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SSDI and Malignant Neoplastic Problems

Home  /  SSDI and Malignant Neoplastic Problems

Malignant Neoplastic Problems


Every day in the United States, there are 4,620 new cases of cancer as well as 1,630 deaths from cancer. While the numbers of cancer deaths are increasing worldwide, this is more than just a statistic but individual’s lives. Symptoms from different cancers along with the many invasive forms of treatment can cause you to miss days from work, or even months.


Social Security Disability Insurance (SSDI) benefits are, therefore, a lifeline for many cancer patients dealing with the disease every day who are forced to leave work. If you are one of them, you too can get SSDI benefits if you meet the Social Security Administration’s (SSA’s) eligibility criteria.


What Criteria Does the Social Security Administration Use to Evaluate Malignant Neoplastic Problems?


Section 13 of the Blue Book deals with malignant neoplastic and other cancer-related problems. In general, the SSA considers:

  • Origin of the cancer
  • Extent of its spread, usually beyond the regional lymph nodes
  • Duration, frequency, and its response to anticancer therapy, which means it is inoperable, unresectable, or recurrent
  • Side-effects of treatment
  • Inability to work for 12 months or more as a result of the cancer


There are some kinds of cancer that receive an approval for disability immediately. Metastatic brain or spinal cord carcinomas, inflammatory breast cancer, primary cancer of the liver, bile ducts, or gall bladder are examples of cancer that get sanction based on the diagnosis alone.


What Kind of Medical Evidence Is Required?


The SSA requires medical evidence that documents:

  • Place of origin, type, and severity of the malignancy
  • Treatments attempted like chemotherapy, surgery, transplants, and any other anticancer treatments
  • Response to therapy and its side effects as well as persistence and progression of the cancer


In case of operative procedures, they require a copy of the operative note and pathology report. Relevant medical reports, including summaries of hospitalization, are also accepted in case these are not available.


What Malignant Neoplastic Problems Appear in the Section 13 of the Blue Book?


Section 13 includes a broad range of cancers and cancer-related problems. In fact, there are 27 categories in this section.


Brain cancer: Advanced brain cancer is found in Section 13.13 of the Blue Book and describes an advanced form which has spread and recurred even after anticancer treatment.


Breast cancer: Breast cancer is the second most leading cause of cancer deaths, after lung cancer. To qualify under the listing, you need to show that you have:

  • Advanced breast cancer that has spread to the chest, skin, or internal mammary nodes
  • Carcinoma that has extended below or above the collar bone, or has spread to more than ten nodes, or other regions of the chest
  • Carcinoma that has returned after treatment
  • Small-cell carcinoma


Leukemia: Leukemia refers to blood or bone marrow cancers that result in abnormal production of blood cells.

  • Acute leukemia qualifies as a disability until at least 24 months from the diagnosis date
  • In case you’ve had a stem cell/bone marrow transplant, then 12 months from that date
  • Leukemia in its final stages also qualifies immediately for disability benefits


In these cases, you are eligible for Compassionate Allowance benefits which start within a month of applying.


Lung cancer: Both non-small cell and small cell lung cancers qualify as disabilities. In addition, carcinoma of the top part of either the left or right lung is also counted as eligible for disability benefits until at least 18 months from the date of diagnosis.


Prostate cancer: Progressive or recurrent prostate cancer that has spread despite treatment, or cancer that has spread to other internal organs qualifies as a disability. Cancer of the testicles and penis are also listed in Section 13.25 and 13.26 respectively.


Stomach cancer, digestive system and urinary system cancers: Cancer of the esophagus, stomach, small intestine, large intestine, kidneys, adrenal glands, ureters, and urinary bladder are all included in Sections 13.16 to 13.22 of the Blue Book.


In most cases, the cancer needs to be recurrent, inoperable or unresectable with metastases beyond the regional lymph nodes. However, in the case of cancer of the liver, gall bladder, and pancreas, diagnosis alone is enough to qualify.


Cancers of the female genital tract: Cancer of the uterus, cervix, vulva, vagina, fallopian tubes, and ovaries are listed in Section 13.23, and need to meet the same criteria as digestive system cancers.


In addition to these, there is provision for cancers where the primary site of origin is unknown and Section 13.29 covers malignant melanomas. Any cancer treated by bone marrow or stem cell transplant is considered as a disability for 12 months from the date of the transplant.


What Happens When Your Malignant Neoplastic Problem Does Not Meet a Blue Book Listing?


The cancer listings that appear in Section 13 of the Blue Book are examples of cancer that can be regarded as debilitating enough to prevent a person from doing gainful activity. However, in case your cancer is not listed, the SSA will:

  • Determine whether your malignant neoplastic problem meets the criteria of a listing in another body system
  • Ascertain whether your cancer medically equals a listing
  • Test your Residual Functional Capacity (RFC) to see if you are able to engage in substantial gainful activity


A medical vocational allowance will be approved for those whose medical conditions that prevent you from working for at least 12 months.


Is There a Faster Way to Process SSDI Benefits?


The Compassionate Allowance (CAL) program is a fast-track option available to those claimants whose cancer has spread beyond regional lymph nodes. Certain kinds of cancer like leukemia and gall bladder cancer are considered under CAL automatically. There is no special procedure for this application; the SSA expedites the applications with a CAL condition. In these cases, approval is given in weeks rather than months or years.


Apply for SSDI Benefits Today


If your cancer has kept you from work (or will keep you from work) for at least 12 months or more, or you have had a bone marrow/stem cell transplant, you should immediately apply for disability benefits.


Providing appropriate medical evidence is vital to getting your claim approved. Disability United can connect you to an advocate in your area who specializes in SSDI cases. An advocate can help you through the application process and improve your chances of approval at the earliest possible stage. Fill out our free disability evaluation form today.