A traumatic brain injury (TBI) can dramatically change your life. These injuries often cause cognitive, emotional, and physical impairments that make it difficult to maintain employment or manage daily tasks. For veterans and civilians alike, disability benefits may provide critical financial support during recovery and long-term treatment.
Those suffering from traumatic brain injuries may qualify for disability benefits through the U.S. Department of Veterans Affairs (VA) and through Social Security Disability Insurance (SSDI) administered by the Social Security Administration. Understanding how each system evaluates TBI claims can help individuals pursue the benefits they deserve.
What Is a Traumatic Brain Injury?
A traumatic brain injury occurs when a sudden blow or jolt to the head causes the brain to move within the skull, potentially leading to bruising, swelling, or internal bleeding. TBIs can result from a variety of incidents, including:
- Motor vehicle accidents
- Falls
- Physical assaults
- Sports injuries
- Military training or combat-related incidents
While approximately 80% of TBIs are classified as mild, even mild injuries like concussions can cause serious symptoms such as headaches, dizziness, fatigue, and memory problems. Moderate and severe TBIs often involve loss of consciousness for more than 30 minutes and may lead to long-term complications such as impaired speech, poor concentration, and loss of motor control.
According to the National Institutes of Health, moderate to severe TBIs can be disabling or fatal for hundreds of thousands of people each year. Veterans are particularly vulnerable due to exposure to blasts, training accidents, and combat conditions.
VA Impairment Ratings for Traumatic Brain Injury
With TBIs, the VA uses a “facet system” to rate the impairment. They evaluate 10 “facets” of TBI impairment, including:
- Memory, attention, executive functions
- Judgment
- Social interaction
- Orientation
- Motor activity (with intact motor and sensory system)
- Visual spatial orientation
- Subjective symptoms
- Neurobehavioral effects
- Communication
- Consciousness
Each facet is scored 0-3 or “Total.” The highest facet determines your rating.
The three areas of dysfunction they analyze are cognitive (memory, attention, executive function), emotional/behavioral (often overlaps with PTSD and related symptoms), and physical (headaches, dizziness, balance, etc.).
Another important aspect of TBI claims is that TBI is often not the only rating they receive. There might also be separate ratings for things such as migraines, PTSD/mental health, and/or vertigo which can increase total compensation significantly.
Common VA Errors in TBI Claims
Common errors in TBI claims are the VA ignoring the facet system, underrating the highest facet, and/or relying upon bad exams. The most common error by far, however, is the failure to assign separate ratings for other symptoms. This is often where we end up assisting veterans that are already service connected for TBI.
For TBI claims on the VA side, the overarching idea is that a single overlooked facet or symptom can be the difference between a 10% and a 70% rating and it is a mistake the VA often makes. Most veterans have no idea about this “facet” system and how it impacts their ratings. Our VA disability lawyers are here to help make sure this facet system is applied appropriately and ensure your symptoms are fully and accurately evaluated.
When a Traumatic Brain Injury Qualifies for SSDI
In addition to VA benefits, individuals whose brain injuries prevent them from working may qualify for Social Security Disability Insurance (SSDI) through the Social Security Administration. To receive SSDI, a person must have a medical condition that:
- Prevents them from performing substantial gainful activity
- Is expected to last at least 12 months or result in death
- Is supported by sufficient medical evidence
The more severe and persistent the symptoms of a TBI are, the more likely a claimant is to qualify for disability benefits.
Social Security Listing 11.18 for Traumatic Brain Injury
The Social Security Administration evaluates TBIs under Listing 11.18, which addresses severe neurological impairments resulting from brain injuries. A person may qualify if their symptoms persist for at least three months after the injury and they experience one of the following:
- Severe Motor Function Limitations: A claimant may qualify if they experience disorganization of motor function in two extremities, such as the arms or legs, resulting in extreme limitations in their ability to:
- Stand up from a seated position
- Maintain balance while standing or walking
- Use their hands or arms effectively
- Physical and Mental Function Limitations: A claimant may also qualify if they experience marked limitations in physical functioning along with significant limitations in one area of mental functioning. These impairments must persist for at least three consecutive months after the injury:
- Understanding, remembering, or applying information
- Interacting with others
- Concentrating or maintaining pace while completing tasks
- Adapting or managing oneself in daily life
Listing 12.02 for Neurocognitive Disorders
If a traumatic brain injury causes primarily cognitive impairments without significant physical limitations, Social Security may evaluate the claim under Listing 12.02 for neurocognitive disorders. To meet this listing, a claimant must show:
- A significant decline from prior functioning in areas such as attention, memory, language, executive functioning, or social cognition, and
- Either an extreme limitation in one area of mental functioning or marked limitations in two areas, including understanding instructions, interacting with others, completing tasks, or regulating behavior.
In some cases, individuals may meet the listing criteria because their symptoms are controlled only by living in a highly structured environment such as a supervised living facility.
Qualifying Through a Medical-Vocational Allowance
Even if a claimant does not meet a specific disability listing, they may still qualify for SSDI through a medical-vocational allowance.
In these cases, Social Security evaluates the claimant’s residual functional capacity (RFC), a detailed assessment of the most the individual can still do despite their impairments. For individuals with TBIs, an RFC may include restrictions such as:
- Inability to perform skilled or complex work
- Difficulty maintaining attention or completing tasks
- Limits on lifting, standing, or walking
- Difficulty using hands or maintaining coordination
- Challenges in communicating effectively with others
If Social Security determines that these limitations prevent a person from performing any full-time work, the claimant may still be awarded disability benefits.
Medical Evidence Needed to Support a TBI Disability Claim
Strong medical documentation is essential for both VA and SSDI claims involving traumatic brain injuries. Important evidence may include:
- Emergency room records after the injury
- Medical records from treating physicians
- Neurologist evaluations and medical source statements
- Imaging results such as MRIs, CT scans, or X-rays
- Neuropsychological testing or IQ testing
- Counseling or therapy notes
- Statements from family members, friends, or former employers
People with TBIs frequently develop related conditions such as depression, anxiety, or PTSD. Social Security must consider the combined effects of all impairments when determining whether someone can work.
Why Many Veterans Apply for Both VA and SSDI Benefits
Veterans with traumatic brain injuries often apply for both VA disability benefits and SSDI because the programs evaluate disability differently.
- VA disability compensation is based on service connection and the severity of the condition.
- SSDI benefits are based on work history and the inability to maintain employment.
Receiving VA disability benefits does not disqualify someone from receiving SSDI, and many veterans rely on both programs for financial stability.
How Kerr Robichaux & Carroll Can Help
Applying for disability benefits after a traumatic brain injury can be complicated, especially when dealing with the physical and cognitive challenges that often accompany these injuries.
The attorneys at Kerr Robichaux & Carroll help individuals and veterans pursue the benefits they deserve. Our team can assist with:
- Filing VA disability claims for service-connected TBIs
- Preparing evidence for Social Security disability applications
- Gathering medical documentation and expert opinions
- Appealing denied disability claims
We understand how overwhelming the disability process can feel, and we are committed to helping clients secure the financial support they need to focus on recovery.
Speak With a Disability Attorney About Your TBI Claim
If you or a loved one is suffering from the long-term effects of a traumatic brain injury, you may qualify for VA disability compensation, Social Security Disability benefits, or both. Speak with the experienced VA disability and SSDI attorneys at Kerr, Robichaux & Carroll today to discuss your situation and learn how we can help you secure the benefits you need and deserve.
Contact us today by submitting an online form or calling our office at (503) 255-9092 for a free case evaluation.