Qualifying for Disability Benefits (SSDI) with Cancer in Pennsylvania

Millions of Americans who cannot work due to poor health rely on disability benefits from the Social Security Administration (SSA) to help cover their basic living expenses.  These expenses may include housing payments, utility bills, grocery bills, medical treatments, and more.  But while SSA benefits are an indispensable form of financial assistance for those who qualify, it can be extremely difficult to have a claim approved.
The SSA uses various standards to determine applicant eligibility for disability benefits. One of the most basic and important standards is the presence of a severe disability.  While claims representatives do consider input from doctors and physicians, the SSA also has its own set of guidelines, and each condition and illness has a unique set of qualifying points. So how does the SSA evaluate cancer?

Cancer in the United States

Cancer is one of the most physically, emotionally, and financially devastating health conditions affecting our society today.  Cancer can cause a host of extremely unpleasant physical symptoms across multiple body systems, and sadly, sometimes results in death.  In addition to the devastation wrought by the illness itself, some of the treatments for cancer can be extremely hard on the human body, inflicting their own set of side effects.
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According to the American Cancer Society, over one million Americans develop some form of cancer on annual basis.  Cancer can be caused by lifestyle factors, exposure to radiation or carcinogenic materials, or heredity.  Some cancers tend to attack men, while others have a higher incidence rate in women.  According to the National Cancer Institute, some of the most common forms of cancer in the United States include:

  • Bladder Cancer
  • Breast Cancer
  • Kidney Cancer
  • Lung Cancer
  • Melanoma (Skin Cancer)
  • Prostate Cancer
  • Thyroid Cancer

How to Qualify for Disability Benefits with Cancer

The SSA maintains an extensive “Blue Book,” also known as the Listing of Impairments.  As the name suggests, the Listing of Impairments is a catalog of common health conditions which can potentially qualify claimants to receive disability benefits.  How does the Listing of Impairments address cancer?
Cancer is handled by Section 13.00, Malignant Neoplastic Diseases.  This section covers “all malignant neoplasms” (i.e. tumors) except those associated with HIV (which is covered by Section 14.00, Immune System Disorders).
This means that you can qualify for benefits with cancer.  However, your illness and its effects must meet further requirements.

SSA Medical Record Requirements

Section 13.00B outlines the four basic factors the SSA considers when evaluating cancer:

  1. “Origin of the malignancy.”
  2. “Extent of involvement.”
  3. “Duration, frequency, and response to antineoplastic therapy (e.g. hormones, chemotherapy).”
  4. “Effects of any post-therapeutic residuals.”

Asserting that you have cancer is simply not “enough” in the eyes of the SSA.  To quote the SSA under Section 13.00D, “We need medical evidence that specifies the type, extent, and site of the primary, recurrent, or metastatic lesion.”  This evidence may include operative notes, pathology reports, and other detailed information regarding “recurrence, persistence, or progression of the malignancy, the response to therapy, and any significant residuals.”

Types of Cancer Covered by Disability Benefits

Sometimes, such as in the case of a rare disease, the SSA will consider conditions which are not included in the Listing of Impairments.  Therefore, while every single possible type of cancer is not listed, that does not necessarily mean it cannot qualify.  Generally speaking, the SSA is mainly concerned with determining that you do in fact suffer from a debilitating condition.
That said, the Listing of Impairments notes a fairly comprehensive list of cancers and tumors:

  • Soft Tissue Tumors of the Head and Neck (Section 13.02)
  • Skin (Section 13.03)
  • Soft Tissue Sarcoma (Section 13.04)
  • Lymphoma (Section 13.05)
  • Leukemia (Section 13.06)
  • Multiple Myeloma (Section 13.07)
  • Salivary Glands (Section 13.08)
  • Thyroid Gland (Section 13.09)
  • Breast (Section 13.10)
  • Skeletal System — Sarcoma (Section 13.11)
  • Maxilla, Orbit, or Temporal Fossa (Section 13.12)
  • Nervous System (Section 13.13)
  • Lungs (Section 13.14)
  • Pleura or Mediastinum (Section 13.15)
  • Esophagus or Stomach (Section 13.16)
  • Small Intestine (Section 13.17)
  • Large Intestine (Section 13.18)
  • Liver or Gallbladder (Section 13.19)
  • Pancreas (Section 13.20)
  • Kidneys, Adrenal Glands, or Ureters — Carcinoma (Section 13.21)
  • Urinary Bladder — Carcinoma (Section 13.22)
  • Cancers of the Female Genital Tract — Carcinoma or Sarcoma (Section 13.23)
  • Prostate Gland — Carcinoma (Section 13.24)
  • Testicles (Section 13.25)
  • Penis (Section 13.26)
  • Primary Site Unknown (Section 13.27)
  • Malignant Neoplastic Diseases Treated by Bone Marrow or Stem Cell Transplantation (Section 13.28)

Getting Social Security Benefits for Cancer Therapy in Pennsylvania

Cancer is unlike many other conditions in that treatment itself can be debilitating.  The SSA acknowledges the potential for negative side-effects of cancer therapies, stating under Section 13.00G,  “Because the therapy and its toxicity may vary widely, we consider each case on an individual basis.”  Therefore, applicants must provide information about many different aspects of their treatment, including:

  • Drugs and Dosage
  • Radiation Therapy Schedule
  • Surgery Information
  • Symptoms of Therapy

Our Philadelphia + Bucks County Disability Attorneys Can Help

If you or someone you love is living with cancer which interferes with employment, you may be able to qualify for assistance. To schedule a free and confidential legal consultation with a social security disability attorney, contact Young, Marr & Associates online, or call (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania.

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