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    Beth Alpert & Associates

    53 W. Jackson
    Chicago, IL 60604-3607
    312-427-2611 phone
    312-427-2644 fax

    Cerebral Trauma

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

    To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your cerebral is severe enough to meet or equal the cerebral trauma listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your cerebral trauma is severe enough to meet or equal the listing, you will be considered disabled.

    The listing for chronic anemia is listing 11.18, which is merely a reference to possible other appropriate listings for evaluation of brain-trauma associated seizures (listing 11.02; see How to Get Disability Benefits for Epilepsy by Meeting a Listing), strokes (listing 11.04; see How to Get Disability Benefits for Stroke by Meeting a Listing), or organic mental disorders (listing 12.02; see Meeting Social Security Administration Listing 12.02 for Organic Mental Disorders).

    Due to the sometimes unpredictable course of TBI during the first few months post-injury, adjudication of these cases should be deferred until evidence of the neurological and mental conditions at least 3 months, and possibly 6 months, post-injury is obtained, to allow time for the conditions to stabilize. Of course, adjudication will not be delayed if a case can be allowed because of some other impairment.

    The important facet of this policy is to protect the claimant from inappropriate denial decisions based on the presumption that although allowance level severity is present at the time of adjudication the claimant’s impairment is not expected to be at allowance level severity for 12 months.Such presumption that allowance level severity will not be present 12 months after injury could incorrectly be based on the observation that the claimant is improving at 3 months post-injury although still at allowance level severity. Reliance on such an improvement projection at 3 months from onset is not reliable in cases of TBI. Such cases may appear to be improving significantly at 3 months post-injury, but plateau by 6 months. If SSA adjudicated the claim as a denial at 3 months post-injury by presuming continued improvement through 12 months, an injustice could be done. This does not mean that all TBI cases must be held 6 months. If no significant improvement has taken place by 3 months, the case can be adjudicated at that time.

    Cases of marked brain damage should be allowed immediately without waiting—especially if the claimant needs SSI Medicaid assistance to pay for rehabilitation. Waiting on rehabilitation in neurological impairments can have a very negative effect on the level of eventually recovery. Also, other impairments having nothing to do with the TBI may permit an earlier allowance.

    Meeting Social Security Administration Listing 12.02 for Organic Mental Disorders

    The listing for organic mental disorders is listing 12.02, which has three parts, A, B, and C. To meet the listing you must satisfy either both parts A and B, or part C alone. To satisfy any part of the organic mental disorders listing, you must have psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests must demonstrate the presence of a specific organic factor judged to be directly related to the abnormal mental state and loss of previously acquired functional abilities.

    Meeting Listing 12.02A

    You will meet listing 12.02A if you demonstrate a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following:

    1. Disorientation to time and place; or
    2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or
    3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or
    4. Change in personality; or
    5. Disturbance in mood; or
    6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or
    7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing (e.g., Luria-Nebraska, Halstead-Reitan, etc.).

    Meeting Listing 12.02B

    You will meet listing 12.02B if you meet the requirements in 12.02A and the loss of specific cognitive abilities or affective changes result in at least two of the following:

    1. Marked restriction of activities of daily living; or
    2. Marked difficulties in maintaining social functioning; or
    3. Marked difficulties in maintaining concentration, persistence, or pace; or
    4. Repeated episodes of decompensation (inability to maintain defense mechanisms in response to stress), each of extended duration.

    Meeting Listing 12.02C

    You will meet listing 12.02C if you demonstrate a medically documented history of a chronic organic mental disorder of at least 2 years’ duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following::

    1. Repeated episodes of decompensation, each of extended duration; or
    2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
    3. Current history of 1 or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

    Continue to Residual Functional Capacity Assessment for Cerebral Trauma.

    Go back to About Cerebral Trauma and Disability.