April 2017


Social Security Disability Newsletter


Traumatic Brain Injury Challenges Disability Determinations

Effects of TBI vary widely among patients - documentation of symptoms is key.


Traumatic brain injuries (TBI) are becoming a more common diagnosis for claimants needing Social Security disability benefits with advances in testing and imagingand more publicity from injured veterans and athletes.

Many of the symptoms of TBI are subtle. Also, because most of the patients are not good historians due to their brain injuries and often lack self-insight, proof of total disability is challenging. The involvement of family members, friends and coaches is helpful for reporting symptoms to the treating physicians.

There are two listings in Social Security’s guidelines that apply to people with TBI and they have been modified by Social Security’s recent amendments to the Mental Impairment Listings.

Under the neurological heading, which most often includes strokes and other physical trauma, Listing 11.18 sets high standards with the requirement of either:

  • Extreme” limitation in the ability to stand up from a seated position, balance while standing or walking, or the use of upper extremities for at least 3 consecutive months; or,
  • Marked” limitation in physical functioning complicated by at least a marked limitation in one of these areas of mental functioning: understand, remember or apply information; or, interact with others; or, concentrating, persisting or maintaining pace; or, adapting or managing oneself.

In our last several newsletters we discussed SSA’s new definitions of mild, moderate, marked and extreme for mental impairments. Requiring the use of a walker, two crutches or two canes will meet the definition of extreme physical impairments. An extreme limit in use of upper extremities will require at least 3 months inability to perform even gross motor movements.

Traumatic Brain Injuries also impact cognitive functioning and this is addressed in the Mental Impairment Regulations at 12.02 in the new “Neuro-cognitive Disorders” Listing. This Listing is now more complex and requires:

Proof of a significant cognitive decline in one or more areas of: complex attention, executive function, learning and memory language, perceptual-motor, or social cognition AND extreme limitations in one, or marked limitation of two, of the same B criteria as in 11.18 above; OR, the mental disorder is “serious and persistent” for more than 2 years and medical and psychosocial supports, or living in a highly supportive environment, has diminished some symptoms and proof of minimal capacity to adapt to changes in environment or to demands that are not already part of the claimant’s life.

If these listings are not met, we can still prove entitlement with evidence of fatigue, mood swings, and limited motor functioning which would prevent full time work activity. Like any other subjective symptoms, the law requires strong documentation from the treating neurologists, therapists and counselors. In our law practice we carefully teach our clients and family members the importance of reporting and documenting these symptoms at every clinical visit.




Struggling with TBI?
Call Our Offices For A Free Consultation

If you have a patient, client or family member struggling with TBI issues do not hesitate to give us a call so that we can evaluate the current evidence and help you develop the facts that SSA requires to provide assistance. If we can help by providing training or an in-service session with your colleagues please do not hesitate to call!

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