One of the questions I get all the time is when should a person apply for possible Social Security disability benefits. Watch the video below for the answer then please contact us. We are here to help. Remember, we charge no fees unless we win your case!
Cancer is a serious, debilitating condition. Any type or state of cancer is disabling, but a diagnosis alone will not automatically qualify you for Social Security disability benefits for cancer. If you are suffering from an aggressive cancer that prevents you from working for at least 12 months, you may qualify for disability benefits under the Social Security Administration (SSA). Disability benefits can help you alleviate some of the financial stress of medical bills, prescriptions, everyday living expenses, and other costs you will face while you are unable to work.
Qualifying for Social Security Disability Benefits for Cancer Under Compassionate Allowances
Disability claims filed to Social Security primarily on the basis of cancer may be treated differently from other claims in one way: the most severe conditions and prognosis are expedited in the system. This is referred to as a “compassionate allowance.” Compassionate Allowances (CAL) is the SSA’s way of quickening the application process for diseases and medical conditions that are obviously disabilities based on objective medical information so that allowances can be obtained quickly.
Most cancers will qualify as a CAL if one of the following has occurred:
- The cancer has spread beyond the region of origin
- The cancer is inoperable
- The cancer is recurrent despite treatment
For example, cancer of the pancreas, Inflammatory Breast Cancer (IBC), inoperable kidney cancer, and small-cell cancer of the large intestine, ovaries, prostate, thymus, uterus, or lung are types of carcinoma that meet one of the SSA’s official CAL listings for disability based on a diagnosis of the cancer alone. Minimal medical records are required if an applicant meets a CAL listing.
Other forms of cancer may still qualify for benefits but you must prove, through medical evidence, that such cancer meets the guidelines set forth by the SSA and prevents you from working. When making a disability determination and evaluating the level of impairment resulting from a malignant tumor the SSA will consider:
- Location of the cancer;
- Formation and development of the tumor;
- Degree of involvement;
- Response to treatment; and,
- Severity of post-treatment symptoms
Medical Evidence for Non-CAL Applicants
A disability application for cancer in adults is reviewed according to SSA’s Blue Book listing Section 13.00, which is broken down by the body system where the cancer first develops.
Medical documentation to the SSA must include a diagnosis of cancer supported and verified by symptoms, laboratory findings, and signs, as well as statements indicating the origin of the cancer and whether the malignant tumor is a primary, recurrent, or a metastatic one. The SSA can use the operative report from a biopsy that includes the gross and microscopic examination of tissues and other pertinent observations as part of the case documentation.
Medical records are essential in a request for disability benefits for cancer. The SSA will usually require all of the following prior to approving a disability claim for cancer:
- Surgical or biopsy notes from a physician;
- Biopsy results or a pathology report documenting the type of cancer found;
- Imaging scans showing the location(s) of tumors or spread of the disease; and,
- Details of the frequency of cancer treatments and their affects.
A cancer case will be decided on the basis of the medical record documentation which includes admission and discharge summaries from hospitals, physician’s office notes and reports of blood work and imaging studies. Medical records are crucial and unexplainable gaps in them may result in a denial of your claim for benefits.
Qualifying for Social Security Disability Benefits for Cancer Under a RFC Analysis
If you have a form of cancer that does not qualify as a CAL or a specifically listed condition in Section 13.00, it is still possible to receive benefits through the SSA’s “residual functional capacity” or RFC analysis. The SSA will evaluate the medical records and RFC reports to determine how the cancer itself and its treatments have impacted your ability to function normally throughout the day. In order to qualify under an RFC analysis, however, the SSA will investigate whether the cancer, required treatments, and the side effects are so severe that you are not able to work any job. Your age, education, and work-skills are important factors. Older individuals and those with less education are more likely to be approved for benefits because they are considered harder to train and able to perform fewer jobs.
You may suffer from the side effects of the cancer treatment even more than the symptoms themselves, making it difficult to work. Certainly, chemotherapy and radiation treatments which cause nausea, vomiting, fatigue, and other ailments can have a significant impact on your ability to function normally. However, it is difficult to obtain disability benefits solely because of treatments. The negative side effects over the course of chemotherapy or radiation treatment do not, generally, last for a full year as the SSA requires.
Documenting side effects in a personal journal and with your physician is important to support your disability claim. It may also be helpful to provide a statement by another person who has witnessed the effects of the treatment on you.
It is easier to get Social Security disability benefits when the long-term effects of the chemotherapy or radiation treatments are disabling. In such cases, the SSA will evaluate the long-term effects (heart or liver problems, bone weakness, reproductive disorders, eye problems, etc.) of the cancer treatments on their own, without considering the original cause.
Notify the SSA About Changes to Your Medical Status
It is imperative to keep the SSA informed of changes to your medical condition even if you have already been denied benefits. If your cancer has progressed, alert the SSA that the cancer has metastasized, or, if you were already denied benefits, reapply for a CAL. Likewise, if after three or more years the original tumor and any metastatic disease are no longer evident, the SSA should be notified because the impairment may no longer meet the disability criteria.
Learn More About Obtaining Social Security Disability Benefits for Cancer
For those who qualify, Social Security disability benefits can help provide monthly financial support for the medical treatments you require. If you are seeking to obtain Social Security disability benefits for cancer, consult our knowledgeable and experienced representatives with Adams & Associates Disability, Inc. by calling (888) 551-1190.
Whether you applied for Social Security Disability benefits or someone you know applied for benefits, you may be called to testify at a Social Security Disability hearing before an Administrative Law Judge. Your testimony at a Social Security Disability hearing is crucial to your claim. Not only will your testimony provide additional support that you, or a loved one, have a qualifying disability, but it is also your opportunity to explain away any misgivings that the Social Security Administration has regarding your qualification for disability benefits.
Preparing to Testify at a Social Security Disability Hearing
If you are going to be testifying at your Social Security Disability hearing, or if you are going to testify on behalf of another at such a hearing, to ensure your best testimony, there are things you should do well in advance of the time you enter the courtroom. Most of us do not testify on a regular basis. Consequently, it can be a nerve wracking experience. By taking the time to prepare ahead of time, you will be able to thoughtfully consider possible events, and plan for your responses.
Review What You Have Already Submitted
Take a few minutes to review the documentation that has already been provided to the Administrative Law Judge in your case. Look at your original application, as well as your medical file. Take a moment to review when your medical information was submitted. Review any diaries you have recording your symptoms and restrictions or limitations. Have you seen a doctor or other medical professional (including mental health professionals) since the file was submitted? If so, make sure to update the Social Security Disability file.
Once you have assured yourself that your Social Security file is up to date, review what has been submitted. This will allow you to understand what the Administrative Law Judge already knows about your case.
Pause and Reflect
If you are going to testify at a Social Security Disability hearing, you have something to provide to the Administrative Law Judge over and above what is in the medical file. Stop and consider what you will contribute to the Administrative Law Judge’s understanding of your condition or your loved one’s condition. This is the time to talk about your abilities, limitations, and struggles. Whether you are testifying about yourself or a loved one, consider what concrete examples you can provide to illustrate the point. For example, “She’s tired all the time,” is not particularly illuminating. Rather, consider providing more specific information, such as “She gets up at 8 in the morning and by 11:00, she’s back in bed, napping. She usually gets up again around 2:00 pm, and can stay awake until after dinner. But then she goes back to bed for the night by 7:00 pm.”
If there are three different challenges that you or your loved one faces, come up with concrete examples to illustrate each of these challenges. By taking the time to do this ahead of the hearing, you will be assured that you have come up with the best examples to illustrate your points.
When You Go to Testify at a Social Security Disability Hearing
What to Wear
This is a judicial proceeding, and should be treated accordingly. You should dress in a manner that makes it clear to the Administrative Law Judge that you have respect for him or her, and for the proceedings. If you have a suit, wear it. For women, if you do not have a suit, a nice button down blouse and dress pants or a skirt that goes at least to the knee is appropriate. For men, a button down shirt and khakis or dress pants is appropriate.
What to Expect
You should expect to be sworn in before you testify at a Social Security Disability hearing. First you will be asked some preliminary questions, such as your name, address, perhaps your age, as well as your relationship with the relevant party, if you are testifying at someone else’s hearing. Once the preliminary matters have been put on to the record, the Administrative Law Judge will begin questioning you. Judges are people, just like everybody else, and as you might expect, different judges will have different preferences as to how they like to proceed with their questioning. Some might have a very relaxed and open attitude. They might simply ask, “What would you like me to know about this person?” and let you provide a narrative. Others may ask more detailed, specific questions, such as “What have you observed?” “When did you see this?” “How often does this occur?” You probably won’t know your Judge’s style until you are in the courtroom.
The critical thing to keep in mind when you testify at a Social Security Disability hearing is to listen to what questions are being asked, and answer those questions only. Do not provide commentary about things you have not been asked about. Administrative Law Judges have wide latitude when it comes to deciding whether or not to take your testimony. If you launch into narrative, providing details that are all included within your medical file, which the Judge has already read, the Judge may decide you have nothing of value to add to the case. She may cut you off before you get to the important part of your testimony, which, in the judge’s mind, will be the answer to the question she asked you.
Understand that when you are done answering the Judge’s questions, you may be asked additional questions by your representative, or the representative of your loved one. This will provide another opportunity to provide relevant information. Because the representative is in the best position to determine what the Administrative Law Judge should know, you may rest assured that any information you have that was not brought out during the questioning of the Judge can be brought out by the representative.
A Critical Piece of Information When Testifying
When you testify at a Social Security Disability hearing, you are under oath. This means you have agreed to tell the truth. If you do not tell the truth, you could be subject to civil and criminal penalties for your perjury. In other words, you could be subject to a fine or jail or prison time. Consequently, it is critical that you not exaggerate or stretch the truth. Simply provide factually accurate information.
Have you been diagnosed with Inflammatory Bowel Disease? Are your symptoms so severe that it is debilitating and prevents you from substantially performing your duties? If so, you may be entitled to social security disability benefits for inflammatory bowel disease.
What Is Inflammatory Bowel Disease?
Not to be confused with the non-inflammatory functional disorder of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) involves the chronic inflammation of a part or all of the digestive tract. IBD primarily includes Crohn’s disease as well as ulcerative colitis; however, there are other diseases that may fit under the general title of “Inflammatory Bowel Disease.”
Crohn’s disease is an IBD that causes inflammation of the lining of the digestive tract. This inflammation can spread deep into the affected tissues and can involve different areas of the digestive tract. Crohn’s disease can involve any portion of the alimentary tract from mouth to anus. This inflammation can present in an asymmetrical and segmental fashion. Common manifestations of Crohn’s disease include obstruction, stenosis, perineal involvement, and fistulization. There can also be extra-intestinal manifestations. Rarely is Crohn’s disease curable. Surgical resection is a treatment option; however, recurrence of Crohn’s disease can be a lifelong battle.
Unlike Crohn’s disease, which can affect the alimentary tract from mouth to anus, ulcerative colitis only affects the colon. The inflammation that comes with ulcerative colitis may be limited to the rectum. Alternatively, ulcerative colitis could extend proximally to include any contiguous segment. Finally, ulcerative colitis can, in some cases, involve the entire colon. A total colectomy may cure ulcerative colitis.
Symptoms of Inflammatory Bowel Disease
If you have been diagnosed with IBD, you may experience the following symptoms:
- Perineal disease;
- Palpable abdominal mass (this is usually inflamed loops of bowel);
- Fecal incontinence;
- Abdominal tenderness;
- Rectal bleeding;
- Arthralgia (joint pain);
- Abdominal pain;
There can be other laboratory findings that may be indicative of IBD, including weight loss, malnutrition, edema, hypomagnesemia, anemia, hypocalcemia, hypoalbuminemia, or hypokalemia.
IBD can also manifest symptoms that are “extra-intestinal” – in other words, in other body systems. For example, there can be eye involvement, with uveitis, iritis, or episcleritis present. Gallstones and other hepatobiliary diseases may present themselves. Urologic diseases such as obstructive hydro nephrosis or kidney stones may manifest. There may be skin involvement, such as pyoderma gangrenosum or erythema nodosum – the most common cutaneous manifestations that occur with inflammatory bowel diseases. Vascular disease and thromboembolic disorders can manifest as part of IBD. Finally, non-destructive arthritis may manifest along with IBD.
How Is Irritable Bowel Disease Diagnosed?
Crohn’s Disease Diagnosis
Crohn’s disease has a broad range of symptoms. As such, there is no single test that can definitively diagnose Crohn’s disease. Diagnosis is done through a combination of evaluating symptoms and attempts to exclude other potential causes for the symptoms. Preliminary testing can include lab tests on stool and blood, and X-rays of both the lower and upper GI tracts. A colonoscopy or an upper endoscopy may be appropriate. Doctors also frequently desire a biopsy of the colon or other affected area, to determine the presence of Crohn’s disease. Finally, a doctor may wish to order small intestinal imaging to better visualize portions of the intestine not readily visualized by either an endoscopy or colonoscopy.
Ulcerative Colitis Diagnosis
Like Crohn’s disease, evaluating for ulcerative colitis will start with lab tests on blood and fecal matter. Specifically, the lab tests will assess stool specimens for the possibility of a parasitic, viral, or bacterial cause of diarrhea. Blood tests will evaluate for anemia and signs of infection. Endoscopy, either sigmoidoscopy or a total colonoscopy, may be employed. A biopsy may also be taken. Finally, as with Crohn’s disease, an evaluation of the lining of the small intestine may be ordered.
Criteria for Disability
There are a number of different types of symptoms which can lead to a diagnosis of IBD. As a starting point, IBD can be documented by a biopsy, endoscopy, or other appropriate medically acceptable imaging, or operative findings; along with either the following documented symptoms from Category A or B of the Social Security Administration’s (SSA) blue book listing 5.06 for disabilities.
Category A requires documentation of an obstruction (not an adhesion) of stenotic areas in the colon or the small intestine, with proximal dilatation. This must be confirmed by imaging or surgery, with hospitalization or surgery for intestinal decompression. This obstruction must have occurred, within a six month time frame, on at least two occasions that are at least 60 days apart.
Category B requires two of the following symptoms present, despite ongoing treatment, within a six month period:
- The need for supplemental daily parenteral nutrition through a central venous catheter or enteral nutrition through gastrostomy; or
- Anemia with hemoglobin test results of less than 10.0 g/dL, on two separate evaluations at least 60 days apart; or
- Involuntary weight loss of at least 10%. This weight loss can be calculated in kilograms, pounds, or by using the Body Mass Index. There must be documentation of two evaluations at least 60 days apart; or
- Serum albumin of 3.0 g/dL or less, on two separate occasions at least 60 days apart; or
- Perineal disease with a fistula or draining abscess, accompanies by pain that cannot be completely controlled by prescribed narcotic medication, on at least two evaluations 60 days or more apart; or
- A tender abdominal mass, clinically documented, that is palpable on physical examination with abdominal cramping or abdominal pain that cannot be completely controlled by prescribed narcotic medication, present on at least two separate evaluations that occur at least 60 days apart.
In determining impairment, if your IBD impairment does not meet any of the criteria of SSA’s listing 5.06, the SSA will consider the effects of the extra-intestinal manifestations if they meet or are medically equal to another system. SSA will also consider the extra-intestinal manifestations when assessing residual functional capacity.
No one knows your pain better than you. And if you seek relief through Social Security Disability Insurance it may be quite a “pain in the back.” Be assured, back problems are the most common of all petitions to the Social Security Administration (SSA). Social Security Disability benefits may be available for chronic back pain but it will not be easy to prove. Evidence of pain and other symptoms, severity of impairment, and your credibility will all be considered.
Objective Signs of Chronic Back Pain
Benefits primarily go to those who have “medically determinable” back impairment; applications for moderate or intermittent back pain will not be granted. Success on your application for disability benefits are most likely to succeed when there is medical evidence supporting spinal disorders such as:
- Spinal stenosis
- Nerve root compression
- A chronic and untreatable herniated disc
Accordingly, the back injury must meet or “equal” those listed in the Social Security regulations “Listing of Impairments” found in The Social Security Bluebook Section 1.04 for Disorders of the Spine. In order to be eligible for Social Security disability benefits you must meet any of the three parts: A, B, and C listed in this section.
The Social Security Administration (SSA) will consider medical evidence of abnormalities on X-rays, CT scans, or MRIs of the spine. But objective abnormalities on these exams, standing alone, are not conclusive. At times, an individual may experience no or minimal symptoms, but an X-ray could reveal significant degenerative abnormalities. Contra, an individual whose X-ray revealed minimal or moderate objective abnormalities could experience severe and debilitating pain when bending over, standing for a length of time or walking long distance.
Thus, since objective evidence alone is insufficient, the SSA may also consider your behavior in seeking relief from the alleged symptoms, the nature and frequency of your visits to your treating physicians, responses to treatment, and activities performed and limited by pain.
A functional limitation is something you cannot do because of your back pain or injury. The question of disability depends on how much the chronic pain experienced interferes with the ability to perform everyday activities, such as walking, bending, lifting, or twisting. Most acute lower back pain is a result of a strain of ligaments and other soft-tissue supportive structures of the spine which will recover in less than one year even with no treatment. The SSA scrutinizes for chronic pain.
Some examples of limitations related to back problems that the SSA considers:
- Being unable to bend or stoop to pick something up
- Inability to walk more than a block without taking a break
- Not being able to lift or carry more than ten pounds occasionally
- Inability to sit or stand for at least two hours in a day
- Requirement that you be allowed to get up and move around or to change positions whenever you need to
- Need to keep at least one of your legs elevated throughout the workday
- Need to lay down throughout the day, and
- Inability to sit for at least six hours in a workday.
Most claimants with back problems do not qualify for Social Security disability benefits under the social security listing 1.04 and require a residual functional capacity (RFC) assessment. Functional limitations are used to determine your residual functional capacity (RFC). Although SSA doctors will prepare an RFC assessment form that considers functional limitations, it is still an essential part of your claim to have your treating doctor, a back specialist, also fill out an RFC form.
Your credibility matters. Since pain is subjective and hard for doctors to scientifically measure, it may be helpful to record your pain, discomfort, and functioning capacity in a journal. Your credibility compares the medical evidence in your file with statements of treating physicians as well as statements made by you to others (particularly employers and doctors) regarding symptoms impacting the ability to work, attempts to work, and how well you responded to treatments.
Your file should be consistent. The SSA will be looking for statements or behaviors that are not consistent with the record. If you tell the SSA that you cannot bend or stoop to pick something up, yet the record indicates that you continued to perform gardening and routine yardwork tasks, your credibility will be damaged.
Another factor in determining your credibility is the efforts taken to alleviate pain symptoms. The SSA is more persuaded by records that indicate a long-term effort at finding successful treatment to relieve the back pain. A claimant who has tried alternative treatments or different medications with varying dosages is more persuasive.
If you are seeking to obtain Social Security Disability benefits for chronic back pain, consult our knowledgeable and experienced representatives with Adams & Associates Disability, Inc. by calling (888) 551-1190.