Applying for Social Security Disability Benefits with Prostate Cancer
The Journal of The National Cancer Institute reports there are nearly 2 million men living in the America today who are prostate cancer survivors, and the Prostate Cancer Foundation reports more than 220,000 new cases are diagnosed each year in the U.S.
While prostate cancer is among the leading causes of cancer-related death for American men as well, it is also among the most treatable and curable forms of cancer, which is why it may or may not qualify you for disability benefits.
If your prostate cancer was advanced when diagnosed or has recurred after initial treatment, then you automatically medically qualify Social Security Disability. If it is not advanced, you will need to meet Blue Book listing 13.24 to qualify. Either way, you will need to apply and provide medical reports to back up your claim though.
If your prostate cancer is caught early and responds to treatment, then you won’t qualify for benefits through the typical review process. Instead, you’ll have to show that your cancer symptoms, treatments, and complications severely disrupt your ability to function on a daily basis.
The Costs of Prostate Cancer
A prostate cancer diagnosis is often followed by multiple consultations with specialists, including urologists, medical oncologists, and radiation oncologists, among others. Follow-up appointments with various doctors and specialists may also be necessary.
Office visit co-pays are among the initial expenses, but you must tack on top of these the costs of various treatments, which may include a combination of radiation, chemotherapy, hormone therapy, prescription drugs, and surgery.
The Prostate Cancer Foundation and Dr. Jay Ciezki of the Cleveland Clinic report that patients accumulate medical expenses at varying rates after initial treatment. Annual expenses depend highly on the type of treatment a patient undergoes. For example, men that have their prostate gland surgically removed incur annual direct medical costs that average about $3,200 thereafter.
Patients that undergo other initial treatment methods average annual medical expenses that range from about $2,600 to $6,400.
According to a study published in the Journal of the National Cancer Institutes, between 22 and 30 percent of men report that their cancer and cancer treatments affect their ability to perform physical job functions 12 months after diagnosis. For many, this is well after initial treatment for prostate cancer has ended.
If you are no longer able to work, then Social Security disability can be a means of ensuring consistent income.
Medically Qualifying for Benefits for Prostate Cancer
There are two ways in which you can qualify for benefits medically with prostate cancer. The first is to meet the SSA’s prostate cancer listing. The second is to show through a residual functional capacity (RFC) analysis that you’re disabled despite not meeting the Blue Book disability listing for the disease.
If your cancer is advanced, recurrent, or terminal, then you meet the SSA’s listing requirements. Otherwise, your prostate cancer does not qualify under this listing. This is because most men are able to return to work after treatment, if their cancer is found early and treated appropriately.
Specifically, to meet the SSA’s prostate cancer listing, your medical records must show one of the following:
- The disease has progressed or returned despite initial treatment
- Your cancer has metastasized (spread) to internal organs
- You have oat or small-cell carcinoma
If your prostate cancer has recurred or metastasized, then your application for benefits will be flagged for expedited review and approval under the SSA’s compassionate allowances (CAL) program.
The SSA will still need to see minimal medical evidence before approving your claim, but very few claims that are denied disability are denied for medical reasons under the CAL program.
Qualifying for Benefits without Meeting a Disability Listing
Any applicant that doesn’t meet the Blue Book listing for prostate cancer must be able to prove disability through an RFC evaluation. An RFC is the process the SSA uses to take a closer look at your daily activities. The goal is to determine if you’re so limited by your cancer, cancer treatments, or lasting side effects that you cannot work in any job.
This can be very difficult to prove if you don’t work in a physical job, because most prostate cancer survivors don’t report experiencing any problems with thinking, learning new tasks, keeping pace with others in conversations, or other types of duties required in sedentary jobs. Few studies have been conducted on the lasting effects of prostate cancer, but according to those published by the Journal of the Cancer Institutes, most men can return to work if they work in non-physical jobs.
If you work in an industry that requires strenuous activity though, you may be able to show that your cancer has eliminated your ability to perform essential job functions. For example, if you are no longer able to remain on your feet for hours at a time and traditionally have worked as a machine operator in a production facility, then the SSA may find you disabled by your current medical limitations.
Using Your VA Disability Rating For Prostate Cancer
VA benefits are different from SSD benefits, so your rating does not impact how much you’ll receive in disability benefits. You can use your VA rating and any medical evidence from the VA to support your SSD claim for prostate cancer.
Medical evidence required to support your claim for disability benefits should include the following:
- a medical report prepared by your doctor indicating your prostate cancer diagnosis and shows that the cancer has spread or has returned;
- results of a biopsy that shows the presence of oat or small-cell carcinoma, if it is relevant to your case;
- the results of radiology tests that indicate the cancer has spread or has returned
- present treatment and results so far.
To qualify for SSD, your prostate cancer doesn’t have to be connected to your military service, but it could be. You can combine your prostate diagnosis to include service-connected and non-service-related reasons for your diagnosis.
The higher your VA rating, the more benefits you may be eligible to receive as it may relate to a more severe diagnosis. The VA considers you to be fully disabled if you have a 100% P&T disability rating. If this happens to you, the SSA will make a decision about eligibility for SSD more quickly than usual.
How to Apply for Disability Benefits with Prostate Cancer
Medical evidence to support your claim is essential to proving your disability with prostate cancer. If you’re able to meet the disability listing in the Blue Book, the SSA will require less evidence than if you must go through an RFC evaluation.
If you meet the listing, your medical records must include:
- Radiological exams or clinical observations that show your cancer has spread or returned
- Biopsy results showing oat or small-cell carcinoma, if applicable
- Treatment plans and/or results
- A report from your physician, describing your cancer and prognosis
If you do not meet the listing, then the SSA will needs additional records, including:
- A detailed report from your doctor, documenting lasting side effects of treatment or complications from your cancer. Your doctor’s report should provide information on how frequently you experience side effects, how severe they are, and how long your doctor believes you’ll be affected.
- Detailed records of hospitalizations or other clinical visits related to your cancer or cancer treatment side effects. These may include things like IV therapy for anemia, an ER visit for gastrointestinal issues, or repeated visits to your primary care doctor regarding fatigue, weight loss, bone loss, or other common complications of prostate cancer treatment.
In addition to your medical information and contact details for all of your doctors, you’ll need other documents at the time you apply for benefits as well. These include information on your finances, education, job training, work history, and personal life and living situation.
If you are ready to begin your application, visit the SSA’s website to submit your SSDI application online, or go to the local Social Security office to apply for SSI and/or SSDI. Keep in mind that you can have someone else help you with your online or local application. A friend, family member, Social Security advocate, or an attorney can assist you throughout the application process and can even submit an application on your behalf. It might also be helpful to fill out this free evaluation form that will help you learn more about your case and, if you so choose, lead you to legal representation.
