Kidney Disease and Social Security Disability Benefits

Chronic kidney disease, renal failure, and kidney transplant surgery all qualify for disability benefits from the Social Security Administration (SSA). The SSA understands that kidney disease and similar conditions present challenges in terms of medical expenses, everyday functional limitations and maintaining employment. Because of this, the SSA has standard disability listings for each of these conditions.

The Cost of Kidney Disease

The sad reality of being diagnosed with a chronic condition is that you not only have to worry about the diagnosis itself, but you have to worry about how you will pay your bills and pay for treatment.

If your condition has the potential to impact your ability to work, then your stress level will be even higher.

Kidney disease has many stages and levels of severity, and the CDC reports that chronic kidney disease can cost upwards of $23,000 per person per year.

Medication has been shown to slow the disease’s progression or to stop it entirely, but in some cases by the time it is diagnosed it has already reached kidney failure. No matter where you fall on the spectrum there will be costs associated with kidney disease and this is something that patients worry about as they cope with their condition.

In addition to frequent doctor visits, patients who must undergo dialysis will miss work frequently and this can use up all of your paid medical leave very quickly. Once your paid time off runs out, you will be losing money as you miss work for treatment, and not only could this place your job at risk but the additional stress from worrying about your bills can also negatively impact your treatment.

Medically Qualifying with Kidney Disease

The SSA maintains disability listings for recognized impairments in its Blue Book manual. These listings are used to review disability applications, applicant medical records, and other documentation to determine eligibility for Social Security Disability (SSD) benefits.

Any of the following listings may apply to your disability claim.

Chronic Kidney Disease, which appears in Section 6.02, requires:

  • You must undergo dialysis or a kidney transplant

    OR

  • Your serum creatinine levels from a three-month period are:
    • Above 4 mg per deciliter

      OR

    • At a clearance level of 20 ml or lower per minute

      AND

    • You experience at least one of the following complications:
      • Renal osteodystropy
      • Motor or sensory nephropathy
      • Chronic fluid overload syndrome, accompanied by diastolic hypertension, vascular congestion, or anorexia

Nephrotic Syndrome, which appears in Section 6.06 and requires:

  • Consistently serum albumin of 3.0 per deciliter or lower AND elevated proteinuria of 3.5 g or higher over a 24-hour period

    OR

  • Proteinuria measurements over a 24-hour period of 10 g or higher AND a total-protein-to-creatinine ratio of 3.5 or higher
  • Chronic Kidney Disease with Complications, which appears in Section 6.09 and requires:
  • you have been hospitalized at least three times within 12 months, with no more than 30 days in between hospital admissions

    AND

  • each hospital stay started in the ER and resulted in inpatient treatment of at least 48 hours.

Kidney Transplant, appears in Section 6.04 of the SSA's Blue Book. If you have chronic kidney disease and need a kidney transplant, you likely qualify for benefits under the Section 6.02 listing. However, if you have transplant surgery, you will qualify for benefits for a period of at least 12 months under this Section 6.04 listing instead.

Compassionate Allowance (CAL) Listings are severely disabling or terminal illnesses that fall under special review and approval guidelines with the SSA. Applications filed on these conditions are expedited to get benefits started as quickly as possible. Two kidney diseases are among the CAL program listings:

  • Heptorenal Syndrome
  • Nephrogenic Systemic Fibrosis

No matter which listing you may qualify under, you must ensure your application and medical records are thorough and detailed. Specifically, the SSA may need to see any or all of the following medical documentation of your kidney disease:

  • A formal diagnosis and physical exam notes
  • Repeated and recent urinalysis results, documenting serum creatinine and albumen
  • Imaging scans, if you have kidney or renal abnormalities
  • Renal biopsy results and any surgical notes
  • Neurological exam results, if you experience nephropathy
  • Other diagnostic test results documenting any complications of your kidney disease
  • A statement from your doctor, outlining the diagnosis, treatment, and prognosis

Medically Qualifying Through an RFC Analysis

The Social Security Administration utilizes a comprehensive set of medical guidelines, commonly referred to as the Blue Book, to determine whether a case qualifies for disability benefits.

In some cases, the SSA will rule that even though you have a condition like kidney disease, the disease will not prevent you from doing work and if you are capable of working then you are not qualified to receive disability benefits.

However, your condition could still prevent you from working and so the SSA will request that you will out a residual function capacity form (RFC). The RFC form helps to determine how much work you are capable of performing given your condition.

Your doctor will be the one to fill out and submit the RFC form, which allows the SSA to trust that the information provided is accurate.

Since your doctor is likely the one who diagnosed your condition and is responsible for your treatment, your doctor knows how much you are capable of doing and what you cannot do, in addition to how you are responding to treatment and any side effects you might be encountering.

This is all very valuable information because it paints a picture of your unique situation and your actual abilities and limitations, which is something that the Blue Book cannot do.

The RFC form will allow you and your doctor to outline your treatment plan and how the treatment for your kidney disease might make it difficult for you to keep up with the demands of your job.

You should inform your doctor as soon as you are diagnosed with your plan to file for disability benefits so that he or she can help you obtain all of the information needed for both the application and the RFC form.

Getting Help with Your Claim

While qualifying for disability is often clear-cut with kidney disease, not all applicants experience a quick or smooth case review. Work closely with your doctor to document your illness and to ensure the SSA has the information and medical records they need to evaluate your claim. You may wish to seek help of an experienced Social Security advocate or attorney as well, especially if your kidney disease prevents you from working but does not meet one of the Blue Book listings mentioned above.