Medical Criteria Needed to Qualify with Prostate Cancer

Approximately 1 in 7 men will be diagnosed with prostate cancer during their lifetime. Although prostate cancer is serious, many men who experience recovery.

If you have prostate cancer, and your symptoms are so severe that you are unable to earn a gainful living, there could be financial help available to you. The Social Security Disability Insurance (SSDI) program was created to assist those, such as yourself, who have become disabled due to a diagnosis such as prostate cancer.

If your prostate cancer is advanced, such as if it has spread or is terminal, you will likely qualify for financial assistance from the Social Security Administration (SSA).

However, not everyone who has prostate cancer will be granted benefits.

If your prostate cancer was caught early or treated successfully, it might be more difficult to get disability benefits.

You will need to provide medical evidence to the SSA demonstrating the severity of your prostate cancer, as well as how it impacts your ability to work.

While the SSA may offer some assistance in gathering particular information, your ability to provide timely, accurate, and complete medical records about your condition will help your application to be processed more quickly.

The Importance of the “Blue Book”

Prostate cancer is listed under Section 13.24 of the Blue Book. The Blue Book is a publication developed by the SSA which contains all of the disabling conditions that could qualify an individual for disability benefits, as well as the medical criteria needed with those conditions.

According to the Blue Book, those who are seeking SSDI need to have prostate cancer that is advancing or has come back despite treatment, or the cancer needs to have spread to distant organs.

Evidence Needed Related to Your Prostate Cancer Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your prostate cancer. You should be able to provide both evidence of your prostate cancer diagnosis, and the extent to which it has grown or spread. This includes:

  • Progress reports from your oncologist should include the results of your digital rectal exam (DRE) or ultrasound, if performed, as well as any other evidence your oncologist has found verifying your cancer.
  • If you have had any procedures or surgery related to the diagnosis of your prostate cancer, such as a biopsy, a needle aspiration, or an exploratory surgery, you will need to provide those records. Documentation should be in the form of a pathology report and an operative note from your oncologist or surgeon.
  • Significant diagnostic blood lab results may include:
  • PSA levels – PSA, or prostate-specific antigen levels, is a blood test that measures the amount of protein being produced by the prostate. While it varies from person to person, normal levels are typically below 4.0 ng/ml. Elevated PSA levels are often the first sign of prostate cancer.

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

  • Imaging results such as an X-ray, Bone scan, CT scan, MRI, or a PET scan
  • Lymph node biopsy results
  • Blood lab results such as:
  • CBC and BMP
  • Calcium levels
  • PSA levels
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After determining the spread of your disease, your oncologist will document the stage and grade of your prostate cancer. The SSA will use this information to assist in determining the extent of your illness.

You should work with your oncologist, urologist or surgeon to gather this important medical evidence.

Evidence Needed Related to Your Prostate Cancer Treatment

Prostate cancer is treated differently depending on the severity and spread of the cancer. The SSA will need to know what treatments you have received, your response to those treatments, and if your prostate cancer has come back, or recurred, despite those treatments.

Possible treatments for prostate cancer may include oral medications, chemotherapy, radiation, hormone intervention, and cryotherapy.

The male hormone, androgen, is known to stimulate prostate cancer growth. As a result, hormone therapy, also called androgen deprivation therapy (ADT), works to reduce the levels of this male hormone in the body.

Treatments used to reduce androgen production include medications or surgery to remove one or both testicles.

According to the Blue Book, to qualify for SSDI, your prostate cancer will need to have progressed or recurred despite having this hormonal intervention.

Evidence Needed Related to Side Effects from Your Treatment

The Blue Book notes that not every prostate 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
  • How often you require medication
  • Your plan for continuing medication
  • Your chemotherapy or radiation schedule
  • Any related medical complications, like weakness, neurological complications, heart problems, or intellectual problems

Many prostate cancer patients have post-treatment residual effects from their treatments that make it very difficult to earn substantial, gainful employment. For example, some individuals who have gone through prostate cancer treatment go on to have bowel and bladder difficulties for years to come.

Be certain that your physician documents all of your treatments, as well as any side-effects or residual problems that you experience. This will help the SSA get a sense of how disabling your prostate cancer can be.

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

If you do not meet the Blue Book listing, you still might qualify for SSDI benefits through a medical vocational allowance. This means that the SSA will evaluate your limitations using a residual functional capacity (RFC) assessment.

Your physician should carefully document your physical and mental capabilities and limitations. For example, is your life impacted by the need to urinate on a frequent basis? Do you experience pain in your back or groin?

Are you depressed as a result of your condition? The more specific you are about your pain, ability to move, and quality of life, the better your chances are of being approved for disability benefits.

Steps You Can Take to Win Your Disability Claim

The majority of people who apply for disability benefits are initially denied. It can be discouraging to be so sick and yet feel that others do not think you are too ill to work.

Remember that medical evidence is arguably the most important factor in winning your Social Security disability claim for prostate cancer.

Formally, the Blue Book was a paper manual printed with a blue cover, hence the name. However, the entire Blue Book is now available exclusively online. You should review section 13.24 with your oncologist.

Together you can determine if you meet the listing as described in the Blue Book.

There are several ways your oncologist can help including:

  • Ensuring that your full medical history related to your prostate cancer 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
  • Documenting any mental or emotional difficulties that you are having related to your cancer.

Individuals who hire a Social Security disability attorney or advocate are much more successful at winning their claim for disability than those who do not have representation. You should consider a free evaluation with an experienced lawyer or disability advocate in your area today.

Don’t let the financial concerns of paying for a lawyer scare you. Your disability advocate or attorney will not get paid unless you are awarded benefits for your prostate cancer disability claim.