Cancer and Social
Security Disability Claims
By: Pitt
Dickey - Attorney
Cancer and Social Security
Cancer is a common fact of life. When a worker is stricken with
cancer, his bills don’t stop just because he can no longer work.
Cancer patients can receive a monthly income from the Social
Security Administration (SSA) if they meet the disability
standards. This column will examine some of the general rules the
SSA uses to evaluate disability claims based on cancer.
SSA disability benefits include
regular monthly payments. After the patient has been determined to
have met the SSA disability standards for two years he will
receive Medicare Part A Hospital Insurance Benefits which helps
cover in patient hospital costs. To qualify for disability
benefits, the patient must prove that he has a condition which can
be expected to last at least twelve months and that he does not
have the ability to perform full time work in any job.
Cancer Terminology
To make it easier to understand
how the SSA evaluates disability claims based upon cancer, it is
helpful to understand what cancer is, how doctors categorize
tumors and the types of treatment available for cancer. To greatly
simplify, cancer is a condition in which the cells of the body
multiply out of control and form what are called malignant tumors.
A malignant tumor can spread and can sometimes lead to death. Not
all tumors are cancerous, benign tumors, are not formed
from cancer cells. The problem with cancer is that its
unrestrained growth can destroy the organs in which it is located
and some forms of cancer can spread through the body through the
lymph system or the blood stream.
When cancer spreads from its
original site in the body it is said to metastasize.
Cancers can be divided into three types which are determined by
the location of the tumor. The three categories are carcinoma,
sarcoma and mixed tissue tumors. A cancerous tumor
called a carcinoma is found in what is called epithelial
tissue such as the glands, digestive, urinary, reproductive organs
and in the skin. Carcinomas are the most common form of cancer. A sarcoma
tumor is found in connective tissue such as bones, muscle,
cartilage and the lymphatic system. Mixed tissue tumors are
found in both epithelial and connective tissues.
The medical study of cancer is
called oncology. A doctor who specializes in treating
cancer is called an oncologist. Oncology classifies tumors
into various classifications based on where the tumor is, how the
tumor is constructed and whether the tumor has spread from its
original site in the body. Tumors are classified by oncologists by
grade and staging. The grade of the tumor
which refers to how developed the cancer cells are in the tumor
when examined under a microscope. The stage of the tumor
which refers to how much the tumor has spread throughout the body
away from its original site.
Tumors are graded on a scale of I
to IV. A Grade I tumor is the least dangerous tumor as Grade I
means that the cancer cells are very similar to the cells in the
original site in the body. At the other end of the spectrum is a
Grade IV tumor which is the most dangerous types and consists of
cancer cells that are so mutated that it is difficult to determine
from what part of the body the cells originated.
The tumors are also classified on
the basis of whether they have spread under the Staging
classification. The larger the number in the staging scheme means
that the cancer has spread farther in the body.
General Rules to Evaluate
Cancer Disability Claims
The SSA in evaluating disability
claims based on cancer requires documentation based upon the
medical records of the patient. The SSA uses the following general
evaluations rules. When a malignant tumor is a local lesion that
has spread into regional lymph nodes and all of the cancer has
been surgically removed the SSA assumes that the cancer will not
return immediately and will not award disability benefits. However
there are a number of exceptions to this general rule.
In a case where there has been a
recurrence of cancer either locally or in the region after radical
surgery or after a pathology report shows that despite the radical
surgery that cancer remains in the area, the SSA can determine
that the cancer is inoperable under its guidelines and pay
disability benefits if the patient meets the other listing
requirements. When a malignant tumor has spread beyond the
regional lymph nodes, this cancer will normally be considered to
meet the requirements of a specific listing for a cancer
associated with the original location of the tumor. .
The SSA will also consider any
side effects from cancer therapy such as chemotherapy, radiation
or surgery which can be very hard on the patient. The SSA will
consider the type of therapy undergone, the drugs given, the
dosage of the drugs, frequency of the drug usage and future plans
for chemotherapy. The SSA is also required to consider any side
effect from the therapy such as nausea, vomiting, diarrhea,
weakness, dermatological disorders or reactive mental disorders
such as depression.
In general a patient meets the
SSA standards for a disability claim based upon cancer when it is
determined that the malignancy is inoperable or beyond control of
any other forms of therapy. It is possible for disability benefits
to be granted for a period prior to the determination that the
cancer is inoperable if the patient’s physician bases his
opinion on the patient’s medically reported symptoms, the type
of specific malignancy, its location and the extent of the
involvement of the tumor when it is first diagnosed.
When a patient has been cancer
free without a recurrence for three years that the patient is
deemed no longer disabled. This rule primarily effects patients
who have been awarded disability benefits based upon cancer when
the SSA makes a routine review of their disability claim to
determine if they should still receive disability benefits.
Cancer is difficult enough for a
family to face. The financial burdens can be eased to some extent
by the successful pursuit of a Social Security Disability claim.
Note: Since Social
Security Disability is directed under Federal law, the information
in this column will apply anywhere in the United States.
However each Office of Hearings and Appeals and District Office
have their own ways of doing things as does the various Federal
District and Circuit Courts. I have kept this column
primarily dealing the the mechanics of how the Social Security
District Offices and Office of Hearings and Appeals evaluates
disability claims.
- Pitt Dickey
Pitt Dickey has practiced law
in Fayetteville since 1978. He has handled SSA disability claims
for over twenty years. He practices with the firm of Smith,
Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place
and can be reached at 910-485-8020 or at pitt@smithdickey.com
. Or at the firm web site of www.smithdickey.com
.
Copyright © 2002 Pitt Dickey -
Used with permission
