If you have been diagnosed with multiple myeloma and it has rendered you unable to work, you may qualify for Social Security Disability benefits. Social Security Disability Insurance (SSDI) pays benefits to individuals who are totally and permanently disabled. The disabled individual may have certain dependents who are also eligible to receive benefits. The individual who is disabled needs to have worked long enough to have earned adequate credits, which indicates enough taxes have been paid in to Social Security.
Multiple myeloma is cancer involving the plasma cells. Plasma cells are a type of white blood cell that are present in the bone marrow. While these cells are designed to make antibodies to help fight off infections, some of these plasma cells develop abnormally and multiply. These additional cells are making proteins, increasing the protein levels in the bloodstream to hazardous levels.
In order to receive benefits, you have to meet the guidelines or qualifications set forth by the Social Security Administration (SSA). The SSA guidelines for being permanently disabled are not the same as the guidelines for being disabled according to other agencies. During the disability determination process, the SSA gets a lot of information about you and your medical condition, including medical records to determine if you meet the guidelines to receive SSDI benefits.
Financial Expenses Related to Multiple Myeloma
Like other cancers, multiple myeloma can be very expensive to treat. According to Everyday Health, this form of cancer is extremely expensive to treat because of the kinds of medications that are used. List prices on medications such as Revlimid or Velcade can cost more than $5,000 per month.
Patients may also require stem cell transplants or chemotherapy, which add to the costs. Many of those diagnosed with the cancer are 65 and older so they are on Medicare. While Medicare offers prescription drug coverage, there is a “doughnut hole” gap that can cost thousands every year. The chemo treatments and transplants can cost tens of thousands of dollars more, boosting it to one of the most expensive conditions to treat today.
Also sometimes you may have to travel considerable distances to undergo treatments for this particular cancer. Travel expenses also add to the cost. There are many programs available where patients diagnosed with multiple myeloma can apply for financial assistance covering medical expenses. Clinical trials can also help reduce costs.
Medical Qualifications Required by the Social Security Administration
The SSA has determined multiple myeloma is one of the diseases that can cause a person to qualify for Social Security Disability benefits. In the SSA Blue Book, SSA has detailed criteria that are used to evaluate how the disease impacts the patient’s life and thus if the patient is rendered disabled. Multiple myeloma is listed in the Book Blue under section 13.07.
To qualify for benefits, the SSA requires medical evidence of either:
- Failure for the disease to respond to medical treatment or the disease continues despite the use of therapy to grow new cells
- Multiple myeloma with bone marrow or stem cell transplantation will make the patient considered disabled for 12 months following the surgical date. The patient’s condition will be evaluated regularly based on any ongoing complications. As an example, if the kidney disease lingers farther than the one-year established deadline, the disability case would continue to be evaluated based on that diagnosis.
It is also essential that the SSA specify how the disease is to be confirmed, such as by urine tests, blood tests or bone marrow examinations, including bone marrow biopsy. It is important that the SSA indicate how any follow-ups are to be conducted to determine whether the disease remains active.
Qualifying for Social Security Disability Benefits Using an RFC
A residual functioning capacity (RFC) form is a detailed form that is completed by a physician giving complete details on an individual’s medical diagnosis and how it impacts their life in general. It gives the specifics such as how activities are limited.
The RFC indicates any medications being taken, the prognosis, how activities have been limited or changed, how frequently the individual can bend or reach, any issues with grasping or lifting, how long he or she can sit, stand or lie without having to reposition.
This form is so complete and detailed it can determine whether or not an individual is rendered disabled by a medical condition. It also lists problems or symptoms experienced from multiple medical conditions and how these combined conditions can limit functioning or cause disability.
Even if an individual does not meet the Blue Book guidelines to be considered disabled, a completed RFC could be reason enough to deem someone disabled for Social Security Disability benefits. The RFC can be used in conjunction with medical records and tests by Disability Determination Services to declare an individual legally disabled per the SSA guidelines.
Applying Specific Medical Tests
Although the SSA will have access to your medical records and any other documents detailing how your condition impacts your ability to work, they can still order medical evaluations or tests at their expense to help clarify any questions they may have or to make final determination as to whether someone is indeed completely disabled.
In regards to multiple myeloma, tests could include blood tests, urine tests and bone marrow tests, including bone marrow biopsies. If you have undergone a bone marrow biopsy, it is unlikely the SSA will order an additional test because they are very expensive. Any new tests will be compared to any existing tests to determine if the condition has improved or worsened with treatment and how it has responded to different kinds of treatment.
The medical evaluations and tests ordered by the SSA can be used to help them in the decision making process for disability claims. In addition to medical conditions and how those conditions impair an individual, several other things are taken into consideration, including past work done by the claimant, educational background or level and any skills that the individual may have accumulated from his or her job or education.
Then the disability determination services team decides if any of these skills can be transferred to another kind of work. In order to qualify for Social Security Disability benefits, an individual has to be declared totally disabled. If he or she can do another form of work, even if it is not the job he or she held in the past, the individual is not considered disabled.
If an individual is disabled, he or she may appeal their claims all the way up until they have a hearing before an administrative law judge who will rule on his or her case and decide whether the individual is eligible for disability benefits.
Multiple Myeloma and Your Social Security Disability Case
If your initial claim for Social Security Disability benefits is denied, it is important that you consult with a Social Security Disability attorney or advocate as soon as possible. These professionals will work with you to prove your case to the Social Security Administration. They will help you gather the necessary medical evidence and may retain expert witnesses to testify on your behalf at your disability hearing. Statistically, your chances of being awarded Social Security Disability benefits are much greater with proper representation.