Social Security Disability Benefits for Kidney Failure
Claimants with poor kidney function will likely be approved for Social Security Disability benefits.
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If you have end-stage renal failure (also called chronic kidney failure or chronic renal failure), you can get SSDI or SSI disability benefits if your condition is severe.
How Does Social Security Evaluate Kidney Disease?
Social Security evaluates kidney failure under its disability listings for "genitourinary" impairments. These listings call for disability benefits to be granted in cases where any of the following is present:
- the need for regular dialysis
- completion of a kidney transplant
- reduced glomerular filtration combined with symptoms of damage
- nephrotic syndrome, or
- serious complications of kidney disease.
We discuss each of these situations below. If you don't have any of the above problems, yet you still can't work due to kidney failure, you still can win disability benefits if you can show Social Security that your condition causes such limitations it keeps you from working. More on this below. First, we'll look at Social Security's official disability listings on kidney failure.
Chronic Kidney Disease
Listings 6.03. 6.04, and 6.05 grant automatic disability for poor kidney function caused by any chronic (not acute) disease, if one of the following is present:
- ongoing peritoneal dialysis (a method of hemodialysis that involves dialyzing solution being put into and removed from the peritoneal cavity intermittently or continuously)
- ongoing hemodialysis (the removal of toxins from the blood with an artificial kidney machine)
- kidney transplantation, or
- reduced glomerular filtration.
Reduced glomerular filtration can be shown by persistently high levels of serum creatinine (a natural product of muscle metabolism), low creatinine clearance levels, or a low estimated glomerular filtration rate (eGFR). To qualify by showing reduced glomerular filtration, you must also show that you suffer from one of the following:
- renal bone degradation and bone pain
- peripheral neuropathy (inability to filter toxic substances from the blood)
- fluid overload syndrome despite taking medication, documented by diastolic hypertension, signs of vascular congestion or anasarca (massive edema or swelling), or anorexia with weight loss and BMI of 18.0 or less.
Listing 6.06 covers a group of kidney diseases that are evidenced by excess protein in the urine (proteinuria) and swelling (edema) of varying levels. Low serum albumin (hypoalbuminemia) and hyperlipidemia (high cholesterol) are also sometimes present. To be automatically granted disability benefits, the listing requires an individual to have extreme edema for at least three months plus:
- low serum albumin levels with either moderately high levels of protein in the urine or a total-protein-to-creatine ratio of 3.5 or greater, or
- very high levels of protein in the urine.
Complications of Chronic Kidney Disease
If you have kidney disease but don't meet one of the listings above, you can still get disability benefits if you've experienced serious complications over the last year. For example, some individuals with kidney disease suffer from congestive heart failure, stroke, hypertensive crisis, or acute kidney failure requiring hemodialysis. If you were hospitalized at least three times for such complications (at least 30 days apart) within one year, you can qualify under this listing (listing 6.06).
Medical Evidence Required
What type of evidence does Social Security use to determine if an individual has a listing-level impairment (that is, it fulfills one of the above listings) from chronic renal disease? Social Security needs a longitudinal medical history that includes a record of all hospitalizations, medical treatment notes from your treating physician or physicians, and laboratory findings that document progressive renal disease. Also, clinical or lab evidence that shows a deterioration of kidney function is also important. An example of this might be lab findings that show an elevation of serum creatinine or proteinuria.
Additionally, Social Security likes to have current clinical observations and treatment notes. Lab findings must have to have been obtained on more than one occasion over a three-month period.
If an individual is undergoing dialysis, there should be laboratory findings that document renal function prior to the start of dialysis, and a doctor's statement as to the need for ongoing dialysis.
If an individual has been diagnosed with nephrotic syndrome, the medical record should show the extent of edema, including presacral, peritibial, and periorbital edema. Additionally, medical evidence should describe any instances of ascites, pericardial effusion, or pleural effusion. Finally, the records must include serum albumin and proteinuria levels.
Lastly, if there has been a renal biopsy performed, medical evidence should include the microscopic examination of specimen report. If the actual microscopic examination report is unavailable, Social Security will accept a statement from a doctor that indicates a biopsy was performed and a description of the results.
Benefits for Claimants with a Kidney Transplant
A kidney transplant gives an individual 12 months of disability automatically, after that the first year, Social Security will evaluate ongoing disability eligibility upon an individual's residual impairments. When Social Security determines if an individual has had medical improvement post-transplantation, the agency will consider things like kidney rejection episodes, renal infection frequency, side effect of immunosuppressants and corticosteriod treatment, other systemic infections, neuropathy, or other organ system deterioration. Social Security can also consider the fact that an individual has an absence of symptoms, signs, or laboratory findings that are indicative of kidney failure when making a medical improvement determination.
Disability Based on Functional Limitations
If your kidney disease does not meet one of the above listing requirements, Social Security will considers the effect of the disease on your abilities. Social Security will look at the patient's symptoms and decide how they limit the patient's ability to work. If the doctor has included a detailed opinion about how the disease limits the patient's ability to work, Social Security will take that into account. Social Security will come up with a "residual functional capacity" (RFC) rating based on the type of work it thinks you can do (sedentary work, light work, medium work, or heavy work).
Some patients with kidney failure or nephrotic disease suffer from bone pain, fatigue caused by anemia, shortness of breath, trouble with exertion, or swelling of the knees or feet. These symptoms can cause problems with walking or standing for long periods of time, which might mean an individual gets an RFC for no more than sedentary work. In assessing your RFC, Social Security also considers factors like the side effects of therapy and medication, the effects of any post-therapeutic residuals, and the expected duration of treatment.
Social Security will use your RFC in combination with your age, education, and work experience to see if there are any types of jobs you can do. For instance, if you are 50 years old, have only done what’s considered “unskilled work,” and you didn’t graduate from high school, the SSA is likely to grant you disability benefits if you’ve been given an RFC of sedentary work because of fatigue, anemia, and bone pain caused by your kidney disease.
Learn more about when Social Security grants benefits based on functional limitations.