SSDI Benefits for Breast Cancer Patients

To qualify for SSDI benefits or SSI based on breast cancer, you must be unable to work and your breast cancer must have lasted for one year or more -- or be expected to last a year or more.

By , Attorney UC Law San Francisco

Breast cancer is a type of cancer that develops in the cells of the breast. Symptoms of breast cancer may include swelling or a change in the shape of your breast, a nipple that is inverted inward, unusual discharges from the nipple, the feeling of a lump in your breast, or irritated and peeling skin over your breast. This cancer can be present in both men and women. Your doctor can diagnose breast cancer through the use of a clinical breast exam, a mammogram (an x-ray of the breast), a biopsy (removing cells for testing), and/or an MRI (magnetic resonance imaging). The stages of breast cancer range from Stage 0 to Stage IV.

Obtaining Disability Benefits With Breast Cancer

There are three ways to obtain disability benefits from Social Security if you have breast cancer:

  • Your breast cancer qualifies as a Compassionate Allowances condition.
  • Your breast cancer meets or equal a disability listing in the Listing of Impairments.
  • Your breast cancer results in physical or mental limitations that prevent you from performing any work.

Compassionate Allowances Conditions and Breast Cancer

The Compassionate Allowances program was set up by the Social Security Administration (SSA) to quickly grant benefits to individuals who have serious diseases that are likely to qualify for benefits with minimal medical evidence. If your condition qualifies for the Compassionate Allowances program, the SSA will perform expedited processing of your disability claim.

Breast cancer that is diagnosed as having distant metastases (cancer that has spread to other parts of the body) or that is inoperable (surgery not available) or unresectable (not able to be completely removed) qualifies as a Compassionate Allowances condition. Stage IV cancer qualifies as a Compassionate Allowance.

To provide evidence of that your breast cancer qualifies for Compassionate Allowance treatment, the SSA prefers that you send a pathology report and an operative report. If these reports are unavailable, the SSA may use the opinion of your physician.

Learn more about how compassionate allowances get disability benefits faster.

Qualifying for a Disability Listing With Breast Cancer

The SSA has created a Listing of Impairments (known as the "Blue Book"), which contains a wide range of specific medical conditions and the requirements needed to prove disability for these conditions. If your condition matches the requirements of one of these disability listings, the SSA will automatically find you disabled. Breast cancer is included as Listing 13.10.

To meet the listing for breast cancer, you need to provide medical evidence showing locally advanced cancer in the breast tissues. You also need to show one of the following factors:

  • Breast cancer that has spread to the supraclavicular (above the clavicle) or infraclavicular (below the clavicle) nodes or to 10 or more axillary nodes.
  • Breast cancer with distant metastases (spreading of the cancer to distant areas).
  • Recurrent breast cancer (cancer that has returned), except a local recurrence that stops with the use of antineoplastic therapy.

The SSA will want to see medical evidence indicating the type, size, and area of your breast cancer. If you have been hospitalized, the SSA will want a copy of the pathology findings and any other medical reports.

For more information on the requirements regarding inoperable, unresectable, recurrent, or metastasized tumors, see our article on when cancer qualifies for disability benefits.

Determining Your Residual Functional Capacity

When you do not meet or equal a disability listing contained in the Listing of Impairments, usually because your breast cancer is not as advanced as the disability listing (above) requires, the SSA will assess your residual functional capacity (RFC) to see if you are unable to work any type of job. Your RFC is the most you can do in a work setting (such as heavy work, medium work, light work, skilled work, or unskilled work). The SSA will determine the length of time you are able to sit, stand, and walk; the amount of weight that you can lift and carry; how well you can use your hands and arms; whether you can understand and follow instructions; and whether you can work with the public and coworkers. The SSA will use your RFC to decide if there are any jobs you can perform. If you are unable to perform any jobs, you will be considered disabled. (Learn about the basics of getting Social Security disability based on your RFC.)

Breast cancer can greatly affect your ability to work. You might be given surgery and radiation as treatment to heal your cancer. These treatments can cause pain, fatigue, headaches, depression, mood swings, and memory loss. If you have moderate pain and fatigue, your RFC might look like the following: can lift and carry less than ten pounds, can sit for six hours out of an eight-hour day, can stand/walk for two hours of an eight-hour day, and can perform only simple unskilled work. This RFC would still allow you to perform only sedentary work. But, if your fatigue is severe, you might be unable to work in a sedentary position because you would be absent too many days during the month. Furthermore, if you have pain in your breast area, that could affect your ability to use your arms, thus reducing the amount of jobs that you can perform. Generally, if you can't perform even sedentary work (unable to sit for six hours a day and stand/walk for two hours a day), you will be found to be disabled. Or, if you are over age 50, it is easier to be found disabled even if your RFC allows you to perform a greater range of work activities.

In addition, depression and memory loss, which affect some patients going through chemotherapy, radiation, and/or surgery, can affect your ability to concentrate on work tasks or follow simple instructions.

To create your RFC, the SSA will gather copies of your medical reports to learn about your symptoms and their severity. To help the SSA form a accurate opinion, it's helpful for you to obtain a detailed medical opinion from your treating doctor regarding your ability to perform work. Most helpful would be if your doctor can fill out an RFC form.

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