This document provides an overview of Social Security disability benefits and the process for applying. It discusses the two main programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is for those who have worked enough to be insured, while SSI has additional income and asset limits. Both use the same definition of disability, determined through a 5-step evaluation process assessing medical eligibility and ability to work. The document outlines the steps and eligibility requirements, including listings for specific cancers. It concludes with information on how to apply for benefits.

1. SOCIAL SECURITY
DISABLITY BENEFITS
AND METASTATIC
BREAST CANCER
PRESENTED BY:
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2. • This presentation provides a broad overview only. These are very
complex topics and many additional rules, processes, and requirements
apply that are not discussed here.
• This presentation does not constitute legal advice. No attorney-client
relationship is formed based on your participation in this workshop.
• We cannot give advice about what you should do or answer questions
about your specific situation in this presentation.
• It is always recommended to consult with an attorney or other expert
about complex individual questions.
• These rules relate to adults only. There are very different rules and
processes involved for children with cancer or other disabilities.
Disclaimers
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3. Disability-Related Social Security Benefits
• Both programs administered by Social Security Administration (SSA) for people
who meet SSA’s definition of “disabled”
• Same medical eligibility / definition of disability for both programs
 Spoiler: Their definition of disability is all about your ability to work.
• Only for people with long-term disabilities
• Different financial and other eligibility requirements
• Some people may receive both SSDI and SSI
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Social Security Disability Insurance
(also called SSD, SSDI, DIB, Title 2, Title II)
Supplemental Security Income
(also called SSI, Title 16, Title XVI)

4. Social Security Disability Insurance (SSDI)
OVERVIEW
• Provides benefits to people who are insured through the program (based on
their work history) at the time that they become disabled.
• Eligible individual receives monthly payments. Amount of benefit varies based
on personal work history.
• May be able to get additional monthly benefits for certain dependent family
members (minor children, disabled adult children, or spouse)
• Eligible for Medicare coverage after 24 months of entitlement to SSDI
• There is a 5-month waiting period after the date the person is determined to be
disabled (not necessarily the same as date of application) before SSDI benefits
can be paid.
 If applicant meets other eligibility rules for SSI (low income/assets), they
may be able to receive SSI during the waiting period.
• Can receive benefits retroactively for up to one year before application date
(depending on when claimant became disabled).
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5. Social Security Disability Insurance (SSDI)
BASIC ELIGIBILITY REQUIREMENTS
• Must be “disabled” per SSA definition
• Must be “insured” based on work history (“earnings record”)
 Must have worked both long enough and recently enough
 Only work done “on the books” (with Social Security taxes paid) counts
 Need a specific number of “credits” or “quarters of coverage”
 Can earn up to four credits per year worked, depending on income
 Specific requirements vary based on age at which disability starts (younger
people need fewer credits)
• Income: Generally cannot be earning more $1,170 / month in 2017 (amount changes
annually), otherwise won’t be considered disabled (some exceptions apply).
 Incentive programs and exceptions exist for people who return to work after
becoming disabled, etc.
 No limit on unearned income
• Resources/Assets: No resource/asset limit
• Citizenship/Immigration: Non-U.S. Citizens must have certain specified immigration
statuses
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6. Supplemental Security Income (SSI)
OVERVIEW
• Monthly cash payment to elderly, blind, or disabled individuals who have limited
income and assets to assist in paying for basic needs (food, clothing, shelter).
• Work history does not matter.
• Maximum monthly benefit amount (“Federal Benefit Rate” or FBR) is set each year
($735/month for 2017).
 Actual amount that a person receives is based on their other income (earned and
unearned, including “in-kind support”) and living arrangement.
 People who live alone may be eligible for a higher benefit amount than
people who live with others.
 Different amount if both spouses in a married couple receive SSI ($1,103/month
per couple for 2017).
• Some states supplement the federal benefit amount with state funds (“State
Supplement Program” or “SSP”).
 Seehttps://www.ssa.gov/ssi/text-benefits-ussi.htmfor moreonstatesupplements
• No additional benefits for family members.
• Automatically eligible for Medicaid. No related Medicare eligibility.
• Benefits can only begin as of month after application, regardless of when disability began.
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7. Supplemental Security Income (SSI)
BASIC ELIGIBILITY REQUIREMENTS
• Must be aged (65+) or blind or “disabled” according to SSA definitions.
• Income:
 Claimant’s earned income generally cannot be above $1,170 /month in 2017 (amount
changes annually), otherwise won’t be considered disabled (exceptions may apply).
 Special rules and incentive programs may allow higher earned income for
people who return to work after being determined disabled.
 Total “countable” income (earned and unearned) must be below the relevant FBR.
 Some income is not counted.
 Your spouse’s income is “deemed” to you.
 Amount of benefits paid will be adjusted based on income each month.
• Resources/Assets: Must have less than $2,000 in countable assets for an individual (or
$3,000 for a married couple).
 There are penalties for transferring or giving away assets in order to become eligible.
 Your spouse’s assets will be “deemed” to you and considered to be yours.
 Not all assets are “countable.”
• Citizenship/Immigration: Additional restrictions and requirements for non-U.S. Citizens
 See https://www.ssa.gov/ssi/spotlights/spot-non-citizens.htm for more info.
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8. Medical Eligibility (Definition of“Disability”)
To Social Security, the term “Disability” means:
“inability to engage in any substantial gainful
activity by reason of any medically determinable
physical or mental impairment which can be
expected to result in death or which has lasted or
can be expected to last for a continuous period of
not less than 12 months” (Social Security Act)
SSA uses a 5-Step “Sequential Evaluation” to apply this definition.
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9. Medical Eligibility (Definition of“Disability”)
Step 5: Ability to do Other Work
Could you do any other kind of work?
YES: NOT DISABLED NO: DISABLED
Step 4: Ability to do Past Work
Could you go back to doing any of your past jobs from last 15 years?
YES: STOP - Not Disabled NO: Go to Step 5.
Step 3: Listing of Impairments
Do(es) impairment(s) satisfy criteria for a condition described in SSA’s “Listing of Impairments”?
YES: STOP - Disabled. NO: Go to Step 4.
Step 2: Severity and Duration of Impairment
Is/are impairment(s) severe AND expected to last 12 months or result in death?
YES: Go to Step 3. NO: STOP - Not Disabled
Step 1: Current Work Activity
Are you currently working and earning more than “SGA” amount?
YES: STOP - Not Disabled. NO: Go to Step 2.
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10. Sequential Evaluation: Step 1
Step 1: Are you currently “engaging in Substantial Gainful
Activity” (meaning working and earning more than a
specified dollar amount per month)?
• Engaging in Substantial Gainful Activity (“SGA”) is defined as earning
more than a specific dollar amount per month through work.
• “SGA level” changes each year.
• 2017 SGA level is $1,170 per month.
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If working and earnings average more
than $1,170 per month, you will not be
found disabled, regardless of medical
condition.*
* Except in specific limited circumstances.
Speak to an attorney or other expert.
If not working, or working but earning
less than $1,170 per month (in 2017),
proceed to Step 2.

11. Sequential Evaluation: Step 2
Step 2: Do you have a severe medical impairment that is
expected to last at least 12 months or result in your death?
• Must have one or more medical or mental health condition(s) diagnosed by an
appropriate medical professional.
• Severe means impairment(s) interfere with ability to do basic work-related
activities like walking, sitting, standing, lifting, following instructions, making
decisions, completing tasks, interacting with others, etc.
• Condition(s) must be expected to remain severe for at least 12 months, or to
result in death. (SSA does not provide benefits for short-term disability,
regardless of how severe).
• Must consider condition itself and side effects of any treatment.
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If your condition does not satisfy any one
of these requirements, you will not be
found disabled and the evaluation ends.
If your condition satisfies all of these
requirements, proceed to Step 3.

12. Sequential Evaluation: Step 3
Step 3: Does your medical condition match the criteria for a
condition in Social Security’s Listing of Impairments?
• SSA regulations include a list of medical conditions (the “listing of impairments” or
“listings”).
• Each condition has specified medical criteria, such as test results, symptoms, anatomical
findings, treatment requirements, etc. The criteria are chosen such that they would only be
met if the condition were so severe that it would likely prevent someone from working.
• In Social Security lingo, this is called “meeting a listing”. You can also “equal a listing”
(if condition is of “equal medical significance”, but not exactly the same as a listed
condition or criteria. Often requires expert opinion.)
• Listings are available at www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
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If your medical records show that your
condition satisfies all of the specified
criteria for one or more listing, then you
are disabled and medically eligible for
SSI or SSDI benefits.
If, based on your medical records, your
condition does not match the criteria for
one of the listings, proceed to Step 4.

13. Listing: Breast Cancer
13.10 Breast Cancer (except sarcoma—13.04) (See 13.00K4.)
A. Locally advanced cancer (inflammatory carcinoma, cancer of any size with direct
extension to the chest wall or skin, or cancer of any size with metastases to the
ipsilateral internal mammary nodes).
OR
B. Carcinoma with metastases to the supraclavicular or infraclavicular nodes, to 10
or more axillary nodes, or with distant metastases.
OR
C. Recurrent carcinoma, except local recurrence that remits with anticancer
therapy.
OR
D. Small-cell (oat cell) carcinoma.
OR
E. With secondary lymphedema that is caused by anticancer therapy and treated by
surgery to salvage or restore the functioning of an upper extremity. (See 13.00K4b.)
Consider under a disability until at least 12 months from the date of the surgery
that treated the secondary lymphedema. Thereafter, evaluate any residual
impairment(s) under the criteria for the affected body system.
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14. Listing: Ovarian Cancer
13.23 Cancers of the female genital tract (carcinoma or sarcoma, including
primary peritoneal carcinoma)
…
E. Cancer of the Ovaries, as described in 1 or 2:
1. All cancers except germ-cell cancers, with at least one of the following:
a. Extension beyond the pelvis; for example, implants on, or direct extension
to, peritoneal, omental, or bowel surfaces.
b. Metastases to or beyond the regional lymph nodes.
c. Recurrent following initial anticancer therapy.
OR
2. Germ-cell cancer--progressive or recurrent following initial anticancer therapy.
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15. Sequential Evaluation: Step 4
Step 4: Do you have the physical and/or mental capacity to
do any of your past relevant work?
•SSA will first consider the ways that your impairments limit your physical and/or mental
functioning, and then what you can still do despite these limitations (your “residual functional
capacity” or “RFC”).
•Your physical RFC is often expressed in your ability to do work at various “exertional levels”
(sedentary, light, medium, heavy, etc.). A mental RFC should also be assessed.
•SSA will then consider the physical and mental demands of all your “past relevant work” (work
in which you earned more than the SGA level for that year, during the previous 15 years), based
on how you specifically performed the job or how it is usually performed.
•They will then determine whether, given your limitations and RFC, you could still theoretically
perform any of these past jobs. (It doesn’t matter whether that job still exists, whether the
company still exists, etc. )
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If you stillhavethephysicalandmental
capacityto do any of your pastrelevantwork,
you arenotdisabledand theevaluationends.
If your impairments prevent you from
doing any of your past jobs from the
previous 15 years, then proceed to Step 5.

16. Sequential Evaluation: Step 5
Step 5: Do you have the physical and/or mental capacity to
perform any other kind of work on a full-time basis?
• SSA will consider your RFC, physical/mental limitations, AND your age, education,
past work experience and skills, to determine whether there are any other types of
jobs that you could do on a full-time basis.
• It does not matter whether in reality you would actually get hired for such a job, only
that such job exists and theoretically you could do it. Only requirement is that this
type of job must exist in “significant numbers” in the national economy.
• Reference is made to certain publications regarding occupations, statistics, etc., from
the Department of Labor.
• Short-cut “Grid Rules” for people who have only physical/exertional impairments.
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If SSA can come up with any job(s) that you
could still do full-time, then you are not
disabled and cannot receive SSDI or SSI
benefits.
If SSA determines that there are no other
jobs that you could do based on your
impairment(s), then you are disabled and
medically eligible for SSDI or SSI benefits.

17. How to Apply
WAYS TO APPLY:
• Online (for SSDI and many categories of SSI applicants):https://secure.ssa.gov/iClaim/dib
• Call 1-800-772-1213 to schedulean appointmentor phone-based interview if home-bound.
• Visit yourlocal Social Security Office (be preparedfor a long wait).
APPLICATIONPROCESS:
• Generally,SSA will take applicationsfor both SSI and SSDI together.In some situations it mightmake
sense to applyonly for SSDI. This should be discussedwith an expert.
• Must establishidentity,citizenship/immigration,other eligibilitybefore consideringmedical.
 For SSI, you must provide informationand documentsregardingincome, living situation,payment
of expenses, etc. to determinefinancialeligibility.
• SSA will interview you and you’ll fill out forms aboutmedical conditions,disability,limitations,medical
treatment,medical providers,education,work history, etc.
• SSA will have you sign releases for them to obtain medical records from yourtreatingmedical providers.
 You can and should submit medical records,doctors’notes, statements from family/friends,etc.
• Checklist of informationneeded to apply: https://www.ssa.gov/hlp/radr/10/ovw001-checklist.pdf
• You may be sent for evaluationby a medical provider contracted by SSA (“consultative examination”).
• DisabilityDeterminationService will review documents and informationand apply five-step evaluation
process to determineif you meet SSA definitionof disability
• Notified of decision by mail, usuallytakes around 3-6 months,sometimes more or less.
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18. Compassionate Allowance Program (CAL)
• Allows SSA to quickly identify medical conditions that, by definition, meet their
standards for disability and to process these cases more quickly.
• Helps reduce waiting time to reach a disability determination for individuals with
the most serious disabilities.
 Applications can be approved in days sometimes, instead of months.
Depends on how long it takes to receive medical evidence confirming
condition.
• Same list of Compassionate Allowance conditions for both SSI and SSDI
• Not a separate set of rules/processes. Still have to meet all other eligibility
requirements for SSDI or SSI program (i.e., not working over SGA-level, etc.).
• 5-month waiting period still applies for SSDI.
• List of conditions and more info at:
https://www.ssa.gov/compassionateallowances/
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19. Compassionate Allowance – Breast Cancer
Breast Cancer with Distant Metastases or Inoperable or Unresectable
• “Inoperable” refers to a physician's opinion that surgery would not be beneficial
based on a review of imaging studies, laboratory results, and physical
examination findings.
• “Unresectable” cancer is established when the operative report indicates that
the cancer is not completely removed or the pathology report notes that the
surgical specimen has positive margins.
• Documentation:
 A pathology report and an operative report are the preferred methods for
documentation.
 They may accept a physician's opinion (letter from treating doctor) that
indicates the cancer is inoperable or unresectable based on described
objective findings.
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20. Compassionate Allowance – Ovarian Cancer
Ovarian Cancer With Distant Metastases or Inoperable or Unresectable
• “Inoperable” refers to a physician's opinion that surgery would not be beneficial
based on a review of imaging studies, laboratory results, and physical
examination findings.
• “Unresectable” cancer is established when the operative report indicates that
the cancer is not completely removed or the pathology report notes that the
surgical specimen has positive margins.
• Documentation:
 A pathology report and an operative report are the preferred methods for
documentation.
 They may accept a physician's opinion (letter from treating doctor) that
indicates the cancer is inoperable or unresectable based on described
objective findings.
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21. 6 Tips for a Successful SSI/SSDI Application
• Apply as early as possible, especially if applying for SSI
 But be careful about applying while still working if earnings are close to or
above SGA-level
• Collect and Submit your own Evidence
 Medical records
 Letters from your doctor about disease, treatment plan, prognosis, etc.
 Pathology/operative report showing metastases
 Other medical evidence of listing/CAL criteria
• In application forms, list every single medical and mental health condition that
you have (even if it seems like it’s not a big deal)
• List every doctor, hospital, clinic, etc. that you have seen since the date you think
you became disabled
• Review your calendar and/or journal so you know dates of treatment, all
hospitalizations, changes in work activity
• Speak to family and friends about whether they have noticed any new
limitations or problems that may be related to your medical conditions
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22. Appeals
• Denial notice should include information about how to appeal.
 Online (https://www.ssa.gov/forms/ssa-3441.html).
 In-person at local SSA Office
 Completing and mailing appropriate forms.
 Can call SSA hotline (1-800-772-1213) for more information or to request appeal forms.
• Must appeal within 60 days of the notice of the adverse decision.
 Deadline can be extended if there is “good cause” for not requesting timely appeal.
• States have different processes for appealing a disability determination. In many states, there is an
initial “reconsideration” process, in which a new person, not involved with the initial decision,
reviews all the evidence in your file. Some states skip this step.
• The next level is appeal of a medical determination involves an administrative hearing before an
Administrative Law Judge (“ALJ”). In some states this is the first level for appeal.
• There can be a very long wait for a hearing (close to two years in some places).
• Should get confirmation of request for hearing within a few weeks of appeal request
• If found disabled after appeal, you can receive benefits going back to the time you should have
started receiving, if initial application had been correctly approved (or back to a different date if
determined by judge).
• Next level of appeal is to Social Security’s Appeals Council, after that is appealing to Federal Court.
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23. Ongoing Requirements forSSI/SSDI Recipients
• Report changes to SSA (Notices from SSA give detailed list of reporting requirements).
 Household income
 Household composition, living arrangement, marital status, moving, etc.
 Work activity (back to work, more hours, more earnings)
 Resources/Assets (for SSI only)
• Monitor assets/resources (for SSI Recipients):
 Countable assets/resources (including bank accounts, investments, excess
vehicles, etc.) for SSI recipients cannot exceed $2000 (or $3000 for a couple).
 You cannot be eligible for SSI in any month in which your assets were over the
limit as of the 1st of the month. If assets exceed limit, you will be discontinued
from benefits, and may owe SSA money for benefits previously paid.
• Every few years, most recipients will be subject to a “continuing disability review”
(“CDR”) in which SSA gathers new medical information to determine whether
recipient still meets definition of disability, or whether condition has improved to the
point of no longer being disabled.
 Length of time before CDR depends on specific condition/likelihood of
improvement.
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24. Working While Receiving SSI or SSDI
• SSA wants people to go back to work and has many rules and programs to incentivize this.
• Include rules that allow you to try working while keeping your benefits, and vocational
training programs that can help you find appropriate work.
• Different rules and programs for SSI and SSDI.
• For more information about work incentives, see https://www.ssa.gov/redbook/index.html.
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The rules about working while receiving SSI or SSDI benefits are very complex.
Speak to an attorney or other expert before going back to work (or increasing
hours or earnings) so that you can understand the consequences and plan
appropriately.
Be careful earnings do not exceed SGA-level ($1,170 in 2017), especially during first 12
months after onset of disability. This could show that you did not meet SSA’s definition of
“disability” and may make you ineligible for benefits.

25. Questions?
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SOCIAL SECURITY DISABILITY BENEFITS
AND METASTATIC BREAST CANCER
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