The Social Security Disability Application Process for Oral Cancer

Oral cancer is a broad term. It is a cancer that affects the tongue, salivary glands, lips, and/or buccal mucosa, which is the inner lining of the cheeks and lips. Oropharyngeal cancer is a kind of oral cancer that involves tumors developing in the upper throat and back of the mouth. This kind of oral cancer can impact the tonsils, tongue, back wall of the throat and the soft palate. With oral cancer, ulcers or open sores are common. This disease frequently spreads, either locally to other areas within the mouth or distant areas of the body.

If you have been diagnosed with oral cancer and it is impacting your ability to work, you may be eligible to receive Social Security Disability benefits. The Social Security Administration (SSA) pays disability benefits to those who have worked enough to earn sufficient credits through the Social Security Disability Insurance (SSDI) program. During that time, you have had to pay in enough taxes to the SSA.

Those who receive benefits have to be disabled for at least a year and fully disabled. This means no partial disability of short-term disability, but only benefits for full, permanent disability. The SSA adheres to strict guidelines to determine whether an individual’s condition warrants permanent disability. With accurate documentation, the process may seem simple but at other times, the process can be time consuming and lengthy.

Financial Expenses Related to Oral Cancer Treatment

Everyone knows that any kind of cancer treatment is expensive, and oral cancer is no exception. According to Delta Dental, the average cost for treating advanced oral cancer can well exceed $200,000. The treatment varies greatly, depending on how advanced the cancer is and where it is located. There are 34,000 new patients diagnosed with oral cancer in the U.S. each year. Only half of those diagnosed with oral cancer live past the milestone of surviving five years.

About 6,900 people die from oral cancer every year in the U.S., and those who do survive may be severely disfigured or suffer from having an impacted quality of life. About one-fourth of those who are diagnosed with oral cancer have no risk factors, while those who use tobacco products or use tobacco products with excessive alcohol have a significantly higher risk of not only oral cancer, but other medical problems as well.

According to the statistics, about a third of those diagnosed with oral cancer are younger than 55. The average age of diagnosis is 62. Men are twice as likely to be diagnosed with oral cancer, but in recent years there have been increasing numbers of women, non-smokers and those younger than 40 being diagnosed.

The Evaluation Conducted by the Social Security Administration and the Medical Qualifications

The SSA uses a precise five-step process to determine whether an individual is eligible to receive SSDI benefits. The guidelines set forth for approval can be found in the Blue Book, which is very specific in what conditions qualify for disability and how those conditions meet the specific qualifications.

In regards to oral cancer, there are several sections of the Blue Book that you need to review. The section depends on the kind of oral cancer with which you have been diagnosed.

  • Section 13.00 – Malignant Neoplastic Diseases - Adult
  • Section 13.04 – Soft tissue sarcoma with regional or distant metastases OR persistent or recurrent following initial anticancer therapy.
  • Section 13.08 – Salivary glands
  • Section 13.27 – Primary site unknown after the appropriate search has been conducted for metastatic carcinoma or sarcoma, except for squamous cell carcinoma confined to the neck nodes.

While there are numerous kinds of oral cancers, there is only one that has its own dedicated listing in the Blue Book and that is cancer of the salivary glands. The other forms will have to meet the general criteria that apply to “malignant neoplastic diseases” or match another Blue Book listing, such as the listing for soft tissue sarcoma.

In order to determine that your condition is severe enough to keep you from maintaining gainful employment, you have to either have medical documentation that meets the criteria of a Blue Book condition listing, have documentation that matches or equals the criteria of a listed condition or meet the requirements of a medical vocational allowance which involves a residual functioning capacity (RFC) form completed by your physician.

Qualifying for Disability Using an RFC if the Blue Book Listing Doesn’t Meet the Needs

Medical vocational allowance can be used to determine approval for SSDI benefits. This involves using an RFC that has detailed information, such as how the surgical procedures have affected your ability to bend or lift. It can also include how your disfigurement after surgery has impacted your mental state causing depression or anxiety and how it hurts your ability to work.

It should indicate your difficulty to stand or sit long periods of time. Also, how much you can lift may have been significantly impacted by any surgeries or treatments. Other things may include decreased ability to grasp after having under gone chemotherapy.

Addressing problems such as fatigue, fevers and sudden episodes of nausea or stomach problems is also important in the evaluation and determination process. Each of these symptoms or side effects have a major role in whether you are able to work. Several other things are taken into effect when determining if you are eligible for benefits using the medical vocational allowance.

In addition, several other things are taken into consideration with this particular allowance. The disability determination team looks at your educational background, past work experience, work skills, any transferable work skills and whether you could perform some other kind of work duties in another field.

Applying Specific Medical Tests

When applying for SSDI benefits because of oral cancer, you need to include documentation of any tests. This includes pathology reports, diagnostic test results, the kind of treatments and their frequency and duration, the extent to which the cancer may have spread, notes from your physician detailing any physical exams and any spreading or recurrence of the disease.

The SSA may order a medical evaluation for informational purposes at their expense and at their discretion. This is to help determine your condition. Sometimes a mental evaluation may also be ordered. These evaluations can help determine whether you do meet the requirements to be approved for SSDI benefits.

Getting Help with Your Oral Cancer SSD Application

Since oral cancer can qualify for SSD benefits in several ways, you must work cooperatively with your doctor to ensure your documentation satisfies one procedural review requirements for eligibility. Doing so will help decrease your wait for a determination on eligibility and could increase your chances of receiving SSD benefits as well. Additionally, as receiving a quick and favorable decision on your eligibility is your goal, you’ll want to consider the benefits of working with a Social Security advocate or disability attorney to complete your initial application and collect the appropriate documentation for supporting your claim.

Free Evaluation of Your Oral Cancer Disability Claim