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.