End Stage Renal Disease (ESRD), or kidney failure, is an irreversible condition most often caused by Chronic Kidney Disease (CKD), though it can occur suddenly or from other disorders. The National Institutes of Health estimates that over 26 million people have CKD, and many don’t realize until the damage to the kidneys is severe. According the latest U.S. Renal Data System Annual Report, ESRD affects over 660,000 Americans of all ages.
If you are suffering from End Stage Renal Disease, and you are unable to work because of the disease, you may qualify for Social Security disability benefits. The SSA has two types of disability benefit programs for those with debilitating conditions, like End Stage Renal Disease, that make it too hard to keep a stable job.
The Financial Costs of ESRD
The latest United States Renal Data System found that Medicare spent over $500 billon on kidney disease, making it one of the most expensive disorders. On just ESRD, Medicare spends $32 billion annually, along with an estimated additional $15 billion for non-Medicare patients.
Because ESRD puts a whole organ out of commission, the treatments are very costly. Most of the costs (about 20 billion) are from inpatient and outpatient medical care. Individuals waiting for a kidney transplant, must undergo dialysis. The National Kidney Foundation found that dialysis costs $83,000 each year for the average patient. When a kidney becomes available, the transplant will cost over $30,000.
Because the condition requires so much time at the hospital, ESRD is a leading cause of lost productivity. Dialysis requires three days a week for about four hours, which puts a toll on those trying to work, both on their physical abilities and available time.
Medically Qualifying for Benefits with the Blue Book
The SSA evaluates every application with the Blue Book to determine whether or not the applicant meets the medical disability requirements. The Blue Book is the SSA’s official list of qualifying disabilities. If you meet or equal a listing, you may automatically be approved for benefits.
ESRD can be found under multiple entries for CKD in section 6.00—Genitourinary Disorders.
To qualify for benefits, the SSA requires medical evidence of chronic heart failure while on prescribed treatment that shows either:
- Chronic kidney disease with chronic hemodialysis or peritoneal dialysis that has lasted or is expected to last for 12 months.
- Chronic kidney disease with a kidney transplant. 12 months after the transplant, the SSA will consider your disability based on any other affected body systems.
- Chronic kidney disease, with impairment of kidney function, with reduced glomerular filtration, which is the rate at which your kidneys filter waste and chemicals out of the blood stream, shown by laboratory findings on two occasions at least 90 days apart during a consecutive 12-month period showing abnormal levels of serum creatinine or creatinine, or a low glomerular filtration rate (eGFR), with at least one of the following:
- Bone degeneration occurring when the kidneys are unable to maintain the necessary levels of minerals, hormones, and vitamins required for bone structure and function, called renal osteodystrophy, with severe bone pain and imaging studies documenting bone abnormalities.
- Neuropathy or other nervous tissue damage that affects peripheral motor, sensory nerves, or both, causing pain, numbness, tingling, and muscle weakness due to toxins the kidneys can't adequately filter from the blood.
- Fluid overload syndrome causing overfilled vessels (vascular congestion) with high blood pressure between heartbeats or signs of vascular congestion, swelling, or fluid retention, both despite at least 90 consecutive days of prescribed therapy and documented on at least two occasions 90 days or more apart in one year.
- Anorexia with weight loss determined by body mass index (BMI) of 18.0 or less, calculated on at least two occasions at least 90 days apart during a consecutive 12-month period.
- Complications of chronic kidney disease requiring at least three 48-hour hospitalizations more than 30 days apart within a consecutive 12-month period.
If you've been diagnosed with kidney failure, or you're experiencing any other symptoms, talk to your doctor about applying for disability benefits.
Qualifying Without Meeting a Medical Listing
If your ESRD doesn’t meet or equal any of the Blue Book listing, you can be approved another way. The SSA also awards benefits based on a medical-vocational allowance. If you can’t work enough to earn the SSA’s minimum substantial gainful activity of $1,130, then you may qualify.
To determine whether or not you can work, the SSA will figure out your Residual Functioning Capacity (RFC). The examiner takes into account your limitations, education level, and work history to first put you in a category of work (sedentary, light, medium, heavy, or very heavy), and then find jobs you’re qualified for with your history. If the SSA can’t find a job you can do or decides you can’t even do sedentary work, you may be approved for benefits.
ESRD is a permanent and very debilitating condition, so it can cause many limitations that would keep you out of work. The National Kidney Foundation reported that CKD patients had an average of 10 doctors’ visits a year, second to only cancer. Additionally, dialysis patients need to spend at least 12 hours a week in the hospital for their necessary treatments. Fatigue, mental confusion, sleep problems, and chest pain can make normal tasks hard to complete. Bone pain, swelling of the lower extremities, and impaired motor skills can make it hard to walk, stand, and perform fine movements.
Those applying with an RFC are more likely to get approved if their work history is in jobs that require more manual labor and standing, like construction, food service, and retail than those who have a college education and a history of sedentary work.
How to Apply for Social Security Disability Benefits
If you find you cannot work while dealing with ESRD, talk to your doctor about applying for benefits. The application process is long, and often requires reconsiderations and appeals, so if your doctor does not think your chances of approval are high, the application may not be worth the effort.
Because ESRD is a serious condition, your likelihood of approval is fairly high. However, if you leave out key medical information, you may be denied, whether or not you meet Blue Book or RFC requirements. To raise your chances of being one of the only 30 percent of claimants approved in the initial claim stage, include all necessary medical evidence and other documentation with your application. A checklist of required documents can be found on the SSA’s website.
Important medical evidence for kidney failure will include:
- Blood tests that measure levels of chemicals and waste the kidney normally filter out
- eGFR (estimated glomerular filtration rate) test
- Urine tests to show irregular chemicals, proteins, or blood
- Kidney biopsy to examine tissue
- Blood pressure test, to check for vascular congestion
- Reports of kidney function before and during dialysis
- List of medications and any other prescribed treatments and outcomes
- Summaries of hospitalizations, operations, and any other related documents
- Detailed reports from your kidney doctor describing the severity of your ESRD and the limitations it causes you.
You can apply for disability benefits using the SSA’s easy online application or by making an appointment at your local SSA office. However, if you want to apply for Supplementary Security Income (SSI) you must apply in person at an SSA office, as the applications can’t be processed online.
Make sure to check your disability application over for mistakes or missed questions before submitting it or have a trusted family member or friend go through it with you. These errors could hinder the SSA’s ability to correctly find medical records and more, which would cause them to delay or deny your claim.
If there are any changes in your condition after you've submitted your claim, make sure to notify the SSA immediately. If you've been hospitalized, prescribed new medications, or had any new tests, the additional information could help your case be approved.
If you are 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.
How a Social Security Disability Lawyer Can Help
Even though people with end stage renal disease will usually qualify for Social Security disability benefits, it is still a good idea to work with a Social Security disability lawyer. You need to focus on your health, not on filling out endless paperwork. A disability attorney will know what you need and how to present your claim effectively so your claim is more likely to be approved when submitted, saving you time and hassle with the often-drawn out appeals process.