Cerebral Trauma

Can I Get Social Security Disability Benefits for Cerebral Trauma?

If you have cerebral trauma, Social Security disability benefits may be available. To determine whether you are disabled by your cerebral trauma, the Social Security Administration first considers whether it is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See How to Get Disability Benefits for Cerebral Trauma by Meeting a Listing. If you meet or equal a listing because of your cerebral trauma, you are considered disabled. If your cerebral trauma is not severe enough to equal or meet a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite the cerebral trauma), to determine whether you qualify for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process.

About Cerebral Trauma and Disability

Cerebral trauma is an extremely complex medical event with numerous possible physical and mental consequences. Multidisciplinary teams are needed to take a patient through the long process of rehabilitation and even then there are often irreversible problems. The specific mechanisms of rehabilitations vary between institutions, but can include specialists such as primary care physicians, social workers, neurosurgeons, neurologists, physical medicine specialists (physiatrists), physical therapists, occupational therapists, psychiatrists, psychologists, nurses, respiratory therapists, financial planners, and others. That is why it is so important for the SSA not to get in a hurry to presume that a claimant with traumatic brain injury (TBI) will have a full recovery, or even some presumed level of recovery, without allowing sufficient time for the treating team to determine (1) how much physical and mental dysfunction is present and (2) what degree of rehabilitation is likely. Memory is a frequent problem post-TBI, but the SSA is particularly likely to miss more subtle abnormalities like defects in judgment and attentional processes unless great care is taken with these claims.

The most widely used scale for determining coma depth is the Glasgow Coma Scale (GSC) (see below). The GSC score is obtained by adding the independent scores regarding eye opening, verbal responsiveness, and motor responsiveness. The severity of traumatic brain injury (TBI) in relation to the GSC at the time of injury may be expressed as:

  • GCS 3 – 8 Severe
  • GCS 9 – 12 Moderate
  • GCS 13 – 15 Mild

Note that although the Glasgow Coma Scale is described below, physical information about the degree of brain damage, as with CT and MRI scans and neurosurgical findings, is also important. There are several million head injuries yearly in the U.S., frequently associated with the inappropriate use of alcohol. Particularly tragic are child brain injuries resulting from parental failure to take precautions for preventing head injury to their children.

See Residual Functional Capacity Assessment for Cerebral Trauma.

Definitions of Cerebral Trauma

No single, concise, universally accepted definition of traumatic brain injury (TBI) exists. According to Lehmkuhl (1996), TBI is defined as “damage to living brain tissue caused by an external, mechanical force. It is … characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The specific disabling condition(s) may be orthopedic, visual, aural, neurologic, perceptive/cognitive, or mental/emotional in nature. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma, or degenerative processes.” The Centers for Disease Control and Prevention (Thurman et al., 1995) defines TBI as either

“an occurrence of injury to the head that is documented in a medical record with one or more of the following conditions attributed to head injury:

  • observed or self-reported decreased level of consciousness
  • amnesia
  • skull fracture
  • objective neurological or neuropsychological abnormality
  • diagnosed intracranial lesion

or as an occurrence of death resulting from trauma, with head injury listed on the death certificate, autopsy report, or medical examiner’s report in the sequence of conditions that resulted in death.”

Causes of Cerebral Trauma

Some of the most frequent causes of brain trauma are accidents in motorcycles, or automobiles especially when seat harnesses are not being worn. Thousands of children suffer brain trauma every year in the U.S. as a result of falls from bicycles or skates without wearing head protection. Many tragic incidents of irreversible brain damage are seen by SSA, often associated with driving while intoxicated. Other cases involve diving into shallow water or sustaining blows to the head as victims of assault. Gunshot wounds to the brain, including attempted suicides, can produce tremendous damage.

The brain is extremely delicate, as soft as gelatin and easily traumatized. The cerebral cortex upon which all higher thought depends, is only several millimeters thick (the thickness of a few sheets of paper) and forms the outer thinking surface of the brain. Repeated blows to the head, even if each does not cause any obvious damage or subjective distress in itself, can result in slowly progressive but severe brain damage over time. That is what happens to some boxers. Every blow to the head can produce micro-bleeds with accumulative effect, and also possibly damage areas of the brain producing important neurotransmitter chemicals necessary for the brain to function properly. For example, the dime-sized nucleus ceruleus at the base of the each frontal lobe produces the critical neurotransmitter acetylcholine and is often damaged in head trauma, especially repeated head trauma as in boxing. Insufficient acetylcholine results in dementia. If one believed the entertainment media, being hit in the head with guns and other objects, as well as numerous fights, has little residual effect on heroes. In reality, this is far from the truth. Even mild blows to the head insufficient to cause loss of consciousness can cause death by brain damage, especially if repeated.

Coronal View of the Brain

Neurophysical Complications of Traumatic Brain Injury

  • Aneurysm
  • Arachnoid/leptomenigeal cysts
  • Arteriovenous malformations (including carotid/cavernous sinus fistula)
  • Cerebrospinal fluid leak (from ears or nose)
  • Compressive neuropathies (injuries to cranial nerves, e.g., facial, olfactory {smell}, vestibulo-cochlear {balance and hearing})
  • Headache
  • Motor impairment (spasticity, weakness, ataxia)
  • Movement disorders
  • Neuroendocrine dysfunction (pituitary and/or hypothalamic damage)
  • Seizures
  • Sensory dysfunction
  • Subdural hygroma (fluid collection under the dural membrane covering the brain)
  • Ventricular enlargement (hydrocephalus)

Cognitive Complications of Traumatic Brain Injury

  • Decreased speed of information processing
  • Executive dysfunction
  • Impaired attention and concentration
  • Impairment of visual-spatial skills
  • Intellectual decline
  • Language dysfunction
  • Memory impairment and amnesia

TBI has profound effects on memory function. Memory deficits following TBI include anterograde (impaired memory for events after TBI) and retrograde (impaired memory for events before TBI) amnesia. The period of anterograde or posttraumatic amnesia (PTA) appears to be a reliable predictor of outcome following TBI.

Neurobehavioral Complications of Traumatic Brain Injury

  • Aggression
  • Agitation
  • Anxiety
  • Apathy
  • Depression
  • Disinhibition/poor impulse control
  • Emotional lability
  • Hostility
  • Hysteria
  • Mania
  • Mood disorders
  • Obsessive-compulsive disorder
  • Psychosis
  • Sexual dysfunction
  • Violence
  • Withdrawal

Attentional processes are commonly affected following TBI and should be carefully assessed before attributing cognitive dysfunction to a specific domain. After TBI, detailed neuropsychological testing can reveal deficits in vigilance (sustained attention), freedom from distraction (focused attention), and the capacity for divided attention. The inability to attend to incoming information can result in an information-processing deficit that can affect performance in other cognitive domains. Slowed information-processing speed is a sensitive and well-documented result of TBI.

Language dysfunction is variably affected after TBI. Language deficits encountered after TBI can include mutism, inability to name objects (anomia), impaired comprehension, decreased fluency, impaired repetition, paraphasia (inability to select correct words or sounds within a word), circumlocution, disorganized and impoverished narrative, tangential or socially inappropriate conversation, disturbances in speech intonation, and the loss of speech spontaneity. Chronic insomnia and sleep disturbances may last for years after TBI, aggravating the individual’s inability to cope with other medical, cognitive, and emotional problems.

Continue to How to Get Disability Benefits for Cerebral Trauma by Meeting a Listing.