Facts about Pancreatic Cancer and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. The pancreas is an organ located behind the stomach, and it is responsible for aiding digestion and regulating blood sugar levels. Pancreatic cancer is cancer that begins in the pancreas, but tends to spread quickly to other parts of the body before it can be successfully caught and treated. For this reason, those diagnosed with pancreatic cancer do not usually have good prognosis.
2. Part of the problem in early diagnosis is that there are no noticeable symptoms of pancreatic cancer until the disease is advanced. Once they occur, symptoms are upper abdominal and back pain, yellow skin and whites of the eyes, poor appetite, weight loss and signs of depression.
3. Cancer involves mutated cells that accumulate rather than dying the way normal cells would, often causing a tumor. Different types of abnormal cells cause different types of pancreatic cancer, and determine the way the cancer can be treated.
4. Adenocarcinoma is cancer that develops in the ducts of the pancreas where enzymes and digestive juices are produced. This is the most common type of pancreatic cancer. Endocrine cancers, which are very rare, form in the cells that produce hormones in the pancreas.
5. Pancreatic cancer occurs most commonly among adults over the age of 70 and African Americans.
6. Personally having, or having family members with, pancreatic conditions such as cancer or inflammation of the pancreas increases an individual's risk. A number of hereditary conditions that increase the risk of cancer overall also increase the risk of pancreatic cancer specifically.
7. Pancreatic cancer generally leads to death. Even when diagnosed and treated early, there is a high rate of recurrence.
8. Treatment may involve any combination of surgery, radiation and chemotherapy, depending on how advanced the cancer is, where it is located in the pancreas, and the overall health of the individual.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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