Social Security disability benefits are available for cancer patients. The SSA offers two different programs that those with cancer can possibly qualify for. For more aggressive cancers, the qualifications may be more straightforward.
Applying for Social Security Disability Benefits with Cancer
There are more than 200 types of cancer according to the American Cancer Society, and about 1.7 million new cases are diagnosed each year. Some forms of cancer are non-invasive and easily treatable. Others are aggressive, spread quickly, and must be addressed with equally aggressive treatment methods.
Cancer of any type, grade, and stage is clearly disabling. The physical and psychological effects of the disease in addition to the side effects of radiation, chemotherapy, or biological treatments, usually make it impossible to work while fighting cancer. Some people may only be off work during their course of treatment, but others experience residual effects of the disease and treatment. People that do experience lingering affects may be unable to return to work for many months, if they are able to go back to their jobs at all.
While cancer is a disability regardless of how long it puts you out of work, only some people will qualify for disability benefits through the Social Security Administration (SSA). This is because Social Security disability eligibility requires you have a terminal illness or a disability that has or will prevent you from working for at least 12 months. If you are able to qualify though, disability benefits can help you meet your everyday living expenses as well as cover medical bills, prescription costs, and other healthcare expenses.
The Financial Costs of Cancer
The financial impact of cancer includes medical bills and prescription medications costs of course, but loss of earnings is perhaps the most difficult monetary hurdle to overcome. Making ends meet is hard enough when income is consistent, but periodic or extended absences from work mean no paycheck or a reduced paycheck with which to cover everyday living expenses, let alone major medical bills.
Even if you’re able to receive benefits through an employer-sponsored or private short-term disability (STD) or long-term disability (LTD) insurance plan, it is still likely you’ll only receive somewhere between 60% and 70% of your usual paycheck while you’re off work on medical leave. To complicate matters further, disability and LTD coverage eventually run out, with most disability plans paying about three months of benefits and most LTD plans covering about six months.
Treatment costs vary, but cancer is expensive. Chemotherapy and radiation remain the most common treatment methods, though new biological treatments are increasing in number. Due to their relative newness, biologicals are often pricier, but the costs of cancer drugs in general also continue to rise. In fact, the IMS Institute for Healthcare Informatics reports the average cost of a one-month supply of cancer drugs hit $10,000 as of 2014.
The costs of fighting or living with cancer don’t end there though. Surgeries, biopsies, imaging scans, lab work, pathology reports, and other diagnostic, treatment, and monitoring costs pile up. The stress of covering these bills, especially when you’re unable to work, can be overwhelming. If you’re able to qualify, Social Security disability benefits for cancer can provide monthly financial support.
Medically Qualifying for Disability Benefits through the Blue Book Listing
The SSA has a manual called the Blue Book and within this manual are hundreds of listings for recognized disabilities. The book helps doctors and their patients understand what qualifies under the SSA’s regulations. It additionally allows disability examiners to compare applicant medical records to SSD requirements to determine eligibility for benefits.
The Blue Book is made available in its entirety online and you’ll find the cancer listings in Section 13.00. Disability listings in the cancer section are broken down by where cancer originates or first develops. Each form of cancer will qualify differently. For example, a diagnosis of esophageal cancer will automatically qualify for disability benefits. Breast cancer, on the other hand, will need to have spread to distant regions of the breast or other areas of the body to qualify. You can review the SSA's Blue Book listing for cancer on the SSA's website.
Compassionate Allowances and Cancer
Some forms of aggressive cancer can also qualify under the SSA’s Compassionate Allowance (CAL) program. This program ensures applications are reviewed and approved as quickly as possible. 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
Whether your cancer meets a Blue Book listing or qualifies for expedited review under the CAL program, medical records are an essential part of your disability claim. Work closely with your doctor to understand Blue Book requirements and to ensure your application and medical history provide the information the SSA needs.
Keep in mind that if your cancer doesn’t meet a listed condition, then you will need to go through additional review procedures. The SSA automatically requests more information from you and your doctor if you don’t meet or closely match a disability listing. This process is known as a “residual functional capacity” or RFC analysis.
Medically Qualifying for SSD through an RFC Analysis
Qualifying through an RFC with cancer can be difficult. This is because the SSA only considers cancer eligible once it meets a particular severity level and that severity level is established in the Blue Book listings. If you don’t meet or closely match a listing, you’ll have to show that your cancer, required treatments, and the side effects or residual challenges you face are severe enough that they prevent you from working in ANY job.
The RFC process requires you and your doctor to complete “functional” report forms. The report form you fill out will ask about your daily life and may seem to have no bearing on whether or not you could work. However, the SSA uses the information you provide in your functional report to better understand your everyday limitations.
If, for example, your cancer treatments make it impossible for you to do laundry, shop, or mow the grass without help from someone else, this lets the SSA know that you would struggle with or not be able to do certain kinds of job duties. From these kinds of details, the SSA is able to determine that you therefore cannot work in particular types of jobs.
Keep in mind that the SSA will consider age to be a large factor when applying for disability benefits through an RFC. This is because older men and women are considered harder to retrain and unlikely to be able to take a new, easier job than someone in their 20s. If you do not have a college degree, you will also be more likely to qualify through an RFC.
Your doctor must also complete a functional report for the SSA as part of the RFC process. The SSA needs an “expert” opinion on your everyday limitations and what causes them, so your doctor's RFC report is crucial.
How to Apply for Benefits with Cancer
The SSA has two different disability programs for which you may qualify with cancer. Social Security Disability Insurance (SSDI) is available for disabled workers, but Supplemental Security Income (SSI) may also be an option for you, if you have a low household income.
You can submit an SSDI application online, via the SSA’s website, or you can apply at your local SSA office. SSI applications must be completed in-person or via a personal interview with an SSA representative, so a local office visit to the Social Security Administration is usually required.
Whether you apply for just one program or for both, you will need to gather your documentation and be prepared to provide consistent and thorough details about your, employment history, financial situation, medical records, and education and job training.
The forms you fill out during the application process ask many questions and some may be repetitive, but don’t leave anything blank. Even if the question doesn’t apply to you, give an answer. Stating “not applicable” or “N/A” is fine, and doing so will prevent the SSA from having more questions and delaying your application in the process.
Keep in mind that medical records are the key to getting disability benefits and that the SSA must usually have all of the following in order to approve disability claim for cancer:
- Surgical or biopsy notes, or a report from a physician noting why cancer is not operable or can’t be removed
- Biopsy results or a pathology report documenting the type of cancer you have
- Imaging scans showing the location(s) of tumors or spread of the disease
- Details of your cancer treatments, including how often you undergo them and what their affects have been
Report complete contact information for all your healthcare providers, including hospitals, doctors, and outpatient treatment clinics, among others. The disability examiner that reviews your claim must be able to obtain your medical records. Any gaps in those records may cause you to be denied benefits. You can even get copies of your own medical records and forward those to the SSA, if necessary. This will sometimes speed up the application process. With any luck, your claim will be approved quickly and you can focus on your treatments.
How to Appeal a Denial
Each year the Social Security Administrations receives tens of thousands of applications for Social Security disability benefits, and the vast majority of those claims are denied initially. They are denied for a variety of reasons, including incomplete applications, missing information or simply that the applicant does not meet the guidelines to receive benefits.
It is very important not to panic if your application is denied at first. You have 60 days to file an appeal, so you need to focus on responding to the SSA with a request for reconsideration. It is possible that another representative will take a different approach with your application. This is also an opportunity to add more information to your application that you might have missed the first time. Make sure that you have a complete medical record of your diagnosis, your treatment plan and all test results related to your condition. If you are taking medication, make sure you list all of your prescriptions and note any side effects that are impacting your ability to work.
Since time has passed since you submitted your initial application, the appeal process is an opportunity to include any relevant updates, including additional doctor visits, new reactions or side effects or developments in your condition that were not present when you first submitted your claim.
If your request for reconsideration is denied, the next step is to go to a disability hearing, where an administrative judge will hear your case. The judge will rely upon a medical expert and a vocational expert to interpret the information in your application. You will be able to bring witnesses to the hearing who can help support your claim. From there, if your claim is denied again the next step is the Appeals Council, where the decision from the disability hearing will either be upheld or overturned.
The appeal process can be daunting. If you need more support or want to work with someone who understands the nuances of the process, consider hiring a Social Security disability attorney to increase your chances of winning your appeal.
Cancers that Qualify
Qualifying for disability benefits with cancer depends on the kind of cancer and the treatment. Certain cancers will qualify for benefits automatically while others can qualify if certain criteria are met. Some of the cancers that qualify for disability benefits include:
- Esophageal Cancer
- Gallbladder Cancer
- Brain Cancer
- Inflammatory Breast Cancer
- Liver Cancer
- Pancreatic Cancer
- Sinonasal Cancer
- Salivary Cancer
- Any Small Cell Cancers
- Thyroid Cancer
The above listed cancers are not only aggressive, but they are all difficult to diagnose and treat.
Other forms of cancer may qualify for benefits, but qualification will be dependent upon treatment and response to treatment. Section 13.00 of the Blue Book has an entire section dedicated to cancer, and the SSA will look at factors like age and response to treatment to decide whether your particular diagnosis will qualify.
If you don’t qualify for disability benefits with your cancer diagnosis, you could qualify for benefits under a medical-vocational allowance, which determines whether or not you are capable of working with your diagnosis. You might not be considered disabled under the Blue Book, but your diagnosis could prevent you from performing the mental and physical demands of your job, in which case you would not be able to work.