How to Get Disability Benefits for Leukemia by Meeting a Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your leukemia is severe enough to meet or equal the leukemia listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your leukemia is severe enough to meet or equal the listing, you will be considered disabled.
You will meet listing 13.06A if you have acute leukemia (including T-cell lymphoblastic lymphoma). You will be considered under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, any residual impairments that you have will be evaluated under the Social Security Administration’s criteria for the affected body system.
T-cell lymphoblastic lymphoma is an extremely aggressive form of lymphoma that is closely related to, if not a different manifestation of, T-cell acute lymphoblastic leukemia and so is included by the listing (see Figure 2 below).
Figure 2: Abnormal lymphocytes travel via the lymphatic system in lymphoblastic lymphoma / leukemia.
Part A is unambiguous. Any form of acute leukemia results in an automatic allowance of disability benefits for at least 24 months from the date of diagnosis or relapse or 12 months from stem cell or marrow transplantation, whichever is later.
The initial diagnosis of acute leukemia is based on definitive bone marrow examination. Additional diagnostic information is based on chromosomal analysis, cytochemical and surface marker studies on the abnormal cells, or other methods consistent with the prevailing state of medical knowledge and clinical practice. Recurrent disease must be documented by peripheral blood, bone marrow, or cerebrospinal fluid examination. The initial and follow-up pathology reports should be included.
The standard for diagnosis of leukemia has been unchanged for many years—microscopic evaluation of bone marrow smears. If the examining pathologist and treating hematologist-oncologist interpret the bone marrow as diagnostic of acute leukemia and therapy proceeds accordingly, any question should be resolved in favor of the claimant.
In regard to relapse (recurrence), bone marrow biopsy information will probably be available. However, once the initial diagnosis has been established by prior bone marrow biopsy, a recurrence can also be documented by peripheral blood smear or identification of leukemic cells in cerebrospinal fluid. A bone marrow biopsy is not required to document relapse.
You will meet listing 13.06B if you have chronic myelogenous leukemia, as described in 1 or 2:
1. Accelerated or blast phase. You will be considered under a disability until at least 24 months from the date of diagnosis or relapse, or at least 12 months from the date of bone marrow or stem cell transplantation, whichever is later. Thereafter, any residual impairments you may have will be evaluated under the criteria for the affected body system; or
2. Chronic phase, as described in a or b:
a. You will be considered under a disability until at least 12 months from the date of bone marrow or stem cell transplantation. Thereafter, any residual impairments you may have will be evaluated under the criteria for the affected body system.
b. Progressive disease following initial antineoplastic therapy.
Part B.1 is satisfied by the presence of a blastic transformation of leukemia. When chronic myelogenous leukemia (CML) undergoes blastic transformation, it has essentially converted to an acute myelocytic leukemia. Part B.1 criteria are the same as part A of the listing, above.
Part B.2 deals with evaluation of the chronic phase of CML. Before the advent of bone marrow and stem cell transplantation and the development of tyrosine kinase inhibitors for the treatment of CML, the prognosis was grimmer and the Social Security Administration had a policy of finding listing-level equivalence for any new diagnosis of CML even though there was no blastic transformation. With a change in prognosis, that policy is no longer applicable.
Part B.2.a is consistent with other listings in giving at least 12 months of automatic allowance following treatment with stem cell or bone marrow transplantation. This allowance cannot be shortened by any other medical factors, such as the opinion of treating or other physicians that your prognosis is favorable.
Part B.2.b is probably the most problematic part of this listing. The listing is satisfied by progressive disease following treatment, as defined by cancer which has become “more extensive.” For a solid tumor cancer, such a requirement could easily be identified by the development of any metastases. However, this part of the listing could be more problematic for some adjudicators in the case of leukemia, a disorder that does not begin as an identifiable solid primary tumor.
Often the diagnosis of CML comes about by the onset of symptoms and signs (e.g., chronic fatigue, infection), and the detection of abnormal peripheral (circulating) blood, followed by a diagnostic bone marrow biopsy. The question could arise regarding how the CML can be “more extensive,” in view of the presence of leukemic cells throughout the blood. In the absence of more specific policy guidance from the Social Security Administration, “more extensive” could reasonably be interpreted to mean (1) increase in severity, as appreciated by repeated blood or bone marrow smears showing increased abnormality despite treatment (especially if changes in the treatment regimen are required); or (2) leukemic cell infiltration into organs—despite treatment—such as the brain, spleen, liver or intestine. (Such infiltrations could be identified by either imaging or biopsy.) Leukemia cells can intrude into any tissue, including the eye or muscles and peripheral nerves that serve limb function. Leukemic cells are not spread only by the bloodstream; they can also move through lymphatic vessels and infiltrate tissues in that manner.
This listing specifies chronic myelocytic leukemia as the only form of chronic leukemia to be considered. T-cell chronic lymphocytic leukemia (T-cell CLL) and prolymphocytic leukemia (PLL) have such a poor prognosis that they also should be considered under this listing. However, this is not official policy by the Social Security Administration.
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