A cancer diagnosis can evoke many feelings: fear, overwhelm, sadness, uncertainty. Treating cancer can be a life-changing experience requiring many adjustments.
For many who are receiving cancer treatment, continuing to work is no longer advisable, maybe not even possible. In such cases, patients may wonder whether they qualify for disability benefits.
So, how do disability benefits for cancer work?
Unfortunately, a cancer diagnosis does not automatically make you eligible to receive disability benefits.
Your eligibility depends on what type of cancer you have, how much the cancer has progressed, treatment options, and other situational elements.
It makes sense to consider cancer to be a disability, but the Social Security Administration (SSA) has a very specific definition of disability. Not all cancer cases fit the SSA’s strict criteria.
In this article, we’re going to go over…
- What types of cancer qualify for disability benefits;
- How compassionate allowances work;
- What medical evidence to provide when you apply for disability benefits;
- And what your options are if your disability claim application is denied.
First, let’s unpack exactly what types of cancer qualify for disability benefits.
What Types of Cancer Qualify for Disability?
To summarize the SSA’s definition of disability, here are the essential criteria that must be met:
- You have a medically determinable physical or mental impairment
- The impairment can be expected to last continuously for 12 months or more OR is expected to result in death
- The impairment prevents you from engaging in substantial gainful activity (SGA); that is, it prohibits you from working enough to fully support yourself
Your case must fulfill all three of these criteria in order for you to qualify for disability benefits, whether Social Security disability insurance (SSDI) or Supplemental Security Income (SSI). Essentially, your condition must be considered severe enough to prevent you from working.
If you have cancer, the cancer has to meet the criteria found in section 13.0 of the SSA’s Blue Book. There are about 30 different types of cancer covered in this section. Each type of cancer has its own description of what is considered sufficient severity that would qualify the patient for benefits.
Should you decide to look up your particular type of cancer in the Blue Book, just know that the document was primarily written for medical and legal professionals. There is a lot of technical terminology that might be confusing for an untrained person. You may need someone with medical training to help you determine whether your condition meets the Blue Book criteria.
Note that the cancer listings are based on the origin of the cancer.
Let’s say your cancer has spread to your kidneys, but it started in your liver. The listing you would look at would be “Liver,” not “Kidneys.”
This is really important because the criteria differ between each type of cancer. So, for example, the criteria for liver cancer and kidney cancer are totally different from each other.
If you have an advanced form (Stage IV or terminal) of the following types of cancer, you may automatically medically qualify for disability benefits:
- Brain cancer
- Liver cancer
- Sinonasal cancer
- Pancreatic cancer
- Esophageal cancer
- Salivary cancer
- Thyroid cancer
- Inflammatory breast cancer
- Gallbladder cancer
- Any small cell cancer
All these types of cancer qualify for what is called the Compassionate Allowances (CAL) program, which we’ll be unpacking in the next section.
There are other types of cancer that in more severe stages are eligible for Compassionate Allowances, but the above list includes those cancers that automatically qualify. If you have a severe condition that is not listed above, you can search for it under the CAL Conditions list.
How Do Compassionate Allowances Work?
So, what is the CAL program?
Essentially, it’s a program that allows Social Security to expedite the approval process for individuals with extremely severe medical conditions that obviously meet the definition for disability.
As mentioned above, certain cancers fall under Compassionate Allowances, as do adult brain disorders and some rare disorders that affect children.
The conditions are not arbitrarily selected. SSA uses information from…
- Public outreach hearings;
- Social Security and Disability Determination communities;
- Research from the National Institutes of Health (NIH);
- And scientific and medical experts
…in order to establish which conditions should be considered under CAL.
A lot of research and external input has gone into the attempt that the SSA has made to make an objective decision about which medical conditions are CAL-eligible. Again, you can find the full list of CAL conditions on the SSA website.
The whole purpose of CAL is to reduce the amount of time it takes to reach a disability determination for applicants with the most severe disabilities.
No special application or form is necessary to submit for Compassionate Allowances. All that is required is to apply for disability benefits using the standard application for either SSDI or SSI. Using special technology, Social Security will then identify whether you have a Compassionate Allowance condition and treat your application accordingly.
The same rules for evaluating CAL conditions apply to both the SSDI and SSI programs.
For those with a cancer diagnosis, it’s critical to know that most cancers meeting on of the following criteria will qualify for CAL:
- The cancer keeps recurring despite all treatment efforts
- The cancer has spread from its origin to other regions of the body
- The cancer is inoperable
If you can’t find your condition on the list for Compassionate Allowances conditions, you can submit a potential CAL condition to SSA at Submit the Name of a Condition for Consideration.
While CAL conditions can qualify you for disability benefits without extensive medical evidence, all individuals filing an application must provide medical documentation of their disability.
Let’s dive into what medical evidence you need in order to build your case for disability benefits.
Medical Evidence You Need to Provide
The most helpful medical documentation to support your case is a physician’s note(s).
Your doctor should give the following details in their documentation of your condition:
- Your diagnosis
- Symptoms you experience with description of severity
- Treatments and their effectiveness
- Side effects of treatments you experience (including prescribed medications)
- Your restrictions and limitations
- Prognosis of full or partial recovery or no recovery
These details are critical for helping Disability Determination Services (DDS) quickly determine whether your cancer is indeed disabling and/or falls under Compassionate Allowances.
Again, if your condition falls under CAL, your application will be prioritized, and you’ll receive an approval faster. But you need to prove that you have a CAL condition.
Here is some of the other information to include in your application:
- Your physician’s name, address, and contact information
An SSA representative may need to reach out to your doctor in order to verify medical information you’ve provided with your disability claim.
- Results of diagnostic tests and detailed descriptions of treatments and rehabilitation
- A list of your medications including names, dosages, and the purpose of each medication
- The names and contact information of all the medical facilities where you’ve been treated
- A note of recommendation for disability benefits from your physician
There is a lot of other information that you need to provide for your disability claim application. Make sure you review at the Adult Disability Starter Kit and the Checklist for Online Adult Disability Application before you begin the application process.
Though you need to provide other information about identity and work, all the medical evidence you include is the heart of your case. For individuals struggling with cancer, medical documentation is crucial to secure an approval for their disability claim.
Gathering all the various kinds of information and documentation you need for your application can get a bit overwhelming. We have a great article with some tips for navigating this preliminary part of the application process. You may find something helpful there.
Remember also that you do not have to go through the application process alone.
Consider teaming up with a disability attorney to ensure that all your documentation is together, in order, and ready to be reviewed by DDS. Not only can a disability lawyer help you gather all your information and documentation, he or she can look over your application to correct errors that might otherwise have resulted in a denial.
Now, if you’ve looked at the Blue Book criteria and think that you are ineligible for that program, you do have another option.
What to Do If You Don’t Think You Qualify
So, if your cancer diagnosis has no Blue Book listing or doesn’t meet the listing requirements, don’t give up quite yet.
Ask for a Residual Functional Capacity (RFC) evaluation.
The SSA does not award disability benefits simply based on your disabling medical condition. Rather, they look at whether your disability prevents you from working. The whole purpose of the Blue Book criteria is to evaluate your ability to work.
If you successfully complete an RFC evaluation, also known as the “Ability to Do Work Related Activity” form, that means you have adequately shown your total inability to engage in work considered to be substantial gainful activity (SGA) due to your medical condition.
If you have cancer, qualifying through an RFC can be tricky. The SSA only considers cancer to be a disability if it meets the severity level established in the Blue Book listings. So, when you complete the RFC evaluation, you really need to show that the cancer, the required treatments, and the various side effects resulting from treatment (i.e. residual challenges) are so severe that you cannot work any job at all.
As we said, qualifying via an RFC can be difficult… but it can be done.
This process requires that you and your doctor complete “functional” report forms, which ask about your day-to-day activities. While this report seems like it has no bearing on your job performance, it actually creates a picture of your limitations for the SSA that applies to the types of skills necessary for various jobs.
For example, let’s say you report that the side effects of your cancer treatments make grocery shopping, mowing the lawn, or basic cleaning tasks impossible without support from someone else. This information shows the SSA that you couldn’t possibly do work that requires physical effort.
Your age will also be considered in your RFC evaluation, as older adults are considered more difficult to retrain in order to take on a new job. If you’re an older applicant with cancer, you may be more likely to qualify for benefits through an RFC.
The SSA considers whether your skills are transferable to another job.
Whether this is right or wrong, Social Security’s logic is that having a college degree tends to mean your skillset can be transferred between different jobs.
But if you, for example, learned a trade and have a very specific, non-transferable skillset, it’s less likely you’ll be able to do another job without significant retraining. So, if you never got a college degree, you will also be more likely qualify through an RFC.
The RFC form is pretty straightforward, but it’s important to know that every single question is designed so that the SSA can clearly determine the disability level of the applicant. Because your doctor will be the one filling out the form, the information will be considered more credible than any information you yourself report.
Need Disability Benefits for Cancer? Get Disability Benefits Assistance
There is a lot that goes into the disability claim process, especially for those who are battling cancer. It can be easy to omit important information and evidence from your application and even easier to overlook basic errors on the application.
Unfortunately, these omissions and errors are a big reason why over 60% of first-time disability claim applications are denied.
You have a much higher chance of receiving a decision of approval for your disability claim if you seek out disability benefits assistance. Typically, this means partnering with a disability benefits attorney who can help you with your case.
At BenefitsClaim.com, we offer a free online disability case evaluation consisting of just a few questions to help you determine your eligibility for benefits.
There is absolutely no cost for the online disability case evaluation. You can complete the evaluation here.
From there, if you still need help, you can hire a disability benefits lawyer from our team who can help increase your chance of an approval from Social Security. An experienced disability attorney can build a compelling case for why Social Security should give you the benefits that you truly need and deserve.
This is especially important for individuals with a cancer diagnosis, as your eligibility depends on the type and severity level of the cancer.
A legal professional can help you present the best possible evidence to persuade Social Security of your real need for benefits, as well as walk you through the RFC process if that becomes necessary.