How Does Social Security Evaluate Kidney Disease?
Social Security evaluates kidney failure under its disability listings for "genitourinary" impairments. These listings grant disability benefits in cases where the following is present:
regular dialysis treatment
a kidney transplant
reduced glomerular filtration combined with symptoms of damage
nephrotic syndrome, or
severe complications of kidney disease.
Even If you don't have any of these problems, but still can't work due to your kidney failure, you can still win disability benefits if you can show Social Security your condition causes severe limitations that would prevent you from working.
First, let’s look at at Social Security's disability listings on kidney failure.
Chronic Kidney Disease
Under Listings 6.03. 6.04, and 6.05, SSA will grant automatic disability for poor kidney function caused by any chronic (not acute) disease, if just one of the following is present:
ongoing peritoneal dialysis
ongoing hemodialysis (the removal of toxins from the blood with an artificial kidney machine)
kidney transplant, 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).
Nephrotic Syndrome
Under Listing 6.06, your kidney disease must show 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 approved for social security disability benefits under this listing, it requires you 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
Even If you have kidney disease but don't meet one of the listings above, don’t worry, you can be approved if you experience serious complications. For example, if you were hospitalized at least three times for kidney complications within one year, you can qualify under listing 6.06.
Medical Evidence Required
Social Security needs a deep medical history that includes a record of all hospitalizations, medical treatment notes, and laboratory findings that document worsening renal disease. Clinical or lab evidence that shows a deterioration of kidney function is also very important to have. For example, lab findings that show an elevation of serum creatinine or proteinuria is helpful. Additionally, Social Security likes to see current clinical observations and treatment notes.
If an individual is undergoing dialysis treatment, there should be lab findings that document renal function prior to the start of dialysis, and a doctor's medical 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.
Finally, the records must include serum albumin and proteinuria levels.
Benefits for Claimants with a Kidney Transplant
A kidney transplant will automatically approve you for 12 months of disability automatically. After that year, Social Security will evaluate ongoing disability upon an individual's residual functional impairments. When Social Security evaluates whether an individual has shown medical improvement post-transplant, SSA will consider things like kidney rejection, renal infection frequency, side effect of medications and corticosteriod treatment, neuropathy, or other organ deterioration.
Disability Based on Functional Limitations
If your kidney disease does not meet any of the above listings, Social Security will considers the effect of the disease on your activities of daily living. Social Security will review your symptoms and decide how they limit your ability to work. If you can have your doctor provide a medical
opinion with regards to your limitations and restrictions, that will also help. Social Security will usually come up with a "residual functional capacity" (RFC) rating based on the type of work they believe you can do. That means it’s up to SSA to decide if you can do medium, light, or even sedentary work. So having a medical opinion from your physician will help to show SSA what your doctor reasonably believes your limitations to be. Some patients with kidney failure or nephrotic disease suffer from bone pain, fatigue, shortness of breath, trouble exhaling or swelling of the knees and/or feet. These symptoms can cause problems with walking or standing for extended periods, which could limit your ability to perform no more than a sedentary type job. In assessing your RFC, SSA also factors in side effects of therapy and medication, effects of any post therapeutic residuals, and the anticupdated duration of treatment. Social Security will also factor in your age, education, and work experience to see if there are any types of work you may be able to do. For example, if you are 55 years of age and have only done unskilled previous work, and you have a limited education, SSA will likely grant you social security disability benefits if they’ve limited you to only sedentary work because of fatigue, anemia, and bone pain caused by your kidney disease. The medical vocational allowance rules AKA GRID rules will also apply in this scenario.