Breast Cancer and Social Security Disability Benefits

by Molly Clarke
Writer for Social Security Disability Help Blog

Molly works to promote disability awareness and assist individuals throughout the application process for disability benefits. Contact Molly at mac@ssd-help.org.

In the weeks after being diagnosed with breast cancer, you and your loved ones are likely to be focused on the immediate future—scheduling appointments, figuring out treatment options, and coming to terms with your diagnosis. While these are all vital to your health and recovery, you should also plan for the future, financially.

Leaving work to deal with a serious health condition can cause significant monetary strain. If you find yourself facing these circumstances, you may be eligible to receive Social Security Disability benefits. Although the process of applying for disability benefits can be long and complicated, the financial support is often a necessary lifeline for many people.

With the correct research and preparation, you can increase your chances of success and speed up the application process. The following article will provide you with further information regarding the benefits available to you.

Is Breast Cancer a Disability?

The Social Security Administration (SSA) oversees the distribution of two types of benefits. These are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).  The most basic eligibility requirement for either of these programs is to meet the SSA’s definition of disability. This definition is made up of three different criteria and is listed below.

The SSA will consider an adult to be disabled if:

  • He or she cannot do work they did prior to becoming disabled; and
  • They have a physical or mental condition(s) that prevents them from learning to do a different type of work; and
  • His or her condition has lasted or is expected to last for at least one year or to result in death.

As you may have noticed, this definition was put in place to ensure that disability benefits are awarded to individuals with serious, long-term health conditions. For this reason, individuals who have less advanced forms of breast cancer may not be eligible to receive disability benefits.

SSDI vs. SSI

As stated earlier, the SSA operates two different benefit programs that serve those with disabilities and serious health conditions—SSDI and SSI. Each of these programs works differently to aid different groups of people. SSDI is intended to assist disabled workers who have paid Social Security taxes while SSI is intended to assist disabled individuals with very little income. Depending upon the situation, some applicants may be eligible for both SSDI and SSI benefits.

To learn more about meeting the technical requirements for SSDI and SSI, visit the following page: http://www.disability-benefits-help.org/disability-tips/difference-between-social-security-disability-insurance-ssdi-and-ssi.

Medical Eligibility

In addition to the technical requirements of the SSDI or SSI programs, disability claimants will also have to meet specific medical requirements. These can be found in the SSA’s blue book—a manual of medical requirements for all potentially disabling conditions. Breast cancer is evaluated under blue book listing 13.10. To qualify for disability benefits with breast cancer, this listing states that applicants must meet the following requirements:

  • Applicants must provide medical evidence that documents a 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 notes); or
  • Applicants must provide medical documentation of a carcinoma with metastases to the supraclavicular or infraclavicular notes, to 10 or more axillary notes, or with distant metastases; or
  • Applicants must have a medically documented recurrent carcinoma, except local recurrence that remits with antineoplastic therapy.

Because this listing uses highly medical terminology, it is recommended that you sit down with your doctor or doctors to ask any questions that you may have. If you provide your doctor with a copy of this blue book listing, they should be able to help you determine whether or not your breast cancer qualifies for disability assistance.

See the complete blue book listing: http://www.ssa.gov/disability/professionals/bluebook/13.00-NeoplasticDiseases-Malignant-Adult.htm#13_10.

Compassionate Allowance Listing

Although all forms of breast cancer are serious, more advanced forms of breast cancer may progress more quickly. For this reason, the SSA has included breast cancer among its list of Compassionate Allowance conditions. The Compassionate Allowance program allows severely disabled individuals to be approved for benefits in as little as ten days. If your breast cancer meets the medical requirements outlined above and is inoperable or unresectable, you may qualify for Compassionate Allowance processing.

For more information about breast cancer and Compassionate Allowance processing, please see the following page: https://secure.ssa.gov/apps10/poms.nsf/lnx/0423022125.

Medical Vocational Allowance

If you do not meet the blue book listing or the Compassionate Allowance listing, you may still be able to qualify for disability benefits under a medical vocational allowance. Essentially what will happen is that the SSA will evaluate your age, job training, and physical capabilities. If they determine that you are capable of working, they will deny your application for disability benefits and will offer you alternate career suggestions. If the SSA determines that your breast cancer prevents you from working completely, they will approve your application under a medical vocational allowance. 

Disability Benefits Application

The actual application for disability benefits can be completed on the SSA’s website or in person at a local Social Security field office. The application will consist of several forms and will require extensive medical evidence and records to support your claim. The Adult Disability Checklist will provide you with a list of documents that you should collect and submit along with your application.

Adult Disability Checklist: http://www.socialsecurity.gov/disability/Documents/Checklist%20-%20Adult.pdf.

Be sure to provide complete, detailed information when filing your application or responding to the SSA’s inquiries. The information that you offer should give the SSA a thorough understanding of your breast cancer and the limitations that it causes.

Receiving a Decision

After submitting your application for disability benefits, you will not receive a decision for several months—typically three to five. If your breast cancer qualifies you for Compassionate Allowance processing, you will receive a decision much sooner. If you are approved, you will receive a letter notifying you of the amount of your benefit and the payment schedule. If you are denied—which occurs frequently—you will be told why your claim was denied and you receive information regarding the appeals process.

If your claim is denied, it is important that you do not give up. You will have 60 days in which to appeal this decision. View the appeals processes as a chance to correct any mistakes that were made during the initial application.  It is encouraging to note that many more applicants are approved during the disability appeal hearing than during the initial application.

Once you are awarded benefits, you will be able to focus on comfort and recovery rather than your financial distress. Learn more about applying for disability benefits with breast cancer, here: http://www.disability-benefits-help.org/compassionate-allowances/breast-cancer-and-social-security-disability.