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Disability Benefits for Kidney Disease, Transplant & Dialysis

Disability Benefits for Kidney Disease, Transplant & Dialysis

If you meet all non-medical eligibility requirements for Social Security Disability, then a kidney transplant will make you eligible for 12 months of disability benefits if you are approved. After that period, the Social Security Administration will evaluate your symptoms for 'ongoing disability for residual symptoms'.

What is considered adequate kidney disease for SSDI?

Your kidneys are the natural filters that remove toxins and waste from the body. If the kidneys stop working well, toxic fluid can build up and deposit within the body causing problems like high blood pressure, and at some point, kidney failure.

Many a times doctors prefer to perform a kidney transplant than a dialysis – this is due to the fact that people with a transplant live longer than people on dialysis, which uses a machine or a tube to filter and clean the blood mimicking the functionality of kidneys.

However, both processes require timely and frequent visits to the doctors, dialysis requiring two to three visits a month, etc. Moreover, the treatments are costly. Likewise any kidney disease itself, whether it is being treated by dialysis or a kidney transplant is painful and makes a person usually unable to perform substantial gainful activity (SGA) to earn a handsome livelihood on their own.

This is because claimants with a kidney disease with eligibility for SSDI are very likely to be approved for SSDI benefits. It does not need to be reinforced that people with an end-stage renal failure (also called kidney failure or chronic renal failure) are more likely to receive SSDI benefits.

How does the Social Security Administration assess Kidney Disease?

The Social Security Administration has listed kidney disease in its Blue Book of Impairments in various different categories including kidney cancers, cancers of the urinary tract or reproductive tract. It also includes chronic renal problems that require dialysis. Yet, having kidney disease is not sufficient to win disability benefits. You will need to prove to the SSA that your disability is severe enough to cause you limitations in your daily functioning due to particular disabilities like urinary disorder, urinary tract cancer or reproductive cancer, etc.

The SSA evaluates kidney failure under its disability listings for 'genitourinary disorders' – this may include various kinds of symptoms including one or more of the following:

  • -Pathology lab reports;
  • -Need for dialysis;
  • -Completion of a kidney transplant;
  • -Nephrotic syndrome;
  • -Reduced glomerular filtration combined with symptoms of damage;
  • -Serious complications of kidney disease;
  • -Ongoing hemodialysis (using an artificial kidney machine for the removal of toxins from the blood);
  • -Ongoing peritoneal dialysis (a method of hemodialysis that involves dialyzing solution being put into and removed from the peritoneal cavity intermittently or continuously);

Reduced glomerular filtration can be shown by lab reports indicating persistently a) high levels of serum creatinine (a natural product of muscle metabolism), b) low estimated glomerular filtration rate (eGFR) and c) reduced creatinine clearance levels. To qualify for benefits based on reduced glomerular filtration, you must also be able to prove that you suffer from the following:

  • -Renal bone degradation or bone pain;
  • -Peripheral neuropathy (inability to filter the toxic substances from the blood);
  • -Fluid overload syndrome even after taking medication, shown by medical documentation indicating diastolic hypertension, signs of vascular congestion or anasarca (massive edema or swelling), or anorexia with weight loss and BMI of 18 points or less;

*Note that the serum creatinine levels evaluated for SSDI for kidney disease are assessed for the last three month period: i) above 4 mg per deciliter and ii) at a clearance level of 20 ml or lower per minute; **In addition to the above, the SSA will evaluate for the following:

  • -renal osteodystopy;
  • -motor or sensory nephropathy;
  • -Chronic fluid overload syndrome, accompanied by diastolic hypertension, vascular congestion, or anorexia

However, the above symptoms are not exclusive to win Social Security benefits. Instead if you have other symptoms of kidney disease and are able to prove that they are severe enough to cause disability in your daily functioning, then you have a high chance of winning the disability benefits.

Other than the above, the SSA may evaluate you for nephrotic syndromes based on the following which is also covered by the SSA's listing 6.06 in the Blue Book of Impairments.

Nephrotic Syndrome

This covers a group of kidney diseases that are indicated by increased levels of protein in the urine (proteinuria) and swelling (edema) of various levels. Sometimes low serum albumin (hypoalbuminemia) and hyperlipidemia (high cholesterol) may also be present. The SSA will evaluate for three months plus results of extreme edema indicated by the following medical documentation:

  • -very high levels of protein in the urine, or
  • -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;

Other nephrotic syndrome may include:

  • -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;
  • -Consistent levels of serum albumin of 3.0 per deciliter or lower AND elevated proteinuria of 3.5 g or higher over a 24-hour period;
  • -Proteinuria measurements over a 24-hour period of 10 g or higher AND a total-protein-to-creatinine ratio of 3.5 or higher;
  • -History of hospital stays started in the ER and resulted in inpatient treatment of at least 48 hours

However, since each person and their disability symptoms differ, every person will have to be evaluated based on individual symptoms. It is very important to be able to not only present your case effectively but also reap full benefits of the Disability claims for kidney diseases. Moreover, the SSA will also grant you disability benefits based on the RFC symptoms of sedentary work such as fatigue, anemia and bone pain caused by your kidney disease. A professional disability advocate is very professional and knows the 'how-tos' of presenting the case properly.

If you or a loved one with kidney disability need help filing for the SSDI or an appeals process, you may seek counsel of our disability lawyers for legal advice.

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Saturday, 24 October 2020