Traumatic Brain Injury (TBI) or Encephalomalacia caused by head trauma can have a significant impact on your life, leaving you unable work or care for your self. The Social Security Administration (SSA) has a program called Social Security Disability Insurance (SSDI) that enables eligible individuals to qualify for monthly TBI disability benefits or benefits from other head injuries.
To meet this criteria for social security disability benefits, you must meet specific medical criteria outlined by the SSA Blue Book list of impairments. Here’s a look at various brain and head injuries and how you may qualify for TBI disability or Encephalomalacia disability.
What is a Traumatic Brain Injury (TBI)
A Traumatic Brain Injury (TBI) is a closed head injury or acute brain injury that can be caused by a blow or jolt to the head. Common causes of a TBI include car and motorcycle accidents, sports and military injuries, falls and assaults. The severity of the TBI can vary from a mild concussion and to permanent brain damage.
When a head injury occurs, the soft brain crashes back and forth inside of the hard scull causing contusions, bruising, increased pressure, bleeding, blood clots and shearing of the brain in what’s known as a “counter blow.” According to the Mayo Clinic, there are 3 classifications to the severity and mechanism of the head injury.
Severity of Brain Injuries
- Mild: person is awake, with eyes open but can be disoriented, confused or experiencing memory loss and headaches or mood swings.
- Moderate: May experience a loss of consciousness lasting 20 minutes to 6 hours, lethargy but the eyes open to stimulation. This TBI indicates brain swelling, bleeding, contusions causing sleepiness.
- Severe: Person is unconscious, eyes do not open with stimulation. Loss of consciousness lasts more than 6 hours. Long term damage to the brain.
Types of Traumatic Brain Injuries Include
- Concussions
- Contusions
- Diffuse Axonal Injury (DAI)
- Traumatic Subarachnoid Hemorrhage (tSAH)
- Hematoma
Does A Traumatic Brain Injury Qualify For Disability?
In the SSA Blue Book listing for TBI, the Social Security Administration considers a TBI to be brain damage caused by a skull fracture, a closed head injury or penetration by an object into the brain tissue. To qualify for TBI benefits under the SSA listing, your medical records but document one of the following:
- The inability to control the movement of at least two extremities due to nerve damage (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.”)
OR
- “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 controlling behavior (such as problems with responding to demands, adapting to changes, and being aware of normal hazards).
It’s important to note that marked means problems that are worse than moderate, but not extreme – or something that is considered seriously limiting. This would directly impact your ability to work or take care of yourself.
If you suffered a TBI but don’t have lasting physical problems (long term effects), your condition may be eligible for evaluation under listing 12.02 – Neurological Disorders.
TBI Disability Benefits
A disability claim for a TBI can be complicated – therefor your brain injury disability living allowance may vary. It’s important to work with your medical providers to get a list of service dates and supporting medical documentation showing your diagnosis, the severity of damage to the brain, the prognosis, the treatment plan and how it affects your daily life.
Backpay & Retroactive Payments
Backpay can be awarded as soon as you’re approved for disability benefits by the SSA. This is effective from the date of your original filing and continuing until the claim has been approved. Most social security disability claimants get their first installment of backpay within 60 days of claim approval.
Retroactive payments are awarded if you can prove you were disabled before filing your disability application. You must show that you were disabled for at least 5 months before applying for TBI disability benefits.
Calculating Your TBI Social Security Disability Benefits
The benefit amount you can receive for an approved TBI Disability claim depends on how much you paid in to your Social Security taxes. The SSA reviews your earnings history and average indexed monthly earnings (AIME). From these figures as well as your age as a consideration, the SSA can calculate your monthly TBI disability benefits.
Applying for TBI Disability Benefits
If you are unable to work with a TBI, you can start your disability application with the SSA. Filing can be done by visiting www.ssa.gov or by calling 1-800-772-1213. If you need appeal assistance or any other social security disability assistance, contact the San Diego Disability Law Group. Things like medical records, ct scans, x-rays, etc. can help help you with your case.
Attorneys Aline Gaba and George Heppner of the San Diego Disability Law Group have helped hundreds of individuals successfully pursue social security disability claims, and we believe a large part of our success is due to recognizing and addressing our clients’ needs and concerns on an individual basis. We regard our clients as people in need of our expertise in the field of social security disability, not just another file. Contact us today for a free, confidential consultation.