Breast Cancer and Disability Benefits

(Editor’s note: This guest post is from Molly Clarke on behalf of the organization Social Security Disability Help. It is not affiliated with the Social Security Administration.) 

Breast cancer and its treatment effects can make it impossible to work. The resulting loss of income and medical insurance can cause a significant financial burden. If you find yourself facing these circumstances, you may be eligible to receive Social Security Disability (SSD) benefits.

The Social Security Administration (SSA) governs two programs that offer financial assistance to people who can no longer work due to an illness or disability.

Social Security Disability Insurance (SSDI) is funded by the FICA taxes that most workers pay into the system. Eligibility is based on an applicant’s work history and the amount of taxes they’ve paid throughout their career. The SSA assigns “work credits” to each quarter an individual works and pays taxes. See if you meet the work credit requirements for SSDI here.

Supplemental Security Income (SSI) is a needs-based program that provides financial assistance to disabled, elderly, or sick individuals who have very little income. Unlike SSDI, SSI is based on financial standing. It is a good option for people who may not have earned enough work credits to qualify for SSDI. Learn more about the financial requirements for SSI here. In some cases, individuals may qualify for both SSI and SSDI.

Breast Cancer Criteria

In addition to the technical requirements listed above, applicants must meet certain medical requirements. The most basic requirement is to meet the SSA’s definition of disability. Essentially this means that you must have a serious health condition that prevents you from working for at least a year.

Although breast cancer can be debilitating at any phase, the SSA has very stringent requirements to qualify for SSD with breast cancer. Unfortunately this can make it very difficult—but not impossible—to qualify with early stage breast cancer.

Typically, applicants’ conditions and symptoms are analyzed by the SSA in accordance with their official guide of disabling conditions known as the blue book. The blue book listing for individuals who have breast cancer requires that your cancer is a carcinoma that has advanced locally, including metastases in your breasts, chest wall, skin, and/or lymph nodes. You may also qualify if your cancer is recurrent and does not go into remission despite receiving appropriate treatment.

Requirements are stringent because cancers that meet these standards are expected to last at least 12 months—satisfying the SSA’s definition of disability. However, if you do not meet these specific requirements, you may still be able to qualify if you can provide medical proof that your cancer and cancer treatments are expected to last at least a year and keep you from working

If it has been determined that your breast cancer is inoperable, unresectable, or has distant metastases, you may qualify for compassionate allowance processing. This program allows individuals with particularly serious conditions to be approved for disability benefits in as little as 10 days. There is no separate application for the compassionate allowance program. The SSA will determine whether or not you qualify and will expedite your claim accordingly.

Starting the Application Process

The SSA requires that applicants provide documentation of their education, employment history, financial history, and most importantly their medical history. You should collect documentation of your diagnosis, laboratory tests, treatments, reaction to treatments, history of hospitalizations, and even personal notes from your doctor and submit them with your application.

It is important to have documents ready prior to beginning the application process so that there are no delays. Once you are ready to begin the application process, you can do so on the SSA’s website or in person at your local Social Security office. If you decide to complete your application in person, schedule an appointment in advance to avoid delays.

The SSD application process can be extremely difficult to navigate. If you find yourself overwhelmed or confused, it may be in your best interest to retain the services of a qualified disability attorney or advocate. He or she will have a thorough understanding of SSD benefits and will be able to guide you through the application process to ensure that you don’t make any mistakes.

Appealing a Denial

Many applications are denied due to lack of medical evidence or small technical errors. If your initial application is denied, do not panic. You are allowed to appeal this decision. It is important to remember that no matter how difficult it may be to be awarded disability benefits, these programs exist to help you. Do not give up. Once you are awarded benefits, you will be able to focus on your health instead of your finances.

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