Employment after TBI

Introduction

As a person with a traumatic brain injury (TBI), you may want to get a job or return to work after your TBI. Work provides an income and health insurance. Work can also improve your quality of life, social engagement, and overall well-being.

The effects of TBI may interfere with returning to, finding, and keeping a job. These effects may be

Cognitive. This includes decreased attention, memory, communication, reasoning, and problem-solving.

Physical. This includes fatigue, sleep problems, poor coordination, and impaired vision.

Emotional. This includes depression, irritability, post-traumatic stress disorder, anger management, and anxiety.

Behavioral. This includes impulsiveness, aggressiveness, and social inappropriateness.

Supports and services are available to help you return to, find, and keep a job. These resources vary based on (1) the severity of your TBI, (2) the type of job and its duties, and (3) the jobs that are available. This factsheet provides an overview of these resources.

Vocational Rehabilitation

Vocational rehabilitation (VR) programs help you get the services you need to go back to work and to find and keep a job. VR counselors help with job seeking skills and job placement. VR counselors also help you learn and perform activities needed for your job (job coaching). They can also help with exploring career options and with training that may be needed.

Tips to Prepare for Returning to Work

Plan what you need to do emotionally and physically to go back to work. For example: Practice waking up at the same time each day; work on increasing your cognitive or physical endurance; or practice commuting to and from the worksite.

Talk with your health care team about going back to work. They may have recommendations, such as working part-time at first and slowly returning to full-time or taking longer rest breaks. They can list these kinds of recommended workplace changes, called accommodations, on a release form to return to work.

Stay in touch with your employer about your recovery and when you might go back to work. A VR counselor or disability advocate can help you update your employer.

Work with a VR counselor to help plan your return to work. They can put supports in place at your worksite. VR counselors are available through state vocational rehabilitation agencies.

Volunteer to help you return to the community and to work. For example, volunteering can help improve communication skills, teamwork, and cognitive and physical endurance.

Where to Find VR Services

People with TBI often find jobs on their own. But, sometimes you need help. When you are in rehabilitation, you can ask your doctor, rehabilitation therapist, or social worker to refer you to a VR program. You can also find your state’s VR agency at the Rehabilitation Services Administration website (https://rsa.ed.gov/about/states).

For service members and veterans, contact your Veteran Readiness and Employment (VR&E) program (Chapter 31) to explore employment opportunities and educational or training needs (https://www.va.gov/careers-employment/vocational-rehabilitation/).

How Does VR Work?

Trained VR counselors provide services to people with disabilities. These counselors receive training to help or guide people with disabilities in finding or keeping a job or going back to work. VR counselors work closely with employers and rehabilitation teams.

The Job Search

When helping you look for a job, your VR counselor will start by asking you about your interests and abilities. They will also look at your work skills, your health needs, your work and education history, and your personality style. The counselor will get this information from interviews or questionnaires. They will get information about your health from your health care providers. They may also do testing. They may set up opportunities for you to learn more about various jobs. The VR counselor will match your work interests, skills, and needs with the skills and demands of jobs in your local job market.

The Job Market

Part of the process may be looking at different jobs in the job market. You may want a certain job in a specific industry. But if job opportunities in that industry are declining or not available in your area, you may need to look at other options that relate to your interests or use the skill sets you have. Your VR counselor can help you find open jobs in your area. They can help you look at the wages, tasks, education needs, training, and other features of jobs that may interest you.

Setting Short-Term and Long-Term Work Goals

The result of the VR process is choosing the career or job you want to go back to or pursue. This is your long-term goal. You will work with your VR counselor to make a written plan with specific steps to reach your short- and long-term goals. For example, you may need to finish high school or go to college to enter the job of your choice. You may need to find transportation and accessible housing. Setting goals is important but keep in mind that you may need to adjust your goals as you work through this process. Do not get discouraged.

Discrimination

Discrimination in hiring is illegal, even if the discrimination is not done on purpose. Some employers are unaware that their attitudes or stereotypes about people with disabilities can affect their actions and decisions. They may not have the experience to understand that people with disabilities can work and be successful in a job. In these cases, a VR counselor can work with an employer to help educate them on the facts. The VR counselor can also suggest work accommodations that may help to increase the employer’s comfort hiring a person with a disability.

The Americans with Disabilities Act (ADA)

The ADA protects people with disabilities from job discrimination.

• When you apply for a job, an employer can’t ask you if you have a disability. Also, they can’t ask about the nature of your disability. They can only ask you about your ability to carry out certain job duties.
• An employer can require you to pass a medical exam. But it must be related to the job and required of all employees in similar jobs.
• If you think that an employer has discriminated against you, the U.S. Equal Employment Opportunity Commission (EEOC) can help. Call 800-669-4000 to find an office near you. You can also go to http://www.eeoc.gov. Many states also have powerful disability rights laws.

Workplace Accommodations to Help You Return to Work

If you choose to disclose that you have a disability, it is OK to ask your employer to make changes at your workplace to help you return to work and stay at work. The ADA requires employers to provide you with reasonable workplace accommodations. But these changes must not cause the business undue hardship. You can find more information on the ADA at http://www.ada.gov/.

VR counselors and your rehab care team can help you find the accommodations that are right for you. They can also help you figure out if the accommodations create “undue hardship” for the employer.

When employers provide accommodations, they help you become more successful in your work. This benefits the employer and you. Here are a few workplace changes your VR counselor may suggest.

To be protected by the ADA:

1. You must have a disability that limits major life activities.
2. You will need to make a request for accommodations.
3. Your health care team or VR counselor can provide information to support your request.

Changes to Schedule

• A flexible work schedule, which includes starting with reduced hours and slowly increasing hours
• Extra or longer breaks while at work
• More time to learn new duties
• Uninterrupted work time

Changes to Work Environment

• Limiting distractions due to noise, visual stimuli, and interruptions
• On-site job coaching to help with organization skills; extra job training
• High-intensity white lights instead of fluorescent lights

Use of Technology

• Glare guards for computer monitors to minimize discomfort caused by bright light or glare
• Software to help stay on task
• Use of audio recordings of meetings and phone calls to decrease demands on memory and on processing information

Frequently Asked Questions (FAQs)

Should I tell employers about my TBI? Whether to tell employers about your TBI and what to tell them is a personal decision. Talk to your VR counselor about the pros and cons of doing this. You can also talk to members of your rehabilitation team, your family, peers, and others who are close to you.

Who pays for VR services? (1) State VR programs are free for anyone who has a disability that limits their ability to work. (2) Some private health insurance companies pay for these services; check with your insurer to learn what services they cover. (3) State workers’ compensation programs provide free VR services to those who are injured on the job. (4) The Veterans Administration (VA) provides free VR services to those who are eligible.

What if I can’t work? If you can’t work, financial help is available. The Social Security Administration (SSA) provides disability benefits to those who qualify. To qualify, you must be unable to do any kind of work at a “substantial and gainful” level. Also, your disability must be expected to last at least a year. The SSA pays disability benefits under two programs:

• Social Security Disability Insurance (SSDI). This is a long-term disability insurance program funded by payroll taxes. Eligibility is based on your past work history and income.
• Supplementary Security Income (SSI). This is a federal welfare program for people with disabilities who can’t work and have low incomes.

People with a recent TBI should apply for SSA benefits right away if it seems likely that they will not return to work for at least a year. There may be a waiting period before you start to receive benefits. Once enrolled, you will be eligible immediately for state Medicaid benefits or, after a waiting period, for federal Medicare benefits. Even if you can’t work now, you may have more options in the future.

Will I lose my benefits if I go back to work? Maybe, but if this does happen, it usually happens after you’ve worked for a while. This gives you time to find a good balance between your work income and benefits. The best way to find out is to talk to a VR counselor or a social worker who knows how your benefits work. You may get benefits through your employer.

• Federal work incentives allow people with disabilities who receive Medicaid, Medicare, or Social Security benefits to keep some of their earnings from a job.
• Social Security benefits include SSDI and SSI.
• The Ticket to Work Program allows individuals to work up to 20 hours per week if they are receiving SSDI or SSI.
• Some private or state long-term disability plans include VR benefits or incentives to go back to work.
• The VA’s VR program protects veterans’ federal benefits while they are receiving services. (Also see the “Resources” section in this factsheet).

Should I volunteer? If a paid job is not possible, think about doing a volunteer activity. Volunteering can be fun, rewarding, and helpful to others. You can also learn new skills, gain confidence, and make contacts that might lead to a paid job.

Resources

• Social Security Disability Insurance (SSDI) and Social Security Income (SSI) website called “Disability”: http://www.ssa.gov/disability/ This site provides a description of SSDI and SSI programs. It also gives information on how to apply for disability benefits.
• Brain Injury Association of America: Adults and Brain Injury: Returning to Work: https://biausa.org/adults-what-to-expect/adults-brain-injury-returning-to-work
• Brain Injury Association of America: Employment After Traumatic Brain Injury: https://bianys.org/wp-content/uploads/2015/05/Employment-after-TBI.pdf
• Flint Rehab: Returning to Work After Brain Injury: What to Expect and How to Prepare: https://www.flintrehab.com/returning-to-work-after-brain-injury/
• Centers for Independent Living: https://acl.gov/programs/aging-and-disability-networks/centers-independent-living
• For information about workplace accommodations and disability employment issues: Job Accommodation Network (JAN), a service of the U.S. Department of Labor’s Office of Disability Employment Policy: https://askjan.org/
• Social Security Administration: The Red Book: A Guide to Work Incentives and Employment Supports: http://www.socialsecurity.gov/redbook/
• Location of Social Security Regional Area Work Incentive Coordinators (AWICs): http://ssa.gov/disabilityresearch/wi/awic.htm This site helps you find contact information about work incentive resources in your area.
• Ticket to Work Program: https://www.ssa.gov/work/ This site provides information about work and work development program offerings in your area.

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Authorship

Employment After Traumatic Brain Injury was developed by Bridget A. Cotner, PhD, Therese M. O’Neil-Pirozzi, ScD, Lauren Ratcliffe, PsyD, and Brick Johnstone, PhD, in collaboration with the Model Systems Knowledge Translation Center.

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model System (TBIMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs. The content of the factsheet has also been reviewed by individuals with TBI and/or their family members.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended citation: Cotner, B. A., O’Neil-Pirozzi, T. M., Ratcliffe, L., & Johnstone, B. (2025). Employment after traumatic brain injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/tbi/factsheets/employment-after-tbi

Copyright © 2025 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.