There are several ways to obtain disability benefits based on a diagnosis of brain cancer. Individuals with malignant brain tumors that are inoperable, metastatic (spreading), or not responding to treatment will meet the medical requirements for receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). There is a good chance that many of them will be approved quickly and without the need for a hearing. Others with brain cancer may qualify for benefits if the disease limits their ability to perform full-time work, or if the side effects from treatment leave them unable to work.
It is important to remember that there are also non-medical criteria for receiving SSDI or SSI, mostly related to your employment history, income, and assets.
A brain tumor is composed of an abnormal mass of cells that grow and divide uncontrollably, located within the brain or the central spinal canal. Tumors that originate in the brain are called primary brain tumors, whereas those that spread to the brain from other parts of the body, such as the lungs, kidney, breast, or pancreas, are known as secondary tumors, or metastatic tumors. Brain tumors can cause a variety of devastating symptoms, from nausea, headaches, and seizures to problems with speech, sight, and sound.
There are a number of treatment options for brain cancer, and their chances of success will hinge on the size and location of the tumor, and whether the cancer has spread to the rest of the body. Surgery may be an option to remove or reduce the size of a brain tumor, but many tumors will be inoperable. Other options for treating brain tumors include radiation therapy and, less commonly, chemotherapy. Side effects from these therapies are serious and may form a basis for a disability claim on their own.
Those who meet the requirements for Social Security's "Blue Book" listing on neoplastic diseases (which includes brain cancer) will automatically medically qualify for disability benefits. The listing requirements for any central nervous system cancer are as follows:
As examples of highly malignant tumors, Social Security cites glioblastoma multiforme, medulloblastoma or PNET with documented metastases, grades III and IV astrocytomas, ependymoblastoma, diffuse intrinsic brain stem gliomas, and primary sarcomas.
Social Security will decide whether you meet the listing by looking at the medical evidence in your case, including physician notes, clinic notes, radiology reports, and lab work. If a biopsy has been performed, SSA will consider the resulting operative report. A written statement from your doctor regarding your diagnosis and outlook may be helpful, and Social Security will also consider your doctor's opinion about whether you meet the listing. If your disease meets a listing you will likely be approved without having to wait for a hearing.
An individual whose diagnosis does not meet the above listing can still receive benefits under a "medical-vocational allowance." This type of approval is given when a person is judged to be unable to return to any past work or even switch to less demanding work. Social Security makes this determination based on one's age, work history, education, and Residual Functional Capacity (RFC), an assessment of your remaining ability to work.
Your condition and limitations may prevent you from performing full-time work because of the underlying cancer or because of the side effects of treatment. Radiation therapy, especially whole brain radiation, is notorious for its brutal side effects, including nausea, fatigue, cognitive difficulties, and a compromised immune system.
Social Security will consider all your recent medical records in determining your RFC and whether you are capable of performing full-time work. The opinion of your treating physician, especially your oncologist, is vitally important in Social Security's determination of your RFC. Your physician may write a letter on your behalf or complete an RFC form. Your doctor should consider both your underlying cancer and the side effects of treatment, offering his or her opinion on your ability to stand, walk, lift, carry, bend, and stoop, as well as your ability to focus and follow directions. Other important factors include how much work you would miss in the average month, whether you would require unscheduled breaks, and how much rest you would need during the day.
Social Security's Compassionate Allowances program allows a person with a very serious qualifying condition to be approved for disability benefits in a matter of weeks, not months or years. Glioblastoma multiforme, a fast-spreading tumor located in the central nervous system and formed from the glial tissue in the brain and spinal cord, is one of the qualifying conditions. It is the most common type of primary brain tumor (and can also be referred to as Grade IV astrocytoma). Symptoms of this disease include memory loss, personality changes, vomiting, headaches, and seizures, and the median survival time after being diagnosed is 12 to 16 months.
If you have been diagnosed with this type of brain tumor and want to apply for disability benefits, you should make sure Social Security has all the medical evidence related to your disease, including your medical records, lab results, and, if possible, a statement from your treating doctors about your diagnosis. Approvals under the Compassionate Allowances program can occur in as little as two weeks from the filing of your application -- if you point out that your condition is a compassionate allowance when you apply.
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