Lung Cancer and Social Security Disability Benefits

Lung cancer is a growth of cells in the body that affects the lungs. It is currently the most common type of cancer in the United States and worldwide.

According to the American Cancer Society, the three types of lung cancer are

  • Non-small cell (this is the most common type)
  • Small cell (also called Oat cell)
  • Lung carcinoid (also called lung carcinoid tumors)

In 2012, 86,740 men and 70,759 women died of lung cancer. There are more than 221,000 diagnosed cases in the United States every year. Lung cancer makes up about 13% of all new cancer diagnoses. Many people survive lung cancer when detected and treated in the early stages. There are over 400,000 living people in the United States who have been diagnosed with lung cancer at some point. Unfortunately, symptoms are much less prevalent in the early stages of the cancer.

The obvious culprits like cigarette and cigar smoke and asbestos exposure give the highest risk factors, but there are also smaller ones, such as radon, air pollution, and a personal or family history of lung cancer. More than 80 percent of lung cancer patients are age 60 and older. As the population grows older, this is an issue that will get more important over time.

The Financial Costs of Lung Cancer

The financial costs associated with treating lung cancer in the United States are staggering. The American Lung Association reports that lung cancer care cost 12.1 billion dollars in 2010. Lost productivity because of cancer deaths cost 36.1 billion in 2012. The US National Library of Medicine’s research says that lung cancer accounts for 20% of Medicaid’s overall spending on cancer treatment.

According to Costhelper.com, the costs of treating lung cancer varies greatly, depending on one’s situation. Those with insurance can expect to pay anywhere from ten percent to half of the total costs, depending on their health care plan. Those without insurance can expect to pay anywhere from $10,000 to $200,000 for treatment. The different types of treatment and their estimated costs are itemized:

  • Chemotherapy: patients can pay as much as $200,000
  • Surgery: has an average cost of $15,000
  • In addition, drug therapy can cost as much as $4,000 a month, depending on the drugs prescribed.
  • The Agency for Healthcare Research and Quality estimated that lung cancer patients often need to be hospitalized for seven days or more at a time. This can cost as much as $2,200 per day.

The types of treatments used and the cost can vary depending on the how long the treatments are employed, the type (and stage) of lung cancer that the patient has, and what type of facility the care is given in.

Medically Qualifying for Benefits with Lung Cancer

In order to qualify for benefits under Social Security disability, a claimant’s lung cancer diagnosis will have to meet certain criteria according to a document known as the Blue Book. This is the standard that the Social Security Administration uses to evaluate the injuries and illnesses of applicants to determine if they qualify for benefits. The Blue Book has different parts for adult and child illnesses and conditions, and both parts are divided into multiple sections that detail the different conditions, as well as give specifications of what the criteria is for every type of condition.

Lung cancer is located under section 13.14 of the Blue Book listing. Section 13 covers various types of cancer for adult applicants.

For non-small cell carcinoma, the cancer should not be able to be operated upon or it should be recurring cancer or it should be metastatic, which means that the cancer has spread to other places in the body.

Two other types of lung cancer described in the Blue Book listing are small cell (or oat cell) carcinoma, and carcinoma of the superior sulcus (also known as a Pancoast Tumor), which is a type of tumor that is defined by its location within the lung. Small cell cancer will automatically medically qualify for disability benefits.

Individuals who believe that they qualify should speak to their primary care physician, who may need to refer them to a specialist for a specific diagnosis.

Medically Qualifying Without the Blue Book

There will be many people who may have a diagnosis of lung cancer and still not meet the Blue Book’s qualifications to receive Social Security Disability benefits. Those individuals can still qualify for benefits even if they have not qualified under the Blue Book definition. They should have a Residual Functional Capacity Form, or RFC, completed. An RFC form evaluates the lung cancer, all the symptoms of it, as well as medical and personal claimant information and will determine what work or functions can be performed, if any. A claims evaluator from Disability Determination Services will fill out the RFC form and will make a decision based on that.

The form will describe a claimant’s complete medical history and the symptoms that the lung cancer has given them. For example, two very common symptoms of lung cancer are chest pain and a chronic cough which can be accompanied with blood. Those could be severe hindrances to performing many types of work. Those factors, along with many others, will be taken into consideration by the claims examiner in determining whether there is any work that a claimant could reasonably be expected to perform. After the claims examiner is finished with the evaluation, he or she will provide a write-up with the decision and the reasons behind it.

There are various personal factors regarding the claimant that will come into play when determining if a claimant meets the requirements in the RFC evaluation. There is

  • Age. Usually a person diagnosed with lung cancer is older, which is advantageous in an RFC evaluation.
  • Education level. A person who has a higher level of education is more likely to be able to perform different types of work than someone with less education.
  • Social skills. This will evaluate how well a person can work with others in their current condition.
  • Comprehension skills. This will judge how well a person can understand directions and understand written or verbal instruction.
  • Motor skills. This determines how well a person can sit, walk and stand with the condition.

After an evaluation, the claims evaluator will place the claimant in one of three categories, depending on the kind of work that he or she has been evaluated to be able to do, if any: sedentary, light, or medium.

Applying for Social Security Disability Benefits with Lung Cancer

To apply for lung cancer Social Security Disability benefits, an individual can:

  • Apply in person at a Social Security Office near you. An appointment will usually be need to be made for this.
  • Call the Social Security Office at 1-800-772-1213. The hours are 7 a.m. to 7 p.m. from Monday to Friday.
  • Go online on the SSA’s website to apply. This is by far the most convenient method.

When applying, it is important to have as many medical documents related to your lung cancer diagnosis as possible. There are several ways in which your doctor can test for lung cancer. A biopsy, or taking a tissue sample to search for abnormal cells, is a possibility. Your doctor can also perform something called sputum cytology, where a sample of sputum, or mucus, is examined for abnormal cell growth. Lastly, your doctor can do an X-ray test of your lungs to see if there is a growth of cancerous cells.

You should also have your work history available and your Social Security number when applying. The Social Security Administration will review your case and should return a decision within 3 to 5 months of applying. It is also possible to seek the assistance of a Social Security Disability attorney or representative when applying, if you would like to do this.