What this listing covers
Cancers of the maxilla, orbit, or temporal fossa involve malignant tumors originating in your upper jaw, eye socket, or the space at the side of your skull.
These conditions often cause severe pain, vision loss, facial disfigurement, and difficulty eating or speaking. The physical toll of the tumor and the intensity of required treatments like surgery or radiation often make it impossible for you to maintain a consistent work schedule.
How SSA evaluates a claim under this listing
Under Listing 13.12, the SSA evaluates these cancers based on their location and extent. They look for evidence of sarcoma or carcinoma that has spread to regional lymph nodes or distant sites. They also specifically consider cases where a carcinoma of the antrum has extended into your orbit or sinuses, or where the cancer has reached your meninges or base of the skull.
The SSA requires documentation that the cancer is inoperable, unresectable, or has persisted or recurred following your initial treatment. Because these cancers are highly aggressive, the evaluation focuses on the medical evidence confirming the site of the lesion and the failure of your initial therapy to achieve complete remission.
Evidence that strengthens a claim
To support your claim, you need a complete medical file including pathology reports and operative notes from any biopsies or surgeries. Imaging studies such as CT scans or MRIs that document the exact site, size, and spread of your tumor are essential to show your cancer meets the listing criteria.
Statements from your oncologist detailing your treatment plan, including any multimodal therapy like chemotherapy combined with radiation, are vital. Records documenting the persistence of your disease or the severity of post-therapeutic residuals, such as neurological deficits or chronic pain, help clarify the impact on your daily functioning. An attorney can help you gather this evidence to support your claim.
How an attorney helps
A disability attorney helps by ensuring your medical records clearly map to the specific requirements of Listing 13.12. They can coordinate with your medical team to obtain detailed functional capacity statements that highlight how your symptoms prevent you from performing basic work tasks. By organizing your evidence and preparing you for potential hearings, an attorney helps you present a complete and accurate picture of your impairment to the Social Security Administration.
Frequently asked questions
Yes, cancer of the orbit may qualify under Listing 13.12 if it meets specific criteria regarding the extent of the tumor and its spread. The SSA evaluates the location, the type of cancer, and whether it has invaded surrounding structures like your sinuses or skull base. An attorney can review your medical records to see if your diagnosis aligns with these requirements.
The most important evidence includes pathology reports confirming your cancer type and imaging studies showing the extent of your tumor. The SSA also looks for documentation of any spread to lymph nodes or distant sites and records of your response to treatments like surgery or radiation. A disability attorney can help ensure these documents are properly submitted to support your claim.
The SSA evaluates recurrent cancer by looking at whether the disease has returned after you completed your initial planned treatment. You must provide medical evidence documenting the recurrence, such as new imaging or biopsy results. An attorney can help you gather the necessary documentation to prove that your condition remains disabling.
If your claim is denied, you have the right to appeal the decision through the reconsideration process and, if necessary, a hearing before an ALJ. You must file your appeal within the strict deadlines set by the SSA. A disability attorney can help you identify why your claim was denied and strengthen your case for the next stage of the process.
