Applying for Social Security Disability Benefits with Colon Cancer
The American Cancer Society ranks colon cancer as the third most common form of cancer in America today, with more than 93,000 cases diagnosed every year. While the disease affects men slightly more often than women, colon cancer doesn’t discriminate. New cases are diagnosed in patients of all ages, sexes, and races.
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Thanks to more effective treatment methods and earlier detection of the disease, more than 1 million Americans alive today are colorectal cancer survivors, according to the American Cancer Society. Cancer patients and survivors are often disabled though by not just the disease, but also the required treatments and the complications and residual effects they experience. For people who qualify, Social Security Disability (SSD) benefits can be the financial support they need to get by when they are unable to work.
The Costs of Colon Cancer
Illness takes its toll on all aspects of a person’s life, not just financial matters, but the monetary costs of colon cancer can be devastating. Although most employers provide short term disability (STD) benefits to workers that have a serious illness like colon cancer, STD pays only an average of about 60% of a typical paycheck. Most STD plans only cover a period of between three and six months. If your colon cancer keeps you from work for longer than your STD benefits cover, then you’ll face the challenge of surviving without any paycheck at all.
While new treatments for colorectal cancer introduced in recent years have increased survival rates, new medications and surgical methods also come at higher costs. The American Journal of Managed Care reports that costs vary significantly based on what treatments are used. The three most common chemotherapy drug cocktails range in cost from just over $1,000 to more than $38,000 for a 6-cycle round of treatment.
In addition to six or more cycles of chemo, other bills pile up for colon cancer patients, including surgical charges, hospital bills, and lab fees, to name just a few. With high medical bills and decreased or no income, cancer patients must often seek assistance through state and federal programs. The good news is that many colon cancer patients are able to qualify for disability benefits from the Social Security Administration (SSA).
Can You Get Disability Benefits for Colon Cancer?
Colon Cancer, if it is advanced or has reached an incurable stage, may be disabling enough to prevent someone from continuing their participation in gainful employment. As such, the Social Security Administration (SSA) may approve disability benefits payments to people who have Colon Cancer if they match the criteria necessary for benefits payments’ approval.
The main criteria that must be met in order to be approved for disability benefits for Colon Cancer are listed below:
- The symptoms of the Colon Cancer must match the description in the SSA’s Blue Book listing under Section 13.18 – Cancers of the Large Intestine. The Blue Book is the SSA’s manual that details the symptoms and specific criteria of various medical conditions that qualify for Social Security disability benefits. In other words, a Blue Book listing is basically the definition of what conditions the SSA regards as serious enough to justify disability payments being made.
- There needs to be sufficient medical evidence to support the application for disability benefits. This evidence should include the applicant’s medical history, how the Cancer developed and what treatment was given, results of tests and scans showing the severity of the Colon Cancer; any surgery that has been performed; what the prognosis is for the patient’s immediate future, i.e., has the Cancer reached the point of being at an inoperable stage.
- The applicant must be able to show that gainful employment for at least the next 12 months is not possible because of the Colon Cancer, or that the Cancer is terminal, i.e., the applicant is likely to die within the next 12 months. Additionally, the applicant may decide to ask their doctor to complete a Residual Functional Capacity (RFC) assessment, which can show the SSA exactly how much they are able to do and what they cannot do physically as a result of their Colon Cancer.
- Sufficient work credits must be accumulated in order to qualify for payments through the Social Security Disability Insurance (SSDI) scheme. There is an additional disability benefits program available that is called Supplemental Security Income (SSI). Unlike SSDI, SSI is available for those individuals who have a disability but do not have many assets or income, and also have not worked for long enough to meet SSDI’s work credit requirements.
Medically Qualifying for Benefits for Colon Cancer
Colon cancer, no matter how severe it is, is clearly disabling. The disease, the required treatments, and the side effects of chemotherapy, all prevent you from working after all. But the SSA only pays disability to applicants under certain circumstances. Specifically, you must:
- Have a disability that will prevent gainful employment for a period of at least one year
OR
- Have an illness that is terminal in nature
In other words, your illness must meet severity level requirements before you’ll be approved for disability benefits. You must have medical records that show you meet the Blue Book listing for colon cancer. The Blue Book is a procedure manual that the SSA uses when they review applications for benefits.
Colon cancer applications are reviewed under the listing in Section 13.18, which covers various forms of cancer that occur in the large intestines. To meet this listing, your cancer must:
- Be an Adenocarcinoma form of cancer AND
- have come back after treatment
OR
-
- is impossible for a surgeon to remove
OR
- Be a squamous cell carcinoma form of cancer AND
- affects the anus
And
-
- has come back after surgical removal of cancer cells or tumors
OR
- Be a small-cell or oat cell carcinoma form of cancer
OR
- Is any form of colon cancer that has spread past the lymph nodes in the area where the cancer originally developed.
The SSA also needs to see that your doctor believes your colon cancer, even after treatment, will prevent you from earning a gainful living. Work closely with your doctor to understand the Blue Book listing for your illness and to ensure your medical records show you qualify for disability benefits under this listing.
Qualifying for SSD without Meeting a Listing in the Blue Book
Although not all applicants can meet the Blue Book colon cancer listing, some are still able to get benefits through a “residual functional capacity” (RFC) analysis. In this process, the SSA will request that you and your doctor fill out “functional capacity” reports. The SSA may also send a report form to a family member, caregiver, or friend that is very familiar with your medical condition and how it affects your daily life.
The SSA uses the information from the RFC to look at how your illness limits your “activities of daily living” or ALDs. This gives them insight into how your illness would affect your ability to complete typical job functions as well.
As part of the RFC evaluation, the SSA also takes your age, education, job training, and employment history or work experience into consideration. These details help them understand if you could easily get or learn to perform a different job – a job in which your illness wouldn’t stop you from working and earning a living.
Every disability presents specific challenges to a worker. Colon cancer may for example, stop you from working on a production floor where you must be on your feet all day and consistently lift a specific number of pounds. It may not however stop you from being able to work a sedentary job at a computer workstation.
The SSA uses an RFC analysis to understand whether you have the knowledge, skills, and abilities to find work despite your limitations. You’ll only be granted benefits if the SSA finds you cannot work in any job.
How to Apply for Disability Benefits with Colon Cancer
The disability application can take some time to complete. It asks for many details about your medical history, employment, education, job training, and your daily life and financial situation. Answer every question, even if it doesn’t apply to you. Do not leave anything blank. This will only delay the processing of your application and lead the SSA to contact you for clarification. If a question doesn’t apply, state that by writing “N/A” for “not applicable” or “doesn’t apply.”
You’ll need to provide accurate contact information for every doctor, hospital, or other healthcare provider or facility you’ve been to as well. The SSA needs these contact details to get your medical records and to see critical pieces of evidence in your medical history. Your records should include:
- Colorectal screening reports or other test results showing the discovery of your cancer
- Biopsy reports that document the type of cancer you have
- Surgical notes from tumor removal surgeries or reports from a surgeon explaining why your cancer cannot be removed
- A detailed history of your treatments, including how long and how often you’ve undergone chemotherapy or radiation treatments
- Information on the types of drugs used in treating your colon cancer, including chemotherapy cocktails as well as any prescription medications you take
Some people with colon cancer can receive SSD benefits through both of the SSA’s disability programs. Others may only be able to qualify for one form of benefits. The SSA pays benefits through Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each program requires its own application.
You can apply online with the SSA or at your local SSA office for SSDI benefits. To apply for SSI benefits through, you must complete an interview with an SSA representative. Interviews are usually held at the local office.
