Cancer

Cancer is always a tricky subject when it comes to disability benefits.  There are so many different types of cancer, and each type affects each individual in so many varying ways.  Sadly, it is often the case that for this reason people with cancer are turned down for disability benefits.  For each cancer patient, the reason why they cannot work is going to be different.  For instance, some types of cancer are very painful, but other types of cancer have virtually no symptoms at all.

Recently I spoke with a doctor who was baffled that his client had not been approved for disability benefits immediately once she was diagnosed with her particular form of cancer.  His comment was, “Obviously she cannot work!  She has cancer!”  Unfortunately her cancer did not neatly fit the disability regulations, and her doctor’s pronouncement that it is obvious she is disabled is just not enough.  Because she did not meet the requirements on the listing, I had to have the doctor spell out for me in detail what all her limitations would be if she attempted to work.  It is sometimes the case that a person with cancer is going to miss work frequently due to having too many doctors appointments.   Other times the fatigue and malaise from chemotherapy and radiation treatments are what puts a person out of work.  In many cases the regulations will analyze your disability based on the body system affected.

Another problem in obtaining disability benefits on the basis of cancer is what is called the “durational” requirements.  In order for a medical problem to be considered disabling, it is has to have lasted (or can be expected to last) a year or more before it is considered disabling.  It is more and more the case that the treatments for cancer are so effective that people are not sick long enough to be eligible for disability benefits.

Section 13.00 of the Social Security Listing of Impairments covers malignant neoplastic diseases, ie., cancer, and is copied below:

13.01 Category of Impairments, Malignant Neoplastic Diseases

13.02 Soft tissue tumors of the head and neck (except salivary glands—13.08—and thyroid gland – 13.09).

  1. Inoperable or unresectable.

OR

  1. Persistent disease following initial multimodal antineoplastic therapy.

OR

  1. Recurrent disease following initial antineoplastic therapy, except recurrence in the true vocal cord.

OR

  1. With metastases beyond the regional lymph nodes.

OR

  1. Soft tissue tumors of the head and neck not addressed in A-D, with multimodal antineoplastic therapy. Consider under a disability until at least 18 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

13.03 Skin.

  1. Sarcoma or carcinoma with metastases to or beyond the regional lymph nodes.

OR

  1. Melanoma, as described in 1 or 2:
  2. Recurrent after wide excision (except an additional primary melanoma at a different site, which is not considered to be recurrent disease).

2.With metastases as described in a, b, or c:

a. Metastases to one or more clinically apparent nodes; that is, nodes that are detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination.

b. If the nodes are not clinically apparent, with metastases to four or more nodes.

c. Metastases to adjacent skin (satellite lesions) or distant sites.

13.04 Soft tissue sarcoma.

  1. With regional or distant metastases.

OR

  1. Persistent or recurrent following initial antineoplastic therapy.

13.05 Lymphoma (excluding T-cell lymphoblastic lymphoma-13.06 ). (See 13.00K1 and 13.00K2c.)

  1. Non-Hodgkin’s lymphoma, as described in 1 or 2:
  2. Aggressive lymphoma (including diffuse large B-cell lymphoma) persistent or recurrent following initial antineoplastic therapy.
  3. Indolent lymphoma (including mycosis fungoides and follicular small cleaved cell) requiring initiation of more than one antineoplastic treatment regimen within a consecutive 12-month period. Consider under a disability from at least the date of initiation of the treatment regimen that failed within 12 months.

OR

  1. Hodgkin’s disease with failure to achieve clinically complete remission, or recurrent disease within 12 months of completing initial antineoplastic therapy.

OR

  1. With bone marrow or stem cell transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system .

13.06 Leukemia. (See 13.00K2.)

  1. Acute leukemia (including T-cell lymphoblastic lymphoma). Consider under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

OR

  1. Chronic myelogenous leukemia, as described in 1 or 2:
  2. Accelerated or blast phase. Consider under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
  3. Chronic phase, as described in a or b:
  4. Consider under a disability until at least 12 months from the date of bone marrow or stem cell transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.
  5. Progressive disease following initial antineoplastic therapy.

13.07 Multiple myeloma (confirmed by appropriate serum or urine protein electrophoresis and bone marrow findings).

  1. Failure to respond or progressive disease following initial antineoplastic therapy.

OR

  1. With bone marrow or stem cell transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

13.08 Salivary glands–carcinoma or sarcoma with metastases beyond the regional lymph nodes.

13.09 Thyroid Gland.

  1. Anaplastic (undifferentiated) carcinoma.

OR

  1. Carcinoma with metastases beyond the regional lymph nodes progressive despite radioactive iodine therapy.OR

    C. Medullary carcinoma with metastases beyond the regional lymph nodes.

13.10 Breast (except sarcoma—13.04) (See 13.00K4.)

  1. Locally advanced carcinoma (inflammatory carcinoma, tumor of any size with direct extension to the chest wall or skin, tumor of any size with metastases to the ipsilateral internal mammary nodes).
  2. Carcinoma with metastases to the supraclavicular or infraclavicular nodes, to 10 or more axillary nodes, or with distant metastases.

OR

  1. Recurrent carcinoma, except local recurrence that remits with antineoplastic therapy.
  2. 11 Skeletal system— sarcoma.
  3. Inoperable or unresectable.

OR

  1. Recurrent tumor (except local recurrence) after initial antineoplastic therapy.

OR

  1. With distant metastases.

OR

  1. All other tumors originating in bone with multimodal antineoplastic therapy. Consider under a disability for 12 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

13.12 Maxilla, orbit, or temporal fossa.

  1. Sarcoma or carcinoma of any type with regional or distant metastases.

OR

  1. Carcinoma of the antrum with extension into the orbit or ethmoid or sphenoid sinus.

OR

  1. Tumors with extension to the base of the skull, orbit, meninges, or sinuses.

13.13 Nervous system. (See 13.00K6.)

  1. Central nervous system malignant neoplasms (brain and spinal cord), as described in 1 or 2:
  2. Highly malignant tumors, such as medulloblastoma or other primitive neuroectodermal tumors (PNETs) with documented metastases, grades III and IV astrocytomas, glioblastoma multiforme, ependymoblastoma, diffuse intrinsic brain stem gliomas, or primary sarcomas.
  3. Progressive or recurrent following initial antineoplastic therapy.

OR

  1. Peripheral nerve or spinal root neoplasm, as described in 1 or 2:
  2. Metastatic.
  3. Progressive or recurrent following initial antineoplastic therapy.

13.14 Lungs.

  1. Non-small-cell carcinoma–inoperable, unresectable, recurrent, or metastatic disease to or beyond the hilar nodes.

OR

  1. Small-cell (oat cell) carcinoma.OR

    C. Carcinoma of the superior sulcus (including Pancoast tumors) with multimodal antineoplastic therapy. Consider under a disability until at least 18 months from the date of diagnosis. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

13.15 Pleura or Mediastinum.

  1. Malignant mesothelioma of pleura.

OR

  1. Tumors of the mediastinum, as described in 1 or 2:
  2. With metastases to or beyond the regional lymph nodes.
  3. Persistent or recurrent following initial antineoplastic therapy.

13.16 Esophagus or stomach.

  1. Carcinoma or sarcoma of the esophagus.

OR

  1. Carcinoma or sarcoma of the stomach, as described in 1 or 2:
  2. Inoperable, unresectable, extending to surrounding structures, or recurrent.
  3. With metastases to or beyond the regional lymph nodes.

13.17 Small intestine –carcinoma, sarcoma, or carcinoid.

  1. Inoperable, unresectable, or recurrent.

OR

  1. With metastases beyond the regional lymph nodes.

13.18 Large intestine (from ileocecal valve to and including anal canal).

  1. Adenocarcinoma that is inoperable, unresectable, or recurrent.

OR

  1. Squamous cell carcinoma of the anus, recurrent after surgery.

OR

  1. With metastases beyond the regional lymph nodes.

13.19 Liver or Gallbladder– tumors of the liver, gallbladder, or bile ducts.

13.20 Pancreas.

  1. Carcinoma (except islet cell carcinoma).

OR

  1. Islet cell carcinoma that is inoperable or unresectable and physiologically active.

13.21 Kidneys, adrenal glands, or ureters- carcinoma.

  1. Inoperable, unresectable, or recurrent.

OR

  1. With metastases to or beyond the regional lymph nodes.

13.22 Urinary bladder -carcinoma.

  1. With infiltration beyond the bladder wall.

OR

  1. Recurrent after total cystectomy.

OR

  1. Inoperable or unresectable.

OR

  1. With metastases to or beyond the regional lymph nodes.

13.23 Cancers of the female genital tract -carcinoma or sarcoma.

  1. Uterus (corpus), as described in 1, 2, or 3:
  2. Invading adjoining organs.
  3. With metastases to or beyond the regional lymph nodes.
  4. Persistent or recurrent following initial antineoplastic therapy.

OR

  1. Uterine cervix, as described in 1 or 2:
  2. Extending to the pelvic wall, lower portion of the vagina, or adjacent or distant organs.
  3. Persistent or recurrent following initial antineoplastic therapy.

OR

  1. Vulva or vagina, as described in 1, 2, or 3:
  2. Invading adjoining organs.
  3. With metastases to or beyond the regional lymph nodes.
  4. Persistent or recurrent following initial antineoplastic therapy.

OR

  1. Fallopian tubes, as described in 1 or 2:
  2. Extending to the serosa or beyond.
  3. Persistent or recurrent following initial antineoplastic therapy.

OR

  1. Ovaries, as described in 1 or 2:
  2. All tumors except germ-cell tumors, with at least one of the following:
  3. Tumor extension beyond the pelvis; for example, tumor implants on peritoneal, omental, or bowel surfaces.
  4. Metastases to or beyond the regional lymph nodes.
  5. Recurrent following initial antineoplastic therapy.
  6. Germ-cell tumors–progressive or recurrent following initial antineoplastic therapy.

13.24 Prostate gland- carcinoma.

  1. Progressive or recurrent despite initial hormonal intervention.

OR

  1. With visceral metastases (metastases to internal organs).

13.25 Testicles— tumor with metastatic disease progressive or recurrent following initial chemotherapy.

13.26 Penis-carcinoma with metastases to or beyond the regional lymph nodes.

13.27 Primary site unknown after appropriate search for primary—metastatic carcinoma or sarcoma, except for squamous cell carcinoma confined to the neck nodes.

13.28 Malignant neoplastic diseases treated by bone marrow or stem cell transplantation. (See 13.00L.)

  1. Allogeneic transplantation. Consider under a disability until at least 12 months from the date of transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.

OR

  1. Autologous transplantation. Consider under a disability until at least 12 months from the date of the first treatment under the treatment plan that includes transplantation. Thereafter, evaluate any residual impairment(s) under the criteria for the affected body system.