qualify you for.

Mental and physical impairment listings are contained in the Social Security Disability evaluation guidebook known as the blue book. The blue book is sometimes referred to as the Social Security Disability list of impairments; however, this is an erroneous description of the blue book since it does not contain most of the conditions for which a claimant might potentially be approved for disability benefits. In truth, it contains a small sampling of the wide array of psychological, psychiatric, and physical impairments that are known to exist which are potentially disabling.

While Social Security has a specific impairment listing, 11.18, in the neurological section of the blue book for traumatic brain injury (TBI), the listing merely refers you to evaluation criteria contained in other mental and neurological impairment listings. TBI is evaluated under the criteria contained in the convulsive and non-convulsive epilepsy listings, 11.02 and 11.03, , the listing for central nervous system vascular accident (CVA, or stroke), 11.04, and the organic brain disorders listing, 12.02.

Social Security uses the severity and functional evaluation criteria of other listings because TBI can result in mental and/or neurological impairments that exhibit a large variety of post-traumatic symptoms.

If an individual's TBI results in seizures, either convulsive or non-convulsive, or causing loss of consciousness, or impaired awareness or behavior, their TBI might be evaluated under 11.02 or 11.03 of the neurological impairment listings. Both listings state that the seizures must be documented by a detailed description of the seizure pattern and phenomena and they must occur at least once per month in spite of treatment.

To satisfy listing 11.02 (convulsive), the claimant's disorder must involve convulsive seizures and loss of consciousness or nocturnal episodes that significantly interfere with an individual's activity during the day.

In order to satisfy the severity requirement of 11.03 (non-convulsive), an individual must have the same medical documentation with alteration of awareness, unconventional behavior, significant interference of normal daily activities, loss of consciousness and transient postictal manifestations (altered state of awareness after an individual has experienced a seizure).

Even if your TBI injury does not involve seizures, your symptoms (loss of consciousness, awareness, etc.) may meet or equal the impairment criteria of the seizure listings. While some individuals with TBI exhibit neurological impairment, others experience impaired brain function that can cause loss of coordination, motor function, ambulation, speech, or communication. Individuals who have these posttraumatic symptoms may be evaluated under neurological listing 11.04, or mental impairment listing 12.02.

Listing 11.04 provides approval criteria for those who have had central nervous system vascular accidents (strokes). The listing criteria require that an individual have sensory or motor aphasia that results in ineffective speech or communication; or persistent significant disorganization of motor function in two extremities that causes constant disturbance of gross and dexterous movements, or gait and station.

If an individual's TBI results in psychological or behavioral abnormalities, their disability case might be evaluated under the criteria of listing 12.02 of the mental disorder listings.

While listing 12.02 addresses organic mental disorders, in order to meet the severity requirement of this impairment listing an individual must demonstrate a loss of specific affective changes or loss of cognitive abilities and have medical documentation of one of the following: disorientation to time and place; or memory impairment (short-term, intermediate, or long term); or perceptual or thinking disturbances (delusions, hallucinations); or personality change; or disturbance in mood; or emotional lability (sudden crying or explosive temper outbursts); or impulse control impairment; or loss of measured intellectual ability of 15 I.Q. points from premorbid (i.e. prior to the traumatic injury) levels, or overall impairment index clearly within the severely impaired rage on neuropsychological testing.

Any one of these criteria must result in at least two of the following:

severe restriction of activities of daily living (i.e. household chores, shopping, dealing with money or finances, making decisions, driving, visiting with friends or family, working, etc.);
or significant problems maintaining social functioning;
or marked difficulty in concentrating, persistence, or pace;
or repeated episodes of decompensation that are of extended duration.

If an individual cannot meet the organic brain syndrome listing criteria, they may still meet or equal this impairment listing if they have a medically documented medical history of TBI impairments of at least two years duration that have caused more than minimal limitation of their ability to perform basic work activities, with symptoms or signs eased by medication or psychosocial support along with one of the following:

repeated episodes of decompensation of extended duration,
residual symptoms for which even a minimal increase in mental demand or environmental change could be predicted to cause decompensation;
or a current history of one or more years of an inability to function outside a highly supportive living arrangement with an indication of continued need for the arrangement.