The Social Security Administration (SSA) is the governmental agency responsible for the oversight of federal disability programs in the United States. The SSA is tasked with determining which medical conditions are disabling enough to keep an individual from earning a living.
To ensure that all claimants are evaluated as fairly as possible, the SSA created an online document called the “Blue Book.” The Blue Book, also referred to as the “Listing of Impairments,” contains the various physical and mental illnesses that could qualify an individual for a disability award. Understanding the purpose of the Blue Book is imperative for winning a traumatic brain injury (TBI) claim.
How the Blue Book Can Help You Medically Qualify for Disability with a TBI
Each year in the United States approximately 1.5 million people sustain a traumatic brain injury, or TBI. According to the SSA, a TBI is damage to the brain resulting from a skull fracture, collision with an external force leading to a closed head injury, or penetration of the skull and brain with an object. TBI’s are evaluated under the neurological section 11.18 of the Blue Book.
According to the Blue Book, one of the following two criteria must be met to be considered disabled as a result of the TBI:
- Disorganization of motor function in two extremities, such as the legs, feet, hands, arms, or fingers, resulting in the inability to stand up from a seated position, to balance while standing or walking, or to use the arms or hands. Individuals who must use a wheelchair, two canes, crutches, or the assistance of another person to rise to a standing position or to stand or walk would likely meet this listing. Also, those who have trouble with fine and gross motor movements, such as pinching, gripping, holding, reaching, or lifting, might also be disability candidates.
- Marked limitation in physical functioning as described in section A, as well as marked limitations in one of the following:
- Understanding, remembering, or applying information: This area of mental functioning refers to the ability to learn, recall, and use information to perform work activities. Examples might include understanding and learning terms, instructions, procedures; asking and answering questions and providing explanations; and recognizing a mistake and correcting it.
- Interacting with others: This area of mental functioning refers to the abilities to relate to and work with supervisors, co-workers, and the public. Examples might include cooperating with others; asking for help when needed; handling conflicts with others; and keeping social interactions free of excessive irritability, sensitivity, or argumentativeness.
- Concentrating, persisting, or maintaining pace: This area of mental functioning refers to the abilities to focus attention on work activities and to stay on task at a sustained rate. Examples might include working at an appropriate and consistent pace; changing activities or work settings without being disruptive;
completing tasks in a timely manner; and working a full day without needing more than the allotted number or length of rest periods during the day. - Adapting or managing oneself: This area of mental functioning refers to the abilities to regulate emotions, control behavior, and maintain well-being in a work setting. Examples might include distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; and being aware of normal hazards and taking appropriate precautions.
When evaluating a TBI claim, the SSA requires a minimum of three months of evidence following the injury to determine the impact that the disorder has had on both the physical and mental functioning of an individual. In some cases, the SSA might defer a decision on the claim until six months of medical documentation is gathered.
What Evidence Do I Need to Win My TBI Claim?
The Blue Book is an excellent resource for impairments, but it also includes the medical evidence required by the SSA to evaluate a claim, such as a TBI claim.
According to the Blue Book, both medical and non-medical evidence is necessary to assess the impact of your TBI. In terms of medical evidence, the SSA will want a medical exam and full history, relevant laboratory findings, and any imaging results, such as x-rays, CT scans, MRIs, or EEGs. Also, claimants will need to include descriptions of prescribed treatments, as well as responses to the treatment.
For non-medical evidence, the SSA will accept written statements from the applicant or others. The statements can include information about the TBI and restrictions, such as physician orders not to drive or to participate in certain physical activities. The SSA will also want to know about your daily activities or your efforts to work.
Can A Lawyer Help Me Win My Claim for a TBI?
For those who have suffered a TBI, the long-term ramifications are tremendous. Many people express having “normal” days, followed by challenging days. It might be hard for those who do not know that an individual suffered a TBI to understand certain behaviors.
Individuals seeking Social Security disability benefits for a TBI would greatly benefit from hiring a lawyer to help represent their case. An experienced disability lawyer or advocate can assist in painting a very clear picture of your illness, as well as the residual difficulties that have occurred as a result.
