Some medical impairments are so serious and certain to qualify for disability benefits that the Social Security Administration (SSA) expedites the handling of applications for benefits based on these impairments. These are called “compassionate allowance conditions."
The cancers on the list of conditions that qualify as compassionate allowances are those that are easily assessed based on a small amount of objective evidence, such as a doctor's diagnosis or a biopsy, and those that would meet the criteria of an SSA disability listing based on that evidence. Cancers fall under Section 13 of the disability listings: Malignant Neoplastic Diseases. The cancers on the compassionate allowance list usually have a poor prognosis.
There are currently about 50 types of cancer that are compassionate allowance conditions. For some of these cancers, a simple diagnosis is all that's required to qualify for compassionate allowance program and an expedited approval of your disability benefits. But for most of the cancers on the compassionate allowance list, the cancer has progressed in some way to be eligible for the compassionate allowance program.
As mentioned above, some types of cancer need to have progressed to a certain point in order to be a compassionate allowance condition. To qualify for the compassionate allowances program, the SSA requires that these cancers be either:
Let’s look at one example of a cancer that needs to have progressed to a certain point in order to be a compassionate allowance condition: stomach cancer.
If your medical records show that you have been diagnosed with stomach cancer AND your condition meets at least one of the following, your application will be expedited under the compassionate allowance program:
If you are diagnosed with stomach cancer and one of the five criteria above apply to you, the SSA will expedite your application for disability under the compassionate allowance program. As long as your medical records support that diagnosis, you will be found disabled by the SSA.
Although the SSA prefers a diagnosis based on a biopsy, the following are examples of what may also be used to diagnose stomach cancer: blood tests, endoscopy, fecal occult blood test (a test that looks for blood in the stool), and a CT scan.
Not every cancer and stage of cancer is a compassionate allowance condition. Many types/stages of cancer, mostly those with a good prognosis, are not considered compassionate allowance conditions. That does not mean you won't qualify for disability if you don't have a compassionate allowance condition; it just means your application will not be fast-tracked by the SSA. People with compassionate allowance conditions may receive a decision from the SSA in a few weeks after applying, while those people without impairments on the compassionate allowance list may wait a few months or longer for a decision.
You do not need to fill out a special application to be eligible for a compassionate allowance on the basis of cancer. If your diagnosis meets the criteria on the compassionate allowance list, you will be found eligible for disability and the process will be much faster.
You should make sure your application contains enough medical evidence to support your diagnosis. Some of the compassionate allowances for certain types of cancer require a pathology report detailing the findings of a biopsy, while other types of cancer on the compassionate allowance list do not require a biopsy. If you have had a biopsy, the findings of the pathologist who examined your tissue samples should be included.
In some cases, whether or not a certain type of cancer qualifies as a compassionate allowance condition depends on how far it has spread. For instance, metastatic breast cancer is eligible for the compassionate allowance program, but Stage I breast cancers are not. If your cancer has spread, your medical file should have documentation of these secondary, metastatic tumors.
If you have had any surgeries related to removing cancerous tissue, the surgeon’s notes should be in your record, including any reports from the microscopic examination of any tissue that was removed in the surgery.
Your medical record can also include supplemental information like lab tests involving blood or urine, CT scans, ultrasounds and any other tests that are applicable for diagnosing your particular kind of cancer.