Get Social Security Disability & SSI Benefits: Kidney Disease

Winning Your Case

Social Security considers you disabled for SSDI and SSI disability benefits with kidney disease when you prove two things:

1. Non-Medical Criteria, and
2. Disability Criteria.

Proving the disability criteria means –

1. You know how Social Security reviews a kidney disease case (discussed on this page);
2. You satisfy a kidney disease Social Security Listing (also discussed on this page) or you have disabling Functional Limitations (discussed on the next page); and
3. You Submit Winning Evidence (discussed on the next, next page).

Social Security’s Rationale – Kidney Disease And Your Medical Evidence

Kidney disease, or kidney failure, can cause serious symptoms and disability, and it is the ninth leading cause of death in America. It is a frequent basis of a Social Security disability & SSI application. Your kidneys filter your blood, and kidney disease means the loss of kidney function. In nearly all cases, kidney disease is irreversible.

It is essential to Social Security that you have diagnostic testing to establish you have kidney disease and to establish its severity. A diagnosis is made with a blood tests; urine tests; liver CT, MRI, ultrasound, or biopsy. Your stage of kidney disease is determined by blood test that checks your glomerular filtration rate (GFR) – how much blood your kidney can filter in one minute.

There are five stages of kidney disease (loss of function):

1. Stage 1 – Normal
2. Stage 2 – Mild
3. Stage 3a – Mild to Moderate
4. Stage 4b – Moderate to Severe
5. Stage 4 – Severe
6. Stage 5 – End Stage Failure

Social Security spends a great deal of time evaluating your medical treatment and records. Kidney treatment is based on the stage of your kidney disease. If you have stage 4 or 5 kidney disease, you will need dialysis or a kidney transplant. Kidney dialysis is done with either hemodialysis (a machine is used to filter your blood) or peritoneal dialysis (a solution called dialysate is placed into your stomach and the lining of your abdomen is used to filter your blood). If you have stage 1-3 kidney disease, the kidney disease itself is not treated and treatment is instead limited to a low-protein diet, lowering your cholesterol, calcium and vitamin D supplements, and treating your symptoms.

When Social Security reads your file, it will look for both you and your doctor’s descriptions of your kidney disease symptoms. It will read what you report to your doctor, and it will read both your doctor’s opinion and his medical evaluations about your physical condition. The degree of symptom severity depends on the stage of kidney disease but generally include:

1. Fatigue,
2. Weakness,
3. Nausea and sickness,
4. Muscle aches,
5. Swelling,
6. Anemia,
7. Urination changes, and
8. High blood pressure.

Social Security & SSI Kidney Disease Listings

Chronic Kidney Disease

An adult meets Adult Listing 6.05 if they meet points 1, 2, and 3. A child meets Child Listing 106.05 if they meet points 1 and 2.

1. Kidney dysfunction;
2. Impaired glomerular filtration; and
3. One of the following –
   • Renal osteodystrophy,
   • Peripheral neuropathy,
   • Fluid overload syndrome, or
   • Anorexia with weight loss.

Chronic Kidney Disease With Dialysis

An adult meets Adult Listing 6.03 and a child meets Child Listing 106.03 if you or your child undergo hemodialysis or peritoneal dialysis for at least 12 months.

Complications Of Chronic Kidney Disease

An adult meets Adult Listing 6.09 and a child meets Child Listing 106.09 if you or your child have at least three medical center visits (lasting at least 48 hours each) within a year at least 30 days apart.

Nephrotic Syndrome

An adult meets Adult Listing 6.06 and a child meets Child Listing 106.06 for a nephrotic syndrome (your body produces too much protein) if you or your child have lab findings showing abnormal proteinuria or serum albumin levels and anasarca (a severe form of widespread edema). The lab findings must occur twice in a year at least 90 days apart.

Child’s Failure To Grow Due to Renal Disease

A child meets Child Listing 106.08 if they meet one of the following:

1. A serum creatinine level of at least 2 mg/dL at least twice in a year at least 60 days apart, and
2. Limited growth (primarily based on the child’s weight).

Congenital Genitourinary Disorder

A child meets Child Listing 106.07 if your child has three or more urologic surgeries in a 12-month period each at least 30 days apart. Your child will be found disabled for one year after the last surgery. Then Social Security will consider whether your child’s disability continues.

Kidney Transplant

An adult meets Adult Listing 6.04 and a child meets Child Listing 106.04 for one year. Thereafter Social Security will evaluate the claim for continued disability.