While most mild traumatic brain injury patients recover fully, a significant percentage experience permanent impairments.  Many designated doctors and RME doctors give zero percent impairment ratings for these injuries.  If you want to get the benefits and treatment you deserve, it is important for you to know how to calculate an impairment rating for a traumatic brain injury.

What Are The Components Of An Impairment Rating For A Traumatic Brain Injury

An impairment rating for a traumatic brain injury should be considered under Chapter 4 of the AMA Guides To The Evaluation of Permanent Impairment.  As the introduction to Chapter 4 notes, “impairment criteria are defined in terms of the restrictions or limitations that the impairments impose on the patient’s ability to carry out activities of daily living, rather than in terms of specific diagnoses.”  Therefore, an impairment rating should not be affected by a diagnosis of “post concussion syndrome” vs. “concussion” if the effects of the injuries are the same. 

Chapter 4 contains five sections – the central nervous system, the brain stem, the spinal cord, the muscular and peripheral nervous systems, and pain.  The certifying doctor must rate an injured worker under each of these sections if functional deficits are found in each, and combine the ratings for each section for a total brain injury impairment rating. 

The most common impairment in the traumatic brain injury patient will most likely be found under the central nervous system section.  This is where the neuropsychological examination becomes a factor.  Under the central nervous system section of Chapter 4, the doctor  must look at specified functional deficits of brain injury, such as sleep disturbance, cognitive problems, speech deficiency, and emotional and behavioral problems.  Then, each one of those aspects is rated using the tables contained in Chapter 4.  Those tables provide numeric ranges for mild, moderate and severe injury.  The most severe of the impairments, which is the highest impairment rating for the above deficits, represents the impairment rating for the central nervous system.  If no other impairments under Chapter 4 are noted, then this number will represent the appropriate impairment rating for the traumatic brain injury.

Examples Of How Certain Impairments Are Graded

For example, an injured worker with a traumatic brain injury who is able to perform activities of daily living with the assistance of a journal, which is a common brain injury rehabilitative device, may be rated under Table 2 of Chapter 4.  This table, titled “Mental Status Impairments,” provides a whole person impairment range from 15% to 29% for a person whose “impairment requires direction and supervision of daily living activities.”  It is within the discretion of the doctor as to what impairment between 15% and 29% best fits the injured worker’s condition.  Under that same table, a traumatic brain injury patient who requires continued supervision and home or facility confinement would be given an impairment rating between 30% and 49%. 

Because objective improvement in brain injuries can take two or more years, according to the Medical Disability Advisor, prematurely rating a mild to severe traumatic brain injury patient may result in an inflated impairment rating.  Access to targeted rehabilitation programs can facilitate a faster and more complete recovery, which is the goal of the Texas workers’ compensation system. 

Proving a diagnosis of traumatic brain injury requires being familiar with the expected symptoms and a thorough review of the available medical records.  In most every case, specialized testing will be necessary to diagnose and document the functional deficits associated with a traumatic brain injury.  If these deficits exist, then special attention should be given to the impairment rating certification because of the potential ranges of impairment in play.

Severe injuries like these may make a patient eligible to receive other benefits. You can turn your Texas workers’ comp injury into social security disability payments.