Social Security Disability Benefits for Cancer
We explain how cancer patients may be eligible for social security disability benefits and possibly supplemental security income, what you need to document your illness to qualify, and how your case will be evaluated.
There are two Social Security benefit programs for cancer sufferers: Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI). The first is for disability benefits and the second is if your household income is below Social Security’s threshold for low household income. The general rule for disability is that you are completely unable to work for a full year and are not able to perform at a different job even with reduced physical requirements because of the limitations of your disease. If you can meet the requirements, you may apply for one or both programs.
With over 200 types of cancers, it is difficult to say how your particular illness will affect your ability to work. Some cancers are slow to develop while others are extremely aggressive, such esophageal, pancreatic, or liver cancer. In addition, the treatments given for your particular type will vary and your individual reaction to the treatments and medications may be severe to tolerable. Also, some patients suffer from the after effects of the treatments for days, weeks or months after completion.
Even if you are unable to keep your job and you consider yourself disabled, the Social Security Administration (SSA) has its own disability evaluation system. Their key criteria is that you are unable to work for at least a year or that your disease is considered terminal.
Because of this standard, many people will not qualify for Social Security Disability benefits, and their first application may be turned down. However, if you are able to meet their requirements, a monthly disability check could certainly help. It could assist you in meeting the rent or house payment, keeping food on the table, and helping to pay for medical bills, including treatments and prescription drugs.
Determining the Onset Date
The SSA uses a one-year timeline from the date of onset to determine your qualification for disability benefits, so establishing the date you contracted a disease is very important. Of course, there’s difficulty in determining a cancer onset date because all cancers grow and spread at different rates and are not immediately discovered.
If your medical doctor ran tests and scans and decided your tumor was not treatable or was inoperable as of a particular date, the SSA may use that date as the “official onset date” that you contracted the disease, for the purpose of calculating benefits.
With a better diagnosis, the Disability Examiner will look at other factors to decide a date, such as the type of cancer you have, when you first told the doctor about your symptoms, where it is located, and if it has spread.
Normally, without other evidence, the SSA will give benefits no further back than six months before you were first diagnosed.
The SSA Blue Book
The SSA uses what it calls their Blue Book that breaks down numerous diseases and explains how they are evaluated to determine if benefits are approved. Since there are so many types of cancer, and some are more mild and treatable than others, not all will be covered in those listings, and the ones detailed are specific to what factors are considered, such as:
- Location of where it began
- How involved it has become
- How long it lasts
- How it develops
- Probable response to treatment
- After treatment effects
Another case is if the cancer has developed in a different location in the body not close to the original area. This is known as metastases beyond the regional lymph nodes. In this case, benefits will probably be approved automatically. Having the original tumor removed does not matter. There could be an exception if the secondary cancer is expected to be completely treatable. The SSA may wait to see the results of such treatment before approving benefits.
Medical Records Needed
Your complete medical file related to your cancer should be presented to the Disability Examiner at the time of your initial interview or application. Typically, those records will include:
- Complete description of the cancer
- How far it has developed
- Where it first occurred
- If it reoccurred, what location
- Location of any metastatic lesions
- Medical Imaging reports
- Biopsy results
- Surgeries and notes
- If not operable, a doctor’s explanation as to why
- Pathology reports
- A detailed report of your treatment plan and your body’s response to it
Cancer Treatment Side Effects
Oftentimes, the treatment for cancer, such as radiation or chemotherapy, causes side effects that are worse than the disease seems at that point. Such reactions could be vomiting, disorientation, nausea, fatigue, diarrhea, lethargy, or skin issues. You may wonder if severe side effects would enable you to qualify for benefits. The rule for Social Security benefits is that you are unable to work for one year. The difficulty with side effects is they usually fluctuate up and down as treatment goes on, and you may be able to work in between. Some weeks may be worse than others. Because of this, the SSA may say this does not meet their standards.
As part of your comprehensive documentation of your illness for benefits, you should keep a personal daily record of all the effects from both the disease and from the treatments. Make certain you keep your doctor advised of all of these changes. Also, include any witnesses to your adverse reactions.
Long term side effects are easier for Social Security personnel to understand and document. Some of these may be permanent and may include organ damage, problems with the reproductive system, fragile bones, eye problems, intestinal disorders, and a decline in your cognitive functions that affect your ability to work.
Compassionate Allowances and Cancer
The SSA has a program called Compassionate Allowances and Cancer (CAL). The program applies to aggressive forms of cancer. The goal is to have a person’s file reviewed for approval as quickly as possible. There are three occasions where the CAL program can be implemented.
- Surgery is not possible.
- The cancer has spread beyond the original source.
- The cancer has returned even though treatment was begun. Because this type of review is fast tracked, it is essential your medical records are completely up-to-date and thoroughly detailed. You don’t want your assessment delayed because of missing information. Work closely with your doctor to be certain the necessary facts are included and explain to him the requirements of Social Security.
- The goal here is to prove that you cannot work, acknowledge the severity of your illness, and allow you to get payments so you can concentrate on your treatments and trying to get better.
If your cancer is not specifically listed in the Blue Book, a different review will be conducted by the Disability Examiner. With this review, additional records and details may be requested from you and your treating physician.
The Blue Book listings are the first step in the approval process, but if your particular cancer does not fit, or closely fit, any of the listings, the weight of proving the case is on you. Your ultimate goal is to show the Disability Examiner your disease is so severe it is impossible for you to return to your old profession, even in a reduced capacity, such as a desk job. In addition, you must further convince the examiner your health condition prevents you from working at any other job, despite being retrained.
Residual Functional Capacity Test (RFC)
To further assess your ability to work, the SSA may request a Residual Functional Capacity (RFC) test from your medical doctor. In this assessment, the doctor will record your ability to stand, walk, carry, sit, push, pull, bend, and lift objects of different weights. This will help your Disability Examiner to determine exactly what your limitations are because of your disease. Your doctor will be considered an expert at assessing your limitations because of his contact with you while navigating your illness.
Coupled with the RFC evaluation will be the consideration of your age, job history, skills, and education. The examiner will judge whether you could return to your old job, even one with less physical demands. If that seems impossible, the examiner will determine if it would be feasible for you to be retrained at a different job in light of the mentioned factors.
When a person reaches their 50s, the SSA realizes it is becoming increasing difficult to retrain someone with enough time to gain experience and build expertise for a new career. They take that into account when considering recommending you for job training in the same or another field.
Applying for SSDI and SSI benefits
Whether applying for SSDI or SSI, prepare yourself by having all of your records available, including medical records, tax forms, salary information, your work history, schooling, training, and your asset and liability information. It is to your benefit to be able to submit everything needed the first time around.
Both program applications will take a considerable amount of paperwork to complete. Try to answer every question on every form, otherwise, the reviewer may be forced to follow-up and ask you the question again, just delaying your application. So even if a question does not apply to you, enter N/A or Not Applicable so the evaluator will understand you did not skip over a question. Failure to answer a question clearly could result in a denial of your claim, and they may not even explain why the claim was denied.
The Three Year Rule
Once you have been approved for benefits for cancer, the SSA will keep those benefits in place for at least three years, even if your doctors decide your cancer was cured.
Also, if your cancer was eliminated according to your physicians and there have been no reoccurrences or evidence it has spread, the benefits will stop after three years.