How to Qualify for Social Security Benefits with Breast Cancer

March 9, 2018

A cancer diagnosis can have a major impact on your life. If you have been diagnosed with breast cancer and you are unable to work, you may qualify for Social Security disability benefits. Because a high number of women are diagnosed with breast cancer each year and because of the severity of the condition, breast cancer is listed in the Social Security Administration’s (SSA) medical guide, which lists medical conditions and their criteria for qualifying for disability benefits.

The SSA oversees the distribution of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). In order to qualify for either of these kinds of benefits, you must meet the definition of disability per the SSA guidelines[i]. In order to do that, there are three specific criteria that must be met and proven:

  • You cannot do the work you did before you became disabled.
  • You have a physical or mental condition that will keep you from learning how to do a different kind of work.
  • Your condition is expected to last or has already lasted at least a year or will result in your death.

In order to receive disability benefits from the SSA, you have to serious medical conditions[ii] that are with you long-term. Because of this, you may have difficulty being approved for benefits if you have a less advanced form of breast cancer.

In addition to the monetary benefits of SSDI, you will also be considered eligible for Medicare two years after you’ve started receiving disability benefits. If you qualify for SSI, you may also be automatically eligible for Medicaid in many states, though some states do require a separate application for the program.

Meeting the Medical Listing

In order to meet the medical listing for breast cancer and get benefits approval, you must meet the criteria under the SSA’s own list of disabling conditions, the Blue Book. Here, you can find the SSA’s criteria for breast cancer under section 13.10[iii]. The criteria include:

  • You must be able to provide medical evidence of a locally advanced carcinoma, such as inflammatory carcinoma, any sized tumor with a direct extension to the chest wall or skin, or a tumor of any size that has metastases to the ipsilateral internal mammary glands OR
  • You must be able to provide medical documentation of a carcinoma that has metastasized to the supraclavicular or infraclavicular nodes, to 10 or more axillary nodes, or with distant metastases, OR
  • You have a medically documented recurrent carcinoma, not including a local recurrence that benefits from antineoplastic therapy.

Because these are very specific criteria with detailed medical terms, you should consult with your physician to see if you meet the requirements of the medical listing for disability with breast cancer. However, you can still be approved for benefits if you don’t meet the listing criteria or if you have breast cancer in an earlier stage by using a residual functioning capacity (RFC).

Qualifying with a Residual Functioning Capacity

closeup of a Social Security Benefits form
closeup of a Social Security Benefits form

If you don’t meet the medical listing requirements for disability, you can still meet approval with use of an RFC.[iv] This detailed form will explain your limitations and how your life has been impacted by your breast cancer. Even if your breast cancer was caught early, in stages 1, 2 or 3, you may not be able to work because of the treatment process.

The RFC allows your treating physician to explain how your cancer and its treatments, as well as any other medical conditions, are impacting your ability to function. As an example, you may have to go for treatments two or three times a week. These treatments may leave you fatigued, nauseated, and weak, which make it impossible for you to stand long shifts or walk significant distances.

Surgical procedures or ports for treatments may make it difficult for you to lift, bend over or grasp items. Your doctor may indicate you cannot lift more than 5 pounds two or three times a day, he may say you have to reposition every hour or two, he may limit your physical activity, and you may require additional rest. All of these things make it clear that you cannot perform any kind of work because of your medical conditions.

Filing for Benefits

If you are ready to apply for disability benefits from the SSA you don’t have to do it alone. You can get the help of your treating physician, an advocate, or an attorney.  Your doctor can help you determine how your breast cancer medically qualifies, while a qualified advocate can go over your case if you do not meet a Blue Book listing. These are professionals who are familiar with the process and who can make sure you provide all the needed documentation and notes.






Published in partnership with Disability Benefits Help

breast cancer, Disability Benefits Help, Social Security benefits, SSA, SSDI, SSI, survivor, treatment,

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