How to Get Disability Benefits for Lymphoma 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 lymphoma is severe enough to meet or equal the lymphoma 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 lymphoma is severe enough to meet or equal the listing, you will be considered disabled.
The listing for lymphoma is listing 13.05, 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 13.05A for Lymphoma
You will meet listing 13.05A if you have non-Hodgkin’s lymphoma. Part A has two subsections, numbered 1 and 2. To meet the listing you must satisfy either one of the two subsections.
You will meet part A.1 if your lymphoma is persistent or recurrent after initial prescribed therapy (drugs, radiation, and/or surgery).
To determine if cancer is controlled by prescribed therapy, one must have all available medical data to reach a reasonable decision. Objective evidence of residual cancer is needed after treatment methods have been given and failed. 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 the use of multiple treatments. 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.
You will meet part A.2 if you have indolent (low-grade) lymphoma requiring initiation of more than one treatment regimen (drugs, radiation, and/or surgery). Generally, these will be cancers that are Staged I or II, which have a good prognosis. However, “low-grade” doesn’t mean harmless; although not particularly aggressive, indolent lymphomas may be difficult to eradicate.
Part A.2 is satisfied if an indolent lymphoma is treated, that treatment regimen finished, and then another treatment regimen started within 12 months. The second regimen can be the same or different from the initial regimen. Onset should be no later than the date the second regimen is begun and could be earlier. Whether the onset could go back to the time of diagnosis, or before, would depend on the individual facts in the case. It is important to note that an optimistic or uncertain prognostic opinion by the treating physician regarding the outcome of the second treatment regimen does not justify determining failure to satisfy part A.2.
According to the SSA, changes in treatment regimen must occur as a result of an unstable disease condition, i.e., non-responsiveness to treatment as a property of the cancer itself, rather than an arbitrary decision by the treating physician or claimant.
Meeting Social Security Administration Listing 13.05B for Lymphoma
You will meet listing 13.05B if you have Hodgkin’s disease, and either there is a failure to achieve “clinically complete remission,” or there is recurrence of disease within 12 months of stopping the initial treatment regimen. Unless specified otherwise by the SSA at some point in the future, complete remission should not be considered present unless all objective evidence of cancer is gone.
Meeting Social Security Administration Listing 13.05C for Lymphoma
You will meet listing 13.05C if you have stem cell or bone marrow transplantation in the treatment of lymphoma; this is automatic allowance for at least 12 months. It must be emphasized that part C is satisfied by the transplant and time parameter specified. If still within the 12 months post-operative transplant period, the claim should be allowed regardless of how the claimant feels, how well the treating physician states the claimant is doing, or what kinds of activities of daily living the claimant is engaged in.
Continue to Residual Functional Capacity Assessment for Lymphoma.
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