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Disability Benefits for Leukemia

Leukemia

Leukemia is a broad term for cancers of the blood cells. The type of leukemia depends on the type of blood cell that becomes cancerous and whether it grows quickly ("acute") or slowly ("chronic"). Leukemia occurs most often in adults older than 55 (but it is also the most common cancer in children younger than 15).

There are several types of leukemia. The key points about leukemia are as follows:

Leukemia may affect red blood cells, white blood cells, and platelets.

Previous chemotherapy and exposure to radiation may increase the risk of developing leukemia.

Signs and symptoms of leukemia include fever, feeling tired, night sweats, weight loss, and easy bruising or bleeding.

Tests that examine the blood and bone marrow are used to detect and diagnose leukemia.

"Acute" leukemias usually get worse rapidly and require prompt treatment.

"Chronic" leukemias may be more slowly progressive and some may not require treatment, but that depends on the patient.

Acute Lymphoblastic Leukemia (ALL)

Acute lymphoblastic leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). In some cases, it can get worse rapidly and requires prompt and aggressive treatment.

Acute Myeloid Leukemia (AML)

Acute myeloid leukemia is a type of cancer in which the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells, or platelets. In some cases, it can get worse rapidly and require aggressive treatment.

Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). It usually gets worse slowly, and some patients may not require any treatment for many years, or at all.

Chronic myelogenous leukemia (CML)

Most people with CML have a gene mutation called the Philadelphia chromosome, which is a translocation (swapping) of DNA between it (chromosome 22) and chromosome 9 .CML can be aggressive and most patients require prompt treatment.

Hairy Cell Leukemia

Hairy cell leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). This rare type of leukemia gets worse slowly or not at all. The disease is called hairy cell leukemia because the leukemia cells look "hairy" when viewed under the microscope. In most leukemias, the white blood cell (WBC) count may be high or very high. It may be low in other leukemia, such as Hairy Cell Leukemia or Large Granulocyte Lymphocytic leukemia (LGL leukemia).

Treatment of Leukemia

There are many treatments available to successfully treat leukemia. Chemotherapy, immunotherapy, stem cell therapy, and precision based treatments have greatly improved the prognosis of leukemia and new treatments are being developed all the time.

Reference:

https://www.cancer.gov/types/leukemia/patient/hairy-cell-treatment-pdq

Reduced-intensity stem cell transplant (Mini-SCT)

An alternative option for older individuals that may not be able to tolerate the intensive pre-treatment with radiation and chemotherapy that a conventional SCT requires, is what has been called a "mini"-SCT. Mini-transplant patients are pre-treated with lower doses of chemotherapy, generally without radiation therapy, which they tolerate better. They then receive an infusion of donor stem cells from a compatible donor, which reconstitute the bone marrow with healthy stem cells that give rise to normal red blood cells, white blood cells, and platelets.

Mini-SCT has been successfully used to treat aplastic anemia, leukemia, myelodysplasia, myeloproliferative diseases, lymphoma, and multiple myeloma. Unlike conventional SCT, which essentially eliminates all lthe stem cells in the bone marrow, mini-SCT suppresses the bone marrow to allow healthy donor stem cells to reconstitute the bone marrow.

While there are still significant risks with the mini-SCT, it is an option for older patients that may not tolerate conventional bone marrow therapy.  

Obtaining Disability Benefits with Leukemia

The Social Security Administration (SSA) has determined that certain cancers are "bad" enough so that just simply being diagnosed with a cancer of this type will automatically qualify you for disability benefits. These cancers are summarized in the Social Security Disability "Listings," under 13.00 Malignant Neoplastic Diseases.

A diagnosis of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or chronic myelogenous leukemia (CML) automatically qualifies you for SSDI benefits.Those are considered to be the "bad" leukemia's by Social Security.

However, being diagnosed with leukemia has gone from once being an un-treatable, uniformly fatal disease to a chronic disorder that can be effectively treated for many years with medication and other modalities.

The disability resulting from your leukemia will depend on the stage of the disease and on the drugs that are required for treatment. If you are applying for Social Security Disability (SSDI) benefits, the Social Security Administration (SSA) has published a set of criteria called "listings" that automatically entitle you to receive disability benefits, once the diagnosis has been documented by your doctors.

If you do not meet the "listings," you can still qualify for Social Security disability benefits by providing documentation from your doctor of impairments that prohibit you from performing your prior occupation or any other occupation for which you may be suited. If you are applying for long-term disability under an employer-based disability plan (ERISA), there are no "listings" for you to meet. You will need to present medical documentation of impairments that prohibit you from performing your prior occupation or any other occupation for which you may be suited (see below).

Exertional impairments related to leukemia may impose disabling limitations that include difficulty with standing/walking, sitting, or lifting/carrying. These limitations should be documented in the medical record with specificity. For example, if because of fatigue, weakness, and debility, you can stand/walk for less than 2 hours out of an 8-hour day, or sit for less than 6 hours, or lift/carry less than 10 pounds, then your work capacity would probably be considered "less than sedentary," and you would probably be entitled to long-term disability benefits under most circumstances.

Non-exertional impairments related to medications can include such symptoms as nausea, vomiting, drowsiness, confusion, cognitive dysfunction, or an inability to concentrate and "stay on task." They must also be documented in the medical record with specificity and may give rise to an entitlement to long-term disability benefits in their own right.

Unless you have ALL, AML, or CML, just having a diagnosis of leukemia may not be enough to automatically qualify for SSDI. In order to qualify for long-term disability benefits, ether through Social Security (SSDI) or an employer-based plan (ERISA), your medical records must document the specific reasons why you are no longer able to perform your prior occupation or any other occupation for which you may be suited.

Medical Documentation

SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).

SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work. 

SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.

SSA "Blue book" or Listing for Leukemia under Malignant Neoplastic Diseases can be found here. (See 13.06)

Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.

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