Did you know that your kidneys filter all the blood in your body every 30 minutes? That’s amazing for an organ the size of your fist. In fact, properly functioning kidneys are vital since they regularly remove toxins, waste, and excess fluids from your system. But for the 37 million Americans with Chronic Kidney Disease (CKD), this functional filtration breakdown may have debilitating health consequences.
As a result of complications, many individuals diagnosed with CKD may find it difficult to work or earn any income. But is CKD eligible for disability? The short answer is yes, but you’ll have to meet strict financial and medical requirements. Here is what you need to know to qualify.
What are the Symptoms and Risk Factors for CKD?
Chronic kidney disease, also known as chronic renal disease, is basically a gradual loss of kidney function over time. When the kidneys stop working because of damage, trauma, or disease, the body can no longer properly filter blood. This then leads to a buildup of excess waste and fluid in the body which in turn may cause other health issues, such as:
- Heart disease/cardiovascular issues
- Anemia/low red blood cells
- Low calcium levels (leading to weak bones)
- Loss of appetite/poor nutritional health
- Depression/lower quality of life
Diabetes and high blood pressure are responsible for two-thirds of CKD cases. Other causes may include obesity, heredity/genetics, diseases that damage the kidneys, repeat urinary tract infections, and autoimmune conditions like lupus.
More than one in seven adults suffer from CKD, according to the Centers for Disease Control and Prevention. And heart disease is actually the primary cause of death for people with CKD. So obviously, the purification of blood in the body is imperative.
Severe symptoms of CKD are usually absent until the disease progresses, but preliminary signs may include:
- Fatigue/less energy
- Difficulty concentrating
- Swelling in the feet and ankles
- Trouble sleeping
- Muscle cramping
- Changes in the need to urinate (more or less frequently)
- Puffiness around the eyes (especially in the a.m.)
- Dry/itchy skin
Early detection and treatment can help CKD from getting worse. Without proper care it may eventually lead to total kidney failure, which then requires dialysis or a kidney transplant.
When is Disability Available for Patients with CKD?
The Social Security Administration (SSA) will evaluate individuals with CKD according to their “Blue Book” listing for “Genitourinary” disorders. Under this category (Section 6.00), there are a few ways that someone with CKD may qualify for disability benefits.
However, before worrying about the medical qualification aspect, an applicant must also consider if they meet the financial requirements. To be eligible for Social Security Disability Insurance (SSDI), an applicant must demonstrate sufficient work history. In 2023 they must also show they make less than $1,470/month from Substantial Gainful Activity (SGA).
Those who don’t meet the work history requirement may still qualify for assistance through the Supplemental Security Income (SSI) program. However, this is only available for applicants who are very low income with minimal assets.
Additionally, all applicants will have to show they’re unable to work for at least one year because of their condition. If these stipulations are met, then they should proceed with the medical proof part of the application.
What Medical Proof is Necessary for a Disability Application for CKD?
There are several ways someone with CKD can satisfy the SSA’s medical determination for disability benefits.
Listings 6.03 and 6.04 in the SSA’s manual grant disability for individuals with poor kidney function resulting from chronic disease.
In section 6.03, the applicant must show that they have CKD that requires regular peritoneal dialysis or hemodialysis. This means they need regular purification of their blood via artificial means.
Section 6.04 is for CKD applicants with a kidney transplant. A patient undergoing transplantation will automatically qualify for disability benefits for a year after the surgery. At the end of 12 months, the SSA will then review the claim for continued need.
Claimants in either of these categories will need to supply evidence from a qualified medical professional such as a nephrologist. Medical, blood, and urine test results must be part of a disability application, as well as a complete medical history. Applicants undergoing dialysis should have lab results that document renal function prior to the start of dialysis. It is also important to supply a doctor’s statement as to the need for ongoing dialysis. Basically, the more records one can submit, the better.
What If I Don’t Yet Need Dialysis or a Kidney Transplant?
If dialysis or a transplant aren’t yet necessary, it may still be possible to qualify for disability through section 6.05. However, “Chronic Kidney Disease with Impairment of Kidney Function” is more complicated to prove than a cut-and-dry dialysis/transplant case. For this listing an applicant must show “reduced glomerular filtration” (meaning the kidneys aren’t working well enough to clear waste).
To prove this, the SSA requires an applicant show one of the following laboratory findings on two separate occasions:
- Serum creatinine of 4 mg/dL or greater.
- Creatinine clearance of 20 ml/min or less.
- Estimated glomerular filtration rate (eGFR) of 20 ml/min/1.73m2 or less.
Medical/blood tests are necessary to collect this evidence, and the two tests must be at least 90 days apart. In addition to the above, the CKD patient must also demonstrate they’re experiencing at least one of these concurrent conditions:
- Severe bone pain and abnormalities (renal osteodystrophy).
- Peripheral neuropathy.
- Fluid overload syndrome documented by high diastolic blood pressure, vascular congestion (blood pooling in the veins), or major edema/swelling. This must be despite taking medication to treat the syndrome’s manifestation.
- Serious unintentional weight loss (with a Body Mass Index of 18.0 or less).
Listing 6.06 covers “Nephrotic Syndrome.” This is a group of kidney diseases characterized by excessive skin swelling and protein loss in the urine (proteinuria). To qualify through this listing, an applicant must exhibit extreme edema for 90 days. They must also provide two separate tests at least three months apart showing:
1. High urine protein levels of 10.0 g or greater per 24 hours.
2. Serum albumin of 3.0 g/dL or less with either:
- Moderate protein levels in the urine of 3.5g or greater every 24 hours, or
- Urine total protein-to-creatinine ratio of 3.5 or greater.
Disability for Chronic Kidney Disease Complications
If an applicant doesn’t match the SSA’s Blue Book listings, it’s still possible to get disability with proof of consistent CKD complications. This might include conditions like stroke, congestive heart failure, or acute (as opposed to chronic) kidney failure requiring hemodialysis. A patient may qualify if they have three hospitalizations for complications lasting at least 48 hours in a 12-month period. This is in section 6.09 of the “Blue Book.”
There is one final option for individuals who don’t fit neatly into any CKD category. That is to ask the SSA to consider the case in relation to Residual Functional Capacity (RFC). RFC is an assessment of how a medical condition may cause physical and mental limitations in a person’s work setting.
The SSA will look at an applicant through the lens of their RFC and how that would impact work ability. If the SSA determines that their symptoms stop them from being able to work, then they will award disability benefits.
When to Get Legal Help for a CKD Disability Application
Not all patients with CKD will find that their disease progresses to total kidney failure. However, CKD is also not something that will just go away. And there are ramifications from chronic kidney struggles that may negatively affect a person’s health in other ways.
If you have a CKD diagnosis that’s keeping you from working, consider a free consultation with a Social Security attorney. As you may have learned reading this article, while CKD will often qualify for benefits, the process is frequently confusing. But, with representation, you are 3x more likely to have a successful claim on the first try.
CKD is a long-term condition, so don’t hesitate to get the help you need to manage your life. Click the button below to sign up for a free phone call with a helpful advocate today:
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Kimberly Dawn Neumann
Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter @KimberlyNeumann