Lymphoma is a malignancy that starts in the cells (lymphocytes) of the lymphatic system. The lymphatic system consists of the lymph nodes, spleen, tonsils, thymus, and bone marrow.
Lymphoma can be divided into Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma.
Hodgkin's lymphoma is a disease in which malignant (cancer) cells form in the lymph system.
There are two main types of Hodgkin's lymphoma: classical (most common) and nodular lymphocyte-predominant.
Signs of Hodgkin's lymphoma include swollen and painless lymph nodes in the neck, groin or axilla, fevers, drenching night sweats, severe fatigue, pruritis (itchy skin), and unexplained weight loss.
Tests that examine the lymph system and other parts of the body are used to help detect and diagnose Hodgkin's lymphoma. They often include PET/CT scans of the chest, abdomen, and pelvis as well as a bone marrow biopsy. Sometimes a lymph node biopsy is required.
The treatment and prognosis of Hodgkin's lymphoma depends on the stage of the disease (which indicates how far the disease has spread) and other characteristics that suggest either a favorable or unfavorable prognosis.
Stage I disease is typically mostly confined to one group of lymph nodes.
Stage II disease is involvement of two or more groups of lymph nodes, either above or below the diaphragm.
Stage III disease is involvement of multiple lymph nodes both above and below the diaphragm.
Stage IV disease is involvement of one or more organs, such as the liver or the lung.
Standard treatment includes chemotherapy, radiation therapy, and surgery.
Newer types of treatment being tested in clinical trials include chemotherapy and radiation therapy combined with stem cell transplant, and monoclonal antibody therapy (immunotherapy).
Non-Hodgkin's Lymphoma (NHL)
Non-Hodgkin's lymphoma grows and spreads at different rates and can be indolent or aggressive. Indolent lymphoma tends to grow and spread slowly. Aggressive lymphoma grows and spreads quickly.
Examples of indolent non-Hodgkin's lymphoma include follicular lymphoma (most common), lymphoplasmacytic lymphoma, marginal zone lymphoma, and others.
Examples of aggressive non-Hodgkin's lymphoma include diffuse large B cell lymphoma, anaplastic large cell lymphoma, extra-nodal NK/T cell lymphoma, mantle cell lymphoma, Burkitt's lymphoma, and others.
The signs of non-Hodgkin's lymphoma are similar to Hodgkin's lymphoma and can include swollen and painless lymph nodes in the neck, groin or axilla, fevers, drenching night sweats, severe fatigue, pruritis (itchy skin), and unexplained weight loss.
Testing and staging of non-Hodgkin's lymphoma is similar to Hodgkin's lymphoma.
Treatment modalities include chemotherapy, radiation therapy, surgery, and immunotherapy, as for Hodgkin's lymphoma.
Obtaining Disability Benefits with Lymphoma
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.
For example, a diagnosis of non-Hodgkin's lymphoma automatically qualifies you for SSDI benefits, as this is considered a "bad" lymphoma by Social Security.
However, being diagnosed with lymphoma 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 lymphoma will depend on the type of lymphoma ("indolent" or "aggressive"), the stage of the disease, and on the drugs that are required for treatment. As above noted, 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 lymphoma 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 non-Hodgkin's lymphoma, just having a diagnosis of lymphoma 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.
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 Listing or "Blue book" for lymphoma can be found here (See 13.05)
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.