Head and Neck Cancer

How to Get Disability Benefits for Head and Neck 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 head and neck cancer is severe enough to meet or equal the head and neck 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 head and neck cancer is severe enough to meet or equal the listing, you will be considered disabled.

The listing for head and neck cancer is listing 13.02, which has five parts, A, B, C, D, and E. To meet the listing you must satisfy any of the five parts.

Meeting Social Security Administration Listing 13.02A for Head and Neck Cancer

You will meet listing 13.02A if your have head and neck cancer that is either inoperable or unresectable.

Inoperable as defined by the SSA means surgery either cannot be performed or would be of no therapeutic value.

Unresectable as defined by the SSA means there was surgery, or the cancer was incompletely removed. If surgery was done and any tumor remains—either grossly or microscopically—then the tumor is unresectable and qualifies under part A.

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 resectability. Also, resectability may not be known to be present until surgery is actually done.

Meeting Social Security Administration Listing 13.02B for Head and Neck Cancer

You will meet listing 13.02B if you have head and neck cancer that is not controlled by prescribed therapy.

To determine if cancer is controlled by prescribed therapy, one must have all available medical data to reach a reasonable decision. Treatment might be radiation, drugs, surgery or all three. Objective evidence of residual cancer is needed after treatment methods have been given and failed. Such evidence would demonstrate lack of control. In instances in which application for benefits is near the time of diagnosis, SSA may have to hold the claim to evaluate the outcome of treatment, but could consider a cancer uncontrolled if there is no significant improvement after 3 months of therapy, and the assumption would be made that the following 9 months would also be satisfied in regard to listing level severity. However, this policy is modifiable in individual circumstances and, in most cases, it would require more than 3 months of medical information to evaluate multimodal therapy. In many instances, it could require 6 months from the initial diagnosis to determine the status of a claimant’s cancer. Very few cases need to be held by the SSA for longer periods.

Meeting Social Security Administration Listing 13.02C for Head and Neck Cancer

You will meet listing 13.02C if you have head and neck cancer that is recurrent after any type of initial prescribed therapy.

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 head and neck cancer could have x-rays, scans, or magnetic resonance imaging (MRI) of bone, 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.

It is important to note that although a cancer does not necessarily have to be biopsy-proven in evaluation of recurrent malignancy, the biopsy proving the original cancer would still have to be available also. 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 acceptable, if the biopsy of the recurrence (which could be either local or metastatic) shows the cancer to be the same as the original tumor. For instance, 2 years after radical head and neck surgery, a claimant develops headaches and is found to have recurrent cancer in his brain. A biopsy shows malignant cells like those of the original head and neck cancer. Under these conditions, a pathology report of the original cancer is unnecessary.

Part C is also fulfilled by recurrence after radiation therapy. Such radiation is tailored to deliver maximum doses to the tumor and as little as possible to healthy tissues, but precise selectivity may not be possible. External x-ray beams or radium implants are the usual types of radiotherapy given.

The claimant can still qualify under part C, even if the cancer that recurs is successfully treated a second time. Recurrent SCC head and neck cancer after radiation or radical surgery has an overall median survival of only about 6 months. It does not matter how much time has passed since the surgery was done and the cancer reappears; the recurrence could be years after apparent cure and the claimant would still qualify under part C. Qualifying recurrent malignancy entitles the claimant to a minimum of 3 years disability measured from the most recent objective evidence of such recurrent cancer being present.

Meeting Social Security Administration Listing 13.02D for Head and Neck Cancer

You will meet listing 7.02A if you have head and neck cancer, and there are metastases beyond the regional lymph nodes (distant metastasis). In these cases, the cancer has spread so far that it is beyond the area in which surgical removal (resection) could be expected to be curative. For example, head and neck cancer which has spread to the lungs is distant metastasis. Only one tumor might be found as representative of distant metastasis of the primary cancer and it might also be removable surgically. However, such distant spread is indicative that many other as yet undetected cancerous cells are present and un-removable. Cancer which has spread into the lymph nodes of the neck from a cancer anywhere in the head and neck area is not distant metastasis. Even one tumor detectable anywhere outside of the neck is distant metastasis.

If a biopsy was performed, the pathology report should be made available to the SSA. 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 SCC of the head and neck 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. Median survival in such instances of SCC is only about 6 months.

Meeting Social Security Administration Listing 13.02E for Head and Neck Cancer

You will meet listing 13.02E if you have any form of head and neck cancer not covered in parts A-D of the listing. Note that treatment response is not a criterion for allowance/denial decision until at least 18 months has elapsed from the time of diagnosis.

Epidermoid carcinoma is the most frequent kind of cancer occurring in the head and neck areas. This is another term for squamous cell carcinoma (SCC), and accounts for 95% of cancers that arise in the base of the tongue and pyriform sinus.

If such cancer occurs in the pyriform sinus, or in the lower third of the tongue, then the claimant automatically qualifies under part E. The pyriform sinus area is rich in lymphatic drainage, thereby increasing the risk of metastatic spread through the lymphatic system.

Base of the tongue SCC may produce a sore throat or a feeling of a lump in the throat, but the cancer can become quite advanced before any symptoms appear. Radiation is the preferred mode of treatment, with surgery to the base of the tongue in some cases. There is a high risk of metastasis to lymph nodes in the neck, and when surgery is done for a large lesion in the base of the tongue both radical neck dissection of lymph nodes and a laryngectomy are performed. Stage I and II cancers of the base of the tongue have more than a 90% 5-year survival rate with radiation. In contrast, the worst Stage IV lesions have about a 15% survival rate for the same period. Despite the good prognosis in some cases, part E makes no distinction between early and advanced cancer and therefore all SCC in the base of the tongue qualifies. Treatment response is not relevant to fulfilling part E.

Pyriform sinus SCC automatically fulfills part E regardless of the size of the cancer or treatment response. The pyriform sinus is an area of complex anatomy in the posterior part of the throat. The overall disease free survival at 5 years is about 20-25% for advanced cancers after treatment with radical surgery and radiation, but very early lesions have a better chance.

Continue to Residual Functional Capacity Assessment for Head and Neck Cancer.

Go back to About Head and Neck Cancer and Disability.