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A breast cancer diagnosis and the importance of SSDI benefits

By Lauryn November 8, 2021

Each October, an international health campaign, known as Breast Cancer Awareness Month, is celebrated to raise awareness of breast cancer and raise funds for prevention, diagnosis, treatment, and, ultimately, a cure. The campaign, originally founded in 1985, has grown tremendously over the years, with a major focus on highlighting the importance of prevention and early intervention in surviving the disease. For a woman in the United States, the chance of developing breast cancer is about 13 percent, meaning there is a 1-in-8 chance she will develop some form of the disease in her lifetime. This means that over the course of Breast Cancer Awareness Month, more than 28,000 women will have received a breast cancer diagnosis.

Breast cancer remains the second leading cause of death in women in the United States, despite advancement in treatments in recent years. Prevention and early intervention remain the most important forms of treatment with the highest rate of success. For millions of women in the United States – and around the world – breast cancer is life-changing. The diagnosis may alter a woman’s work-life balance as, due to surgeries, treatments, and therapies, she made need to take a significant amount of time off from work. Applying for Social Security Disability Insurance (SSDI) benefits can help women fighting breast cancer to take back some control by knowing they are protecting their financial future.

Applying for SSDI benefits with a breast cancer diagnosis
Each year, thousands of individuals apply for, and receive, SSDI benefits because of a cancer diagnosis. Filing for benefits with a breast cancer diagnosis is just one form of cancer that may qualify an individual for SSDI benefits. While the Social Security Administration (SSA) has strict requirements when determining eligibility, in some instances, the very diagnosis of breast cancer is enough to qualify for benefits. Those with one of the following diagnoses may qualify for SSDI benefits under Social Security’s Compassionate Allowance program, which approves applications for those individuals whose conditions are so severe they automatically meet the definition of disability:

    • Inflammatory Breast Cancer (IBC): A rare, rapidly developing breast cancer that makes the breast red, swollen, and tender.
    • Metastatic Breast Cancer (Metastatic Breast Carcinoma; Stage IV Breast Carcinoma): Breast cancer that has spread to another part of the body, most commonly the liver, brain, bones, or lungs.
    • Metastatic Ductal Cancer (Metastatic Ductal Carcinoma; Stage IV Ductal Carcinoma of the Breast): Breast cancer that originated in the cells of the milk duct linings and has spread to another part of the body, most commonly the liver, brain, bones, or lungs.
    • Metastatic Lobular Cancer (Metastatic Lobular Carcinoma; Stage IV Lobular Carcinoma of the Breast): Breast cancer that originated in the lobules and has spread to another part of the body, most commonly the liver, brain, bones, or lung.

If a diagnosis alone is not enough to qualify for SSDI benefits, Social Security will look at other determining factors, such as age, work history, and education, along with in-depth review of medical evidence.

The importance of medical evidence to the SSDI process
In each SSDI claim, medical evidence is vital in making a favorable decision. If a breast cancer diagnosis is determined to not be severe enough by SSA’s standards to qualify for SSDI benefits, medical evidence becomes even more important. Medical records that detail treatment that is being used to combat the disease, such as chemotherapy, radiation therapy, hormone therapy, targeted drug therapy, and surgery, will provide the most useful information.

Despite their efforts to target the cancer, the treatments may cause adverse side-effects that end up being life-altering themselves. Those side-effects may include fatigue, peripheral neuropathy, bone loss and osteoporosis, memory loss, headaches, and heart problems. The course of treatment, which is determined by the type and stage of cancer, can prolong the amount of a time a woman is out of work. Social Security will be able to use this evidence when making a decision. While it is possible to be approved for SSDI benefits as a result of a breast cancer diagnosis, there is no guarantee of an approval, as each claim is different. Whether the applicant is looking for SSDI benefits to be a temporary or permanent form of assistance, Social Security’s guidelines must be met to receive an approval.

The future of SSDI: Metastatic Breast Cancer Access to Care Act
The National Breast Cancer Coalition (NBCC) is working hard to lobby the passage of the Metastatic Breast Cancer Access to Care Act. The Act, if passed, will waive both the 24-month waiting period for Medicare eligibility and 5-month waiting period for the entitlement to SSDI cash benefits for those who have been diagnosed with metastatic breast cancer. Unfortunately, there is no cure for metastatic breast cancer, despite advancements of treatments. The average survival rate of those with metastatic breast cancer is only three years. The passage of the Act could provide much needed medical and financial relief for individuals, and their families, as they battle the disease.

While most individuals who are approved SSDI benefits and Medicare coverage must wait the appropriate allotted timeframe, there is federal precedent to waive the waiting period for those battling the most severe of illnesses. In late December 2020, former President Donald Trump enacted a law which waived the 5-month waiting period for those living with Amyotrophic Lateral Sclerosis (ALS). If the Metastatic Breast Cancer Access to Care Act is passed, metastatic breast cancer will be added to that list.

Breast cancer is not just a women’s disease
Even though most breast cancer diagnoses are in women, and they are targeted most in awareness campaigns, it is important to remember that breast cancer is not just a women’s disease. Although men only account for approximately 1 percent of all breast cancer diagnoses, that still totals roughly 3,000 diagnoses each year. Awareness surrounding men’s breast health is significantly less than that for women, but morality rates are just as high, if not higher, than in women. As the typical prevention methods are not common in men, when cases are diagnosed, they are often in later stages making it more difficult to treat. Because of this, it is important that prevention and early intervention methods become more commonplace in men, particularly those who may be at higher risk.

It is our privilege at Brown & Brown Absence Services Group to assist individuals who are battling breast cancer, as well as their families. For expert advice in filing for SSDI benefits with breast cancer, you may contact our office or reach out to your local Social Security office directly.

Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security benefits, nor is it intended as financial advice in any way.  The decision to claim benefits is a personal one that is contingent upon each individual’s unique circumstances. Nothing herein is considered medical advice, diagnosis or treatment.

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