TRAUMATIC BRAIN INJURY AND DISABILITY BENEFITS – LISTING 12.02
Traumatic brain injury (TBI) and its symptoms can prevent you from working. If you cannot work for more than 12 months due to a TBI, then you should file an application for SSDI and SSI benefits.
A TBI can occur from a head injury while playing sports. Also, combat veterans may suffer from a head injury from a bomb blast or IED. Learn more about veteran benefits. At our office, we have also seen cases where head injuries occur from individuals falling off of a roof or off of a ladder at work. We have also seen cases were people have head injuries from an every day car accident.
According to the Centers for Disease Control and Prevention (CDC), in the United States, almost 1.7 million people sustain a TBI each year. Out of these, around 52,000 people die as a result of their injury and 275,000 must go into the hospital. Of those who visit the hospital, around 80,000 have long term symptoms as a result of their TBI.
As you can see with the CDC report, TBI can be a serious condition. However, most people can recover from a TBI with sleep, resting during the day, and not watching screens. Even with slowing down daily activities and hours of rest, you may not be able to recover quickly. If a TBI is severe, then some individuals can be off work for over 2 years.
LEADING CAUSES OF TBI IN THE USA
According to the CDC, falls are the leading cause of TBI across all age groups. Falls account for around 35% of all TBIs. For example, children fall on the playground or playing sports. Adults trip and fall or they fall off of ladders or roofs. Falls are especially common in young children and older adults.
Motor vehicle crashes are the second leading cause of TBI. These account for around 17% of all TBIs. Car accidents are the most common in young adults. TBIs can result from car, truck, or motorcycle accidents.
Being struck by or against an object is the third leading cause of TBI. This accounts for around 16% of all TBIs. This cause of TBI can occur at any age, but is most common in children. Examples include being hit by a baseball or a falling object.
You might think that sports injuries are a leading cause of TBI. However, while sports injuries including concussions, can also cause TBI, they are not one of the leading causes of TBI across all age groups. However, the risk of TBI from playing sports can be high in sports, such as football, soccer, and hockey.
A TBI can be avoided by wearing a helmet while playing sports and taking steps to prevent falls in the home or at work.
SYMPTOMS OF TRAUMATIC BRAIN INJURY
The symptoms of traumatic brain injury depend on how severe the impact is to the brain and location of the injury. However, some common symptoms of TBI include:
- Loss of consciousness
- Headache
- Nausea
- Throwing up
- Fatigue
- Difficulty sleeping or sleeping more than usual
- Dizziness or loss of balance
- Blurred vision or sensitivity to light or sound
- Difficulty with focus and making decisions
- Changes in mood, including anxiety, crying spells or mood swings
- Slurred speech
- Weakness in the limbs
- Seizures
- Unusual behavior or personality changes
Some of these symptoms may not appear immediately after the head injury. Instead, they may develop over time. If you experience a head injury and you have any of these symptoms, then it is important to seek medical attention as soon as possible.
TREATMENT FOR TRAUMATIC BRAIN INJURY
In order to determine if you have a serious TBI, instead of a mild TBI, your doctor may perform the following tests:
IMAGING TESTS
- CT scan. This test is usually first done in an emergency room for a suspected TBI. A CT scan uses a series of X-rays to create a view of the brain. A CT scan can quickly uncover evidence of bleeding in the brain, blood clots, bruised brain tissue, and brain swelling.
- MRI. An MRI uses powerful radio waves and magnets to create a view of your brain. It may also be done if symptoms don’t improve soon after the injury.
MEDICATIONS FOR BRAIN INJURY
There are time, when a TBI is severe, that medications are used to limit more damage to the brain immediately after an injury occurs:
- Anti-seizure drugs. People who have a severe TBI are at risk of having seizures during the first week after their injury. Medication may be given during the first week to avoid any more brain damage that might be caused by a seizure.
- Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas because the brain uses less oxygen. This is helpful to the individual with the TBI if compressed blood vessels in the brain are unable to supply brain cells with healthy amounts of oxygen.
SURGERY FOR TRAUMATIC BRAIN INJURY
Emergency surgery may be done to prevent more damage to the brain. Surgery may be used for the following problems:
- Removing clotted blood. Bleeding outside or inside the brain can result in a collection of clotted blood that puts pressure on and damages brain tissue.
- Repairing skull fractures. A surgeon may do surgery to repair severe skull fractures or to remove pieces of skull in the brain.
- Bleeding in the brain. Head injuries that cause bleeding in the brain may need surgery to stop the bleeding.
- Opening a window in the skull. Surgery may be done to relieve pressure inside the skull by draining excess cerebrospinal fluid or creating a window in the skull that provides more room for swollen tissues.
EXAMPLES OF TRAUMATIC BRAIN INJURY & OTHER NEUROCOGNITIVE DISORDERS
If you are unable to work due to a TBI, then you may qualify for SSD benefits. The SSA states there are certain examples of neurocognitive disorders that they look at under listing 12.02. For example, the SSA considers dementia of the Alzheimer type to be a major neurocognitive disorder.
Other examples include vascular dementia; dementia due to a medical condition such as a disease, like late onset Tay-Sachs disease, human immunodeficiency virus infection, vascular malformation, and brain tumor. Other neurological diseases include Multiple Sclerosis, Parkinsonian syndrome, and Huntington disease. TBI can also include substance induced cognitive disorder due to drug abuse, medications, or toxins.
The SSA uses Listing 12.02 to define the symptoms of a TBI. Below is listing 12.02, which shows the symptoms that you must document to prove that you deserve benefits.
LISTING 12.02 – NEUROCOGNITIVE DISORDERS
12.02 Neurocognitive disorders, satisfied by A and B, or A and C:
- Medical documentation of a significant cognitive decline from a prior level of function in one or more of the cognitive areas:
AND
OR
- Your mental condition in this listing category is “serious and persistent;” that is, you have a medical history of the existence of the condition over a period of at least 2 years, and there is evidence of both:
- Medical treatment, mental health therapy, psychosocial supports, or a highly structured setting that is ongoing and that diminishes the symptoms and signs of your mental condition; and
- Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.
If you have these symptoms, to the level in listing 12.02, then you should be able to win benefits. When you have all of the above symptoms, your TBI meets the listing. Read here to learn more about how to prove Part B.
It doesn’t matter whether you live in Utah, Nevada or California. You can learn about Utah SSD benefits and Nevada SSD benefits. California SSD benefits information is also available. The SSA listing is the same throughout the United States. However, you must have your treating doctor document the symptoms of your TBI using listing 12.02. Because medical records and the opinion of your doctor that you have a TBI are crucial to winning your SSDI and SSI benefits.
HOW TO MEDICALLY DOCUMENT YOUR TBI
Your treating doctor must document your TBI or neurocognitive disorder. Typically, this means that your doctor will discuss whether you have had a decline in your mental ability. You may also have memory trouble. This could take the form of memory loss, like losing your keys, phone, or being unable to remember your address.
If you have these issues, then you can request a mental exam at the expense of the SSA. During that exam, you can receive IQ testing on the WAIS IV, which will show your symptoms.
Additionally, a TBI can impact your executive functioning. Executive function is a higher level thinking process. For example, this would be being able to focus your attention or being able to plan for the future. Executive function is also seen in your ability to make decisions. It is also part of your ability to use language and speech, insight, judgment, and understand social standards.
What is not part of 12.02, are conditions such as an intellectual disorder, autism spectrum disorder, and neurodevelopmental conditions.
Your doctor should write a letter and submit all progress notes to your attorney and the SSA. There are forms your doctor can complete that will support your application for benefits. Hiring an attorney who can obtain this information from your doctor will help you win your case. Read here to learn more about the importance of medical evidence in your Social Security claim.
THE MEDICAL EXPERT AT YOUR SOCIAL SECURITY HEARING
Medical Experts or ME’s commonly testify at Social Security hearings. They are called by the ALJ to review your medical records for traumatic brain injury. Also, they explain your medical conditions to the judge. Additionally, they testify as to whether or not your medical condition meets or equals an SSA listing. Similarly, an ME can be requested by your attorney. This is, however, mostly done in complex medical cases.
The medical expert who appears at the hearing is not your treating doctor. The doctor at the hearing must have never met you before. Because, the medical expert is there to give testimony about your medical records and should not be on either side of the case.
Medical experts are doctors or psychologists who the SSA calls to testify about your TBI at the hearing. Usually, the medical expert comes to the hearing. However, they can also testify by video or by telephone.
It is also possible for an ME to answer written questions after the hearing. These written questions are sent to the expert after the hearing. Interrogatories require review and possibly filing objections. If you do not know how to do this, then hire an attorney. Do not make the mistake of not preparing for the medical expert.
SUBMIT ALL OF YOUR TBI MEDICAL RECORDS
Prior to your hearing, you can review the medical experts resume. If an ME is going to testify at your hearing, then they must submit a resume to the court. Your attorney can review the resume of the medical expert. They can also object to the appearance of the ME. Remember, at the hearing, the burden to prove that you deserve benefits is on you.
There are firm time lines in which you must submit your medical records. The SSA rule states that all medical records must be sent to the judge five days prior to your hearing. This means five “working” days. In other words, you must submit all medical records SEVEN days prior to a hearing. If you submit evidence past the seven days, then you must have a good reason as to why you did not submit the records on time. Learn more about the SSA evidence hearing rules.
Remember, everything must be in the SSA record one week prior to the hearing. There are good reasons for this rule. The SSA is dealing with thousands of hearings across the nation. It helps the SSA to have the evidence so the judge and experts can review it. The bottom line is this: one week prior to the hearing is the final date for you to submit all of your medical records. If you have an attorney to help you do this, then it will help your case.
HIRE AN ATTORNEY TO QUESTION THE MEDICAL EXPERT
Unfortunately, if you do not hire an attorney to help you, you will probably lose your case. Most cases turn on the ME’s testimony at the hearing. An attorney can make sure that all of your symptoms are being considered by the medical expert.
You will also need an attorney to question the medical expert. You may be able to provide testimony on your own to the judge, but when it comes time to ask questions of the ME, you need knowledge of SSA’s rules. Likewise, you need to understand your medical condition and the medical record.
The rules regarding the kinds of jobs and how you can perform those job with your physical conditions are complex. If you do not have an attorney, you can lose your hearing due to the negative testimony of the medical expert.
If your attorney has experience, they will also know what the ME is likely to say in response to the ALJ’s questions. They will also know how to question the ME and solicit testimony regarding your RFC. Learn more about the role of your RFC. The RFC is crucial to the judge finding that you deserve to be paid benefits, if you do not meet an SSA listing.
Questioning the medical expert is difficult. Trying to do it yourself is a bad idea. Especially if you have never done it before. If nothing else, you should hire an attorney to represent you if the Judge has called a medical expert to your hearing. Read here if you have questions about your hearing.
HIRE AN ATTORNEY TO QUESTION THE VOCATIONAL EXPERT AT YOUR HEARING
Vocational Experts (VEs) have training at placing people in jobs. They also understand the numbers and types of jobs that exist in the nation. They may be called by the judge to testify at your hearing. The VE answers questions about the kinds of jobs you could perform with your TBI.
Once the Judge asks you questions about your physical and mental limits, she will decide what you are capable of doing during an 8 hour work day. The SSA calls this your residual functional capacity (RFC). Therefore, your answers to the questions about how your TBI impacts you during the course of a normal day are very important. For example, do you need to lie down and sleep for a few hours during the day because of your TBI? This is a fact the judge should know.
The Judge listens to your testimony and reads about your symptoms in the medical records to determine how your TBI would impact you on the job. Then, the Judge asks the VE questions about what jobs someone like you can do.
The SSA does not care whether a job is in your area, near your home, or how much it pays. The judge does not need to consider common sense factors, as if you were searching for a job. Instead, the judge looks at whether or not there are jobs available to you in the entire nation.
Most judges are not experts in how many and what types of jobs there are in the country. They are also not experts at placing people with a TBI in jobs. Therefore, they hire a VE to give testimony about those issues. The ability to question the VE is another good reason to hire an attorney to help you at your hearing.
CONTACT US TO HELP WIN YOUR TRAUMATIC BRAIN INJURY CASE
If you have a TBI or another brain condition and you can no longer work, then contact our law firm. It is likely that we will be able to take your case and represent you before the Social Security Administration. We can usually tell you over the phone whether you qualify for benefits. Learn how to check on the status of your application.
At our law firm, we help our clients file their application for benefits. We also help you appeal any SSA denial. Additionally, we represent you in court before the SSA judge. We will also represent you and only charge you an attorney fee if we win your case. If we do not win, you do not owe an attorney fee. Therefore, you have nothing to lose by calling Cannon Disability Law and hiring us to be your legal team. Give us a call today.
WE CAN HELP YOU WIN BENEFITS FOR TBI
Our lawyers and staff want to be your Social Security legal team. We bring over 30 years of experience to your case. For instance, Dianna Cannon has been helping people win benefits in court hearings for over thirty years. She also has experience filing appeals at the Appeals Council and in Federal Court.
Brett Bunkall and Andria Summers also have many years of legal experience helping our clients in SSA hearings. You can trust that our lawyers and staff. We will do everything they can to win your SSD and SSI benefits.
Many people think they need to hire an attorney where they live, but you don’t have to hire an attorney near you. Instead, you can hire the attorney with the most experience. We can represent you no matter what state you live in, because we have licenses to practice law in Utah, Nevada, Idaho, and California. Utah SSD information can be found here. Read here, if you need more information about Nevada SSD benefits. Idaho SSD benefit information and California SSD information are also on our website.
We want to be your legal team. It is always our goal to win benefits for our clients. But it is also our goal to make the whole review process easier for you. If you have a traumatic brain injury, then you will need help. Contact our legal team now and put our years of experience to work for you.
