Social Security disability and SSI disability claims filed on the basis of cancer are approved in one of two ways: either by meeting the requirements of a specific cancer listing in Social Security's list of eligible disabilities or by receiving a medical-vocational allowance, a type of approval in which it is determined that the claimant cannot return to their past work or engage in forms of other work (more on this below). Social Security will expedite some advanced cancer cases based on condition and prognosis.
Although a diagnosis of cancer is serious, it doesn't guarantee approval for Social Security disability. For many forms of cancer, for a guaranteed approval, the cancer has to be inoperable versus being able to be controlled with treatment, or have distant metastases (has spread to other parts of the body), or be recurrent after surgical procedures or irradiation.
However, there are certain type of cancers that are entitled to an immediate approval for disability. For example, inflammatory breast cancer, esophageal cancer, pancreatic cancer, pleural or peritoneal mesothelioma, oat cell lung cancer (small cell lung cancer), primary cancer of the liver, bile ducts, or gall bladder, and certain types of brain or spinal cord cancers are types of carcinoma that meet one of the Social Security's official listings for disability based on a diagnosis of the cancer alone.
These cancer cases are decided on the basis of medical record documentation; this includes physician's office notes and reports of blood work and imaging studies (xrays, MRI, and CT scans) as well as admission and discharge summaries from hospitals.
In addition, an individual can't be doing a substantial amount of work when he or she applies for disability, and applicants need to meet the work history or financial qualifications of the SSDI or SSI program. For more information, see our section on the non-medical requirements of Social Security disability.
When making a disability determination and evaluating the level of impairment resulting from a malignant tumor, Social Security considers the location of the neoplastic (cancerous) lesion, the formation and development of the tumor, the degree of involvement, the response to treatment, and the severity of residual symptoms (post treatment).
Documentation must include a diagnosis of cancer that can be verified by symptoms, lab findings, and signs, along with a statement that includes the origin of the cancer and whether the malignant tumor is a primary, recurrent, or a metastatic tumor. Additionally, if an individual has had a biopsy, Social Security can use the operative report that includes the gross and microscopic examination of the tissues along with any other pertinent observations as part of their case documentation.
If an individual's carcinoma has spread beyond the regional lymph nodes, the individual will most likely be approved for disability benefits based on meeting one of Social Security's neoplastic disease listings. (In fact, many progressive cancers are eligible for expedited benefits as compassionate allowances.) But for most forms of cancer, in cases where an individual has had a malignant tumor that spread only to a regional lymph node that has been completely removed, Social Security disability examiners will evaluate their residual functional capacity, work history, and education when making a disability determination.
When Social Security decides whether to grant disability benefits under a "medical-vocational allowance," a disability examiner or a disability judge decides whether or not a claimant can engage in work activity while earning a substantial and gainful income. This includes any work activity performed in jobs that the applicant has performed in the past as well as other types of jobs that the Social Security Administration (SSA) believes the applicant would be capable of performing based on his or her limitations and functional capacities. In addition to physical limitations brought on my cancer or cancer treatment, the SSA will consider any long-term side effects of cancer treatment, such as cognitive issues including memory disorders and slowed thought processes. The SSA also consider the applicant's education, age, and work skills through its series of medical-vocational grid rules.
If your cancer progresses, you should alert Social Security that your cancer has metastasized, or, if you were already denied benefits, reapply for a compassionate allowance.
No Social Security disability approval can be considered permanent if there is a chance for medical improvement. Disability approvals based on cancer are no different. If the original tumor and any metastatic disease appear to have disappeared and have not been evident for three years or more, the impairment no longer meets the disability criteria for cancer.
However, even if an individual's cancer has disappeared and has not been evident for three years or more, some individuals may still be able to receive disability benefits. If an individual's residual functional capacity (what an individual is able to do in spite of the limitations imposed by the condition or the residual effects of treatment) is not high enough to work, the individual can still get benefits. In other words, if an individual still has significant post-treatment residual symptoms that severely restrict their ability to perform substantial gainful activity, they can continue to receive disability benefits. For more information, see our section on continuing disability reviews.
Here are the specific requirements for getting disability for the most common cancers.