Disability Benefits for Pancreatic Cancer

Pancreatic cancer occurs when malignant tumors begin to grow in the cells of the pancreas, an important organ that aids in digestion and helps control blood sugar. Because pancreatic cancer is so serious and aggressive, most with pancreatic cancer who apply for Social Security disability benefits are quickly approved.

When Can I Get Social Security Benefits for Pancreatic Cancer?

In order to get disability, you must first meet certain non-medical eligibility requirements for the type of benefit you're applying for. Eligibility for Social Security Disability Insurance (SSDI) is based on your earnings record, while Supplemental Security Income (SSI) is available to applicants with limited income and assets.

If you meet the financial requirements for SSDI or SSI, Social Security can award you benefits if you have symptoms from pancreatic cancer that either meet a listed impairment or keep you from working full-time for at least 12 months.

Types of Pancreatic Cancer

There are two different types of cells in the pancreas—exocrine cells, which make enzymes that help the body to absorb food, and islet (or endocrine) cells that produce the hormones insulin and glucagon, which regulate blood sugar.

Exocrine tumors develop from exocrine cells and make up 95% of all pancreatic tumors. Exocrine tumors are often cancerous (carcinomas).

Islet cell tumors are less common, comprising the remaining 5% of pancreatic tumors, and can be cancerous or not. They also tend to grow less quickly than exocrine tumors.

Symptoms of Pancreatic Cancer

Early stages of pancreatic cancer are generally asymptomatic, meaning they don't show any symptoms. 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 (a yellow tinge to your eyes and skin), and
• blood clots.

Unfortunately, because pancreatic cancer doesn't usually produce symptoms—and therefore isn't typically found—until later stages, the prognosis (medical outlook) for patients is often poor. The disease has a very low five-year survival rate, with about 5% to 10% of patients who are living five years after getting a diagnosis. However, pancreatic cancer is potentially curable if caught very early—up to 10% of patients who receive an early diagnosis can successfully treat the cancer.

Qualifying for Social Security Disability by Meeting the Disability Listing

Pancreatic cancer is one of the listed impairments in Social Security's "Blue Book," which contains medical conditions that the agency considers especially severe. Each listing has a set of criteria that, when met, will qualify you for disability benefits. The criteria for pancreatic cancer are identified in listing 13.20, and vary slightly depending on your specific cancer diagnosis.

Exocrine Carcinoma

If you have medical evidence showing that you have exocrine carcinoma, you'll qualify for disability benefits under listing 13.20—whether or not the carcinoma has spread or been surgically removed ("resected"). Examples of acceptable medical evidence include pathology reports, lab tests, and imaging (such as MRIs, ultrasounds, or X-rays). The medical evidence must show the type, extent, and location of the cancer. If you've had surgery, you should include the operative notes when possible.

Islet Cell Carcinoma

You can meet the requirements of listing 13.20 for islet cell carcinoma in one of the following ways:

• The tumor is inoperable. "Inoperable" means that doctors don't think that surgery would be of any medical value, or that surgery is contraindicated (not recommended) due to your health. Your doctor can determine whether the tumor is inoperable before or after you've tried radiation or chemotherapy to treat the tumor. Make sure that your medical evidence contains a clear statement from your doctor that the tumor is inoperable.
• The tumor is unresectable and the cancer cells are active. Tumors are considered to be "unresectable" if they weren't able to be completely removed after surgery. (Unresectable tumors are common with pancreatic cancer.) You'll need to provide operative notes from your surgery stating that the tumor wasn't completely removed. Additionally, your medical record must show that cancerous cells are still being produced ("active").

As with exocrine carcinoma, your islet cell carcinoma medical records must show the type, extent, and location of the pancreatic cancer.

Qualifying for Social Security Disability Due to Functional Limitations

Most people with pancreatic cancer are likely to qualify for benefits under listing 13.20. But it's possible that someone with pancreatic cancer doesn't quite meet the requirements of the listing—for example, a patient with islet cell carcinoma who had the tumor completely removed. Such a patient may still qualify for disability benefits if they have functional limitations that keep them from working at any job.

The method by which Social Security determines whether you're able to work is called assessing your residual functional capacity (RFC). Your RFC is a set of physical and mental restrictions on what you're able to do in a work setting.

Restrictions in an RFC for Pancreatic Cancer

Physical limitations are common in an RFC for pancreatic cancer. Weakness from radiation and chemotherapy can limit the amount of physical activity you're able to do. Or, if you had surgery, you might need several months to recover, during which time your physical activity may be substantially reduced.

Common physical RFC restrictions include exertional limitations on how much weight you can lift and how long you can be on your feet; postural limitations on whether you can bend, stoop, kneel, crouch, or crawl; and manipulative limitations on your ability to reach and use your hands. Severe fatigue from pancreatic cancer treatment can also result in mental limitations on your ability to finish work tasks, get along with coworkers, and maintain regular attendance.

How Social Security Uses Your RFC

Social Security compares the restrictions in your RFC with the physical and mental demands of your past jobs to see whether you could do those jobs today.

If you can't, the agency then determines if any other jobs exist that you're capable of doing despite your limitations. For most disability applicants under the age of 50, this usually means that your RFC must rule out the simplest, least physically demanding kinds of work. Applicants 50 years of age and older may have an easier time getting disability under a set of rules called the medical-vocational grid.

Applying for Disability Benefits for Pancreatic Cancer

Social Security has several methods you can use to start your application for benefits.

• File online at Social Security's website.
• Call 888-772-1213 between the hours of 8 a.m. and 7 p.m., Monday through Friday, to speak with a representative who can help you fill out the forms. (People who are deaf or hard of hearing can call the TTY number at 800-325-0778.)
• Go to your local Social Security field office to complete the application in person.

If you think you qualify for expedited approval under the Compassionate Allowance program, you don't have to do anything special or file a separate form. Social Security will flag your application for faster processing based on your pancreatic cancer diagnosis.

_{Updated December 18, 2023}