The kidneys are in charge of many body functions, such as cleaning the blood and producing urine. Over time, diseases like Chronic Kidney Disease (CKD) can harm the kidneys, and when the CKD becomes so severe that the kidneys can’t function any longer, the patient develops End Stage Renal Disease (ESRD), and the damage is irreversible. The only solution for ESRD is a kidney transplant, but until a kidney is available for transplant, the patient must have a machine do the work of the kidneys, called dialysis.
The National Kidney Foundation found that almost 500,000 Americans are currently going through dialysis. If you or a loved one is suffering through dialysis and can't work, there is help available. The Social Security Administration (SSA) offers two types of disability benefit programs that you may be eligible for.
The Financial Costs of Kidney Dialysis
There are two main kinds of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis is the more expensive option at about $88,000 per year, according to the National Institutes of Health, because it normally must occur at a hospital with a dialysis machine.
Peritoneal dialysis costs about $71,000 each year, the source adds, but requires patients to do some of the work and upkeep themselves, such as keep the injection area clean and determine how much fluid needs to be inserted into the abdominal cavity that filters the blood.
Aside from the dialysis costs, there are many other costs associated with CKD and ESRD, such as multiple doctors’ appointments, medications, and more. Annually, $99 billion is spent caring for individuals with kidney disease, though this figure doesn’t include prescriptions, so the number is likely over $100 billion, the National Kidney Foundation reported.
Kidney disease is a leading cause of lost productivity, which only increases once a patient needs dialysis. Aside from the debilitating side effects, hemodialysis, which is the most common type, requires patients to take time of work for long dialysis treatments three times per week, plus other necessary appointments.
Medically Qualifying for Benefits with the Blue Book
The SSA screens all disability applications using the Blue Book, which is their official listing of qualifying impairments.
If you are currently undergoing dialysis that is expected to last for at least 12 months, and you have the medical evidence to back up your claim, you will automatically be approved for benefits.
Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis can be found in Section 6.00—Genitourinary Disorders. To qualify for benefits, the SSA requires medical evidence of your chronic kidney failure while on prescribed treatment that requires either chronic hemodialysis (man-made dialysis) or peritoneal dialysis.
If you don’t meet this listing, there are many other listings for kidney diseases. Talk to your doctor about applying for disability benefits.
Qualifying Without Meeting a Medical Listing
If you aren’t currently undergoing dialysis or your dialysis won’t go on long enough to qualify and you don’t meet any of the other listings, you may still be able to get disability benefits with a medical-vocational allowance. Instead of looking at specific disease symptoms, the SSA will look at your limitations as a whole to determine whether or not they keep you from performing the SSA’s 2016 substantial gainful activity (SGA) minimum of $1,130 per month.
The SSA uses your symptoms and limitations and puts you in a work intensity level (sedentary, light, medium, heavy, or very heavy). Then they look at your highest education and work history to find a job you can do in your work level. If the SSA can’t find a job you can be reasonably trained for, or the examiner believes you can’t even do sedentary work, you may quality for benefits.
There are many side effects of dialysis that could restrict you from working, including the time commitment. Dialysis often requires three hospital visits per week for four hours, which is inconvenient for work schedules. Other symptoms include extreme fatigue, mental confusion, sleep problems, bone pain, swelling the legs and feet.
Older adults who didn't complete college or did physically intense or unskilled work have a higher chance of being approved with a medical-vocational allowance, because there are fewer sedentary jobs available without that don’t have training or education requirements.
How to Apply for Social Security Disability Benefits
If you find you just can’t work while on dialysis, talk to your doctor about your likelihood of applying for disability benefits. Not only is a physician’s help and support invaluable and necessary for your claim, but their professional opinion should be as well. If your doctor doesn’t think you’ll be approved, then it may be worth the trouble of starting your Social Security disability claim. Some approvals can take up to two years.
If you decide to apply for benefits, whether with the Blue Book or an RFC, make sure you include all of the necessary medical evidence. Even if you meet a listing, leaving information out could cause your claim to be delayed or denied all together. 70 percent of applications are denied in the initial stage, though many are accepted during the appeal process.
Important medical evidence for kidney dialysis and disease will include:
- Blood tests that measure levels of chemicals and waste the kidney normally filter out
- eGFR (estimated glomerular filtration rate)
- Urine tests to show irregular chemicals, proteins, or blood
- Kidney biopsy to examine tissue
- Dialysis reports showing, kidney function before and during treatment
- Summaries of other treatments, such as surgeries and medications
- Information about any other hospitalizations and any other related documents
- Detailed reports from your primary care doctor and/or kidney doctor describing the limitations caused by your kidney failure and dialysis
Applications for Social Security Disability Insurance (SSDI) can be completed online at the SSA’s website or in person at an SSA office. For Supplementary Security Income applications (SSI), however, you must make an appointment with an SSA representative. But before you submit either application, first check the SSA’s list of required documents online and then double check your application for errors or missed questions, because these can also endanger your application.
If there are any changes in your condition, such as an increase in dialysis, a kidney transplant, a hospitalization, or a change in medication, make sure to let the SSA know as soon as possible. Medical information such as that is important in determining the result of your claim, and may help you get approved faster.
If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance and Supplemental Security Income.