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Advanced Prostate Cancer
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SSDI denied

I thought that having a terminal illness diagnosis would have qualified me for SSDI, social security disability. Got denied. Next step will be to file a reconsideration request. Appreciate hearing from anyone else who dealt with this.

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We just were approved very quickly . It’s my understanding if you have a recurrence of aggressive prostrate cancer which we did you will get it as well as a first time of being diagnosed if it’s aggressive. What hospital do you get your treatment at and drs? Maybe you left some details out on your application perhaps.

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Rutgers Cancer Institute. Will definitely have to think about what I left out from my initial app, as I had believed it would have been sufficient to have a stage 4 metastatic PC diagnosis along with brain fog and fatigue from drug side effects. Also had RRP 6 weeks ago with seminal vesicle intrusion and 2 lymph nodes out of 27 positive. Will keep fighting.

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Usually stage 4 automatically gets it, hmmm I bet you missed something. Did you have someone assigned to you. If so I would contact them.

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You will get it, hang strong.

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Up until last May when I applied, those were the criteria as I understood them. You should easily win on appeal. Just make sure to fill out the forms completely. Also, make sure your providers all know that you have stopped working and the date when you stopped. Again, it is possible that someone has changed the rules this summer but I'm not to sure. There used to be a significant sentence that said "If you have advanced prostate cancer there is an automatic finding" Other material at the site indicated that "advanced prostate cancer" is any PC outside the prostate/enveloping the seminal vesicles.

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Many times they deny people first time around...appeal....hang tough, you will get there...Good luck...

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I was able to get SSDI. You need to be diagnosed with stage IV metastatic prostate cancer. They will check with your doctor

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You can also advise your doctor that you are applying and he/she can assist with the documentation from their end. Make sure you let every medical provider know "I'm not working" every time you see them and they are likely to generate a chart note.

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If all else fails or..... you want to go this route..... Call, email, phone your congressman. They work for you. Keep in contact and call them once or twice a week until you qualify.

🌼Jackie

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I was diagnosed Stage 3. Got it immediately after failure of RP and 38 sessions of radiation. Persistent PSA. I don't exactly remember the verbiage but if there is "two failures"for the treatment of cancer then it is also granted. This because it's not curable. My medical oncologist signed papers as soon as Social Security ask faxed them. If I recall I was approved in about 90 days. My local SS office was very good at working with me after I filled out my application. I took my pathology report in after my application and Social Security actually started calling me after to get it all completed. As a side note I just completed the wait period that allows me to get Medicare. That started last December 1st.

Something must have went wrong? Keep working on it. You don't need a lawyer this is something you can do on your own. Good luck

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Just a reminder, during the Shutdown, SSI is very short-staffed. They have folks there to assist with applications but everyone who processes these has gone home and won't come back until the Shutdown is over. From what I've gleaned, they are issuing payments and helping with applications but that's it at the moment.

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In my case I have Gleason 4/5 PSI was 43 at diagnosis. I've had an RP and am starting radiation today in fact. I was accepted for SSDI based on the fact that I had "Advanced Prostate Cancer" where the cancer had escaped the prostate. Up until recently that apparently let to an automatic finding but when I went back to the SSDI page recently, my impression was that the rules were in flux or being tightened up. I've checked about the Shutdown and at this point, payments are still being issued but if the Shutdown drags on, this is not guaranteed to continue. Appeal! Good luck.

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My suggestion to you is to be your own advocate. I was diagnosed stage 4 mets and was able to call s.s. office and get the ball rolling with them and then got my Dr's to send all of the information to them . in less then 90 days I was approved . Keep at them !!!!

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I read different. Social Security is funded for the year. Payments for SS and disability continue. Read that core functions like disability claims OR appeals over benefits would continue. Call your local SS office....

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I was denied 30 days ago due to not finding the recurrence on imaging (CT & Bone). I have since had a PSMA Scan which found expression on a lymph node. I will have a biopsy and if the node is found to be cancerous I should be able to successfully appeal. If I am still denied I will retain a SSDI lawyer.

Note: I was not eligible after RP due to undetectable PSA level. Thought when I had bio-chemical recurrence that I would be automatically approved but learned that the cancer must be seen via imaging and/or biopsy to be deemed as positive. A rising PSA will not qualify without imaging showing cancer.

Did they give you a specific reason for not approving your application?

Jim

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Reasons for denial-

Surgery has been successful in controlling your condition.

Physical Therapy has been successful in controlling your condition.

Mental condition has not affected your ability to understand, remember, cooperate with others and perform normal daily activities

Although currently unable to work, condition is expected to improve so that you should be able to return to work within 12 months.

Evidence shows no other condition which significantly limits your ability to work.

Prescribed therapy currently causing discomfort. However, it is expected these effects are temporary and will not be disabling for a period of 12 months.

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They are saying that you are not showing any metastasis; is this true? If you can show them (proof with scans and/or biopsy) that the RP did not contain the cancer you will be approved.

All other conditions are window dressing; incontinence, stress from dying, lack of energy or focus were all denied under my application.

Just relaying my experience and interpretation after speaking with SSD rep.

FYI: The lawyer I talked to gets paid by taking all of the back pay benefits but do not take any future payments. Once approved you get paid from the time of your application or approval.

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Today I filed electronically for reconsideration, and made sure to include that I am metastatic. I had assumed that they would have known stage 4 means such.

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Hopefully they will you and you can tell them that the RP in fact did not successfully cure your cancer and you have detectable mets. Good luck!

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Like me ,this the first brush with government aid .. Their goal is not to pay.. ours is to get payed.. I am on your side 1000% percent..

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Freakin lawyers.. I’m so happy I didn’t pay one.. just luck...

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This is a bunch of bull ... they owe you .. you do deserve this help .. I missed my 3yr review forms and they dropped me. I had to go to my onco and grab my drs assistant in order to send my records to disability. Nobody would even respond to there request for my status... my status is 3 yrs with no visable signs or Psa.. to my amazement I was reinstated and back payed four months.. The kind !r Canady that told me That I no longer qualified was hopefully shown my truth by a higher up or someone in the know.. I called a ssdi lawyer and they didn’t want to touch me one ssdi dropped me. I think that once it’s #4 you should never be let go. It’s not long we’re getting stronger with time. APC and treatments can knock the strongest off his feet. If we are so lucky to even survive the first round. I feel that they owe you... there is no shame in getting what is due from our government.. We work half our life just to pay our Uncle Sam. I pray that you get this ssdi soon.. Take care...

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Hey Jim, I’m sorry that you’re going thru this bs with ssdi.. it’s not just...

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Once I get the positive result on biopsy I should be approved. I have 26 more days to appeal. I will do so with or without the biopsy result. Thanks!

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Yikes! Just part of the fun.. I’m pulling for you to get this benifit of which you’ve paid into .. Good luck..👍

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We got my husband’s on first try. The main thing we had to have was listed he was in stage 4. I sent Dr. notes and was on phone for over 2 hours talking to an agent. As soon as I sent notes saying he was stage 4 they expedited the paperwork. They requested clinical notes from Dr. we had our first check within 4 weeks. Goodluck

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Very similar to my experience. Sent 60+ pages of med records for their review/analysis. Had a few phonecons with them, maybe three. The process took about 6 weeks & I was approved.

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Yes we put cancer center of America and being at a cancer facility that is known for cancer helps, and even though most on here are not terminal today , but answering that question yes is technically true , it could be true but most of the drs are here to try and make sure you don’t from this but something else way down the road.

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That is where we go also Cancer Center of America Zion

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Who are your dr’s there?

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Oncology is Dr Piske and Radiologist is Dr Patel. We are there now. Arrived on Sunday had more MRI Monday see both Drs today. Derek developed Bells Palsy a month ago family Dr called Here and they ordered an MRI of brain just to be cautious. Brain showed nothing but they found an abnormality at the base of skull. So they wanted us up here right away but insurance would not approve another MRI until this week. I think it was just because our deductible was already met so they pushed us back until first of year. Insurance rule.

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Dr. Piske is my husbands oncology also! He had Dr. Patel 10 years ago when we had radiation. We also see Dr. osafkosky sp? He was the urologist that his his selvedge surgery aug 2. Have had kidney failure and lots of complications due to surgery. Our scheduled next visit is Jan 28.

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They just found a tumor on Derek’s right side of his skull and face. They are starting radiation right away. They took him off Zytiga today cause it is no longer working. Will discuss options after radiation is complete. Prayer your husbands complication subside and go away. My husband loves Dr Piske that is why we keep driving up here to see him

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Wow , I guess we know why your husband was having pain. Hope that radiation will get him some relief once it’s all done. Yes my husband loves him too. He started out 10 years ago with someone we liked but they went on to CTCA in Az then we were turned over to Piske. Been with him every since. CTCA is ran more corporate now that the owner sold it to the bankers. They use to be the top of their game but some of the treatments o read on here are more aggressive it seems . For instance I saw someone post on here that it is a outdated thought to not to do a prostatectomy if you have a lymphoid involvement but the surgeon told us if they saw involvement of the noids they wouldn’t finish his surgery. So I’m glad we have this forum to bounce ideas off of. Prayers for you and your husband. Keep us informed.

Kim

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My MO said I was doing too well to go for SSDI so at 64 I filed for SS. The difference in benefits for me made it not worth the wait and possible denial. My lawyer advised me the same.

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I am also now 64. When I filed for SSDI originally several months ago when I was 63, I was told that I had an accelerated application. It took about 2-3 months to get a decision. Now I have filed a request for reconsideration with additional details, which will hopefully not take long except for the possible effects of the govt shutdown.

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Does anyone know if it is possible to get SSDI after a person has been on regular SS for a number of years? (Stage 4, recurrence after RP, palliative sacral LN surgery based on positive PSMA scan results)

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Are you stage #4?

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NOTE *** NOTE *** NOTE *** NOTE *** NOTE

From a post by

BY Litlerny 7 months ago.... <-----<<<

My wife and I both worked for SSA for 30+ years.

How old are you now? 63 1/2? For most of us, full SSA retirement age is not until age 66, which opens up the strong possibility that you could be entitled to a higher benefit under SSA Disability than you currently receive under SSA Retirement.

On what date were you diagnosed Stage 4? Is your Stage 4 diagnosis date the same as the date you were diagnosed with PCa (at any stage)?

Without knowing more details of your situation, and you are now 63 1/2 , we think you should definitely file for SSA disability. You have nothing to lose, and potentially a lot to gain by doing so.

Again, It is highly likely that you would be due a higher monthly benefit under SSA Disability v.s. SSA Retirement, even if your disability benefit may reduced due to the number of months you have already received SSA Retirement benefits. [Google POMS RS 00615.410 Reduced DIB after RIB Entitlement (A then HA)].

The determination of whether your SSA DIB benefits will be reduced, and (if so) by how much, requires a special benefit computation by SSA. It is highly possible that your benefits may increase to a higher monthly amount.

Also, there is the possibility that you might qualify for Medicare. A & B prior to age 65 based on your disability.

Finally, filing now protects your DIB application date, potential retroactivity of your DIB benefits, and appeal rights under the SSA Disability program.

BTW...it is NOT true that it will take 2 years to process your disability claim!!

Each claim is unique, just like the level of disability is unique to each person. During our careers both my wife and I have seen countless disability cases processed in a matter of weeks or a few months.

Even many claims that go to the Hearing level of appeal are processed to completion within one year, and for those appeals that are reversed to an allowance, most go back to the original application date (sometimes up to 12 months earlier with retroactivity) based on the date SSA establishes that your impairment is severe enough to be considered disabling under their rules and regulations.

Contact SSA now. The date you contact them to set up an appointment to file is crucial to determining your Disability entitlement date, Medicare eligibility date, and disability benefit amount. SSA cannot refuse your right to file.

If you don’t file, you will get nothing.

Mark

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 01/07/2019 7:11 PM EST (My name day).

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Thanks for this info.

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How do I find Litlerny on here?

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go to HOME and you can do a find on a member ID

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 01/07/2019 9:48 PM EST (My name day).

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Ty John

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You're welcome If you're having trouble I can send him a message that you wish to contact him. BTW his wife is a private Soc Sec consultant.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 01/07/2019 9:53 PM EST (My name day).

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Please 🙏 that would be awesome

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Sorry I'm so late but I just logged on.....

Below is the message I just sent him.

To: Litlerny

A new user Kimmilemo asked me as a favor to contact you regarding his saga with the Soc Sec Admin in getting coverage. Since he's new he does not know how to message anyone. Hopefully you'll be able to help him. Thank you...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2019 4:22 PM EST

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2019 4:28 PM EST

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Your the best. Ty!

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Here's a link to the criteria that the SSA uses to determine eligibility for SSDI,

secure.ssa.gov/apps10/poms....

Pay attention to the last sentence which reads; "Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator." You really need to make your case... the Medical Determination agent that handle my case inferred that a lot of cases "don't get the attention they should". So take into consideration every little ache and pain when filling out your application and while remaining truthful feel free to embellish when appropriate.

I was required to file my SSDI application in person as I was already receiving SSA early retirement benefits. My application (which included a diagnosis of Prostrate Cancer Hormone Refractory Disease, my biopsy report, all my bone, Ct and MRI reports) was then forwarded to the SSA Medical Determination Board for review, and honestly I thought all that would be convincing enough as I have metastasis to my pelvis, spine, ribs and sacrum and had failed 6 rounds of Chemo but one week later I was required to answer a lengthy Pain Questionnaire, a Fatigue Questionnaire and provide 15 years of detailed work history that asked how long I stood, sat, bent over, walked and much weight I lifted etc. etc. before a decision could be made. Then after only 3 1/2 weeks I was found eligible. And as j-o-h-n's repost correctly states I received disability benefits retroactive to my initial diagnosis in January 2017.

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Stage 4 is not automatic! Your benefit will hinge on the letter signed by your Medical Oncologist containing his diagnosis and prognosis. You got one, right?

GD

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Had a virtual online support group meeting last night (1/7/19) with AnswerCancer (www.ancan.org), which I highly recommend. Rick Davis provided a section of the operations manual from Social Security (POMS) effective as of 12/28/18 which states "Listing-level criteria requires prostate cancer to be either metastatic (Stage IV) to lung, liver, or other internal visceral organ (excluding bone metastases); or progressive or recurrent despite initial hormone therapy. Prostate Cancer with visceral metastases meets the criteria in listing 13.24 B."

Not sure if having seminal vesicle intrusion and 2 lymph nodes positive, which was noted in my RRP pathology report, meets the definition of visceral metastasis?

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Were the lymph nodes and seminal vessicles removed during your RRP? Have you had additional mets show up in scans since? If not, that might be what is holding your approval back. I'm in this situation too, though I haven't attempted to get SSDI yet. I'll be interest in following your journey here. I don't have evidence of mets via current imaging yet.

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Nope. They are talking about liver, lungs, etc. For the fast guarantee you need organ Mets or be reoccurrence ie crpc. Just stage 4 with a ton of Mets is not enough and you have to fight. They correctly know that you can be terrible shape at diagnosis but with treatment can bounce back for years. I took a leave from work while I did 10 rounds of chemo. But now am happily back working until the dreaded PSA rise signaling crpc. At that moment I will get my “fast” approval for SSDI

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Yes, they were removed during RRP. No additional mets so far. Having updated scans in 1-2 months. I believed that since my cancer is advanced/terminal then I would meet the SSA's listing requirements, but it doesn't appear to be that simple.

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