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Chronic Kidney Disease and Social Security Disability Insurance

Chronic Renal Disease SSDI Guidelines
Here is an explanation of Social Security's five-step process to determine if a patient with chronic kidney disease qualifies for SSDI:
 
  1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,040 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
     
  2. Conclude the chronic kidney disease disability must be severe enough to significantly limit one's ability to perform basic work activities needed to do most jobs. For example:
  • Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
  • Seeing, hearing and speaking
  • Understanding/carrying out and remembering simple instructions
  • Responding appropriately to supervision, co-workers and usual work situations
  • Dealing with changes in a routine work setting
 
  1. Chronic kidney disease is listed under the category of impairments known as the Genitourinary System - Medical Listing 6.00. The following criteria have been established indicative of the inability to engage in any substantial gainful activity, i.e., if one has a diagnosis of chronic kidney disease and one of the following, a finding of disabled under the Social Security Act is warranted:
  • Renal dysfunction is characterized by impairment of renal function, due to any chronic renal disease that has lasted or can be expected to last for a continuous period of at least 12 months, such as chronic glomerulonephritis, hypertensive renal vascular disease, diabetic nephropathy, chronic obstructive uropathy and hereditary nephropathies.
  • Other considerations evaluated with chronic kidney disease include chronic hemodialysis or peritoneal dialysis, kidney transplantation (warrants a finding of disabled for 12 months following surgery and then further evaluation occurs), persistent elevation of serum creatinine to 4 mg per deciliter (100 ml) or greater, or reduction of creatinine clearance to 20 ml per minute or less, over at least three months, with one of the following:
 
  • Renal osteodystropy manifested by severe bone pain and appropriate medically acceptable imaging demonstrating abnormalities such as osteitis fibrosa, significant osteoporosis, osteomalacia, or pathologic fractures, or;
  • Persistent motor or sensory neuropathy; or
  • Persistent fluid overload syndrome with:
    • Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg; or
    • Persistent signs of vascular congestion despite prescribed therapy; or
     
  • Persistent anorexia with weight loss determined by body mass index (BMI) of less than 18.0, calculated on at least two evaluations at least 30 days apart within a consecutive six-month period (medical listing 5.00G2).
 
  • Medical evidence establishing the clinical diagnosis of nephrotic syndrome also is considered and must include a description of the extent of edema, including pretibial, periorbital or presacral edema, persisting for at least three months despite prescribed therapy with:
       
    • Serum albumin of 3.0 g per dL (100ml) or less and proteinuria of 3.5 g or greater per 24 hours; or
    • Proteinuria of 10.0 or greater per 24 hours.
    • Other medical evidence should describe any ascites, pleural effusion or pericardial effusion, as well as a report if a renal biopsy has been performed.          
  • Effects of treatment are considered by type of therapy, response to therapy, side effects of therapy and effects of any post-therapeutic residuals.
 
  1. Explore the ability of an individual to perform work they have done in the past despite their chronic kidney disease. If the SSA finds that a person can do his or her past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
     
  2. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine chronic kidney disease disability, the SSA enlists medical-vocational rules, which vary according to age.
For example, if a person is:
 
Under age 50 and, as a result of the symptoms of chronic kidney disease, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
 
Age 50 or older and, due to chronic kidney disease, limited to performing sedentary work, but has no work-related skills that allow the person to do so, the SSA will reach a determination of disabled.
 
Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow the person to do so, the SSA will reach a determination of disabled.
 
Over age 60 and, due to chronic kidney disease, unable to perform any of the jobs he or she performed in the last 15 years, the SSA likely will reach a determination of disabled.
 
Any age and, because of chronic kidney disease, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of disabled.
 

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