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Does Cancer mean an ‘Instant Approval’ for your SSDI Benefits?

Does Cancer mean an ‘Instant Approval’ for your SSDI Benefits?

Cancer diagnosis can be traumatic, painful and even financially draining – it sure does have a lasting impact in how your life goes on after the diagnosis – yet, not every diagnosis can be as fatal or aggressive as others. Cancer ranks in top 10 disabilities that people qualify for in SSDI benefits. The SSA is aware of this fact and thus, the disability examiners analyze each SSDI application for applicants with cancer based on the SSA's universal criteria of the severity and longevity of your condition, not the type of your cancer.

With that said, it is nonetheless true that some cancers can be more aggressive than the others.

In November 2019, the SSA published two new set of rules to add up in the already existing rules in analyzing a disability claims application. Under this setup, some disability applicants will have to provide consistent, regular updates to prove that their medical conditions have not improved. Many SSDI and SSI recipients having recurrent diseases or having cancers with constant remissions will be required to take part in a more frequent "continuing disability review" (CDR) that some liken to a medical audit for those already shown to be medically disabled.

While severely aggressive, inoperable or unresectable cancers such as the cancer of the thyroid, liver, pancreas or esophagus are immediately eligible for disability benefits, some mild types of treatable tumors with partial symptoms may not make it up to that list. The SSA requires three basic conditions for cancer patients in order to be considered as eligible for its disability payments:

Some Ins and Outs of Cancer Diagnosis and SSDI

There are two "theories of disability" you can use if you have been diagnosed with any form of cancer. The first is called 'Meeting a Listing' which contains several points. The SSA would consider factors such as:

  • -Origin of the cancer;
  • -Severity of the cancer;
  • -Extent of metastatic involvement;
  • -Effects of any post therapeutic residuals;
  • -Duration of cancer treatment;
  • -Frequency of anti cancer treatments;
  • -Response to cancer treatment;

Your disability examiner would use this medical documentation to assess if your cancer meets the severity requirements listed in the Blue Books section 13.

* Anticancer therapy means surgery, radiation, chemotherapy, hormones, immunotherapy, or bone marrow or stem cell transplantation.

Types of Cancers & Treatments/Therapies

While many cancer patients feel fine after cancer treatments/surgeries while they continue to go to work, even during their chemo or radiation treatments. On the other hand, for others, during cancer treatment, it is the treatment itself, not the symptoms, that makes it difficult or impossible to get out of bed and go to work.

Chemotherapy and radiation both cause significant impact on a person's ability to function and carry out daily tasks. The treatments often cause nausea, vomiting, diarrhea, fatigue, weakness, skin, and mental ailments. However, it's difficult to get disability solely because of chemo or radiation treatments because of the SSA's time requirement. The SSA requires that you are unable to work for at least 12 months (1 year). Often, the negative side effects of chemo or radiation are temporary and are known fluctuate over the course of treatment with symptoms varying from mild to severe. Because side effects fluctuate, the SSA will require a sufficient passage of time from the start of chemo or radiation treatment to determine the ultimate effects of the treatment on the patient, both to see if the treatment was successful and to see if you were unable to work for one year.

While treatment is painful enough for all types of cancers, not all types of cancers are aggressive enough themselves. The SSA has a list of criteria to determine the types of cancers:

- Persistent: This means that the planned initial anticancer therapy failed to achieve a complete remission of your cancer; that is, your cancer is evident, even if smaller, after the therapy has ended;

- Inoperable: this means surgery is thought to be of no therapeutic value or the surgery cannot be performed; for example, when you cannot tolerate anesthesia or surgery because of another impairment(s), or you have a cancer that is too large or that has invaded crucial structures;

- Multimodal therapy: this means anticancer therapy that is a combination of at least two types of treatment given in close proximity as a unified whole and usually planned before any treatment has begun. There are three types of treatment modalities: surgery, radiation, and systemic drug therapy (chemotherapy, hormone therapy, and immunotherapy or biological modifier therapy. Examples of multimodal therapy include:

  • i.Surgery followed by chemotherapy or radiation;
  1. Chemotherapy followed by surgery;
  2. Chemotherapy and concurrent radiation;
  • -Recurrent, relapse: means the cancer that was in complete remission or entirely removed by surgery has returned;
  • -Unresectable: this means surgery or surgeries you had, did not completely remove the malignant cells. This term includes situations in which your cancer is incompletely resected or the surgical margins are positive. It does not include situations in which there is a finding of a positive margin(s) if additional surgery obtains a margin(s) that is clear;
  • -Progressive: This means the cancer becomes more widespread after treatment; that is, there is evidence that your cancer is growing after you have completed at least half of your planned initial anticancer therapy;

Side effects of Cancer Treatments

While for many, painful symptoms may not appear in various stages of cancer or until they start vigorous treatments, for others, some cancer treatments and/or therapies can be even more painful than the carcinoma itself. Some of these side effects are known to affect other body parts and their respective functionalities, which can also be considered as suitable eligibility to qualify for SSDI benefits. Some of these side effects include:

Side Effects of Radio Therapy

  • -lung disease
  • -eye problems
  • -heart problems
  • -intestinal problems
  • -cognitive dysfunction, and
  • -bone weakness
  • -hypothyroidism
  • -reproductive disorders

Side Effects of Chemotherapy

  • -bone weakness
  • -cataracts
  • -reproductive disorders
  • -heart diseases
  • -liver disorders
  • -lung problems

Note that while many patients can face these painful symptoms and side effects during treatments, they may qualify for SSDI benefits for a conditional period of time. This period is the general three-year rule by the SSA – this requires that if your symptoms (which qualified you for SSDI benefits) are completely subsided in three years and have not caused a remission within three years, then your disability benefits will be stopped. Otherwise, you may continue to receive the SSDI benefits provided that you keep the SSA updated on your condition.

Note that cancer is subject to the same one-year duration requirement for getting disability benefits as any other medical condition. If you or a loved one with cancer needs SSDI benefits, we suggest you consider filing right away, given the processing time it takes to actually start taking the benefits can range from 6 to 18 months.

You can take counsel of our disability attorneys for help with SSDI payments, re appeals, applications here.

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Thursday, 01 October 2020