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The term “cancer” is used here for convenience, recognizing that there are many different types of cancers, including solid tumors (like lung and breast) and blood cancers (like leukemia). They have different treatments and prognosis, but with respect to qualifying for disability benefits, there are some common principles.
It's Not Enough to Have a Cancer Diagnosis
With some exceptions, which we will deal with later, just having a diagnosis of “cancer” in your medical records will not automatically qualify you for disability benefits. Your medical records must also show how the symptoms you have from your cancer (or side effects from chemotherapy or radiation) cause you to have functional impairments that restrict your ability to work.
The Social Security Administration (SSA) has determined that certain cancers are “bad” enough so that just simply being diagnosed with a cancer of this type will automatically qualify you for disability benefits. These cancers are summarized in the Social Security Disability “Listings,” under 13.00 Malignant Neoplastic Diseases.
Some of the more common malignancies that automatically qualify for disability benefits under the Listings, are the following:
Brain cancer (astrocytoma, grade III or IV)
Lung cancer, if “small cell”
Breast cancer, if “inflammatory”
Solid Tumors, if Inoperable or with Metastases
Prostate cancer (if hormone resistant)
You May be Eligible for "Compassionate Allowance"
The Compassionate Allowances program is intended to expedite the initial claim process for Social Security disability benefits. The SSAhas compiled a list of more than 200 disabling conditions (including malignancies) that qualify for expedited benefits under its Compassionate Allowanceprogram.
If your cancer diagnosis is included in the Listing and qualities for Compassionate Allowance, you should be able to get quick approval for Social Security disability benefits.
If Your Cancer Diagnosis is Not Included in the "Listings"You may still qualify for Social Security disability benefits even if your cancer diagnosis is not included in the Listings for “automatic” benefits, and if you do not qualify for expedited benefits under the Compassionate Allowance program.
In that case, your medical records must adequately document:
1.         Your cancer diagnosis and it's treatment.
2.         Disabling symptoms, you have suffered from your cancer.
3.         Disabling side effects, you have suffered from treatment with chemotherapy or radiation.
4.       How your symptoms or treatment side effects have impaired your functional capacity to work.
Enlist the Help of Your Doctor to Adequately Document Your Disability.
Doctors are trained to document a patient's diagnosis, treatment, symptoms, side effects from treatments, laboratory findings, and the findings of x-ray, MRI, and CT scans. You can assume, if you are being treated by a competent doctor, that this kind of “medical” information will be documented thoroughly in your medical file.
A doctor's progress notes should explain why a patient is disabled and what specific things a patient can and cannot do, not just state in a conclusory manner that a patient is disabled.
For example, statements like “my patient is not capable of performing any useful work,” or “my patient is completely disabled from any gainful employment,” are conclusory, because they don't explain why. They reach a conclusion (my patient is disabled) without providing or explaining why their patient is disabled.
This is where being a pro-active patient is important.  When you see the doctor, you can help fill-in the why– Tell your doctor, for example, that you have such bad fatigue and tiredness (from your cancer or your chemotherapy) that the most you can sit in an 8-hour day is _____or what physical activities cause you to become tired and fatigued.
Tell your doctor you are seeking disability benefits and explain during your office or clinic visit the specific things (e.g., walking, standing, sitting, lifting, carrying) you can and cannot do. Ask the doctor or nurse to enter that information into your medical records. Do it each time you see the doctor.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.
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