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SSDI and Metastatic Breast Cancer: An Overview

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Qualifying for Social Security Disability with Metastatic Breast Cancer

By Deanna Power

If you have been diagnosed with metastatic breast cancer, the last thing on your mind should be making ends meet financially. Fortunately, there could be resources available for you.

Metastatic breast cancer automatically qualifies medically for disability benefits from the Social Security Administration (SSA), though you will still need to apply and meet the SSA’s technical qualification rules. These include strict financial limits for Supplemental Security Income (SSI) and/or work credit requirements for Social Security Disability Insurance (SSDI).

SSI and SSDI Benefitsmedica

SSDI pays benefits to qualified, disabled workers. This program requires you have a relatively recent work history, within the last ten years, and that you’ve accumulated sufficient work credits over the course of your employment. Work credits build up as you pay Social Security taxes on your income from employment, and most workers earn about four credits per year. Between 20 and 40 credits are typically necessary.  The vast majority of disability recipients are on SSDI benefits. Most women who’ve had at least part-time jobs will qualify for SSDI.

For SSI, there is no work history necessary but you must have very limited financial resources, because this program provides support for only the most financially needy among the disabled. If you have a spouse who’s earning a decent income, you will not qualify for SSI.

Earning Income While Applying

Keep in mind that you cannot be working when you apply for SSDI or SSI benefits. If you’re still working and plan on quitting once you’re approved, or quitting a couple of months after you apply, the SSA will automatically deny your claim.

Also, remember that earning any income will affect your SSDI or SSI eligibility. While metastatic breast cancer will automatically medically qualify (see more under Medical Approval), if you’re still working and earning income, you will not be able to apply for disability benefits. This is because the SSA defines “disabled,” as being unable to work and earn more than $1,130 per month (2016) due to a condition that will last for at least 12 months.

Long-Term Disability and SSDI Benefits

If you’re not working, but instead receiving short or long-term disability (LTD) benefits from your employer (and do not intend to return to work in at least 12 months), your SSDI claim should not be affected. This is because SSDI is awarded based on how much you contributed to taxes, not how much wealth you have at the moment. So long as you’re unable to physically work, your saved income or other forms of benefits should not affect your eligibility.

What will be affected is your monthly payment. If you are approved for SSDI benefits, your LTD provider will adjust your payments accordingly. For example, if you receive $2,000 per month through LTD, and you’re approved for $1,000 per month from Social Security disability, your monthly LTD will be reduced by $1,000.

Medical Approval for Disability

Although SSDI and SSI have different technical eligibility requirements, medically qualification is the same for both programs. The SSA will compare your medical records with the standard disability listing for breast cancer that appears in the Blue Book. If your medical records meet the SSA’s breast cancer listing, then you’re medically eligible for benefits.

To be approved, the SSA must have access to your medical history and they must specifically see you have one of the following forms of breast cancer:

  • Inflammatory carcinoma that has spread to the mammary nodes, chest wall, or skin
  • Carcinoma that has spread locally or distantly, or which has returned after treatment (usually stage III-B or later)
  • Small or oat cell carcinoma
  • Any form of carcinoma with secondary lymphedema

Metastatic breast cancer clearly medically qualifies. To completely evaluate your claim, SSA must see certain medical records in order to approve your disability claim. These include:

  • A pathology report and notes from a surgical resection or biopsy

OR

  • A report from your physician that explains why your cancer cannot be surgically removed

AND

  • Imaging results, like MRIs, x-rays, mammograms, or ultrasounds

Compassionate Allowances and Medicare

Most Social Security claimants wait to be approved in 3-5 months, but this is not always the case for women with metastatic breast cancer. When you submit your disability claim for metastatic breast cancer, the SSA will expedite its review under the rules of the Compassionate Allowances initiative. This ensures you have a decision as quickly as possible.  You could be approved for Social Security in as little as 10 days. Unfortunately, this does not necessarily mean that you will receive benefits quickly. If you have metastatic breast cancer, you will still need to wait for 6 months to receive your first disability payment.

Note that SSDI is awarded based on the date you were formally considered disabled–not necessarily the date of your diagnosis.  If you weren’t able to go back to your job after your diagnosis due to physical limitations, you potentially might be considered disabled from that date. Your date of diagnosis and date of disability would be the same in this example. On the other hand, suppose you worked for two years but were then unable to continue due to the disease. You date of disability would be the day after you stopped working–you would likely get fast approval for SSDI, but you would still have to wait six months for your first SSDI benefit.

Additionally, SSDI and SSI recipients are entitled to Medicare and Medicaid respectively. In most states, if you’re approved for SSI, you will automatically be enrolle d onto Medicaid. For women receiving SSDI, the wait may be much longer. The SSA requires all SSDI recipients to wait for 24 months to receive Medicare. This time period starts from the point at which you have become disabled (most likely when diagnosed), not when you apply, or when you’re approved. Keep in mind that if you continued to work after your diagnosis, your two-year waiting period will begin after you stopped earning income due to your breast cancer. While many attempts in congress have been made to try and change the mandatory wait period, nothing has been successful this far.

Applying for SSDI and SSI

The SSA offers an online application process for SSDI, but a personal interview will still be necessary for SSI. Interviews may be completed at the local office, and you can apply for SSDI at the local branch too, if you prefer.

Disability applications take some time, but an SSA representative, friend, family member, or someone else can help you with your claim. In fact, someone else may even file on your behalf, if you’re unable to handle the application due to your cancer and cancer treatments.

 

After Approval

Once approved, it is unlikely you will lose your benefits unless you begin working. Typically, the SSA reviews claimants’ cases every 1 or 3 years after approval. Because metastatic breast cancer is a serious and life-threatening condition, the SSA will usually wait much longer to revaluate your claim. Many women approved with metastatic breast cancer will not be revaluated for 7 years, sometimes even longer. This allows you to focus on your health instead of finances.

 

Deanna Power is  director of outreach for Disability Benefits Help, an independent resource dedicated to helping people of all ages. You can contact Deanna at help@disability-benefits-help.org.