Disability Benefits for Pancreatic Cancer

Most patients with a diagnosis of pancreatic cancer will get an automatic approval of disability benefits.

By , Contributing Author

Pancreatic cancer occurs when malignant tumors begin to grow in the cells of the pancreas, an organ located behind the stomach. Cancer of the pancreas is serious and aggressive, and almost always disabling. Almost all patients with pancreatic cancer who apply for Social Security disability benefits are quickly approved.

Symptoms of Pancreatic Cancer

The early stages of pancreatic cancer generally do produce any symptoms. Sometimes, a person does have symptoms, but they are not indicative of pancreatic cancer. When symptoms do arise, they can include:

  • fatigue or weakness
  • loss of appetite or weight loss
  • nausea, vomiting, diarrhea, or indigestion
  • pain in the abdomen or back
  • dark urine or clay colored stool
  • jaundice (which is a yellowing of the whites of your eyes or skin), and
  • blood clots.

Types of Pancreatic Cancer

There are two different types of cells in the pancreas. There are exocrine cells, which make enzymes that help the body to absorb food and islet cells (also known as endocrine cells) that make hormones called insulin and glucagon, which control the body's blood sugar.

Tumors that form in the exocrine cells are called exocrine tumors. A large percentage of all pancreatic tumors, 95%, are tumors of the exocrine cells. These tumors are most often cancerous, and these cancerous tumors are called carcinomas.

Tumors that form in the islet cells are called islet cell tumors. These tumors are not common, with only 5% of all pancreatic tumors being islet cell tumors. These tumors can be either benign (meaning they are not cancerous) or malignant (cancerous), and they tend to grow more slowly than exocrine tumors.

Prognosis for Pancreatic Cancer

The prognosis for those who are diagnosed with pancreatic cancer is often not good because the cancer is not found until it is in its later stages, due to the lack of symptoms. More than 80% of pancreatic cancer patients have tumors that have spread and cannot be removed fully; the average survival rate for those patients is less than one year. Sadly, 95% of all patients diagnosed with pancreatic cancer will not live more than five years. Overall, the average time from diagnosis to death is four to six months.

Qualifying for Social Security Disability

In order to qualify for Social Security or SSI disability benefits, you must meet the requirements of Social Security's disability listings for pancreatic cancer or show that your functional limitations prevent you from being able to work.

Meeting the Disability Listing

Pancreatic cancer has a specific listing in the Social Security "blue book," which outlines diseases that will qualify you for disability benefits if you can show that you meet the criteria set out in the listing. The listing is split into the two types of pancreatic cancers.

  • Exocrine carcinoma. Any exocrine carcinoma makes you eligible for disability benefits, whether the carcinoma has spread or is removed in surgery. In order to prove you have an exocrine tumor, you should provide medical records that show the type, extent, and location of the cancer. If you have had surgery, you should include the operative notes and pathology report, if possible.
  • Islet cell carcinoma. This includes all pancreatic cancer that has formed in the islet cells. You should provide medical records that show the type, extent, and location of the cancer. Islet cell carcincoma makes you eligible for disability only if one of the following are true:
    • The tumor is inoperable. To be inoperable, there must be no medical value to having the surgery, or it cannot be performed due to your health. Your doctor can make this determination before or after attempts have been made to decrease the size of the tumor through radiation or chemotherapy. Your medical evidence should clearly state the inoperability of the tumor, or
    • The tumor is unresectable and the cancer cells are active. A tumor is deemed to be unresectable if surgery was completed, but the tumor was not able to be completely removed. This is common with pancreatic cancer. The cancer in the islet cells must also be active, meaning cancerous cells are still being produced, to meet this listing. You will need to provide records from your surgery, including operative notes that state the tumor was not completely removed.

Functional Limitations

If you have pancreatic cancer, it is very unlikely that you won't meet the disability listing above. However, it is possible for someone with islet cell carcinoma to not meet the disability listing (for instance, a patient with islet cell carcinoma had the tumor fully removed). If you have islet cell carcinoma and you cannot perform the duties of a job, you might qualify for disability because of your limitations. When determining if an individual who doesn't meet a disability listing is able to work, Social Security looks at the individual's functional limitations in the areas of physical and mental abilities.

Physical limitations are the most prevalent for those with pancreatic cancer, though your mental abilities may also be impaired due to fatigue. Severe fatigue from radiation and chemotherapy might limit the amount of physical activity you are able to do. Additionally, if surgery was done, the recovery time from surgery can take several weeks to several months. Physical activity would be substantially limited during your period of recovery.

Mental abilities and limitations focus on your ability to comprehend and complete tasks at work and to get along with others in the work place. Severe fatigue from treatment for pancreatic cancer may affect your ability to complete tasks at work.

If Social Security finds that your functional limitations would limit you from working any type of job for at least one year, you could be approved through a "medical-vocational allowance." For more information, see our section on medical-vocational allowances.

How Long Does Disability Last for Pancreatic Cancer?

Those with pancreatic cancer who qualify for disability benefits will be considered disabled until at least three years from the date of remission. If, after three years, the limitations due to the cancer persist, the lingering effects of the cancer (or treatments) will be considered in determining if you are still disabled.

Compassionate Allowance

Due to the severity of and poor prognosis for pancreatic cancer, Social Security has listed it as an illness that qualifies for Compassionate Allowancetreatment. The Compassionate Allowances program allows individuals to receive benefits in an expedited fashion.

Only pancreatic cancer of the exocrine cells (carcinoma that is not islet cell carcinoma) qualifies for the Compassionate Allowances program. To show that you meet the requirements for the Compassionate Allowance, Social Security recommends you provide, with your disability application, a pathology report that shows a definitive diagnosis for carcinoma of the exocrine cells.

For more information, see our article on the Compassionate Allowance.

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