How to Get Disability Benefits for Lung 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 lung cancer is severe enough to meet or equal the lung 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 lung cancer is severe enough to meet or equal the listing, you will be considered disabled.
The listing for lung cancer is listing 13.14, 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 13.14A for Lung Cancer
You will meet listing 13.14A if you have non-small-cell carcinoma that is inoperable, unresectable, or recurrent, and it must have spread to the central chest lymph nodes or beyond. The SSA defines inoperable as meaning that surgery either cannot be performed or would be of no therapeutic value, and it defines unresectable as meaning there was surgery, or the cancer was incompletely removed (for instance, if surgery was done and any tumor remains).
The act of surgery does not in itself mean a cancer is resectable. 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 determined until surgery is actually done.
Part A is also fulfilled if there is incomplete excision of the lung cancer, because it is a type of unresectability. Sometimes, surgery appears to have removed all of the cancer, but unknown and hidden malignant cells are still present in the body that at some future time will grow into another tumor. Although there is always some chance that such cells are left behind, there must be documentation that cancer does remain in the body. Such reasonable evidence of incomplete excision might involve the material removed at surgery or what the surgeon sees at surgery, as well as CT or MRI scan results indicating residual disease. The material resected by the surgeon will be subjected to complete analysis by a pathologist. If there is cancer remaining even microscopically at the surgical margins as denoted by the pathology report, then there is incomplete excision.
Recurrence of cancer could be anywhere in the body, since the cancer may have microscopically seeded other organs. Such spread of cancer would have already been present but unknown at the time of the original surgery, or the recurrence could be the result of cancer cells left behind at the original site of the tumor. For example, the surgeon might visually see no remaining tumor following resection, and the margins of resection even on microscopic pathology evaluation might not show cancer cells. That does not mean all of the cancer was resected at surgery, and recurrence can still occur at a later date. The poor prognosis for lung cancer derives from the substantial percentage of cancers that have already metastasized at the time of diagnosis.
It does not matter how much time has passed since the surgery was done and the cancer reappears. It could be years after apparent cure and the claimant would still qualify under part A, because recurrent malignancy entitles the claimant to a minimum of 3 years disability measured from the last objective evidence of such recurrent cancer being present.
Meeting Social Security Administration Listing 13.14B for Lung Cancer
You will meet listing 13.14B if you have small cell (oat cell) carcinoma. Small cell carcinoma is so rapidly progressive and the cure rate so low that a claimant qualifies under part B if they have it, without any other criteria necessary. It does not matter what kind of treatment is being given, or how well the claimant is initially responding to treatment. Nothing but a pathology report is required.
Meeting Social Security Administration Listing 13.14C for Lung Cancer
You will meet listing 13.14C if you have carcinoma of the superior sulcus (including pancoast tumors), and you are undergoing multiple types of treatment. In these instances, you are eligible for 18 months of disability allowance. Note that a good prognosis prediction by the treating doctor does not negate such an allowance, nor does the fact that a patient appears to be initially responding to treatment. Superior sulcus tumors are those arising at the apex or the right or left lung. Pancoast tumors are a type of superior sulcus tumor that is usually found in smokers and can put pressure on the brachial plexus of nerves supplying the arm, as well as autonomic nervous system fibers that affect eyelid and pupil function—among other possible problems—and which invade the top of the chest wall. Classically, shoulder and possibly arm pain symptoms may be present. Numerous structures can potentially be involved by a superior sulcus tumor—or the tumor may be asymptomatic when discovered. Due to these complications that make superior sulcus tumors more problematic to treat than other lung cancers, it makes sense to give such claimants an automatic period of disability before any consideration of possible improvement.
Go back to About Lung Cancer and Disability.