The Social Security Administration utilizes a fairly complicated set of regulations in determining whether an individual meets its definition of “disabled”. These regulations cover many factors, including how much an individual can earn, how to classify one’s past work experiences, and how to categorize an individual’s age. In addition, there are regulations called “Listings” that describe certain health conditions and diseases that, if present, create a presumption of eligibility for benefits. As medical research and knowledge evolves regarding these medical conditions, the Social Security Administration’s regulations are modified to reflect current knowledge regarding these conditions, their treatment, and the effects on the individual’s ability to sustain employment.
The Social Security Administration has recently published final regulations concerning the medical criteria for evaluating Cancer (formerly referred to in the regulations as “Malignant Neoplastic Disease”). The new regulations go into effect on July 20, 2015. The listings were last revised in 2009, and are only in effect for the next five years. That is, these regulations expire on July 19, 2020, unless they are otherwise extended or modified.
The new regulations address specific cancers, including breast cancer, head and neck cancers, brain cancers, salivary gland cancers, rectal cancers, pituitary gland cancers, leukemia, as well as many other types of cancer. The requirements of the Cancer Listings are quite specific, and require medical documentation supporting the specific requirements of these Listings. Considerations include the treatment for cancer, and how long a person may be disabled as a result of the cancer and its treatment. The Listings for some cancers contain specific timeframe guidance, with the presumption that the individual will be able to return to work after that certain time. That presumption can, of course, be overcome by evidence specific to the individual’s care and treatment, as well considerations of other medical conditions, as well as the impact of other vocationally relevant factors.
Even if the specific medical information required by the Listings is not available, the regulations also provide that a finding of disability can be based upon medical equivalence. That is, if the medical condition is equal in severity to one of the Listed impairments, the individual is presumed to be disabled.
Additionally, in circumstances when a condition described in the Listings is not technically met or equaled, an individual can nonetheless be found “disabled” based upon other factors. These other factors may include other medical conditions. The regulations require that the Commissioner consider all of an individual’s various impairments, not just one condition. Further, when disability is not established by the medical evidence alone, the Commissioner is required, in many circumstances, to consider any adverse vocational factors, including the individual’s age, education and relevant work history, in determining whether an individual is eligible for benefits. In those cases, it is likely that one would need to appear and testify before an Administrative Law Judge.
The process of determining whether an individual meets all of the requirements under the regulation is a very complicated and technical process, and as the new Cancer Listings illustrate, the regulations are frequently revised. Thus, it is important to maintain a current knowledge of the various and multiple regulations that come into play in the context of an individual’s specific situation.
We stay current on these regulations. For a free initial consultation at either our Mobile or Pensacola office, contact us or call us toll free at 800-544-3568 to schedule an appointment with a disability lawyer.