Social Security Disability and Traumatic Brain Injury
Here is an explanation of Social Security's five-step process to determine if an traumatic brain injury (TBI) patient qualifies for SSDI:
1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,040 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
2. Conclude the traumatic brain injury disability must be severe enough to significantly limit one's ability to perform basic work activities needed to do most jobs. For example:
3. Ask if the traumatic brain injury disability meets or equals a medical listing. Traumatic brain injury is listed under neurological disorders.
- Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
- Seeing, hearing and speaking
- Understanding/carrying out and remembering simple instructions
- Responding appropriately to supervision, co-workers and usual work situations
- Dealing with changes in a routine work setting
The guidelines for evaluating impairments caused by cerebral trauma are contained in 11.18, which states that cerebral trauma is to be evaluated under 11.02, 11.03, 11.04, and 12.02, as applicable.
TBI may result in neurological and mental impairments with a wide variety of posttraumatic symptoms and signs. The rate and extent of recovery can be highly variable and the long-term outcome may be difficult to predict in the first few months post-injury. Generally, the neurological impairment (s) will stabilize more rapidly than any mental impairment (s). Sometimes a mental impairment may appear to improve immediately following TBI and then worsen, or, conversely, it may appear much worse initially but improve after a few months. Therefore, the mental findings immediately following TBI may not reflect the actual severity of your mental impairment (s). The actual severity of a mental impairment may not become apparent until 6 months post-injury.
In some cases, evidence of a profound neurological impairment is sufficient to permit a finding of disability within 3 months post-injury. If a finding of disability within 3 months post-injury is not possible based on any neurological impairment (s), adjudication of the claim will be deferred until evidence is obtained of your neurological or mental impairments at least 3 months post-injury. If a finding of disability still is not possible at that time, adjudication of the claim will again be deferred until evidence is obtained at least 6 months post-injury. At that time, any neurological and mental impairment is fully evaluated and the claim is adjudicated.
4. Explore the ability of an individual to perform work they have done in the past despite their traumatic brain injury. If the SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
5. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine traumatic brain injury disability, the SSA enlists medical-vocational rules, which vary according to age.
For example, if a person with traumatic brain injury would warrant a finding of disabled at any age. The inability to meet any of the basic mental demands of work would entitle a claimant to disability benefits.
Social Security Rulings 85-15 and SSR 96-9p both describe how an individual must, on a sustained basis, be able to understand, remember and carry out simple instructions; make simple work-related decisions; respond appropriately to supervision, co-workers, usual work situations and to deal with changes in a routine work setting.
A substantial loss of ability to meet any one of these basic work-related activities would severely limit the potential occupational base for all age groups and justify a finding of disabled. A person who has a medically determinable severe impairment of traumatic brain injury and is unable to understand, remember or carry out simple instructions would be found disabled based on his/her mental residual function capacity.
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