What this listing covers
Bone marrow and stem cell transplants are intensive medical procedures used to treat various forms of cancer, including leukemia, lymphoma, and multiple myeloma. These treatments involve replacing damaged or diseased bone marrow with healthy stem cells to help your body produce new, healthy blood cells.
The recovery process from these transplants is often long and physically demanding. You may experience severe fatigue, immune system suppression, and complications like graft-versus-host disease, which can make it impossible to maintain a consistent work schedule or perform basic daily tasks.
How SSA evaluates a claim under this listing
Under Listing 13.28, the SSA evaluates your claim based on the type of transplant you received. SSA distinguishes between allogeneic transplants, where cells come from a donor, and autologous transplants, where your own cells are used.
SSA considers you disabled for a specific period following your transplant, typically at least 12 months from the date of the procedure or the start of the treatment plan. After this period, they evaluate any ongoing residual impairments to see if they continue to prevent you from performing substantial gainful activity. An attorney can help you navigate these specific timelines to ensure your claim is properly presented.
Evidence that strengthens a claim
Your claim requires clear medical documentation of the cancer diagnosis and the specific transplant procedure performed. You must provide operative notes, pathology reports, and detailed records from your oncology team that outline the treatment plan and your response to therapy.
Evidence of post-transplant complications is also critical. Records documenting persistent infections, neurological issues, or chronic graft-versus-host disease help demonstrate the severity of your condition. Statements from your treating physicians regarding your functional limitations and the expected duration of your recovery are essential. An attorney can help you gather these documents to build a complete case.
How an attorney helps
A disability attorney helps by ensuring your medical records are organized to align with the specific requirements of Listing 13.28. They work with your doctors to obtain detailed functional capacity statements that clearly explain why your post-transplant residuals prevent you from working. By managing the complexities of the application and appeal process, an attorney allows you to focus on your health while they advocate for your benefits.
Frequently asked questions
A transplant does not provide automatic approval, but it does establish a specific timeline for disability evaluation under Listing 13.28. SSA considers you disabled for at least 12 months following the transplant or the start of the treatment plan. An attorney can review your medical records to ensure your claim is properly documented.
Even if your cancer is in remission, you may still qualify for benefits if you have significant residual impairments from the treatment. SSA evaluates these complications, such as immune system issues or organ damage, to determine if they prevent you from working. An attorney can help you present evidence of these ongoing health challenges.
The most important evidence includes your hospital records, pathology reports, and documentation of the transplant procedure itself. SSA also needs records of your ongoing treatment and any complications that have arisen since the transplant. A disability attorney can help you gather these documents to build a complete case.
If your claim is denied, you have the right to file an appeal, starting with a request for reconsideration. If that is also denied, you can request a hearing before an ALJ to present your case. An attorney can guide you through these appeal stages and help you prepare for your hearing.
