Getting Disability Benefits for Cancer

It can be difficult to get Social Security disability benefits for cancer that's not advanced.

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A diagnosis of cancer often causes a great deal of fear in affected patients and their families, but whether a patient will qualify for Social Security disability benefits depends on how the disease impacts the person's ability to work. To be sure, life-threatening and terminal cancer diagnoses typically lead to automatic and sometimes expedited approval of disability benefits. But cancer that hasn't metastasized (spread) beyond the regional lymph nodes, that has responded to treatment, or that has been surgically removed may, in some cases, leave an individual able to return to work in Social Security's view. In these cases, it can be difficult to get disability benefits approved. However, it's possible that even successful cancer treatment can cause severe residual limitations that would qualify an individual for disability benefits.

Qualifying for Benefits Through the Compassionate Allowances List

Social Security's Compassionate Allowances List (CAL) is a collection of serious medical conditions, many life-threatening, that will automatically qualify a Social Security applicant for expedited approval of benefits. Instead of waiting up to a year for a disability hearing, an individual diagnosed with a condition on the CAL can sometimes obtain a disability approval within a few weeks.

There are more than twenty different types of cancer found on the CAL. In general, to qualify for a Compassionate Allowance, your cancer must not only be listed on the CAL, but also have distant metastasis (that is, the tumor must have spread), or be inoperable, unresectable, or recurrent.

Meeting a Blue Book Listing for Cancer

Separate from the Compassionate Allowance List, Social Security's Blue Book describes hundreds of different medical conditions that automatically qualify a person for benefits. In contrast with the CAL, the Blue Book does not involve an expedited processing of claims. Many forms of cancer are found in the Blue Book, including skin cancer (Listing 13.03), leukemia (Listing 13.06), breast cancer (Listing 13.10), and lung cancer (Listing 13.14).

However, as we saw with the Compassionate Allowances List, a diagnosis of cancer by itself is generally not enough to meet the listing requirements. The cancer must have either metastasized or be recurrent, inoperable, or otherwise untreatable.

Obtaining Benefits Through a Medical-Vocational Allowance

If your condition doesn't meet a listing in the Blue Book, you may still qualify for SSDI or SSI benefits based on a "Medical-Vocational Allowance," which takes into account your age, educational level, work history, and Residual Functional Capacity (RFC) to determine whether you can work. Your RFC is an assessment of the maximum mental and physical abilities that you retain in spite of your impairments.

The most common forms of treatment for cancer—radiation, chemotherapy, and surgery—all have the potential to cause severe and permanent functional limitations. Radiation can cause persistent joint pain, lymphedema, or Lhermitte's Syndrome, marked by an electrical sensation that shoots down the spine and spreads throughout the affected nerves. Chemotherapy is virtually always accompanied by nausea, fatigue, weakness, and a panoply of other ailments, many of which can linger even after the treatment has ceased.

If the side effects of your treatment leave you unable to perform full-time work, you'll qualify for benefits under a Medical-Vocational Allowance. It is critical that you provide Social Security with medical evidence proving the functional limitations you experience due to treatment. Your doctors' treatment notes, your hospital records, and the results of diagnostic testing (such as MRIs, x-rays, CT scans, blood tests, lumbar punctures, ultrasounds, or tumor biopsies) should all be submitted to Social Security as soon as they're available. Third-party statements from friends, neighbors, and former co-workers can also lend credibility to your allegations.

For details on getting benefits for specific types of cancer, including the testing and details needed, see our articles on getting disability for most types of cancer.

Residual Functional Capacity Forms in Cancer Cases

When applying for disability benefits based on the residual effects of cancer treatment, it's critical that you obtain an opinion from your treating primary care physician or, preferably, your oncologist. The easiest and most effective way for your doctor to provide an opinion is to complete a Residual Functional Capacity form.

RFC forms in cancer cases should include the following information:

  • type(s) of cancer diagnosed
  • nature of treatment (surgery, chemotherapy, radiation therapy)
  • duration of treatment (with beginning and ending dates), and whether additional treatment is contemplated
  • residual effects from treatment, including exertional limitations (lifting, carrying, pushing, pulling, sitting, standing, and walking) and non-exertional limitations (bending, stooping, manipulating objects, breathing near dust, fumes, and odors, and maintaining attention and concentration), and
  • ability to maintain adequate attendance and punctuality.
The more your physician explains his or her answers and cites medical evidence supporting his or her opinions, the more persuasive the RFC form is likely to be.

Consider a Consultation With a Disability Attorney

Although some disability claims involving cancer are clear-cut and may not require legal assistance (as in cases involving stage IV or terminal cancer), the majority of claimants will greatly benefit from hiring a lawyer to represent them. A disability attorney will understand how to prove that your condition meets a listing, or how to demonstrate that the side effects of your treatment prevent you from engaging in full-time employment. Disability attorneys generally provide a free consultation, and don't charge a fee unless you win your case. Consult Nolo's Lawyer Directory to locate a disability attorney in your area.

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