How the Compassionate Allowances List Speeds Up a Disability Claim

What is the Compassionate Allowances program for disability claims?

Compassionate Allowances handling starts from the same disability application everyone files, with no separate form to request it. On its Compassionate Allowances page, the Social Security Administration (SSA) describes the program, often shortened to CAL, as a way to quickly identify diseases and other medical conditions that, by definition, meet Social Security's standards. SSA says the conditions are mainly certain cancers and adult brain disorders, along with some rare disorders that affect children.

The program covers both disability programs. Social Security Disability Insurance (SSDI) pays benefits based on your work history. Supplemental Security Income (SSI) is a needs-based program with strict financial limits. SSA uses the same rules to evaluate CAL conditions in both.

The point of CAL is speed. A condition on the list is one where the medical question is usually clear from a small amount of objective evidence, so SSA can route the claim to faster handling instead of the ordinary queue. If you are starting a claim, our page on applying for disability covers the application itself, and our step-by-step guide to how to apply for disability walks through the forms.

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How SSA flags a Compassionate Allowances disability claim

SSA's selection software flags a claim when an impairment you list matches a condition on the CAL list by name, synonym or abbreviation. SSA's operations manual, POMS DI 23022.010, says the software identifies cases for CAL processing based solely on the claimant's alleged impairments, as listed on the disability forms.

That has a practical consequence. The software reads what you wrote, so the diagnosis on your forms should match the diagnosis in your records, in the same words your doctor uses. Writing “cancer” is not the same as writing the specific type and stage, and a vague entry gives the software nothing to match. If you have more than one diagnosis, list every one of them, because the software reads each impairment you allege.

Once a claim is flagged, the manual says it goes to designated examiners and is processed as an expedited case. The designation also has a gate. A CAL case must have minimal, but sufficient, objective medical information that meets Social Security's statutory standard for disability, and the manual tells staff not to designate a case as CAL if the condition does not meet those strict criteria. Field office employees cannot add, remove or reinstate a CAL designation.

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How SSA builds and updates the Compassionate Allowances list

SSA adds conditions to the list using public input, expert advice and research. According to SSA's CAL page, the agency draws on information from the public, comments from the Social Security and Disability Determination Services communities, counsel from medical and scientific experts, research with the National Institutes of Health, and information gathered at past public outreach hearings. Disability Determination Services (DDS) are the state agencies that make initial disability determinations for SSA.

The CAL website also holds impairment summaries for all CAL conditions. The current list of conditions includes, among many others:

• Amyotrophic Lateral Sclerosis (ALS)
• Pancreatic Cancer
• Esophageal Cancer
• Acute Leukemia
• Small Cell Lung Cancer
• Breast Cancer, with Distant Metastases or Inoperable or Unresectable
• Kidney Cancer, Inoperable or Unresectable

Read the entries closely, because many name a stage or a feature, not just a disease. A breast cancer diagnosis is not, by itself, a match for the breast cancer entry. The entry calls for distant metastases or a tumor that is inoperable or unresectable, and the records need to show that. Our condition pages on cancer and ALS cover how SSA evaluates those claims in more detail.

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What Compassionate Allowances does not change about SSDI or SSI benefits

CAL changes the order in which SSA handles your claim, not the rules your claim has to meet. The manual is explicit that a CAL case still needs objective medical information meeting the statutory standard for disability. CAL works like an express lane at the grocery store: same prices, shorter line.

The nonmedical rules stay in place too:

• SSDI insured status. Under 20 CFR 404.130, you generally need to be fully insured and to have at least 20 quarters of coverage in the 40-quarter period ending with the quarter your disability began. A CAL condition does not waive that.
• SSI resource limits. SSA's SSI resources page says the limit for countable resources is $2,000 for an individual and $3,000 for a couple. If your countable resources are over the limit at the start of a month, you cannot receive SSI for that month.
• The SSDI waiting period. Under SSA's operations manual, SSDI entitlement generally begins only after a waiting period of 5 full calendar months. Faster processing does not shorten that period. Our guide to the SSDI waiting period explains how it is counted.

ALS is the exception on that last point, and it comes from Congress rather than from CAL. SSA's legislative bulletin on the ALS Disability Insurance Access Act describes the law that eliminated the five-month waiting period for disability insurance benefits for people with ALS.

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Quick Disability Determinations: a separate fast track for disability claims

Quick Disability Determinations (QDD) is a different fast track that relies on a predictive model rather than a list of conditions. POMS DI 23022.010 describes a QDD case as an initial-level case identified electronically by that model. The model looks for claims with a high probability that the claimant is disabled, where evidence of the allegations is readily available and the DDS can process the case quickly.

The regulation behind QDD is 20 CFR 404.1619. It says SSA refers a claim for quick determination when there is a high degree of probability that the person is disabled and the allegations can be easily and quickly verified. The examiner decides on the evidence in the file and consults a medical or psychological consultant when appropriate. If the examiner cannot make a fully favorable determination, the claim is handled under the regular procedures.

The two can overlap. The manual says a QDD case is also designated as a CAL case where that applies, so it keeps priority handling if it leaves the QDD process. Neither fast track is something you apply for. Both start from the claim you file, and under section 404.1619 it is SSA that makes the QDD referral.

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