SSD and SSI disability claims filed primarily on the basis of cancer are handled fundamentally the same way as other cases, the only difference being that some cases, based on condition and prognosis, are expedited in the system. Cancer disability claims are approved in one of two ways: either by meeting the requirements of a specific disability listing in the SSA's blue book or by receiving a medical-vocational allowance, a type of approval in which it is determined that the claimant cannot return to their past work or engage in forms of other work.
Is a Diagnosis of Cancer All That's Needed for Disability Approval?
Although a diagnosis of cancer is very traumatic, it is not a guaranteed approval for Social Security disability. For many forms of cancer, the cancer has to be inoperable versus being controlled with treatment, or have distant metastases (has spread), or be recurrent after surgical procedures or irradiation.
However, there are certain type of cancers that may garner an immediate approval for disability. For example, metastatic brain or spinal cord carcinoma, inflammatory breast cancer, mesothelioma of the pleura, oat cell cancer (small cell cancer) of the lungs, primary cancer of the liver, bile ducts, or gall bladder, and cancer of the pancreas are types of carcinoma that meet one of the SSA's official listings for disability based on a diagnosis of the cancer alone.
These cancer cases are decided on the basis of medical record documentation, and this includes admission and discharge summaries from hospitals as well as physician's office notes and reports of blood work and imaging studies (xrays, MRI, and CT scans).
In addition, an individual can't be doing a substantial amount of work when he or she applies, and applicants need to meet the work history or financial qualifications of the SSDI or SSI program. For more information, see our section on the non-medical requirements of Social Security disability.
What Medical Evidence Is Required for a Disability Determination?
When making a disability determination and evaluating the level of impairment resulting from a malignant tumor, Social Security considers the location of the neoplastic (cancerous) lesion, the formation and development of the tumor, the degree of involvement, the response to treatment, and the severity of residual symptoms (post treatment).
Documentation must include a diagnosis of cancer that can be verified by symptoms, lab findings, and signs, along with a statement that includes the origin of the cancer and whether the malignant tumor is a primary, recurrent, or a metastatic tumor. Additionally, if an individual has had a biopsy, Social Security can use the operative report that includes the gross and microscopic examination of the tissues along with any other pertinent observations as part of their case documentation.
Does Metastatic Cancer Automatically Qualify for Disability Benefits?
If an individual's carcinoma has spread beyond the regional lymph nodes, the individual will most likely be approved for disability benefits based on meeting one of the SSA's neoplastic disease listings. (In fact, many progressive cancers are eligible for expedited benefits as compassionate allowances.) But for most forms of cancer, in cases where an individual has had a malignant tumor that spread only to a regional lymph node that has been completely removed, Social Security disability examiners will evaluate their residual functional capacity, work history and education when making a disability determination.
These cancer cases boil down to a determination that is made by either a disability examiner or a disability judge as to whether or not a claimant can engage in work activity while earning a monthly substantial and gainful income. This includes work activity performed in jobs that the applicant has performed in the past as well as other types of jobs that the Social Security Administration (SSA) believes the applicant would be capable of performing based on their functional capacities, education, age, and work skills called vocational factors). Learn more about disability approval based on vocational factors.
If your cancer progresses, you should alert Social Security that your cancer has metastasized, or, if you were already denied benefits, reapply for a compassionate allowance.
Do Cancer Cases Qualify for Permanent Disability Payments?
No Social Security disability approval can be considered permanent if there is a chance for medical improvement. Disability approvals based on cancer are no different. In fact, if the original tumor and any metastatic disease appear to have disappeared and have not been evident for three years or more, the impairment no longer meets the disability criteria for a neoplastic disease.
However, even if an individual's cancer has disappeared and has not been evident for three years or more, the individual may still be able to receive disability benefits. If the individual's residual functional capacity (what an individual is able to do in spite of the limitations imposed by the condition or the residual effects of treatment) is not high enough to work, the individual can still get benefits. In other words, if an individual still has significant post-treatment residual symptoms that severely restrict their ability to perform substantial gainful activity, they may continue to receive disability benefits. For more informaiton, see our section on continuing disability reviews.
Find out the specific requirements for getting disability for the most common cancers.