If you have end-stage renal failure (also called chronic kidney failure or chronic renal failure), or advanced kidney disease that causes you severe limitations, you can qualify for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) disability benefits.
The Social Security Administration (SSA) evaluates kidney failure under its disability listings for "genitourinary" impairments. These listings call for Social Security to grant disability benefits in cases where an applicant has any of the following:
We discuss each of these situations below. If you don't yet have the above complications, 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 that it keeps you from working. (More on this below.) First, we'll look at Social Security's official disability listings on kidney failure.
Listings 6.03 and 6.04 grant automatic disability for poor kidney function caused by any chronic (not acute) disease, if you have had one of the following:
If you haven't had a transplant and you don't need regular dialysis, you might meet the requirements of listing 6.05, for reduced glomerular filtration.
Reduced glomerular filtration means that your kidneys are not working well enough to clear wastes and excess fluid. You can show that you have reduced glomerular filtration if your blood test results show you have:
You must also show that you suffer from one of the following:
These requirements aren't always easy to decipher; ask your nephrologist or primary care doctor if your condition meets these requirements.
Listing 6.06 covers a group of kidney diseases with excess protein in the urine (proteinuria) and swelling (edema) of varying levels. People who suffer from nephrotic syndrome also sometimes have hypoalbuminemia (low serum albumin, a liver protein) or hyperlipidemia (high cholesterol). To be automatically granted disability benefits, the listing requires you to have extreme edema for at least three months, plus:
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 (high blood pressure) 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 6.09).
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) for chronic renal disease? Social Security needs a longitudinal medical history (one that includes repeated observations over time) that includes a record of all details about 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 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 results must have been obtained on more than one occasion over the last three months before you apply for benefits.
Applicants undergoing dialysis should have lab results that document renal function prior to the start of dialysis and a doctor's statement as to the need for ongoing dialysis.
Applicants who have been diagnosed with nephrotic syndrome should have medical records that include serum albumin and proteinuria levels. The medical records should also show the extent of edema, including presacral, peritibial, and periorbital edema. Additionally, the record should have medical evidence that describes any instances of ascites, pericardial effusion, or pleural effusion. (Ask your doctor about these last few items.)
Lastly, if you have had a renal biopsy performed, Social Security will want to see 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.
A kidney transplant gives an applicant 12 months of disability automatically. After the first year, Social Security will determine your ongoing disability eligibility by evaluating your "residual impairments"—any limitations you still have one year later.
When Social Security considers whether an individual has had medical improvement post-transplantation, the agency will consider things like:
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.
If your kidney disease hasn't advanced enough to meet one of the above listing requirements, Social Security will consider the effect of the disease on your abilities. Social Security will look at your symptoms and decide how they limit your ability to work.
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). If your doctor has included a detailed opinion about how the disease limits your ability to work, Social Security will take that into account.
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 that Social Security gives an applicant 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 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, say Social Security has given you an RFC of sedentary work because of fatigue, anemia, and bone pain caused by your kidney disease. If you are 50 years old, have done only what's considered "unskilled work," and you didn't graduate from high school, Social Security is likely to grant you disability benefits. Why? The rules put in place by Congress, called "grid rules," assume that 50-year-olds who don't have job skills or at least a high school education can't do many sit-down jobs.
Learn more about when Social Security grants benefits based on functional limitations.
You can apply for Social Security disability in person at your local SSA office (after the COVID-19 pandemic ends), by calling Social Security at 800-772-1213, or online at www.ssa.gov.
To complete the disability application, you'll need to have detailed information, including the contact information and dates of treatment for all of your medical providers, the dates of your key blood tests, and the names, addresses, and dates of employment for all of your employers in the last 15 years. You'll also be asked to include both how your bone pain, fatigue, or other symptoms affect your ability to work and your life outside of work. For more information, see our article on applying for SSDI benefits.
If you'd like help with your application, think about working with a disability advocate. Someone who's an expert in SSDI can be a big help in advising you about the program's requirements and how to fill out the application.
Updated November 29, 2022