What this listing covers
Breast cancer occurs when cells in your breast grow uncontrollably, forming a tumor that can invade surrounding tissues or spread to other parts of your body. SSA categorizes this disease based on its origin, the extent of its spread, and how it responds to treatments like surgery, radiation, or chemotherapy.
The condition often impacts your daily life through persistent fatigue, pain, and the physical limitations caused by surgical procedures or systemic treatments. You may face significant challenges with mobility, lifting, or maintaining the focus required for a full-time work schedule due to the ongoing demands of your treatment and recovery.
How SSA evaluates a claim under this listing
Under Listing 13.10, SSA evaluates your breast cancer based on its stage and spread. They look for evidence of locally advanced cancer, such as tumors involving your chest wall or skin, or cancer that has spread to specific lymph nodes. They also consider recurrent disease that does not remit with standard anticancer therapy.
SSA also evaluates cases involving secondary lymphedema caused by treatment that requires surgery to restore your upper extremity function. For these cases, your impairment is considered disabling for at least 12 months from the date of your corrective surgery. Beyond these specific criteria, SSA assesses any residual impairments that prevent you from performing substantial gainful activity. An attorney can help you navigate these requirements.
Evidence that strengthens a claim
Your claim relies on comprehensive medical records that detail the type, site, and extent of your cancer. SSA requires operative notes and pathology reports for any surgical procedures, including biopsies or needle aspirations. If these are unavailable, hospital summaries that document surgical findings and pathological results are essential.
Non-medical evidence, such as detailed statements from your treating physician regarding your response to therapy and any persistent complications, is vital. Documentation of the frequency and dosage of your medications, along with reports on side effects like neurological or gastrointestinal issues, helps SSA understand the full impact of your condition on your ability to work. An attorney can help you gather this evidence.
How an attorney helps
A disability attorney helps by ensuring your medical records are organized to directly address the specific requirements of Listing 13.10. They can assist in obtaining detailed functional capacity statements from your doctors that highlight how your symptoms and treatment side effects prevent you from sustaining work. If your initial application is not successful, an attorney can guide you through the appeals process, including preparing you for a hearing before an ALJ.
Frequently asked questions
No, a diagnosis does not guarantee benefits. SSA evaluates whether your specific condition meets the criteria in Listing 13.10, such as the extent of your cancer's spread or the severity of your treatment-related complications. An attorney can review your medical records to determine how well your case aligns with these requirements.
SSA looks for evidence of metastasis to specific lymph nodes or distant sites. If your cancer has spread to your supraclavicular or infraclavicular nodes, or if you have 10 or more affected axillary nodes, your case may meet the requirements of Listing 13.10. Documentation from imaging and pathology reports is necessary to prove the extent of the spread.
If you have secondary lymphedema resulting from cancer treatment that requires surgery to restore your upper extremity function, you may qualify for benefits. SSA considers this disabling for at least 12 months following your surgery. A disability attorney can help ensure your surgical records and post-operative limitations are clearly presented to SSA.
A denial is not the end of the process. You have the right to request a reconsideration, and if that is denied, you can request a hearing before an ALJ. There are strict deadlines for these appeals, so consulting with a disability attorney early can help you build a stronger case for your next step.
