Social Security Disability and Cancer

Whether your cancer, or "neoplastic disease," qualifies for Social Security disability insurance depends on the type, location, and prognosis of the cancer.

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The Social Security Administration (SSA) approves Social Security disability and SSI disability claims on the basis of cancer in one of two ways. The cancer can meet the requirements of a specific cancer "listing" in Social Security's list of eligible disabilities or the SSA will grant a "medical-vocational allowance," a type of approval in which the agency determines that the applicant can't return to their past work or do other work (more on this below). The SSA will expedite claims for some advanced cancers based on condition and prognosis.

Is a Diagnosis of Cancer All That's Needed for Disability Approval?

Although a diagnosis of cancer is serious, it doesn't guarantee approval for Social Security disability. With many forms of cancer, for a guaranteed approval, the cancer has to:

  • be inoperable, versus being able to be controlled with treatment
  • have distant metastases (spread to other parts of the body), or
  • be recurrent after surgical procedures or irradiation.

But certain types of cancer are entitled to an immediate approval for disability benefits, whether or not they're inoperable, metastatic, or recurrent. For example, the following are types of carcinoma that will meet one of the Social Security's official listings for disability based on a diagnosis of the cancer alone:

  • inflammatory breast cancer
  • esophageal cancer
  • liver cancer
  • pancreatic cancer
  • pleural or peritoneal mesothelioma
  • oat cell lung cancer (small cell lung cancer)
  • primary cancer of the liver
  • cancer of the bile ducts or gall bladder, and
  • certain types of brain or spinal cord cancers

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 to having a qualifying medical condition, 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.

What Medical Evidence Is Required for a Disability Determination?

When making a disability determination and evaluating how a malignant tumor impairs an applicant, 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).

An applicant's 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 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.

Does Metastatic Cancer Automatically Qualify for Disability Benefits?

If an individual's carcinoma has spread beyond the regional lymph nodes, the individual will most likely be automatically approved for disability benefits based on meeting one of Social Security's listings for "neoplastic disease." (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 the applicant's residual functional capacity, work history, and education when making a disability determination.

What if an Applicant's Cancer Doesn't Meet a Listing?

Many cancers, especially those that are detected early, won't meet the requirements of a disability listing, usually because they're not inoperable, recurrent, or metastatic. For these claims, Social Security will decide whether to grant disability benefits under a "medical-vocational allowance." A disability examiner or a disability judge will look at whether an applicant can engage in enough work activity to earn a "substantial and gainful income." The examiner or judge will look at an applicant's age and job history to see whether they can do any activities they did at work in the past or any new job activities within their limitations and functional capacities.

In addition to the physical limitations brought on by 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 considers 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. If you were already denied benefits, reapply for benefits using a new application, and request a compassionate allowance.

Do Cancer Cases Qualify for Permanent Payments?

Social Security disability approvals can't be considered permanent if an applicant has 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. But this doesn't mean the SSA will abruptly terminate benefits. 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.

Post-cancer, some individuals' "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) won't be high enough to work. If an individual still has significant post-treatment residual symptoms that severely restrict their ability to perform substantial gainful activity, they may be able to continue to receive disability benefits. For more information, see our section on continuing disability reviews.

Here are the specific requirements for getting disability benefits for the most common cancers.

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