How to Get Disability Benefits for Breast Cancer by Meeting a Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your breast cancer is severe enough to meet or equal the breast cancer listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your breast cancer is severe enough to meet or equal the listing, you will be considered disabled.
The listing for breast cancer is listing 13.10, which has three parts, A, B, and C. To meet the listing you must satisfy any of the three parts.
Meeting Social Security Administration Listing 13.10A for Breast Cancer
You will meet listing 13.10A if you have breast cancer that is locally advanced, which makes it inoperable for cure.
The act of surgery does not in itself mean a cancer is operable. Sometimes tumors are debulked by surgeons. This term means surgical removal as a part of the tumor mass to increase the comfort of the patient (palliation) and/or to increase the effectiveness of planned radiation or chemotherapy by decreasing the number of tumor cells that must be treated. Such a procedure should not be confused with operability. Also, inoperability may not be known to be present until surgery is actually done.
In the TMN system, all cancers classified as T3b-T4, M0 or N2-N3, M0 are so locally advanced that they are considered inoperable, although there is no evidence of distant metastasis (M1). T4 and N3 lesions are Stage IV cancer, and all Stage IV cancers are inoperable. T3b and N2 cancers are inoperable Stage III. Metastatic disease (M1) is also Stage IV and inoperable, but is considered under part B of the listing.
In inflammatory breast cancer there is a warm, red breast with extensive skin edema and hardness of underlying tissues. However, the clinical appearance is not sufficient for diagnosis. The pathology report must specifically diagnose inflammatory carcinoma on microscopic examination. Inflammatory carcinoma is automatically T4 and Stage IV, inoperable cancer, with associated poor prognosis.
Meeting Social Security Administration Listing 13.10B for Breast Cancer
You will meet listing 13.10B if you have distant metastasis of the breast cancer. In such cases, the cancer has spread so far from the breast that removal of the cancer with surgery is impossible. Distant metastasis is accompanied by a median survival of about 1.5 to 2 years. In addition, Part B is satisfied by metastasis to either the lymph nodes above (supraclavicular) or below (infraclavicular) the clavicle.
If a biopsy was performed, the pathology report should be made available, too. However, reasonable evidence of metastasis without a biopsy is acceptable, provided that the pathology report for the primary tumor is obtainable. For example, a patient with documented breast carcinoma could have x-rays, scans, or magnetic resonance imaging (MRI) of bones, internal organs, or other structures compatible with metastatic cancer. That is sufficient for evidence of metastasis, especially if the interpretation of the treating oncologist is that the laboratory study in question represents metastatic malignancy. The listing is based on the poor prognosis for survival in cases with distant metastasis.
If cancer occurs in both breasts, whether at the same time (synchronous) or at different times (metachronous), SSA will consider them as different local primary cancers. Therefore, cancer involving both breasts does not qualify as distant metastasis and does not qualify under part B, unless other areas of the body are also involved.
Meeting Social Security Administration Listing 13.10C for Breast Cancer
You will meet listing 13.10C if your breast cancer recurs after surgery.
If a biopsy was performed, the pathology report should be made available to SSA. However, reasonable evidence of recurrence without a biopsy is acceptable, provided that the pathology report for the original primary tumor is obtainable. For example, a patient with previously documented breast cancer could have x-rays, scans, or magnetic resonance imaging (MRI) of bones, internal organs, or other structures compatible with recurrent cancer. That is sufficient for evidence of recurrence, especially if the interpretation of the treating oncologist is that the laboratory study in question represents recurrent malignancy.
Although a cancer doesn’t necessarily have to be biopsy-proven in evaluation of recurrent malignancy, the biopsy proving the original cancer would still have to be available, too. This adds weight to the opinion that an abnormal laboratory study does in fact represent recurrent cancer. It is also possible that a biopsy report is available regarding a recurrence, but not for the original cancer. This is perfectly acceptable, if the biopsy of the recurrence (which could be either local or metastatic) cancer shows cells like those of the original tumor. For instance, 10 years after breast cancer and a mastectomy, a claimant develops bone pain in the spine and is found to have cancer in a vertebral body. A biopsy shows malignant breast cells of the same type as the original cancer. Under these conditions, a pathology report of the original breast cancer is unnecessary.
The one exception to recurrence fulfilling part C is cancer that only recurs in the area where the breast was originally removed. This is local recurrence, and if treatment can control it, the claimant would not qualify under part C. Local recurrence is more likely in patients who had cancer in the axillary lymph nodes, and occurs in about 10 – 15% of those cases. Such recurrences can only be controlled half of the time. Return of cancer anywhere other than locally after radical surgery carries a poor prognosis with a median survival of only 1.5 to 2 years.
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