Expedited Benefits May Be Available If Cancer Worsens After Applying for Disability

If your cancer worsens, submit your new medical evidence to Social Security and request an "on-the-record" review.

Question

I applied for disability benefits due to breast cancer six months ago, was denied, and I am waiting for a hearing to be scheduled. My cancer (ductal carcincoma) has just been re-classified from Stage II to Stage IV. Is there anything I can do to expedite my claim?

Answer

Unfortunately, sometimes cancer may worsen significantly during application process for Social Security disability, despite treatment. If this happens to you, you may be able to get benefits more quickly based on the progression of the disease and your prognosis for recovery through the compassionate allowance program. Here is some information that will help you and others in your situation.

What is a compassionate allowance condition?

A compassionate allowance condition is one that the Social Security Administration (SSA) has pre-determined is serious enough to warrant an award of immediate disability benefits. The prognosis for compassionate allowance conditions is generally poor, and it is often medically certain that an applicant with the condition will suffer either permanently disabling symptoms or will die from the illness.

If you have a compassionate allowance condition, it means your disability application will be expedited and you should receive a decision from the SSA on benefits within a month.

When is breast cancer a compassionate allowance condition?

To be awarded a compassionate allowance for breast cancer, it must be determined that the cancer is inoperable, unresectable, or with distant metastases. Here are the definitions for these terms:

  • inoperable means that the treating doctors have determined that surgery will not be helpful to treat the cancer

  • unresectable means that lab reports show the cancer was not completely removed following surgery, and
  • distant metastases is when the cancer cells have spread to organs or lymph nodes far away from the original tumor.

If you are not sure whether your cancer meets any of these requirements, you should review them with your doctor.

What medical evidence does the SSA need?

The SSA will accept any of the following as medical evidence that the breast cancer warrants a compassionate allowance:

  • a pathology report, or

  • an operative report.

If your doctor has determined that the cancer is either inoperable or unresectable, you should also provide the SSA with a statement by your doctor that says this.

Which types of breast cancer qualify for expedited treatment?

Breast cancers that qualify for a compassionate allowance have many different names. To get a compassionate allowance, the important factor is that the criteria discussed above are met. Here are alternative names for qualifying breast cancers:

  • breast carcinoma (stage IV)

  • metastatic breast carcinoma
  • metastatic breast cancer
  • ductal carcinoma of the breast (stage IV)
  • metastatic ductal carcinoma
  • metastatic ductal cancer
  • lobular carcinoma of the breast (stage IV)
  • metastatic lobular cancer
  • metastatic lobular carcinoma
  • recurrent breast cancer, and
  • inflammatory breast cancer.

Does it matter that I am still getting treatments?

If the cancer is inoperable or unresectable, your doctors may recommend continued radiation or chemotherapy. Continued treatment will not affect your eligibility for a compassionate allowance.

How can I get my case expedited?

If your cancer progressed after you filed for disability benefits, schedule an appointment at your Social Security field office and take with you the necessary medical records to show how the cancer has progressed since you first filed. (For those who haven't yet appealed, make sure you appeal on time and file a Disability Report Appeal form. This form lets you add new information about your condition to your claim.)

If you have been assigned a hearing date, you can send an "on-the-record" (OTR) request to the judge assigned to hear your case. An OTR request allows the judge to grant you benefits without the need for a hearing. If you don't yet have a hearing date, send an OTR request to your  ODAR office. For more information, see our article about  on-the-record requests.

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