Cancer And Social Security Disability Claims
By Pitt Dickey
Cancer unfortunately is a common fact of life. When a worker is stricken with cancer his bills don’t stop just because he can no longer work. Cancer patients can receive a monthly income from the Social Security Administration (SSA) if they meet the disability standards. This column will examine some of the general rules the SSA uses to evaluate disability claims based on cancer. Future columns will examine specific types of cancers and how the SSA evaluates them.
SSA disability benefits include regular monthly payments. After the patient has been determined to have met the SSA disability standards for two years he will receive Medicare Part A Hospital Insurance Benefits which helps cover in patient hospital costs. To qualify for disability benefits, the patient must prove that he has a condition which can be expected to last at least twelve months and that he does not have the ability to perform full time work in any job.
To make it easier to understand how the SSA evaluates disability claims based upon cancer, it is helpful to understand what cancer is, how doctors categorize tumors and the types of treatment available for cancer. To greatly simplify, cancer is a condition in which the cells of the body multiply out of control and form what are called malignant tumors. A malignant tumor can spread and can sometimes lead to death. Not all tumors are cancerous, benign tumors, are not formed from cancer cells. The problem with cancer is that its unrestrained growth can destroy the organs in which it is located and some forms of cancer can spread through the body through the lymph system or the blood stream.
When cancer spreads from its original site in the body it is said to metastasize. Cancers can be divided into three types which are determined by the location of the tumor. The three categories are carcinoma, sarcoma and mixed tissue tumors. A cancerous tumor called a carcinoma is found in what is called epithelial tissue such as the glands, digestive, urinary, reproductive organs and in the skin. Carcinomas are the most common form of cancer. A sarcoma tumor is found in connective tissue such as bones, muscle, cartilage and the lymphatic system. Mixed tissue tumors are found in both epithelial and connective tissues.
The medical study of cancer is called oncology. A doctor who specializes in treating cancer is called an oncologist. Oncology classifies tumors into various classifications based on where the tumor is, how the tumor is constructed and whether the tumor has spread from its original site in the body. Tumors are classified by oncologists by grade and staging. The grade of the tumor which refers to how developed the cancer cells are in the tumor when examined under a microscope. The stage of the tumor which refers to how much the tumor has spread throughout the body away from its original site.
Tumors are graded on a scale of I to IV. A Grade I tumor is the least dangerous tumor as Grade I means that the cancer cells are very similar to the cells in the original site in the body. At the other end of the spectrum is a Grade IV tumor which is the most dangerous types and consists of cancer cells that are so mutated that it is difficult to determine from what part of the body the cells originated.
The tumors are also classified on the basis of whether they have spread under the Staging classification. The larger the number in the staging scheme means that the cancer has spread farther in the body.
General Rules To Evaluate Claims
The SSA in evaluating disability claims based on cancer requires documentation based upon the medical records of the patient. The SSA uses the following general evaluations rules. When a malignant tumor is a local lesion that has spread into regional lymph nodes and all of the cancer has been surgically removed the SSA assumes that the cancer will not return immediately and will not award disability benefits. However there are a number of exceptions to this general rule.
In a case where there has been a recurrence of cancer either locally or in the region after radical surgery or after a pathology report shows that despite the radical surgery that cancer remains in the area, the SSA can determine that the cancer is inoperable under its guidelines and pay disability benefits if the patient meets the other listing requirements. When a malignant tumor has spread beyond the regional lymph nodes, this cancer will normally be considered to meet the requirements of a specific listing for a cancer associated with the original location of the tumor. .
The SSA will also consider any side effects from cancer therapy such as chemotherapy, radiation or surgery which can be very hard on the patient. The SSA will consider the type of therapy undergone, the drugs given, the dosage of the drugs, frequency of the drug usage and future plans for chemotherapy. The SSA is also required to consider any side effect from the therapy such as nausea, vomiting, diarrhea, weakness, dermatological disorders or reactive mental disorders such as depression.
In general a patient meets the SSA standards for a disability claim based upon cancer when it is determined that the malignancy is inoperable or beyond control of any other forms of therapy. It is possible for disability benefits to be granted for a period prior to the determination that the cancer is inoperable if the patient’s physician bases his opinion on the patient’s medically reported symptoms, the type of specific malignancy, its location and the extent of the involvement of the tumor when it is first diagnosed.
When a patient has been cancer free without a recurrence for three years that the patient is deemed no longer disabled. This rule primarily effects patients who have been awarded disability benefits based upon cancer when the SSA makes a routine review of their disability claim to determine if they should still receive disability benefits.
Cancer is difficult enough for a family to face. The financial burdens can be eased to some extent by the successful pursuit of a Social Security Disability claim.
Pitt Dickey has practiced law handling Social Security disability claims in Fayetteville since 1978. . He can be reached at 485-8020 or at [email protected] Copies of prior Disability Update articles are available on line at www.smithdickeydempster.com