Neoplastic disease (cancer) can strike virtually every organ system in the human body.  The effect and mortality rate of neoplastic disease varies and depends upon the location and type of cancerous lesion involved.  Generally, cancer symptoms are determined by the type, location and degree of disease.  In this segment, we'll focus our attention on those factors that will help you win a Social Security disability claim involving a neoplastic diagnosis.
 

General Evaluation

The following is a list of variables that should be considered when evaluating cancerous disorders.  You should pay close attention to these variables because they represent the most important factors for consideration when evaluating a Social Security disability claim on a person with a primary neoplastic diagnosis.

Identify the primary location of the cancerous lesion.  The primary site of a cancerous lesion is defined as the original site of first involvement.  To properly evaluate a claim on a person with cancer, it is important to identify the primary organ system with the disease.  Cancers of some organ systems are far more serious than others.  For example, there is a higher mortality rate for those suffering from end stage cancer of the pancreas in comparison to cancer of the breast. 

Once you have identified the primary location of the neoplastic disease, you should then determine if there are secondary sites.  The existence of a secondary site is indicative of metastasis or spreading of the disease from the primary cancerous lesion.  If spreading or metastasis has occurred, this indicates that the claimant is suffering from a far more serious condition. 

A neoplasm tumor can be malignant or benign.  If the neoplastic lesion is focal and is not growing or spreading to other sites within the body, it is said to be benign.  A benign tumor, depending upon its location, is usually less threatening to the life of the patient.  On the other hand, a malignant tumor actively grows and spreads to other organ systems within the body.  Those claimants suffering from a malignant form of neoplastic disease are less likely to recover and will often exhibit more debilitating symptoms.

Once you know the location of the primary lesion, you should then determine how the lesion is affecting the claimant's ability to function.  As with any disorder, the symptoms of a neoplastic disorder must be verified via the claimant's medical evidence.  Identifying the effects of neoplastic disease on the claimant's level of function can be done by interviewing the claimant, family members and of course the claimant's medical evidence.

In all cases where cancer is the primary diagnosis, you should attempt to recover copies of the claimant's x-ray reports, pathology reports, biopsy reports, CT, MRI, physical examinations, surgeries, oncology consults and any other data that supports the diagnosis and the claimant's medical status.

If surgery has been performed as a result of the claimant's neoplastic disease, get a copy of the surgical and pathology reports.  You should also get a copy of the hospital intake and discharge summary reports.  These reports will give you an indication as to the current and future status of the disease.  For example, most surgical reports will indicate whether the cancerous lesion was completely or partially removed. 

If the claimant has undergone a surgical removal of a cancerous lesion, look for any evidence of recurrence.  A recurrence of neoplastic disease can occur in the same or in a different site within the body.  If there has been a recurrence of the same type of cancer, this will lead to an allowance determination.  

If a claimant suffering from neoplastic disease has not undergone surgery, look for evidence that the condition is  inoperable.  As you can imagine, an inoperable lesion is considered by Social Security to be a more serious threat to the future health of the claimant.  Inoperable tumors that are also malignant reduce the treatment options available to the patient.  You should also seek out an opinion from the oncologist or primary physician as to the claimant's prognosis.  The claimant's medical prognosis will immediately address the issue of whether or not the neoplastic condition will result in death.

The next important issue to resolve in a neoplastic disability claim is the effects of treatment on the claimant's ability to function.  For example, claimants who are undergoing radiation or chemotherapy may be physically compromised as a result of the treatment.  Claimants undergoing chemotherapy generally exhibit fatigue, weight loss and a host of other unpleasant side effects.  These treatment side effects must be considered by Social Security in determining the claimant's residual functional capacity.

It is also important to identify any adverse psychological effects that may be secondary to the claimant's neoplastic disorder.  When someone finds out that she is suffering from cancer, there is an undeniably negative psychological impact.  This knowledge may lead to serious and debilitating anxiety and/or depression.  Recognizing and identifying the claimant's mental state is important because any serious adverse findings can be used to lower the claimant's mental residual functional capacity. 

Are there any other significant disorders besides cancer that the claimant is suffering from?  This is an important questions because an additional impairment can be used to lower RFC.   Additional impairments may mean additional restrictions that can be used to further reduce the claimant's residual functional capacity, leading to an allowance determination.

Has there been or will there be frequent hospitalizations or outpatient visits for cancer treatment that will take up a large amount of the claimant's time?   Claimants who are undergoing active treatment for cancer are not in a position to perform work.  Not only must the claimant endure the effects of the treatment, he must also meet the demands of the treatment schedule.  Don't ignore the duration requirement.  Most cancer treatment schedules last for only a few weeks or months and cannot be used alone to meet the duration requirement.  However, if the outcome of the treatment is poor, then you can reasonably expect that the condition will last twelve months.

Remission of a neoplastic disorder is also important to the outcome of a disability claim.  If a claimant is said to be in remission, this does not mean that the case is loss.  In this circumstance, you should determine when the condition was declared in remission.  You should also determine the claimant's physical capabilities from onset to the date of remission.  If the time frame between onset and remission was longer than one year, you may be able to acquire benefits for that period of disability.  If the time frame from onset to remission is shorter than one year, you should then concentrate on determining the claimant's current physical capabilities.  It may be that despite remission, the claimant is still unable to perform work.  Also keep in mind that in many cases of neoplastic disease, remission can be short lived.