Brain Tumors and Qualifying for Social Security Disability Benefits
Can I get disability benefits if I am suffering from the effects of a Brain Tumor?
Author: Attorney Greg Reed
More than 700,000 people in the U.S. are living with a primary brain tumor today; approximately 71% of those brain tumors are benign. Though a brain tumor may not be aggressive and may not spread to surrounding tissue, it can press on parts of the brain that control various functions throughout the body and significantly impact a person’s quality of life. If you are suffering from the effects of a brain tumor you may qualify for disability benefits.
Brain Tumors and SSDI
A brain tumor is a growth of abnormal cells that can occur in brain tissue or nearby tissue such as nerves, the pituitary gland, pineal gland, and membranes that cover the surface of the brain.
Brain tumors that begin in the brain or tissue close to the brain are called primary brain tumors. The location of a brain tumor and how quickly it grows determines how it affects the nervous system. There are many different types of primary brain tumors, each getting its name from the type of cells involved. Some examples of primary brain tumors include:
- Meningiomas. This is the most common type of brain tumor. Meningiomas develop from the lining of the brain and the spinal cord and are usually benign and don’t cause any problems.
- Acoustic neuromas. These brain tumors develop on the nerves that control balance and hearing.
- Pituitary adenomas. These tumors develop in the pituitary gland and can affect the number of hormones released into the body.
- Gliomas. These tumors begin in the brain or spinal cord and can cause headaches, seizures or cranial nerve disorders.
- Medulloblastomas. These tumors occur predominantly in children, beginning in the lower back of the brain and spread through spinal fluid.
Secondary brain tumors are the result of cancer in another part of the body spreading to the brain through the bloodstream or lymph.
Any type of cancer can metastasize (spread to another part of the body), but the most common are lung cancer, breast cancer, colon cancer, kidney cancer and melanoma.
If you are suffering from the effects of a brain tumor and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!
Brain tumors occur when cells in or near the brain have changes in their DNA.
These changes tell the cells to grow quickly and then form a growth called a tumor. It’s not clear what causes the DNA changes that lead to brain tumors and for many people with brain tumors, the cause is never known; however, sometimes parents pass DNA changes to their children and those changes can increase the risk of having a brain tumor.
Symptoms of a brain tumor vary, depending on the brain tumor’s size, location, and rate of growth.
The most common symptom is headaches or a change in the pattern of headaches, but other signs of a brain tumor include:
- Double vision, blurred vision, or loss of peripheral vision
- Loss of balance or difficulty walking
- Weakness or paralysis in one part of the body
- Numbness or tingling in an arm or leg
- Speech difficulties
- Difficulty thinking or concentrating
- Memory problems
- Unexplained nausea or vomiting
- Changes in behavior or personality
- Hearing problems
Brain tumors are diagnosed with a thorough neurological exam and a variety of tests including a CT scan, brain MRI, and PET scan.
A doctor may also order a biopsy and other tests to look for cancer occurring in other areas of the body. Treatment depends on the type, size, and location of the tumor. If a tumor is benign, treatment may begin with monitoring the tumor and the patient’s condition. If a tumor is easy to separate from surrounding tissue, surgery may be recommended; even removing a small portion of the tumor can reduce symptoms. Cancerous tumors may be treated with radiation, chemotherapy or targeted drug. Following treatment, a patient may go through a period of rehabilitation to regain motor skills and speech and cognitive abilities.
Can I qualify for SSDI if I have a brain tumor?
There are a few different ways you may qualify for Social Security Disability benefits if you have a brain tumor.
Social Security has created a manual called the Blue Book which lists impairments Social Security considers disabling and may automatically qualify for benefits. Benign brain tumors are recognized in the Blue Book as a disabling impairment under Section 11.05.
To meet the requirements of this listing, you must show evidence of the following:
- Inability to control movement of at least two extremities; for example, two arms, two legs, or one arm and one leg; OR
- A marked physical problem AND a marked limit in one of the following:
- Understanding, remembering, and applying information;
- Concentrating, persisting, completing tasks
- Interacting with others;
- Adapting and managing oneself (controlling emotions, responding to demands, being aware of hazards)
If your limitations do not exactly match the criteria for this listing, you may be able to receive benefits if you can show that that your impairment is equivalent in both severity and duration to another disability listing for a similar impairment; for example, seizures, strokes or neurological disorders.
In any case, Social Security will want to see the following medical evidence:
- Physician notes
- Clinic notes
- Radiology reports
- Lab work
- Biopsy reports
- Medications and treatments you are taking and your response
Social Security gives a lot of weight to doctors’ opinions. A written statement from your doctor regarding your diagnosis and outlook for your recovery would be extremely helpful.
Another way to qualify for Social Security Disability benefits is to demonstrate your medical condition prevents you from working at your old job or any other job.
Brain tumors cause a wide range of symptoms that can affect your ability to do physical work or sedentary work. You may be experiencing difficulty speaking, loss of balance, paralysis, memory and concentration problems, and loss of balance. A brain tumor may also affect your vision and hearing. If your symptoms don’t match a listing, but you still can’t work, Social Security will conduct a Residual Functional Capacity (RFC) assessment to evaluate your physical and mental capabilities to determine if there is any job you can do, taking into consideration your age, education and whether or not you can drive. If Social Security decides you cannot do your old job or have the skills to perform a new job, you may be approved for a Medical-Vocational Allowance.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
You may also be eligible for Social Security Disability benefits if you have another medical condition, such as asthma.
One disorder by itself may not meet the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
If you have brain cancer, you may qualify for a Compassionate Allowance.
If you have a brain tumor that is inoperable and spreading, or not responding to treatment, you may meet the requirements of another Social Security listing, Section 13.00 Cancer.
To qualify under this listing, you must show that you have an aggressive malignant tumor of the brain, spinal cord or spinal root that has progressed or recurred after treatment. In this case, you may also qualify for Social Security’s Compassionate Allowances program. Social Security allows applicants with extremely serious medical conditions to be approved for disability benefits on an expedited basis. Glioblastoma multiforme, a fast-spreading tumor formed from the glial tissue in the brain and spinal cord, is one of the qualifying conditions. If you have a cancerous brain tumor, make sure you submit as much information as possible to Social Security and let them know you are applying under the Compassionate Allowance program. In these cases, approval can take as little as two weeks.
Social Security also has basic financial requirements.
You must satisfy some basic financial requirements before you are eligible for Social Security disability benefits.
You must: 1) have a disability that has lasted, or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,470 per month in 2023 for nonblind applicants and $2,460 per month for blind applicants.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Absolutely. Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company.
Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
Most initial applications are denied, so don’t be discouraged if this happens to you – you will have the opportunity to appeal. There are four steps to the Social Security appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI and SSI cases and either uphold or overturn decisions to deny SSDI or SSI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney for SSDI or SSI?
If you have a brain tumor and cannot work, you may be eligible for Social Security Disability benefits, but applying for SSDI or SSI is a long process that can take several months to years.
Your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney can not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
Do I need a disability attorney for a long-term disability insurance claim?
Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.
The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
The attorneys at Bemis, Roach & Reed have wide experience in representing clients at all levels of the Social Security Disability process and in long-term disability insurance cases.
At The Texas Disability law firm Bemis Roach & Reed, our attorneys are committed to helping injured or disabled clients receive the benefits they deserve. Mr. Roach is AV Preeminent and SuperLawyers rated and has become a recognized leader in the field of Long Term Disability law. Mr Bemis focuses his practice on Social Security disability while Mr Reed handles both LTD and SSDI claims. Both are AV Preeminent and SuperLawyers rated and all our attorneys have been successfully helping people fight for their rights against big insurance companies and the government since 1993. If you have applied for benefits and been denied call 512-454-4000 for a free consultation and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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