Social Security Disability Benefits for Breast Cancer

There are three ways to be found medically eligible for SSDI or SSI disability benefits when you have breast cancer.

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Breast cancer is the second most common cancer in the world. Although there are many kinds of breast cancer, the most common type of breast cancer for women is mammary ductal carcinoma. Mammary ductal carcinoma comes in two forms: infiltrating ductal carcinoma (invasive proliferation of cancerous cells in the breast tissue) and ductal carcinoma in situ (non-invasive cells that may be malignant and are confined to the lactiferous ducts). The latter, ductal carcinoma in situ, is also known as Stage 0 cancer, because doctors cannot even seem to agree that it is actually cancer. Currently, ductal carcinoma in situ accounts for about 20% of screening-detected breast cancer diagnoses.

Diagnosis of Breast Cancer

Breast cancer screening tests include MRI imaging, mammograms, and biopsies. While these tests are useful in detecting most kinds of breast cancer, they cannot accurately diagnose inflammatory breast cancer. If there is a possibility of inflammatory breast cancer, a surgical biopsy should be done that includes a larger breast skin sample, as well as a sample of the underlying breast tissue. Oncologists are leaning toward PET scans as the preferred testing technique for inflammatory breast cancer, because it allows them to see more of the disease.

Breast Cancer Stages

As mentioned, oncologists use a staging system to evaluate the extent of an individual's breast cancer. Cancer stages are based upon the following criteria: size of the tumor, whether or not the cancer is invasive or non-invasive, whether or not the the cancer has spread beyond the breast, and whether or not the lymph nodes are involved.

Stage 0 generally describes non-invasive breast cancers, such as ductal carcinoma in situ or lobular carcinoma in situ. In Stage 0, cancer cells or non-cancerous abnormal cells have not spread from the part of the breast where they began and have not invaded the neighboring normal breast tissue.

STAGE 1 involves cancerous cells invading normal neighboring tissue. At this stage, the tumor can be up to 2 cm and have no lymph node involvement.

STAGE 2 is divided into two subcategories: 2A and 2B.

2A is invasive breast cancer in which no tumor can be detected in the breast itself, but there are cancerous cells in the lymph nodes under the arms. Or thee can be a tumor that is two centimeters or less and has spread to the lymph nodes under the arms. Or, the tumor is larger than two centimeters but less than five centimeters but has not spread to underarm lymph nodes.

2B means the tumor is five centimeters or more but has not spread to lymph nodes in the underarm area, or the tumor size is greater than two centimeters but less than five centimeters and it has spread to the lymph nodes in the under arm area.

STAGE 3 is divided into three subcategories: 3A, 3B, and 3C.

3A means no breast tumor. The cancer is located in the underarm lymph nodes, either clumped together or sticking to other areas, or the cancer has spread to the lymph nodes near the breastbone, or the size of the tumor is more than five centimeters, or less than five centimeters and the cancer has spread to the auxiliary lymph nodes that are clumped together or sticking to other areas.

3B means any sized tumor that has spread to the chest wall, breast skin, or both. And, the cancer may have spread to the axillary lymph nodes that are clumped together or sticking to other areas, or the cancer has invaded the lymph nodes near the breastbone. Inflammatory breast cancer is considered to be three B or higher.

3C means that a tumor can be of any size and may have spread to the skin of the breast, chest wall, or both, and the cancer has spread to lymph nodes that are above and below the collar bone, and the cancer may have invaded the lymph nodes in the underarm area or near the breast bone.

STAGE 4 means cancer that has invaded other organs of the body such as the lungs, bones, brain, or liver.

Treatment options vary depending upon the type of cancer and the stage of the cancer. Treatment options include chemotherapy, radiation therapy, hormone therapy, lumpectomy, and mastectomy. Most breast cancer treatment involves a combination of these methods to ensure the best chance of survival.

Disability Benefits for Breast Cancer

There are three ways to be found medically eligible for disability benefits when you have breast cancer: qualifying as a Compassionate Allowance, meeting the requirements of the official disability listing for breast cancer, or showing your limitations are too great for you to work at your old job or do any new type of work.

Compassionate Allowances

Social Security recently set up a program called Compassionate Allowances to expedite benefits to those with serious diseases and advanced cancers. Breast cancer that is diagnosed as having distant metastases or that is inoperable (surgery not available) or unresectable (not able to be completely removed) qualifies as a Compassionate Allowances condition. Stage IV cancer always qualifies as a Compassionate Allowance condition, with proper documentation. The SSA requests a pathology report and an operative report, if possible, to provide evidence that your breast cancer qualifies for Compassionate Allowance treatment.

Sometimes breast cancer doesn't qualify as a compassioante allowance at first bu t then progresses; see our article on qualifying for a compassionate allowance when cancer worsens.

Learn more about how Social Security expedites Compassionate Allowance cases.

Meeting the Disability Listing

Social Security evaluates breast cancer under Listing 13.10, Breast Cancer, in its listing of impairments that qualify for disability benefits. In this listing section, Social Security specifies the qualification criteria. If an individual has breast cancer, she must have one of the following to qualify for disability benefits:

  • inflammatory carcinoma
  • tumor with direct extension to the chest wall or skin
  • distant metastases 
  • metastases to the supraclavicularor or infraclavicular nodes
  • metastaes to ten or more axillary nodes
  • metastases to the ipsilateral internal mammary nodes, or 
  • recurrent carcinoma (excluding a local recurrence that is controlled by treatment).

Note: Distant metastases occurs when cancer has spread from the original (primary) tumor to distant organs or distant lymph nodes. 

You can show your doctor the breast cancer listing and ask your doctor's opinion as to whether your cancer meets any of the above criteria. 

If your medical records don't satisfy the requirements of the breast cancer listing, you can still be approved through something known as a medical-vocational allowance.

Medical-Vocational Allowance

When you don't meet the requirements of the breast cancer listing, it's usually because your breast cancer is not as advanced as the disability listing requires. For instance, you may have only metatases to two or three axillary nodes. Fortunately, you still have a chance to get disability benefits, because the SSA will assess how much functional capacity you have left, to see if you are able to work. The SSA will look at how much you can lift and carry and the length of time you are able to sit, stand, and walk. The SSA will use this information to assign you a "residual functional capacity" (RFC) rating. 

Treatment for breast cancer can make it difficult to work because chemotherapy and radiation can cause pain, fatigue, headaches, depression, mood swings, and memory loss. In addition, recent studies show that a significant percentage of breast cancer patients who have undergone surgery later suffer significant pain for protracted periods. If you have pain and fatigue, your RFC may state that you can do sedentary work only. And if you are given a sedentary RFC and are over age 50, you have a good chance of getting benefits under a medical-vocational allowance.

Learn more about how to get a medical-vocational allowance.

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