Prostate Cancer and Social Security Disability

Social Security Disability for Prostate Cancer

If you suffer from prostate cancer and will be unable to work for a year or longer because of your condition, you may be eligible to receive Social Security Disability benefits. The Social Security Administration (SSA) oversees Social Security Disability Insurance (SSDI), which is designed to help disabled workers financially by providing monthly benefits.

In order to be eligible for SSDI, you have to have earned sufficient credits by having worked five of the last 10 years, and you have to have paid in an adequate amount of taxes to the SSA. If you are younger and couldn’t have worked that long, different rules come into play regarding your eligibility for SSDI benefits.

Prostate cancer is the second most common kind of cancer found in men, just behind skin cancer. The cancer is in the prostate, which is a gland in the male reproductive system. It is one of the leading causes of cancer death among men.

However, prostate cancer can often be treated successfully. The treatments can have serious side effects, such as nausea, fatigue, and weakness. Even if the cancer is caught early, the treatments can make you unable to work because of their side effects and frequency. The prostate is in front of the rectum and below the bladder, so it can impact your bodily functions as well.

Your cancer may qualify you for disability benefits

The Cost of Treating Prostate Cancer

According to Drug Watch, the cost of a prostatectomy is about $15,000. The cost for eight weeks of chemotherapy can vary from $8,000 to $20,000. On average, the patient diagnosed with prostate cancer will spend about $20,000 on treatment. It is dependent upon your cancer, its stage, your location, and the hospital and medical providers used.

If you have recurrences of the cancer, the overall treatment for prostate cancer is estimated to be anywhere from $50,000 to $100,000. Even for individuals with health insurance, the copays and deductibles can add up rather quickly.

The Evaluation Conducted by the SSA and the Medical Requirements

The SSA uses the Blue Book, which is a detailed medical guide, to determine if an individual is medically disabled. In order to receive benefits, you have to be unable to work for at least a year or have a condition that is expected to result in your death.

The first six months that you are disabled you are not eligible for benefits. You may apply for benefits during that time so hopefully you can be approved by the time the waiting period is over.

There is a listing for prostate cancer in the Blue Book.

Section 13.24 of the Blue Book refers to prostate cancer. If you meet the following criteria set forth in the Blue Book, you are eligible for benefits:

  • Despite hormonal intervention the prostate cancer is progressive or recurrent OR

  • The prostate cancer has spread to internal organs OR

  • You have oat or small-cell carcinoma

Your claim will be expedited through the compassionate allowances (CAL) program if your prostate cancer is a recurrence or if it has spread to other organs. Otherwise, the average claim takes five months on average for approval. If you don’t meet the medical requirements, you may still be eligible for benefits using another approach.

Getting Disability Benefits Using an RFC and Medical-Vocational Allowance

A residual function capacity (RFC) is a form that is used by the SSA to take a close and in-depth look at your daily activities. This form clearly indicates any restrictions or limitations that your medical conditions may be causing you.

The form is designed to determine if you are too limited by your cancer, cancer treatments, or their lasting side effects so you are unable to perform any full-time job.

In addition to your medical conditions, your age, work experience, transferrable skills, and educational level are considered. If your job isn’t physical, it can be more difficult to prove your case. The SSA can argue that you can learn new tasks and skills so you can perform a sedentary type job. In order to receive SSDI, it has to be determined that you are unable to perform any kind of steady work.

If you work in a strenuous position, you may be able to show that your prostate cancer has eliminated your ability to perform essential job functions. The RFC should indicate if you cannot stand on your feet for more than two hours. If you are a machine operator in a manufacturing facility, your cancer can definitely impact your ability to work.

Other limitations, such as the inability to bend, kneel, lift, carry, or walk long distances should also be clearly and accurately specified. By showing this evidence, the SSA may find you are disabled by your medical limitations and that you are unable to perform your work.

Sometimes a cancer diagnosis can affect you mentally, causing anxiety or depression. These mental illnesses can impact your ability to work and should also be noted in your RFC and medical records.

Applying Specific Medical Tests

If you are applying for benefits because of prostate cancer, you need to provide detailed medical records that include lab results, scans, pathology reports, a treatment plan, and any treatment records. Providing the evidence to back up your claim is essential in gaining approval for benefits.

Your claim may be denied, but you can appeal that ruling twice. The final step would be appearing before an administrative law judge for a hearing.

It is not uncommon for the SSA to order a medical evaluation at their expense. They send you to the physician they choose for informational purposes to confirm your condition. This is for informational purposes only to help with the claim decision. Sometimes a mental evaluation may be ordered to determine if anxiety and depression impact your ability to function as well.

The SSDI claims process can be complicated, so it is imperative that you complete the application in detail and that you provide all of the proper documentation to support your claim. If you are suffering from prostate cancer, you need to focus on recovering and not worrying about your financial needs.

Monthly disability benefits can help cover the cost of living and relieve some financial stress. After you have received SSDI for two years, you are eligible for the government health insurance program, Medicare.