Breast Cancer and Social Security Disability

Applying for Social Security Disability with Breast Cancer

Each year, almost 300,000 women and over 2,000 men are diagnosed with breast cancer, reported. The illness, which affects one in eight women in the United States is the second leading cause of death in women, second only to lung cancer. In 2015, almost 3 million will were either going through treatment or in remission.

If you or a loved one is suffering from breast cancer, there may be assistance available. The Social Security Administration (SSA) offers two benefit programs for those who are unable to work due to a disabling condition.

The Financial Costs of Breast Cancer

There are many costs associated with breast cancer, including, but not limited to, diagnosis, treatment, transportation, child care, and medication. However, the exact costs are virtually unknown according to the Susan G. Komen Foundation of Central and South Jersey.

The National Business Coalition on Health reported that the average cost of the disease was $22,000 in stages one and two, but jump to more than $120,000 in stages three and four. In total, the cost of breast cancer in the United States is about $2.35 billion for direct costs and $3.13 in indirect costs, according to The Silver Book.

One thing researchers are sure of, is that women without insurance are subject to much higher costs than those who aren't, though the financial burden also affects those with insurance. In a study done by the University of North Carolina at Chapel Hill, researchers found uninsured cancer patients pay up to twice as much for doctors’ visits and 43 times as much for chemotherapy drugs.

Working during cancer treatment is hard, because there are many side effects that greatly affect your ability to do normal activities. Though a study at the University of Michigan found 80 percent of women return to work, many of these women were unemployed for a year or 18 months, which can be a long time without an income.

Breast Cancer and Social Security Disability

Medically Qualifying for Benefits with the Blue Book

The Blue Book is the SSA's official list of conditions that qualify for disability benefits. When they receive an application, they first use the Blue Book to medically evaluate the claim and see if the individual meets a listing.

In order to be approved for benefits, you must meet or equal one or more of the following listings:

  • Carcinoma that has spread to the shoulder, collarbone, or armpit region, or anywhere else outside of the breasts.
  • Recurrent carcinoma, except local recurrences that can be treated with anticancer therapy.
  • Small-cell (oat cell) carcinoma, which is a rare, but very aggressive form of breast cancer.
  • Carcinoma with anticancer treatment that causes lymphedema that required surgery
  • Soft tissue sarcoma that has spread outside of the breast or is persistent or recurrent after initial anticancer therapy.

If you're unable to work during or after you undergo breast cancer treatment, talk to your doctor about your likelihood of approval for disability benefits.

Compassionate Allowances List

For individuals with severe conditions that are almost always approved, the SSA developed the Compassionate Allowances List (CAL). Because CAL illnesses are usually approved and the applicants have a higher need for immediate relief, the SSA give answers on CAL claims in as little as a few weeks, instead of months or years.

To meet CAL requirements, your breast cancer needs to have spread outside the breast or be inoperable. Specifically, you'll need meet one of the first three listings above, or provide evidence that your doctor thinks the cancer is partly or fully inoperable.

There isn't anything extra you need to do in CAL applications. The SSA will automatically flag the application and alert when they've made a decision.

Qualifying Without Meeting a Medical Listing

If you were diagnosed in the early stages of breast cancer and it is not severe enough to meet one of the Blue Book listings, but you're still expected to be unable to work for at least one year, you may still be eligible for disability benefits through a Residual Functioning Capacity (RFC).

The SSA uses a series of grid rules to determine your RFC. Using a detailed form filled out by your doctor, the SSA figures out what type of work they think you can do—sedentary, light, medium, heavy, and very heavy. Then, they use your education and work history to find jobs available in your work level.

There are many symptoms and side effects of breast cancer and especially cancer treatment that could make you unable to work. You could experience weakness, fatigue, confusion, memory loss, heart problems, blood clots, cataracts, pain, numbness, constant nausea and vomiting, headaches, and infections.

Additionally, no matter what type of treatment you choose, and many patients combine different types, you will most likely have to take a good chunk of time off work. Surgery will require at least a few weeks, radiation therapy is usually done 5 days a week, and chemotherapy is usually given in varying cycles, but also requires a lot of time in the hospital.

Individuals without higher education or with labor-intensive jobs have higher chances of getting approved than those who graduated from college and worked in an office.

How to Apply for Social Security Disability Benefits

Talk to your doctor before you apply for disability benefits. If your doctor doesn't think your chances are high for an approval either by the Blue Book or an RFC, it may not be worth the time and effort it takes to apply. Many claims require appeals and can take up to two years to be approved, which is a long time to wait if you're not approved.

If you do meet a Blue Book listing, make sure to include all of your relevant medical records with the initial application so your claim is reviewed and approved as soon as possible. Most claims are denied in the initial stage simply because there is too much missing information.

Important medical evidence will include:

  • Mammogram.
  • Biopsy of the tumor.
  • Breast exam.
  • Medical imaging of the breast, such as an ultrasound, MRI, CT scan, and PET scan.
  • Blood tests, such as a Complete Blood Count.
  • Operative reports and hospitalization summaries.
  • A detailed statement from your oncologist and/or primary care physician describing the severity of your condition and the limitations it causes you.
  • Summaries of all treatments you've received, including length of time and outcome.

With the SSA's convenient online application, you don't have to make the trip to an SSA office to apply for Social Security Disability Insurance. However, all applications for Supplementary Security Income must be completed in person at an SSA office. No matter where you're applying, check out the list of required materials on the SSA's website to ensure you have every thing you need. You should also double check your claim for missed answers or mistakes, because they may be the reason your application is delayed or denied.

If your breast cancer worsens after you apply for disability benefits, or there are any other changes in your condition or treatment, let the SSA know immediately. The more evidence you can provide showing the seriousness and debilitating nature of the disease, the higher your chance of being approved.

If you are approved for disability benefits, your spouse and children could also qualify for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance and Supplemental Security Income.

Additional Resources