Can I Get Disability Benefits for Kidney Disease?

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Chronic renal failure (CRF) caused by kidney disease can qualify you for Social Security Disability (SSD) benefits in many circumstances. It’s not important what has caused your kidney disease (such as diabetes, infections, drug use, or hypertension), just that you have symptoms of renal (kidney) failure that is chronic (not short-term). CRF can also be referred to as chronic kidney failure (CKF) or end-stage renal disease (ESRD, usually used for dialysis or transplant patients).

Getting Disability Benefits for Kidney Diseases

To qualify for disability benefits, your kidney disease must be expected to last 12 months. In addition, your condition must fall into one of the following scenarios you can use to qualify for disability benefits when you are suffering from renal failure.

  • Regular dialysis needed
  • Kidney transplant completed
  • High creatine levels combined with symptoms of damage
  • Nephrotic syndrome, or
  • Symptoms that reduce your capacity for working.

Dialysis

Chronic hemodialysis (direct removal of waste products from blood) or peritoneal dialysis (removal of waste products from blood by inserting fluids into the abdomen) is a strenuous, time-consuming process that leaves most people feeling physically and mentally depleted. It’s at the beginning of dialysis, if not sooner, that many kidney patients find it necessary to file for disability benefits. Since most people cannot receive daily dialysis and work, if you are actively receiving chronic daily dialysis, you will qualify for disability benefits. (Some patients receive continuous ambulatory peritoneal dialysis (CAPD), which allows them to function more normally, but this type of dialysis also qualifies for disability benefits, even if the patient could do some type of work.)

Kidney Transplant

You automatically qualify for disability benefits for the 12 months following a kidney transplant, since this transplantation surgery has a long recovery time and high change of rejection and infection. You don’t qualify for disability benefits under this subcategory of renal function impairment if you need a transplant or are about to receive a transplant; the transplant must have been completed.

High Creatine Levels

If your serum creatine levels are elevated to a certain point, and this elevation has lasted three months or more, it is evidence that your kidneys cannot clear waste products sufficiently and will lead to damage. To qualify under this subcategory, you must also have one of the following symptoms:

  • Bone abnormalities (called renal osteodystrophy, the weakening or thinning of bones)
  • Nerve damage (persistent motor or sensory neuropathy, a decrease in your ability to feel touch)
  • Fluid overload syndrome (uncleared fluid, causing high blood pressure or  vascular congestion), or
  • Lack of appetite (“anorexia,” causing weight loss).

For more detailed information, see the SSA’s official impairment listing for renal failure (Listing 6.02).

Nephrotic Syndrome

Nephrotic syndrome is a malfunctioning of the kidneys that causes protein to be lost in the urine. To qualify for disability for nephrotic syndrome, you need to have had whole body swelling (edema) for three continuous months that is accompanied by either:

  • Low serum albumin levels with moderately high levels of protein in the urine, or
  • Very high levels of protein in the urine.

For detailed information on the required levels of serum albumin and proteinuria, see the SSA’s official impairment listing for nephrotic syndrome (Listing 6.06). Note that it’s harder to get disability benefits for nephrotic syndrome than for the three subcategories above (dialysis, transplant, or creatine levels).  

Symptoms Affecting Your Functional Capacity

If you don’t qualify under one of the above four subcategories of kidney problems, the SSA will consider your symptoms and impairments to see how much they impair your daily activities and if there is any kind of work you could do.

Many patients suffering from chronic kidney disease suffer from fatigue, anemia, and/or lack of appetite, and they often develop mobility problems – even though they aren’t yet a candidate for regular dialysis or a transplant. Tell your doctor and the SSA of the various symptoms caused by your kidney disease. The SSA will give you a rating of the type of work it thinks you can do (less than sedentary work, sedentary work, light work, or medium work), called your residual functional capacity (RFC), and then will look at your age, education, and work experience to see if you can do any type of work or if you can’t be expected to work given your symptoms, age, experience, and education. For instance, if you are 50 years old, have only done what’s considered “unskilled work,” and you didn’t graduate from high school, the SSA is likely to grant you disability benefits if you’ve been given an RFC of sedentary work because of fatigue, anemia, and bone pain caused by your kidney disease.

Medicare

If you are found eligible for Social Security disability insurance (SSDI) benefits (not SSI, Supplemental Security Income), normally there is a two-year waiting period before you are eligible for Medicare. However, if you are undergoing dialysis or require a kidney transplant (that is, you have end-stage renal disease), you can get Medicare three months after your dialysis begins. If you are found to qualify for SSI disability benefits, you will be eligible for Medicaid right away.

Kidney Problems That Don’t Qualify for Disability

You cannot get disability benefits just because you have a single kidney; only if your solitary kidney is failing and you have the symptoms we discussed above can you get can disability benefits.

Acute kidney failure, which can occur from infection, drug toxicity, or dehydration, is usually reversible and will not last twelve months, which is a requirement for getting Social Security benefits. Thus, it doesn’t qualify for disability benefits.

Non-dialysis dependent chronic kidney disease (NDD-CKD), kidney disease that does not yet require maintenance dialysis or a kidney transplant, will not qualify for disability benefits, unless your condition can qualify under the high creatine subcategory or the symptoms affecting your functional capacity subcategory.

Starting a Disability Claim

The Social Security Administration (SSA) provides two different programs for those seeking disability benefits. Under the Supplemental Security Income (SSI) program, the SSA looks mainly at the severity of the disability and the financial neediness of the applicant. Under the Social Security disability insurance (SSDI) program, the SSA looks at the severity of the disability and whether the individual has paid enough taxes in to the Social Security system.

Social Security claimants with kidney failure requiring dialysis or a kidney transplant may be entitled to a quicker disability determination process. Call the SSA at 800-772-1213 to set up an appointment to apply for disability, or, if you’re applying for SSDI (you’ve paid taxes into the Social Security system over a number of years), go online to www.ssa.gov.

Appealing a Denied SSDI Claim

If your disability application has been denied, you can file a request for reconsideration with the SSA. At this point, if you’re suffering from worsening kidney disease, you should probably contact a lawyer to help with your appeal. Don’t let lack of money to pay your attorney stop you from hiring one. Disability lawyers are paid out of your back payment on the eventual disability award you’ll receive; if you don’t get an award, the attorney doesn’t get paid. (You can make sure any lawyer you hire expressly states in your contract that he or she is not due any fees until your benefits are successfully obtained.)

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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