Social Security Disability Process for Cancer Patients

Qualifying for Social Security disability benefits for cancer can be straightforward for some aggressive cancers (such as pancreatic, liver, thyroid, mesothelioma, and esophageal cancers), but for others, you'll need to provide the Social Security Administration (SSA) with convincing evidence to show either that 1) your cancer fulfills the qualifications for the SSA's disability listing for that particular cancer or 2) the symptoms or treatment for your cancer limit you so much that you can't work. (For more information on the basic qualifications for disability for cancer, see our overview article on getting disability for cancer.)

Cancers that were inoperable or unresectable with surgery, that have recurred after treatment, or that metastasized to other places are eligible for disability benefits. Here are some explanations of the ins and outs of getting disability for various types and stages of cancer.

When Surgery or Treatment Is Not Successful

If you had surgery to remove your tumor but it was not able to be fully (or partially) removed, it is termed "unresectable." Under the SSA's impairment listings for most types of cancer, this will qualify you for disability benefits. In addition, if your surgical margins are positive following surgery, your cancer should be termed unresectable, qualifying for benefits under most of the cancer listings.

If your tumor is removed but then returns in an area near the site of the original surgery, or if a tumor returns after chemo ro radiation, your cancer will be considered "recurrent" under the listing for your particular cancer. An recurrent cancer automatically qualifies for disability benefits under most of the cancer listings, including lung cancer, colon cancer, kidney cancer, prostate cancer, testicular cancer, and uterine and ovarian cancer (one exception to this rule is carcinoma of the breast). This is applicable even if there is a considerable time lapse between when you first underwent surgery or treatment and the time the cancer returned.

If your tumor is considered inoperable, you will qualify under most of the cancer listings.

If you underwent surgery to remove your cancer and you suffer from lymphedema (the chronic swelling of an arm or leg) as a result, your condition may be evaluated under the musculoskeletal or cardiovascular listings, depending on your symptoms. Lymphedema can occur after any cancer, especially breast cancer and melanoma.

When Your Cancer Has Spread

If your cancer has spread to parts of your body that are far removed from where it originated, this is called "distant metastases." The SSA's cancer listings refer to this complication as "metastases beyond the regional lymph nodes." For instance, lung cancer often metastasizes to the liver.

When cancer has spread, the applicant usually qualifies for automatic approval under the cancer listings, even if the original cancer and the metastic lesion have been removed. However, if the metastases (secondary tumors) are expected to respond fully to chemo or radiation, the SSA may wait to see the outcome.

To qualify for benefits because of metastatic cancer, you must provide the SSA with the appropriate medical documentation that supports your claim. Generally, metastatic lesions are diagnosed by biopsy; therefore, you would need to provide the SSA with the appropriate biopsy report. However, there are times when a metastic lesion cannot be accessed for a biopsy because the patient is too ill to undergo surgery or because the location prevents the doctor from performing a biopsy (such as in brain or bone cancer).

In cases where a biopsy is unattainable, you must provide the SSA with a copy of the x-ray, MRI or CT scan, or other test that was performed that revealed the metastatic lesion. However, even if your doctor provides a statement to the SSA that the lesion visualized on the imaging study is cancerous, the SSA will not accept his or her opinion unless the lesion is medically treated as cancer (for instance, with chemo or radiation).

When Side Effects of Treatment Keep You from Working

While many cancer patients are able to undergo chemo or radiation and continue to work, for others, it is this cancer treatment, not the symptoms, that makes it difficult or impossible to work. Chemotherapy and radiation can have a significant impact on your ability to function normally. The treatments often cause nausea, vomiting, diarrhea, fatigue, weakness, skin, and mental ailments. However, it's difficult to get disability solely because of chemo or radiation treatments because of the SSA's time requirement. The SSA requires that you are unable to work for at least one year. Often, the negative side effects of chemo or radiation are temporary and fluctuate over the course of treatment. Because side effects fluctuate, the SSA will require a sufficient passage of time from the start of chemo or radiation treatment to determine the ultimate effects of the treatment on the patient, both to see if the treatment was successful and to see if you were unable to work for one year.

It is important that you document your side effects both in a personal journal and with your physician. It may also be helpful to provide a statement by another person who has witnessed how the treatments have affected you.

When You Have Long-Term Side Effects From Treatment

Many cancer survivors suffer permanent side effects from their treatment for cancer; often these complications do not appear for months or years following the successful treatment of their cancer. When the long-term side effects of chemo or radiation are disabling, it's easier to get Social Security disability benefits than for the short-term effects.

Chemotherapy has been associated with the following long-term impairments:

• heart problems
• liver problems
• lung disease
• bone weakness
• cataracts, and
• reproductive disorders

Radiation therapy has been associated with the following long-term impairments:

• eye problems
• heart problems
• hypothyroidism
• reproductive disorders
• lung disease
• intestinal problems
• cognitive dysfunction, and
• bone weakness.

If you develop any of these conditions as a result of your cancer treatment, the SSA will evaluate the impairment on its own, without consideration of the cancer. For instance, if you have heart problems following chemo, your condition would be evaluated as a cardiovascular disability.

When You Became Disabled Due to Cancer

People usually do not known exactly when they contracted cancer because each cancer grows at a different rate. If your tumor was deemed inoperable or otherwise untreatable, the SSA will likely use the date that the doctor rendered his or her prognosis as your disability onset date. However, you may be able to prove that you became disabled even before your prognosis was established.

To determine whether you were disabled prior to the time when your cancer was found to be untreatable, the SSA will consider the following factors:

• When you first reported symptoms to your doctor
• What type of cancer you were diagnosed with
• Where the cancer is located, and
• And how far the cancer had spread when it was first diagnosed.

Usually benefits are awarded up to six months prior to when the applicant was first diagnosed with cancer, unless there was sufficient evidence to prove otherwise.

When Will You Be Considered No Longer Disabled From Cancer

If your original cancer (and any metastases, or tumors that spread) have been successfully treated, and there is no evidence of their recurrence for three or more years, then your cancer will no longer meet any of the SSA's impairment listing requirements. This is durational rule for cancer is known as the "three-year rule."

Alternatively, the three-year rule also means that if disability benefits are awarded to an applicant because of his or her cancer, the disability award will stand for a minimum of three years, even if the cancer seems to have been successfully treated prior to the end of the three-year period.

Note that cancer is subject to the same one-year duration requirement for getting disability benefits as any other medical condition.