Cancer

How Do I Get Social Security Disability Benefits for Cancer?Cancer and Disability

The Social Security Administration looks at multiple factors to determine disability on the basis of cancer. These include the type of cancer, the location, the degree that the cancer involves other normal tissues, the response to therapy and the severity of residual problems after treatment.

If you have been diagnosed with cancer, are unable to work and have been denied Social Security Disability benefits, call the experienced Cypress Social Security Disability attorneys at Howard Law and let us fight to get you the benefits you deserve.

Soft Tissue Tumors of the Head and Neck

This disability refers to soft tissue tumors of the head and neck except salivary glands and thyroid gland.

For your condition to be severe enough to meet this listing you must have soft tissue tumors of the head and neck that are

  1. Inoperable or unresectable; or
  2. Persistent disease following initial multimodal antineoplastic therapy; or
  3. Recurrent disease following initial antineoplastic therapy, except recurrence in the true vocal cord; or
  4. With metastases beyond the regional lymph nodes; or
  5. Soft tissue tumors of the head and neck not addressed in A-D, with multimodal antineoplastic therapy. Consider under a disability until at least 18 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

Skin

The most common skin cancers are basal cell carcinomas and squamous cell carcinomas. Both can be very distructive to tissue, but rarely metastasize and can be completely cured if diagnosed early. Malignant melanoma and angiosarcomas are dangerous forms of skin cancer and can lead to death.

For your condition to be severe enough to meet this listing you must have skin cancer that matches either A or B below.

  1. Sarcoma or carcinoma with metastases to or beyond the regional lymph nodes; or
  2. Melanoma, with either 1 or 2:
    1. Recurrent after wide excision (except an additional primary melanoma at a different site, which is not considered to be recurrent disease).
    2. With metastases as described in a, b, or c:
      1. Metastases to one or more clinically apparent nodes; that is, nodes that are detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination.
      2. If the nodes are not clinically apparent, with metastases to four or more nodes.
      3. Metastases to adjacent skin (satellite lesions) or distant sites.

Soft Tissue Sarcoma

Soft tissue sarcomas are any type of connective tissue cancer that does not include bone. Sarcomas are generally very dangerous cancers.

For your condition to be severe enough to meet the listing, you must have soft tissue sarcoma

  1. With regional or distant metastases; or
  2. Persistent or recurrent following initial antineoplastic therapy.

Lymphoma

Lymphoma is a cancer of the lymphocytes, a type of cell that forms part of the immune system. Like other cancers, lymphoma occurs when lymphocytes are in a state of uncontrolled cell growth and multiplication.

For your condition to be severe enough to meet the listing, it must match either A, B, or C below.

  1. Non-Hodgkin’s lymphoma, as described in 1 or 2:
    1. Aggressive lymphoma (including diffuse large B-cell lymphoma) persistent or recurrent following initial antineoplastic therapy.
    2. Indolent lymphoma (including mycosis fungoides and follicular small cleaved cell) requiring initiation of more than one antineoplastic treatment regimen within a consecutive 12-month period. Consider under a disability from at least the date of initiation of the treatment regimen that failed within 12 months.
  2. Or

  3. Hodgkin’s disease with failure to achieve clinically complete remission, or recurrent disease within 12 months of completing initial antineoplastic therapy;
  4. Or

  5. With bone marrow or stem cell transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any remaining medical problems under the criteria of the affected body system.

Leukemia

Leukemia is cancer of the blood cells. It affects the bone marrow and the white blood cell level rises very high.

For your condition to be severe enough to meet the listing, you must have either A or B below.

  1. Acute leukemia (including T-cell lymphoblastic lymphoma).
    Consider under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
  2. Or

  3. Chronic myelogenous leukemia, as described in 1 or 2:
    1. Accelerated or blast phase. Consider under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system; or
    2. Chronic phase, as described in a or b:<
      1. Consider under a disability until at least 12 months from the date of bone marrow or stem cell transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
      2. Progressive disease following initial antineoplastic therapy.

Multiple Myeloma

Multiple myeloma is cancer that starts in the plasma cells in the bone marrow. Plasma cells help your body fight infection by producing antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.

For your condition to be severe enough to meet the listing, you must have had testing showing Multiple myeloma (confirmed by appropriate serum or urine protein electrophoresis and bone marrow findings) with either A or B below.

A. Failure to respond or progressive disease following initial antineoplastic therapy; or

B. With bone marrow or stem cell transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

Salivary Glands

Salivary gland cancer is a rare form of cancer that begins in the salivary glands. Salivary gland cancer can begin in any of the salivary glands in your mouth, neck or throat.

For your condition to be severe enough to meet the listing, you must have any type of carcinoma or sarcoma with metastases beyond the regional lymph nodes.

Thyroid Gland

There are various types of carcinoma thyroid cancer that differ in their degree of malignancy. Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular thyroid cancer) are the most curable. The less frequent types of thyroid cancer (medullary and anaplastic carcinomas) are more serious. Only a minority of thyroid cancer cases qualify under the listing.

For your condition to be severe enough to meet the listing, you must have one of the following:

  1. Anaplastic (undifferentiated) carcinoma; or
  2. Carcinoma with metastases beyond the regional lymph nodes progressive despite radioactive iodine therapy; or
  3. Medullary carcinoma with metastases beyond the regional lymph nodes.

Breast

Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer; (1) ductal carcinoma which starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. (2) Lobular carcinoma starts in the parts of the breast that produce milk. In rare cases, breast cancer can start in other areas of the breast.

For your breast cancer to be severe enough to meet the listing, it must match one of the following:

  1. Locally advanced carcinoma (inflammatory carcinoma, tumor of any size with direct extension to the chest wall or skin, tumor of any size with metastases to the ipsilateral internal mammary nodes); or
  2. Carcinoma with metastases to the supraclavicular or infraclavicular nodes, to 10 or more axillary nodes, or with distant metastases; or
  3. Recurrent carcinoma, except local recurrence that remits with antineoplastic therapy.

Skeletal System

This disability refers to any type of sarcoma cancer affecting bone that is not considered under another disability. Cancer involving the bone can arise from the bone itself or can be cancer that has spread to the bone from tumors originating elsewhere in the body.

For your bone cancer to be severe enough to meet this listing, it must match any one of the following:

  1. Inoperable or unresectable; or
  2. Recurrent tumor (except local recurrence) after initial antineoplastic therapy; or
  3. With distant metastases; or
  4. All other tumors originating in bone with multimodal antineoplastic therapy. Consider under a disability for 12 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

Maxilla, Orbit, or Temporal Fossa

This disability refers to cancer in the upper jaw, eye socket, or sides of the skull.

For your condition to be severe enough to meet this listing, you must have cancer of the maxilla, orbit, or temporal fossa that must match one of the following:

  1. Sarcoma or carcinoma of any type with regional or distant metastases; or
  2. Carcinoma of the antrum with extension into the orbit or ethmoid or sphenoid sinus; or
  3. Tumors with extension to the base of the skull, orbit, meninges, or sinuses.

Nervous System

This disability refers to brain or spinal cord cancers.

To qualify for disability due to brain or spinal cord cancer, your condition must satisfy either A or B below.

  1. Central nervous system neoplasms (brain and spinal cord), as described in 1 or 2:
    1. Highly malignant tumors, such as medulloblastoma or other primitive neuroectodermal tumors (PNETs) with documented metastases, grades III and IV astrocytomas, glioblastoma multiforme, ependymoblastoma, diffuse intrinsic brain stem gliomas, or primary sarcomas.
    2. Any central nervous system neoplasm progressive or recurrent following initial antineoplastic therapy.
  2. Or

  3. Peripheral nerve or spinal root neoplasm, as described in 1 or 2:
    1. Metastatic.
    2. Progressive or recurrent following initial antineoplastic therapy.

Lungs

Lung cancer is a cancer that starts in the lungs. The most frequent type of lung cancer the Social Security Administration sees is squamous cell carcinoma, also known as epidermoid carcinoma, which occurs in the bronchial tubes. Small cell lung cancer is a less common, often fatal form of lung cancer.

For your condition to be severe enough to meet this listing, it must match one of the following:

  1. A. Non-small-cell carcinoma—inoperable, unresectable, recurrent, or metastatic disease to or beyond the hilar nodes; or
  2. B. Small-cell (oat cell) carcinoma; or
  3. C. Carcinoma of the superior sulcus (including Pancoast tumors) with multimodal antineoplastic therapy. Consider under a disability until at least 18 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

Pleura or Mediastinum

The pleura is a membrane that covers the outside of the lungs and the inside of the chest cavity. The mediastinum is the large space between the lungs that contains the heart, esophagus, trachea, lymph nodes and other structures. When cancer originates in the pleura it is referred to as a mesothelioma.

For your condition to be severe enough to meet this listing, it must match either A or B below.

  1. Malignant mesothelioma of pleura; or
  2. Tumors of the mediastinum, as described in 1 or 2:
    1. With metastases to or beyond the regional lymph nodes.
    2. Persistent or recurrent following initial antineoplastic therapy.

Esophagus or Stomach

Esophageal cancer is a cancerous tumor of the esophagus. The most common form of esophageal cancer is squamous cell carcinoma which is associated with smoking and alcohol consumption.

Several different types of cancer can occur in the stomach. The most common type is called adenocarcinoma, which starts from one of the common cell types found in the lining of the stomach.

For your condition to be severe enough to meet this listing, it must satisfy either A or B, below.

  1. Carcinoma or sarcoma of the esophagus; or
  2. Carcinoma of the stomach, as described in 1 or 2:
    1. Inoperable, unresectable, extending to surrounding structures, or recurrent.
    2. With metastases to or beyond the regional lymph nodes.

Small Intestine

Cancer of the small intestine is rare. The most common cancerous (malignant) tumors of the small intestine include adenocarcinoma, carcinoid, gastrointestinal stromal tumor, lymphoma, and cancer that has spread from other places in the body.

For your small intestine cancer to be severe enough to meet the listing, it must match A or B below.

  1. Carcinoma, sarcoma, or carcinoid; or
  2. With metastases beyond the regional lymph nodes.

Large Intestine

Colon cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon).

For your colon cancer to be severe enough to meet the listing, it must satisfy one of the below.

  1. Adenocarcinoma that is inoperable, unresectable, or recurrent; or
  2. Squamous cell carcinoma of the anus, recurrent after surgery; or
  3. With metastases beyond the regional lymph nodes.

Liver or Gallbladder

The most common type of liver cancer is hepatocellular carcinoma. In most cases, the cause of liver cancer is usually scarring of the liver, also known as cirrhosis. Gallbladder cancer is a rare disease in which cancer cells are found in the tissues of the gallbladder.

This listing is satisfied by any type of cancer arising in the liver, gallbladder, or bile ducts.

Pancreas

Pancreatic cancer begins in the tissues of your pancreas. Many cases of pancreatic cancer are inoperable for cure at the time of diagnosis and most patients die within one year.

Therefore, claimants automatically satisfy part A (below) by diagnosis of pancreatic carcinoma. If a claimant is diagnosed with islet cell carcinoma, they must meet part B below.

  1. Carcinoma except islet cell carcinoma; or
  2. Islet cell carcinoma that is inoperable or unresectable and physiologically active.

Kidneys, Adrenal Glands, or Ureters

Carcinomas arising from the kidney, adrenal gland, or ureter create a poor prognosis for survival if they are not surgically removed before they have metastasized.

In order for your condition to be severe enough to meet the listing, you must have carcinoma of the kidneys, adrenal glands, or ureters that meet either A or B below.

  1. Inoperable, unresectable, or recurrent; or
  2. With metastases to or beyond the regional lymph nodes.

Urinary Bladder

Bladder cancers usually start from the cells lining the bladder, called transitional cells. These cancers are called transitional cell carcinomas. Like other cancers, bladder carcinomas have a much better prognosis if detected early.

For your bladder cancer to be severe enough to meet the listing, you must have bladder cancer carcinoma with one of the following:

  1. With infiltration beyond the bladder wall; or
  2. Recurrent after total cystectomy; or
  3. Inoperable or unresectable; or
  4. With metastases to or beyond the regional lymph nodes.

Cancers of the Female Genital Tract

Refer to A-E below for requirements for the different types of cancer of the female genital tract.

  1. Uterus (corpus), as described in 1, 2, or 3:
    1. Invading adjoining organs.
    2. With metastases to or beyond the regional lymph nodes.
    3. Persistent or recurrent following initial antineoplastic therapy.
  2. OR

  3. Uterine cervix, as described in 1 or 2:
    1. Extending to the pelvic wall, lower portion of the vagina, or adjacent or distant organs.
    2. Persistent or recurrent following initial antineoplastic therapy.
  4. OR

  5. Vulva or vagina, as described in 1, 2, or 3:
    1. Invading adjoining organs.
    2. With metastases to or beyond the regional lymph nodes.
    3. Persistent or recurrent following initial antineoplastic therapy.
  6. OR

  7. Fallopian tubes, as described in 1 or 2:
    1. Extending to the serosa or beyond.
    2. Persistent or recurrent following initial antineoplastic therapy.
  8. OR

  9. Ovaries, as described in 1 or 2:
    1. All tumors except germ-cell tumors, with at least one of the following:
      1. Tumor extension beyond the pelvis; for example, tumor implants on peritoneal, omental, or bowel surfaces.
      2. Metastases to or beyond the regional lymph nodes.
      3. Recurrent following initial antineoplastic therapy.
    2. Germ-cell tumors—progressive or recurrent following initial antineoplastic therapy

Prostate Gland

Prostate cancer is cancer a common form of cancer that starts in the prostate gland. Early diagnosis is the key to long term survival.

For your condition to be severe enough to meet this listing, you must have been diagnosed with prostate carcinoma that must meet A or B, below.

  1. Progressive or recurrent despite initial hormonal intervention; or
  2. With visceral metastases (metastases to internal organs).

Testicles

There are two main types of testicular cancer: seminomas and nonseminomas. Seminomas are the most common testicular tumor and can often be treated effectively. This listing deals only with progressive or recurrent metastatic cancer that spread prior to removal of the cancerous testicle.

For your condition to be severe enough to meet this listing, you must have a tumor with metastatic disease progressive or recurrent following initial chemotherapy.

Penis

Penile cancer is a rare form of cancer with the majority of penis cancers being squamous cell carcinomas.

For your condition to be severe enough to meet this listing, you must have carcinoma with metastases to or beyond the regional lymph nodes.

Primary Site Unknown- Metastatic Carcinoma or Sarcoma

Sometimes a metastatic tumor is found, but doctors are unable to determine the origin of the cancer. This listing deals with this type of metastatic carcinoma or sarcoma.

For your condition to be severe enough to meet this listing, you must have metastatic carcinoma or sarcoma, and your doctors must be unable to find the primary tumor of origin after an appropriate search. The one exception that does not qualify is squamous cell carcinoma confined to the neck nodes.

Malignant Disease Treated with Transplants

This listing refers to cancers that are treated with bone marrow or stem cell transplantation.

For your condition to be severe enough to meet this listing, it must meet either A or B, below.

  1. Allogeneic transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
  2. Or

  3. Autologous transplantation. Consider under a disability until at least 12 months from the date of the first treatment under the treatment plan that includes transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

For more information on cancer and the Social Security Administration guidelines, visit the Social Security Administration website.

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Listing vs. Residual Functional Capacity (RFC): How Does the Social Security Administration Determine Whether I Qualify for Disability Benefits for Cancer

Social Security disability benefits may be available for people who suffer from Cancer. The Social Security Administration must first determine whether your Cancer is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. The Social Security Administration will conclude that you are disabled and eligible for disability benefits if it determines that you meet or equal a listing because of your Cancer.

If the Social Security Administration decides that your Cancer is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

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How Can I Meet a Listing and Win Social Security Disability Benefits for Cancer?

The Social Security Administration will determine whether you are disabled at Step 3 of the Sequential Evaluation Process by evaluating whether your Cancer is severe enough to equal a listing.

The term “listing” refers to a compiled list of common impairments. The Social Security Administration created a set of guidelines called the Listing of Impairments that contains the most common impairments. For each listing of a particular impairment, there is an explanation regarding the degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.

The Social Security Administration will consider you disabled if your Cancer is severe enough to meet or equal a listing.

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What is Your Residual Functional Capacity Assessment for Cancer?

If the Social Security Administration decides that your Cancer is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

The Social Security Administration expresses an RFC for physical impairments in terms of whether the Social Security Administration believes you are able to do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

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Can Your Doctor’s Medical Opinion Help You Qualify for Social Security Disability Benefits for Cancer?

The role of the Social Security Administration is to conclusively establish whether you are disabled based on your education, work experience, medical evidence, and your age.

The role of your doctor is to provide the Social Security Administration with information concerning the degree of your medical impairment by providing the Social Security Administration medical source statement that describes your capacity for work which is part of your residual functional capacity assessment. Your residual functional capacity is what you can still do despite your limitations.

The Social Security Administration must consider your treating physician’s opinion because the Social Security Administration considers it to be controlling when making its decision.

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What is the 5 Step Sequential Evaluation Process?

The Social Security Administration has created a five (5) step sequential process to determine whether an adult claimant is entitled to receive disability benefits. Children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

The Social Security Administration presumes that if you are working and that you make a certain amount of money that you are engaging in what it determines to be a substantial gainful activity (SGA). The Social Security Administration considers a person to be engaged in a SGA if that person is earning more than a certain amount of money each month (i.e. net of impairment – related work related expenses).

In 2013, the Social Security Administration has determined that a statutorily blind individual is engaged in a SGA if they earn more than $1740.00 per month while a non-blind individual must earn more than $1040.00 per month. Changes in the national average wage index usually affect the aforementioned SGA amounts.

Step 2: Severe Impairment

The Social Security Administration has determined that each claimant must either have a severe impairment or a combination of impairments. The impairment or combination of impairments must drastically limit the claimant’s physical or mental ability to do basic work activities without regard to age, work history, or education. For many claimants, the level of proof at this level is minimal; therefore, they usually satisfy the Step 2 requirements and proceed to Step 3.

Step 3: Listing of Impairments

The Listing of Impairments details specific impairments that the Social Security Administration considers severe enough to prevent an adult claimant from engaging in a substantial gainful activity and in the case of a minor, the impairment has to be severe enough to cause functional limitations. There is also a durational requirement. The Social Security Administration has determined that the impairment must last for 12 months or long or result in the death of the claimant. If the claimant fails Step 3 because they do not meet or equal a listing then the case will proceed to Step 4.

Step 4: Past Relevant Work

At Step 4, if your condition is severe enough to meet the requirements of Step 2 (Severe Impairment); however, your severe impairment does not meet or equal a listed impairment that is the subject of Step 3 (Listing of Impairments), then the Social Security Administration must decide whether your severe impairment interferes with your ability to do any of the work you previously performed. The Social Security Administration likes to look at the work you performed over the past 15 years prior to the onset of your disability. If the Social Security Administration determines that your impairment does not interfere with work you previously did then you must proceed to Step 5.

Step 5: Ability to Perform Other Work

A majority of disability claims are decided at this level. If you cannot perform work you did in your past, then a determination must be made as to whether you can adjust to different types of work. The determination at this level takes into consideration your education, age, and prior work and is better known as your residual functional capacity.

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