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?
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.
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.
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
If you are not sure whether your cancer meets any of these requirements, you should review them with your doctor.
The SSA will accept any of the following as medical evidence that the breast cancer warrants a compassionate allowance:
a pathology report, or
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.
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)
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.
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.