For New Jersey residents who have suffered a traumatic brain injury (TBI), the damage can go beyond the brain and impact many different areas of the body, hindering their ability to work. With the variety of problems that accompany a brain injury, along with the medical expenses, the inability to work should be accounted for by applying for Social Security disability benefits for the injury. With TBI, knowing how the Social Security Administration evaluates it and what criteria must be met to be granted benefits is integral to a case.
Can You Get SSDI for a Brain Injury?
In short, yes, you can be eligible for Social Security Disability Insurance (SSDI) if you suffer a brain injury that prevents you from working. The Social Security Administration (SSA) examines eligibility for brain injuries under the neurologic impairment rule, which allows eligibility for both physical and cognitive impairments.
Generally, in order to qualify:
- Your injury must have supporting medical documentation and evidence
- Your injury is expected to last at least 12 months or result in death
- Prevents you from performing substantial gainful activity
As such, not all brain injuries will qualify for SSDI benefits. Generally, short-term impairment without ongoing functional limitations will not meet the standards to qualify for benefits.
What Is Considered a Traumatic Brain Injury (TBI) by the SSA?
A TBI occurs when there is brain damage either from penetration by an object going into the skull and contacting brain tissue, an external impact with a closed head injury, or from a skull fracture.
To make its decision, the SSA will need to receive evidence from a minimum of three months after the incident to determine if there is a disorganization of motor function or to gauge how much the injury has affected mental and physical functioning.
Common Causes of Brain Injuries
Understanding the common causes of TBIs is critical. As such, some of the most common causes include:
- Car accidents
- Slips and falls
- Workplace injuries
- Sports-related head trauma
- Physical assaults
- Blunt force trauma
- Penetrating injuries
- Skull fractures
Brain Injuries Do Not Need to Be Visible on Imaging
It’s important to understand that a considerable number of TBIs will not appear on CT scans or MRIs. However, despite your “normal” or “clear” results, you can still suffer severe symptoms. As such, the SSA does not solely focus on imagining results alone, but rather on the functional limitations suffered by the applicant. The SSA will also consider evidence from neuropsychological testing and clinical observations when making a decision.
How the SSA Evaluates Brain Injuries for Disability Benefits
There are categories A and B when the SSA makes its decision. The issues the person suffers from after TBI must meet one of the two categories.
SSA Listing 11.18
Under SSA Listing 11.18, the administration will require medical documentation for both categories for at least three months following the injury before it can provide benefits for eligible applicants. However, in some circumstances, like when recovery is clearly not anticipated, benefits may be approved earlier.
Category A: Disorganization of Motor Function
For A, there must be disorganization of motor function in two extremities, and it must result in extreme limitation in:
- Standing after being seated
- Balancing when standing or walking
- Using the upper extremities
Category B: Cognitive and Mental Limitations
For B, it must:
- Be difficult for the person to understand, remember, or apply information
- Interact with other people
- Concentrate, persist, or maintain pace
- Adapt or manage him or herself
Symptoms of Brain Injuries That Can Support an SSDI Claim
While the SSA will consider a number of factors and elements when determining whether or not to approve a claim for benefits, the symptoms experienced by the New Jersey applicant will also play a significant role.
Physical Symptoms
- Seizures
- Vision issues (blurry vision, double vision, difficulty moving the eyes)
- Balance or coordination issues
- Chronic headaches
- Fatigue that inhibits ongoing activities
Cognitive and Behavioral Symptoms
- Loss of memory
- Reduced tolerance for stress
- Mood changes and irritability
- Poor impulse control
- Difficulty concentrating
Why SSDI Claims For Brain Injuries are Often Initially Denied
It’s necessary to understand that, unfortunately, many New Jersey individuals may find that their claims are initially denied despite having a considerable amount of supporting evidence. As such, understanding the most common reasons for a denial can help you avoid these mistakes and seek a more positive outcome from the start or follow the correct path for an appeal if you are denied.
Common Reasons for Denials
- Lack of long-term medical documentation and evidence
- Symptoms are described but not yet clinically measured
- No connection between symptoms and work limitations
- Incomplete records from medical providers.
Contact Our New Jersey SSDI Law Firm
At the Law Offices of Sheryl Gandel Mazur, we understand how difficult it can be to not only sustain a traumatic brain injury but also navigate the substantial impact it can have on your life. That’s why our team is committed to helping you through these matters so you can receive the benefits you deserve. Contact us today to learn how we can help you.
