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Medical Criteria Needed to Qualify with Multiple Myeloma

Do you have multiple myeloma? If so, you might be eligible for disability benefits. The Social Security disability Insurance program (SSDI) was developed to assist people, such as yourself, who have become disabled due to a diagnosis such as multiple myeloma.

The Importance of the “Blue Book”

The SSA uses its own guide known as the Blue Book to determine whether or not multiple myeloma qualifies for Social Security. Each condition in the Blue Book lists specific criteria and symptoms that you must have in order 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. Multiple myeloma is listed under Section 13.07 of the Blue Book.

To help you with this 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 Multiple Myeloma Diagnosis

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

  • Evidence of your Multiple Myeloma Diagnosis
  • Progress reports from your oncologist should include your presenting symptoms as well as the results of a full physical examination.

Several lab tests will help to confirm 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. Often, those with multiple myeloma have low red cell counts and low hemoglobin, also known as anemia.
  • Serum or urine protein electrophoresis (SPEP): This test can detect the level of various proteins in the blood, including the protein made by myeloma cells called the monoclonal, or M protein. Higher levels of the M protein, called an M spike, typically indicate more severe illness.
  • Urine protein electrophoresis (UPEP): This test can detect the level of protein in your urine. Increased protein in the urine may indicate multiple myeloma.
  • Antibody (Immunoglobulin) blood levels: These blood antibodies include IgA, IgD, IgE, IgG, and IgM. In multiple myeloma, some levels may be high, and some may be low.
  • Free Light Chain Assay (Freelite): Elevated free light chain molecules often indicate multiple myeloma. Your doctor will use this test to monitor the progression of your illness.

Basic Metabolic Panel (BMP): A basic metabolic panel will offer many clues as to the severity of your illness. A few tests included in a BMP of importance to multiple myeloma are:

  • Calcium blood levels: High calcium levels in your blood, called hypercalcemia, is common in multiple myeloma. It is caused by the breakdown of the bone which leads to the release of calcium into the blood.
  • BUN and creatinine: Those with multiple myeloma often suffer from impaired kidneys. Higher levels of BUN and creatinine indicate that your kidneys make be suffering.
  • Results from your bone-marrow aspirate or biopsy, which will typically show more than 10% of plasma cells present in your bone marrow or a plasma cell tumor, called a plasmacytoma. Documentation should be in the form of a pathology report and an operative note from your oncologist or surgeon.
  • Imaging results such as a Bone Scan, X-ray, CT scan or MRI, or PET scan that will often show round (lytic) areas of bone decay, thinning bones, or fractures.

After determining the extent of your disease, your oncologist will document the stage of your multiple myeloma. The SSA will use this information to assist in determining the extent of your illness.

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 or hematologist to gather this medical information.

Evidence Needed Related to Your Multiple Myeloma Treatment

The treatment of multiple myeloma is quite complex and will depend on the severity of the illness. The SSA will need to know what treatments you have received, your response to those treatments, and most importantly if your cancer has progressed despite those treatments.

Possible treatments for multiple myeloma include:

  • Medications (both targeted therapy and biological therapy)
  • Chemotherapy
  • Radiation
  • Steroids
  • Bone marrow or stem cell transplant

It is highly likely that you will be treated with a combination of these therapies. According to the Blue Book, to qualify for SSDI your multiple myeloma will need to be unresponsive to your first treatment or have progressed despite treatment.

According to the Blue Book, if you have had a bone marrow or stem cell transplant, you will be granted disability benefits for at least one-year from the date of your transplant. Therefore, all of your treatments must be carefully documented by your oncologist or hematologist.

Evidence Needed Related to Side Effects from Your Treatment

The Blue Book notes that not every multiple myeloma 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
  • How often you require medication
  • Your plan for continuing medication
  • Your chemotherapy or radiation schedule, as well as side effects from these treatments.
  • Any related medical complications, like weakness, neurological complications, heart problems, or intellectual problems.

Information on your reactions and side effects to your treatments is essential to provide to the SSA because not every person with multiple myeloma 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 or hematologist 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 prepare meals or dress yourself, 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 multiple myeloma.

The entire Blue Book is available online, so you may want to review section 13.07 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 your hematologist or oncologist can help including:

  • Ensuring that your full medical history related to your multiple myeloma is up to date
  • Listing your upcoming treatments and their durations
  • 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. Social Security lawyers are only paid if you win your cancer claim.