How To Win Disability Benefits for Lung Cancer

Lung cancer can gravely impair one’s health and livelihood. In 2024, an estimated 234,580 new cases of lung cancer will be diagnosed in the US. Disability benefits for lung cancer patients may be available from several sources, including:

The Social Security Administration (SSA)
Long-term disability insurance (either from a private policy or under a group disability plan)
Military veterans may qualify for disability compensation from the Department of Veterans Affairs (VA).

These benefits can be a lifeline, offering financial relief and security when a diagnosis of chronic illness, such as lung cancer, prevents you from working for the long term.

Also, anticancer treatments such as chemotherapy, radiation therapy, and immunotherapy often cause severe side effects that would impair daily activities and job performance.

Qualifying for disability benefits for lung cancer requires that you submit a disability claim to the provider of those benefits. Your claim must demonstrate that your condition is severe enough to (1) prevent you from engaging in meaningful work and (2) is expected to last long-term or is terminal.

And while these benefit payments are invaluable, most claimants are unaware of the extent of evidence these government agencies and insurance companies will require before they’ll approve your claim.

If you need to file an initial claim for disability benefits for lung cancer:

Be ready to provide the detailed documentation and meet the medical and vocational criteria required by the SSA, VA, or insurance company.

If the SSA, VA, or an insurance company has denied your initial disability claim:

You have the right to contest, or appeal, that decision.

In these situations, your chances of claim approval are much higher when you have an experienced disability claims lawyer representing you. The rules for filing initial claims and appealing denied claims vary greatly, since the SSA, VA, and large insurance companies operate as separate entities with their own disability programs, criteria, regulations, and internal appeal processes.

Whether you need help with filing a claim or fighting a denial, Marc Whitehead & Associates is here to support you. Please contact us as soon as possible to schedule a complimentary and informative consultation.

Call or text (800) 562-9830 or complete a Free Case Evaluation form

What Are the Types of Lung Cancer?

There are different types and subtypes of lung cancer. The medical field generally refers to two main types: non-small cell lung cancer and small cell lung cancer.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 87% of all lung cancers. This type spreads more slowly than small-cell lung cancer. Diagnosis in the early stages provides the greatest chance for survival. Unfortunately, symptoms of NSCLC usually do not appear until the disease is in an advanced stage. Treatment for Stage IV will not cure the cancer, but it can reduce symptoms and extend and improve the quality of life.
Small cell lung cancer (SCLC) is a fast-growing cancer that forms in tissues of the lung and can spread to other parts of the body. About 13% of all lung cancers are SCLC. While it is generally responsive to chemotherapy, the overall survival rate is poor. Risk factors for small cell lung cancer include: smoking, exposure to second-hand smoke, and exposure to asbestos or radon.

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Who Is Eligible for Social Security Disability Benefits for Lung Cancer?

Working people who have paid into the Social Security system through payroll taxes may qualify for Social Security Disability Insurance, or SSDI.

Certain Lung Cancers Automatically Qualify for SSA’s Compassionate Allowance Program

“Compassionate Allowance” is the SSA’s method for quickly identifying disorders where a person’s condition clearly meets Social Security’s definition and criteria for disability benefits. The program reduces wait times for the most severe disabilities and expedites SSDI benefit payments to these claimants.

Under SSA regulations, people with the following forms of lung cancer are automatically eligible for SSDI benefits under the Compassionate Allowance Program.

Note: Being “automatically eligible” does not mean you are automatically found disabled and awarded SSDI benefits. It does mean that your application for disability benefits will be prioritized for faster approval. The decision to allow or deny the claim rests with the adjudicator.

What if your lung cancer doesn’t qualify for compassionate allowance?

Social Security disability benefits for lung cancer, apart from Compassionate Allowance

The SSA’s official Listing of Impairments is often referred to as the “Blue Book.”

Section 13.00 of the Blue Book addresses cancer, and Section 13.14 outlines the specific disability criteria for lung cancer. SSA examiners refer to these sources to determine if your condition “meets or equals” their strict disability criteria.

Summary:

Non-small-cell lung cancer may qualify if it is:

Inoperable, meaning a tumor that surgery can’t treat;
Unresectable, meaning the cancer is locally advanced, signifying that the tumor is in the lung and may have spread to nearby lymph nodes in the chest, but it has not metastasized to distant parts of the body;
Recurrent, meaning the cancer keeps coming back, or
Has spread beyond the hilar nodes – meaning the cancer has spread to lymph nodes located further away from the lung, indicating a more advanced stage of the disease.

-Or-

Small-cell (oat cell) carcinoma may qualify;

-Or-
Carcinoma of the superior sulcus (also called Pancoast tumors) with multimodal anticancer therapy may qualify − meaning a patient with a tumor in the superior sulcus (the upper part of the lung near the collarbone) is receiving multiple types of cancer treatment, likely including chemotherapy, radiation, and surgery.

Social Security claim examiners will take into account the following:

Anticancer therapy: Social Security disability benefits for lung cancer are available whether your condition is a result of cancer treatment or the disease itself. Therapy and its toxicity may vary widely.

If your cancer is responding to treatment, the SSA may need to review a longitudinal health record, which is a detailed compilation of your health data collected over time. This will give the claim examiner a complete perspective of your lung cancer, including the effectiveness of treatment and the cancer’s likelihood to persist.

Impact on Work: You need to demonstrate that you are unable to engage in any meaningful work due to your medical condition, and this inability must be expected to last for at least 12 months or result in death.
Other factors: The SSA also considers your age, education, and work experience.

Suppose your lung cancer does not meet the medical component spelled out in the Blue Book?

The claim examiner must then evaluate the vocational component of your claim to determine your ability to work and earn a living.

Substantial Gainful Activity (SGA) and Disability Benefits for Lung Cancer

The SSA’s primary focus is on whether you can engage in substantial gainful activity (SGA). The SSA will evaluate the type of work you did to earn your wages and the circumstances of your job. Can you perform your past relevant work? Can you do other available work?

A skilled Social Security claims lawyer will provide a detailed account of your employment history. They will clarify your functional limitations, ensuring that your claim effectively communicates to the Social Security examiner how your remaining ability to perform work-related tasks prevents you from being employed.

Has the SSA Denied Your Claim? You Can “Appeal” the Decision.

Your claim for disability benefits for lung cancer may be one of thousands the SSA has denied. Denial is a common occurrence, and it is never a reason to give up.

A well-developed appeal is your opportunity to overturn the denial with a strong petition justifying your case. Working with experienced SSDI appeal lawyers is the best way to improve your chances of winning Social Security disability benefits on appeal.

SSA Has Recently Changed How it Evaluates Lung Cancer Disability

Over the past decade, SSA has streamlined the evaluation process and expedited approvals for the most severe cases of lung cancer. Some revisions could affect previously denied and/or new disability claims based on lung cancer:

Medical Criteria: The SSA revised its criteria for evaluating cancer in 2015. These revisions include how the SSA:
- Considers the effects of anticancer therapy, and
- Should not delay its decision when a fully favorable determination can be made based on existing evidence.
Definition of “Inoperable” and “Unresectable”: SSA clarified the definitions of “inoperable” and “unresectable” in the context of lung cancer, which are essential for determining eligibility based on the extent of the disease.

“Inoperable” means surgery would not be beneficial, while “unresectable” cancer means the cancer cannot be completely removed with surgery. Several factors influence whether a tumor is unresectable, including the size, location, and spread of the cancer.

Also, if you have early-stage lung cancer, you could still be eligible if you can show that your condition, including treatment side effects, greatly limits your functional ability. It is essential to seek advice from a Social Security disability claims lawyer to help you through the application process and to understand the eligibility criteria for your case.

We Help Veterans Get Maximum Disability Benefits for Lung Cancer

Substantial VA benefits are available for veterans with service-connected lung cancer. These benefits include tax-free monthly disability compensation, health screenings, and support services.

As for VA compensation, a lung cancer diagnosis often qualifies for a 100 percent disability rating, which remains in effect for six months after treatment.

For 2025, a veteran with a 100% disability rating and no dependents can receive $3,831.30 per month, tax-free. A veteran with a dependent spouse and a 100% disability rating can receive $4,044.91 per month.

Lung Cancer Can Be a VA “Presumptive Condition”

The VA presumes that veterans who served in specific locations during a qualifying time period were exposed to toxic materials and thus developed certain conditions. The assumption is that the veteran’s service caused the condition. The VA refers to this as presumptive exposure, which then serves as the “link” that establishes service connection.

In 2022, the PACT Act was signed into law, significantly expanding the list of VA presumptive conditions for veterans. Lung cancer is one of these new presumed conditions.

Presumptive status for lung cancer would be the case when the veteran was exposed to toxic substances involving:

- Burn pits – for eligible Gulf War and post-9/11 veterans, the VA expanded its list of presumptive cancers linked to toxic substance exposure, including burn pits
- Agent Orange and ALL Herbicides

Radiation

The VA considers the following lung cancers presumptive:

Non-small cell lung cancers

Adenocarcinoma
Carcinoid tumor
Large cell carcinoma
Pleomorphic carcinoma
Salivary gland carcinoma
Squamous cell carcinoma (epidermoid carcinoma)
Unclassified carcinoma

Small cell lung cancers

Combined small cell carcinoma
Small cell carcinoma (oat cell cancer)

Other lung cancers

Adenosquamous carcinoma of the lung
Sarcomatoid carcinoma of the lung
Sarcomoid carcinoma of the lung
Typical and atypical carcinoid of the lung

This is not a complete list of presumptive lung cancers. Additionally, the VA presumes service connection for all respiratory cancers, which include cancers of the lungs, larynx, trachea, and bronchus.

Outside of presumptive exposure, what specific service requirements must a veteran meet for lung cancer?

For veterans not covered by the PACT Act, proving service connection requires medical evidence that links your lung cancer to your military service.

The military scene is fraught with diverse ways for servicemen and women to be exposed to lung cancer-causing substances, such as asbestos, chemicals, infectious agents, physical agents, mixtures, and other exposure scenarios. These exposures may happen overseas or even on U.S. military bases. The ensuing health consequences can be devastating.

The VA claims process can be an overwhelming burden for a disabled veteran. Perhaps you’re having trouble establishing a service connection, or the VA wants to reduce your rating after you received treatment. Do not give up. Many veterans who are initially denied benefits based on lung cancer succeed in attaining them on appeal.

If you have questions or wish to appeal an adverse decision, please get in touch with our accredited veterans’ claims attorneys at Marc Whitehead & Associates as soon as possible. We represent disabled veterans across the United States, and we never charge for initial consultations.

For more information about military veterans’ presumptive exposures, visit the ‘.gov’ links below:

What to Do When Your Insurance Company Denies Disability Benefits for Lung Cancer

Long-term disability (LTD) insurance pays out if you have lung cancer and can’t work, but only if you had the policy before your diagnosis. LTD insurance generally comes from two sources:

Private disability insurance, where you purchased a policy and for which you pay premiums. This is also referred to as individual disability insurance and is governed by state contract laws.
Your employer’s group disability insurance plan that is typically employer-sponsored and is governed by strict federal ERISA law.

To get long-term disability benefits for lung cancer, you need to prove to your insurance provider that your diagnosis and/or cancer treatment prevent you from performing your job duties.

When the insurance company won’t pay, you must immediately review the denial letter to understand the reasons. You’ll need to pull together all supporting medical records, doctor statements, and policy details to file an in-depth written appeal by the deadline.

Insurance companies aim to limit payouts.

Understandably, disability insurance claims adjusters must verify claims submitted by insured individuals. However, you must be able to distinguish between proper and improper claim handling and review actions on the part of the insurance company that would wrongfully delay or defeat your claim.

It has become common practice for insurance carriers to systematically deny valid claims as a means of containing costs and increasing profits. Our legal team represents disabled claimants in all 50 states against long-term disability insurance companies that provide group and private insurance.

Our law firm has extensive expertise in spotting and combating wrongful denial tactics. We will challenge all of them, and if the insurer continues to delay or deny payments, we will take legal action to protect your rights under your private disability insurance policy or group disability plan.

Social Security disability insurance frequently influences LTD disability claims. Our experienced disability lawyers know the SSDI regulations, state contract laws, and federal ERISA disability insurance laws and processes down to the last detail.

Legal Help for Lung Cancer Disability Denial

Submitting a successful initial claim for disability benefits – or appealing a claim denial – can be an outright challenge without a good attorney’s help. Will your lung cancer claim hold up according to the SSA or VA’s regulations, or the binding terms of your insurance policy?

Let Marc Whitehead & Associates do all the heavy lifting. We’ll guide you through every step to obtaining the full disability benefits for lung cancer you deserve. Please learn more about how we can help.