Brain Tumors and U.S.A. Social Security Disability Benefits

This is a guest posting from Molly Clarke who writes for the U.S.A. Social Security Disability Help blog. 

John

Brain Tumors and Social Security Disability Benefits

A brain tumor, like any serious medical condition, can severely impact a person’s life. Because brain tumors vary in size, shape, and location, people with brain tumors can be affected in very different ways. Individuals with benign brain tumors may find that they can continue to live as they always have, with little interference. Unfortunately, more serious or malignant brain tumors can stop people in their tracks and force them to put their lives on hold while they seek medical treatment.

Patients who cannot work due to the effects of a brain tumor may find that the resulting loss of income and lack of medical insurance cause a significant financial burden. If you or a loved one is facing these circumstances, you may qualify for assistance in the form of Social Security Disability (SSD) benefits. The following article will provide you with a general overview of the SSD program and will prepare you to begin the application process.

What is a Disability?

To qualify for SSD benefits, all applicants must first meet the Social Security Administration’s (SSA) definition of disabled. This includes meeting the following criteria:

·         Your condition prevents you from performing the job that you typically do.

·         Your condition prevents you from adjusting to a different job.

·         Your condition has lasted or is expected to last at least one year or result in death.

If you do not meet these basic requirements, you will not be approved for disability benefits. If you do meet these requirements, you will also have to meet additional technical and medical eligibility requirements.

Social Security Disability Technical Eligibility Requirements

The SSA governs two separate programs that offer SSD benefits—SSDI and SSI. As previously mentioned, all applicants must meet certain technical requirements to qualify for disability benefits. These technical requirements will depend on which disability program you apply for.

·         SSDI stands for Social Security Disability Insurance. This program is funded by the FICA taxes that are deducted from most workers’ paychecks. Eligibility for SSDI is based on an applicant’s work history. The SSA assigns “work credits” to each quarter that an individual works and pays taxes. To qualify for SSDI, the SSA requires a certain amount of work credits. Learn more about work credits and qualifying for SSDI, here: http://www.disability-benefits-help.org/ssdi/qualify-for-ssdi.

·         SSI stands for Supplemental Security Income. SSI is different from SSDI in that it does not require work credits to qualify. Instead, SSI is a needs-based program, meaning that eligibility is determined by strict financial limitations. SSI is often a good fit for disabled children or adults with little income who do not meet the work credit requirements to qualify for SSDI. Learn more about qualifying for SSI, here: http://www.disability-benefits-help.org/ssi/qualify-for-ssi.

It is important to note that SSI and SSDI are not health insurance programs. After a two year waiting period, SSDI recipients become eligible for Medicare and SSI recipients automatically qualify for Medicaid. In some cases, an applicant may be eligible to receive both SSI and SSDI.

Social Security Administration’s Blue Book

In addition to meeting these technical criteria, applicants must also meet certain medical criteria. To determine the severity of an applicant’s condition, the SSA consults their guidebook of disabling conditions commonly referred to as the blue book.

Although, benign brain tumors are listed under section 11.05 of the blue book, this section states that benign brain tumors are to be evaluated under listings of epilepsy, stroke, or other affected body systems. This is because, depending on their size and location, benign brain tumors can affect each person differently. It is important that you meet with your doctor to discuss how your brain tumor affects you and which blue book listing best covers your impairments.

Malignant brain tumors are evaluated under section 13.13 of the SSA’s blue book. This section states that, in order to qualify for SSD benefits, applicants with malignant brain tumors must meet the following criteria:

·         The brain tumor must be classified as grade II or higher under the World Health Organization classification of tumors of the central nervous system.

·         The tumor is progressive or recurrent even after receiving appropriate treatment.

·         The brain tumor has spread or metastasized to other areas of the body.

The requirements listed above have been summarized from the blue book listing. There are more specific requirements based on the type of tumor you have. These can be found on the SSA’s website.

More serious and life threatening brain tumors may qualify an individual for processing under the Compassionate Allowances (CAL) program. The CAL program allows individuals with particularly severe disabilities to be approved for SSD in as little as ten days. Please note that you do not have to fill out additional paperwork to receive CAL processing. The SSA will evaluate your application and if you qualify, they will expedite your claim accordingly.

Social Security Disability Application Process

It is vital that you go into the application process prepared with the necessary records and documentation. These records include thorough medical documentation of your brain tumor—records of your diagnosis, medical test results, hospitalizations, treatments, and personal notes from your doctor. You should also be prepared to provide records of your work history and financial standing.

Once you decide to begin the application process, you can do so online at the SSA’s website or in person at your local Social Security office.  It is important that you realize how long and stressful the SSD application process may be. In fact, many initial applications are denied. If you yours is denied, do not panic. You have the right to appeal the SSA’s decision.

Remember, SSD benefits exist to help you. It is important to be persistent. Although it may not be easy to get approved, it will be worth the hassle once you can focus on your health rather than your financial distress.

Image credit: <a href='http://www.123rf.com/photo_14055027_social-security-claim-approved-stamp-showing-social-unemployment-benefit-agreed.html'>stuartphoto / 123RF Stock Photo</a>