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The Social Security Disability Application Process for Mesothelioma

Mesothelioma is a difficult cancer to diagnose because its symptoms mimic those of benign conditions. A rare kind of cancer, malignant Mesothelioma develops in the mesothelium, which is the internal organ’s lining. Most often, it is the result of exposure to asbestos. Therefore, those diagnosed with the condition usually have worked in professions that involved routinely breathing in asbestos particles or dust and fiber from asbestos.

Requiring extensive testing for an accurate diagnosis, mesothelioma’s symptoms will not manifest usually until anywhere from 20 to 50 years following the exposure to asbestos. Pleural Mesothelioma has symptoms such as chest pains, coughing, and shortness of breath. Peritoneal Mesothelioma has symptoms such as abdominal pain, swelling, weight loss and cachexia. Some people may experience fever, blood clotting problems, bowel obstructions or anemia.

There can be other symptoms such as swelling of the neck and face, difficulty swallowing or pain of the neck and face. If you have been diagnosed with mesothelioma and it is impeding your ability to work, you may be eligible to receive Social Security Disability Insurance (SSDI) benefits. In order to be eligible for benefits, you are required to have worked enough to earned sufficient credits in the SSDI program and to have paid in a sufficient amount of Social Security taxes.

The Financial Costs Related to Mesothelioma

All kinds of cancer are expensive to treat. Even if you are covered by health insurance, you will have copays and deductibles that come along with doctor visits, prescriptions, testing and hospitalizations. When it comes to treating Mesothelioma, there are several kinds of treatments that depend upon the cancer stage and the kind of Mesothelioma.

Chemotherapy treatment can vary in cost as well. According to asbestos.com, those diagnosed with Mesothelioma can expect to pay as much as $30,000 for an eight-week chemotherapy regimen or as much as $7,000 for the initial treatment. Expenses vary according to the drugs used, the cancer stage and the factors dependent on each individual patient.

The average cost of surgery is $40,000. So, for the average individual diagnosed with Mesothelioma, the lifetime treatment process can cost anywhere from $100,000 to $250,000 depending on how early the cancer is diagnosed and how long you live following the diagnosis. Those who do not have health insurance can expect to pay more out of pocket.

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

The Social Security Administration (SSA) uses its Blue Book for disability determination because it has a list of all of the body systems and what diseases and disorders qualify for disability. When using the Blue Book, being approved for SSDI benefits because of a Mesothelioma diagnosis is actually simple.

According to the Blue Book, under section 13.15 – pleura or mediastinum, the diagnosis requires medical documentation of:

  • Malignant Mesothelioma of the pleura
  • OR
  • Malignant tumors, metastatic to the pleura
  • OR
  • Malignant primary tumors of the mediastinum, not controlled by prescribed therapy

It is necessary to work closely with your physicians to ensure that all of the appropriate records are gathered before you ever submit your application for SSDI benefits to the SSA. The SSA requires extensive detailed medical evidence that will document the kind and location of the main lesion, whether it is metastatic and the extent of the cancer. With the proper documentation, the odds of being approved for Social Security Disability benefits are significantly increased.

Any pathology reports or operative notes should be included with the medical records and the application process. The odds of being approved for SSDI with a diagnosis of Mesothelioma are very good and it is usually a simple approval process.

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

While more often than not Mesothelioma diagnoses qualify for SSDI benefits per the Blue Book, there is a chance that you may not be approved because some of the necessary files are missing from your records. In this case, you can still qualify for SSDI with the help of a residual functioning capacity (RFC) form. This is a form that needs to be completed with accurate detail by your physician. It will indicate what stage your cancer is and if it has spread or metastasized.

In addition, the form will indicate what treatment plans or surgeries have been done or are being scheduled to attack the cancer and how they impact your regular functioning and activities in daily life. As an example, if you are undergoing chemotherapy it will note that the treatments may make you fatigued and require frequent rest breaks. Or, if you are on a medication that causes headaches or nausea, that will also be indicated.

Other examples are that the form will indicate how long you can stand or sit without repositioning. It will also indicate if the cancer and treatments have caused weakness that impact your ability to lift, bend, or grasp. With all of these clear details certified by your physician, the Disability Determination Service team may find approving you for SSDI benefits much easier.

Many people qualify for benefits using an RFC because their diagnosis does not fully meet the Blue Book requirements. Either way, do not give up in your attempt for benefits. If your condition has rendered you unable to work, you should be persistent and continue after denials. You can always file an appeal.

Several things are considered during the SSDI application process, including your age, your educational background, work experience and the skill level affiliated with your job and whether you have skills and the ability to transfer them to a lighter level kind of work.

Applying Specific Medical Tests

In the case of Mesothelioma, medical tests that are applied to the SSDI application process include pathology reports, lab results, biopsies and operative records. These are definitive tests that can clarify your condition and its stage so an accurate determination can be made.

It is not unusual for the SSA to order a medical evaluation at their expense to confirm your condition and how it impacts your regular functioning. This is for information purposes only. Sometimes a mental evaluation is also included as part of the determination process.

Getting Help with Your Mesothelioma SSD Application

Since mesothelioma 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 Mesothelioma Disability Claim