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Medical Criteria Needed to Qualify with Lymphoma

If you have been diagnosed with Lymphoma, you might be eligible for financial aid. The Social Security Administration (SSA) offers monthly resources for people with disabilities who are unable to work. To be approved for disability benefits with Lymphoma, you'll need medical evidence showing you're too ill to earn a gainful living.

The Importance of the “Blue Book”

The SSA uses a medical guide, known as the Blue Book, to determine whether or not a condition such as Lymphoma is severe enough to warrant disability payments. Each condition in the Blue Book lists specific criteria and symptoms that you must have to be approved.

Many of the listings include information on the specific evidence required, such as clinical and laboratory tests.

It is of vital importance to work with your health care providers to ensure that you have completed all of the medical tests required by the SSA and that all of your medical evidence is in order. Lymphoma is a cancer that is listed in the malignant neoplastic disease section, 13.05, of the Blue Book.

To help you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

Evidence Needed Related to Your Lymphoma Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your cancer. You should be able to provide the following evidence:

Evidence of your Lymphoma Cancer Diagnosis:

  • Progress reports from your oncologist should include your presenting symptoms as well as the results of a full physical examination. Your oncologist should note any evidence that indicates that you have Lymphoma, such as the presence of swollen lymph nodes.
  • If you have had any procedures or surgery related to the diagnosis of your Lymphoma, such as a biopsy, a needle aspiration, or an exploratory surgery, you will need to provide those records. Lymphoma is typically diagnosed through an excisional or incisional biopsy. Documentation should be in the form of a pathology report and an operative note from your oncologist or surgeon.
  • Once you have been diagnosed with Lymphoma, your oncologist will work with the pathologist to determine the type of Lymphoma that you have. There are several kinds of Lymphoma, but the Blue Book specifically addresses three types:
  • Non-Hodgkin’s Lymphoma
  • Hodgkin’s Lymphoma
  • Mantle Cell Lymphoma

Evidence to Indicate the Extent to which your Lymphoma has advanced or spread:

If your Lymphoma has spread, or metastasized, medical evidence might include:

  • Imaging results such as an X-ray, Bone scan, CT scan, ultrasound MRI, or a PET scan
  • Several lab tests will help to confirm the extent of your diagnosis, and the following should be included in your records:
  • Complete blood count (CBC): A CBC measures the levels of red cells, white cells, and platelets in your blood.
  • Complete metabolic profile (CMP): A CMP will determine how well your kidneys and liver are functioning and if the Lymphoma have affected these organs.
  • Lactate Dehydrogenase (LDH) levels: These levels are often increased in those with Lymphoma.

Bone marrow aspiration and biopsy results:

  • A bone marrow biopsy is only typically done if there is a reason to believe that the Lymphoma has reached the bone marrow.
  • Documentation should be in the form of a pathology report and an operative note from your oncologist or hematologist.
  • If you have received a bone marrow or stem cell transplant, you will be considered eligible for benefits for at least one year from the day of your transplant. Be certain to include documentation about this.

Your oncologist will also work to determine the stage of your Lymphoma, which will be given a number between Stage I and Stage IV. While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists. Therefore, it is important that you work with your oncologist to gather this medical information.

Evidence Needed Related to Your Lymphoma Cancer Treatments

The treatment of Lymphoma depends on the extent and stage of the disease. Accurate documentation of the type of treatments that you receive for your Lymphoma is critical for your disability claim, as the Blue Book indicates that decisions on your application are often made in regard to your response to treatment.

Possible treatments for Lymphoma may include chemotherapy, immunotherapy, targeted therapy, radiation, stem cell transplants, and in rare cases, surgery. The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

According to the Blue Book, you will need to prove the following, depending on the type of cancer that you have:

Non-Hodgkin’s Lymphoma

  • The Lymphoma has been persistent or recurrent despite initial cancer treatment
  • If you have Indolent Lymphoma, also called Lymphoplasmacytic Lymphoma, you will need to illustrate that you have received at least two or more anticancer treatments within a 12-month period

Hodgkin’s Lymphoma

  • The Lymphoma has not gone into remission or has recurred within 12 months of completing initial cancer therapy

If you have been diagnosed with Mantle Cell Lymphoma, you will automatically qualify for SSDI benefits.

Evidence Needed Related to Side Effects from Your Lymphoma Treatment

The Blue Book notes that not every Lymphoma cancer patient will meet a particular qualifying condition’s listing, but you may be unable to work regardless. The SSA will want detailed evidence regarding any medications that you’re taking while undergoing cancer therapies, and how you respond to treatment. Some information needed includes, but is not limited to:

  • Medications you receive, including the doses and timing
  • Your plan for continuing medication
  • Your chemotherapy or radiation schedule
  • Any related medical complications, like weakness, neurological complications, heart problems, or intellectual problems

Information on your reactions to your treatments, as well as possible side effects, is important to the SSA because not every person with Lymphoma cancer will meet a Blue Book listing. So long as you can prove that you’re still too ill to work due to complications that will persist for at least one year, you might still qualify if you pursue the claim further.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

As noted above, you may not qualify for SSDI under the Blue Book listing. However, you still may be too ill to work. If this is the case, your oncologist should provide physician notes documenting his or her opinion regarding your limitations and inability to function without unscheduled breaks or days off.

The more specific that your doctor is about your limitations, such as your ability to dress yourself or to care for your daily needs, the better your chances are of being approved for disability benefits.

Steps You Can Take to Win Your Disability Claim

If you haven’t applied yet, or if you have applied and were denied, remember that medical evidence listed in the Blue Book is arguably the most important factor in your Social Security disability claim for Lymphoma/p>

The entire Blue Book is available online, so you may want to review section 13.05 with your oncologist to determine what medical records you have on hand, and what may need to be supplemented to be approved. You may need to contact the medical records office at your hospital to obtain some of this information.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

There are several ways that your oncologist can help including:

  • Ensuring that your full medical history related to your Lymphoma is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Performing any additional blood tests or procedures that you are missing

A Social Security disability attorney or advocate can assist you in ensuring that you claim for disability is thorough, thus increasing your chances for approval. Consider a Free Evaluation with a Social Security advocate or attorney in your area today—Disability lawyers are only paid if you win your Lymphoma cancer claim.