Disability Benefits for Cancer

About Cancer

The term “cancer” refers to a group of diseases in which abnormal cells divide uncontrollably and destroy body tissue. Cells within the body divide normally but do so in a controlled and orderly way when other cells die or become damaged. However when a cancer cell forms, it begins dividing at an uncontrolled rate regardless of the presence of a damaged or dead cell. This leads to complications of the affected area as well as the rest of the body and in many cases, results in death.

There are over 100 different types of cancer that vary in origin as well as the way they grow and spread. Certain types of cancer respond to different types of treatments in distinctive ways. There are cancers that are best treated with drugs (chemotherapy) while others are better off treated through surgery. Once a medical professional diagnoses someone with a particular type of cancer, he or she will recommend the treatments that best suit the given type.

Social Security Disability and Cancer

The Social Security Administration (SSA) has a disability guidebook known as the Blue Book (a.k.a. Disability Evaluation Under Social Security) that lists the requirements necessary for particular impairments to qualify for disability benefits. The Blue Book is divided into 14 categories and the SSA has dedicated one of these categories to just cancer. Category 13.00 Malignant Neoplastic Diseases is the sections used to evaluate all types of cancer besides those associated with HIV.

13.00 Cancer (malignant neoplastic diseases)

There are 28 listings within category 13 covering the most common types of cancers, each with their own specific qualifications needed for that type to qualify. Some cancers only meet a listing if treatment and therapy are unsuccessful and the cancer continues to persist, progress, or reoccur. Here is are the 28 listings:

13.02 Soft tissue cancers of the head and neck
13.03 Skin
13.04 Soft tissue sarcoma
13.05 Lymphoma
13.06 Leukemia
13.07 Multiple myeloma
13.08 Salivary glands
13.09 Thyroid gland
13.10 Breast
13.11 Skeletal system – sarcoma
13.12 Maxilla, orbit or temporal fossa
13.13 Nervous system
13.14 Lungs
13.15 Pleura or mediastinum
13.16 Esophagus or stomach
13.17 Small intestine
13.18 Large intestine
13.19 Liver or gallbladder
13.20 Pancreas
13.21 Kidneys, adrenal glands, or ureters – carcinoma
13.22 Urinary bladder – carcinoma
13.23 Cancers of the female genital tract – carcinoma or sarcoma
13.24 Prostate gland – carcinoma
13.25 Testicles
13.26 Penis
13.27 Primary site unknown
13.28 Cancer treated by bone marrow or stem cell transplantation
13.29 Malignant melanoma

If an applicant has cancer that doesn’t meet any of the listings above or isn’t listed at all, the SSA will determine if the symptoms fulfill the requirements of any another listing in the Blue Book. Should an applicant’s symptoms not meet any of the listings, the SSA will evaluate how the applicant’s symptoms impair their ability to engage in activities of daily living or substantial gainful activity (receiving more than $1,130 per month in earned income).

Evaluating Cancer for Disability Benefits

The SSA considers the following when evaluating cancer:

1.) Origin of the cancer
2.) Extent of involvement
3.) Duration, frequency, and response to anticancer therapy
4.) Effects of any post-therapeutic residuals

The SSA needs medical evidence that specifies the type, extent (severity), and site of the primary, recurrent or metastatic lesion. Should the primary site be unidentifiable, the SSA will utilize documentation about the site(s) of metastasis to evaluate the cancer. In regards to operative procedures, the SSA will usually need a copy of the pathology report and the operative note.

If an applicant does not have any of the evidence discussed above, the SSA will accept any other medical or hospitalization reports of the cancer.

Side Effects of Therapy

The effects of anticancer therapy such as chemotherapy can have devastating side effects and cause long-term complications even if the therapy was effective against the cancer. These side effects are known as “post-therapeutic residual impairments” and may qualify an applicant for disability benefits if severe enough. The SSA evaluates each applicant separately due to the fact that therapy and toxicity can differ significantly from case to case. The SSA will request information about the therapy or treatment used as well as:

The drugs given to the applicant
The dosage and frequency of administration for each drug
Future plans for drug administration
Details of any surgeries utilized
Schedule & fields of radiation therapy

The SSA will also ask for details regarding any problems or adverse affects of therapy (post-therapeutic residual impairments) such as:

Gastrointestinal symptoms
Constant weakness
Neurological problems
Cardiovascular problems
Reactive mental conditions

Compassionate Allowances

Thousands of people apply for disability benefits daily. In order to quickly identify the applicants who have serious conditions who clearly meet disability standards, the Social Security Administration developed the Compassionate Allowances (CAL). CAL is a program that lists several severe conditions that most likely already qualify under the listings based on minimal medical documentation. This allows the SSA to quickly pinpoint applicants with serious conditions and approve them for disability benefits as long as they meet the technical requirements (income & asset rules, etc.)

Many forms of cancer appear on this list. To learn more about compassionate allowances and how the program works, click here.

The Three-year Rule

After an applicant has been approved for disability benefits for cancer, the Social Security Administration (SSA) will still consider the applicant disabled for three years after the onset of complete remission. Once the applicant has been in remission for at least three years without any relapses or metastases, the SSA no longer considers an applicant disabled and he or she will be taken off disability benefits.

SSA Cancer Terms

Listed below are some common terms the Social Security Administration uses in the Blue Book (listings of impairments) in regards to cancer.

Anticancer therapy – forms of treatment such as surgery, radiation, transplantation, chemotherapy or hormones.

Inoperable – Surgery can’t be performed or will have no therapeutic benefit. This does not include scenarios where surgery could have been performed but a different treatment option was chosen instead.

Metastases – the spread of cancer cells through body fluids such as blood or lymph.

Multimodal therapy – At least two types of anticancer therapy treatments performed within a short period. For example, surgery followed by radiation therapy.

Persistent – the initial anticancer therapy failed and cancer is still apparent.

Progressive – Cancer becomes worse after an individual’s initial therapy or treatment plan has been completed at least half way.

Recurrent/Relapse – Cancer that was completely removed or in complete remission returns again.

Unresectable – Cancer was not completely removed through surgery.

Social Security Disability application

Medical Qualifications application

Veteran Disability application