CHRONIC KIDNEY DISEASE & SSD BENEFITS
Chronic Kidney Disease (CKD) can result in disabling impairments which prevent you from working. If you have CKD you may qualify for Social Security Disability Insurance (SSDI) and Supplemental Security Income benefits. In order to be eligible for SSD benefits, you must have a disability that keeps you from working for over 12 months. SSD and SSI benefits are designed for people who cannot work at any job.
WHAT IS CHRONIC KIDNEY DISEASE?
Chronic Kidney Disease is longstanding disease of the kidneys which leads to renal failure. Your kidneys filter waste and excess fluid from your blood. If your kidneys start to fail, then waste builds up. Because of that waste build up, you may develop symptoms of CKD. However, some people have no symptoms at all and are diagnosed with the disease by a lab test. Medications can help manage the symptoms of CKD. In the late stages of the disease, you may have to filter your blood with a machine. This is known as dialysis. In severe cases, a kidney transplant may be needed.
If you have end-stage renal disease, then you have a presumptive disability. Learn more about presumptive disability benefits for end-stage renal disease here. The main risk factors for developing kidney disease are having diabetes, high blood pressure, heart disease. Another main risk factor is a family history of kidney failure.
The SSA evaluates chronic kidney disease under listing 6.00. The SSA lists CKD as part of the category of genitourinary disorders. Other examples of these disorders include chronic glomerulonephritis and hypertensive nephropathy. The listing also includes diabetic nephropathy, chronic obstructive uropathy, and hereditary nephropathies. The SSA also evaluates nephrotic syndrome due to glomerular dysfunction under listing 6.00.
CKD IN THE UNITED STATES
According to the Center for Disease Control and Prevention, chronic kidney disease is the “leading cause of death in the United States.”
- About 37 million US adults are estimated to have CKD, and most are undiagnosed.
- 40% of people with severely reduced kidney function are not aware of having CKD.
- Every 24 hours, 360 people begin dialysis treatment for kidney failure.
- In the United States, diabetes and high blood pressure are the leading causes of kidney failure, representing about 3 out of 4 new cases.
- Medicare costs for people with CKD were over $81.8 billion in 2018, or $23,700 per person.
- Total Medicare spending (excluding prescription drugs) for patients with end stage renal failure or kidney failure reached $36.6 billion in 2018, or $80,000 per person, accounting for about 7% of the Medicare costs.
Obviously, CKD is a severe disease with enormous cost, both to the individual and society. One of the most difficult issues to overcome is giving people more tools to understand CKD’s symptoms, so that they can obtain earlier medical treatment.
SYMPTOMS OF CHRONIC KIDNEY DISEASE
Symptoms of chronic kidney disease develop over time, because kidney damage progresses slowly. Unfortunately, many people do not realize they have kidney damage until it becomes severe. Depending on how severe it is, the following is a list of symptoms that people experience when they have kidney damage:
- Loss of appetite
- Fatigue and weakness
- Sleep problems
- Urinating more or less
- Mental fog
- Muscle cramps
- Swelling of the feet and ankles
- Itchy and dry skin
- Uncontrolled high blood pressure
- Shortness of breath due to fluid build up in the lungs
- Chest pain, if fluid builds up around the lining of the heart
Signs and symptoms of kidney disease are often very similar to symptoms caused by other illnesses. Because your kidneys are able to make up for lost function, you might not develop signs and symptoms until irreversible damage occurs. Make sure you talk to your doctor if you have any of the above symptoms. Ask for tests to check your kidney function.
CAUSES OF CHRONIC KIDNEY DISEASE
Chronic kidney disease occurs when a medical condition impairs kidney function. Diseases and conditions that cause chronic kidney disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis – an inflammation of the kidney’s filtering units
- Interstitial nephritis – an inflammation of the kidney’s tubules and surrounding structures
- Polycystic kidney disease or other genetically inherited kidney diseases
- Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones or cancer
- Vesicoureteral reflux – a condition that causes urine to back up into your kidneys
- Pyelonephritis – which is recurrent kidney infection
- Lupus nephritis
If you have any of the above medical conditions, it is important to ask your primary care physician to test your kidney function on a routine basis. This can be done through blood work. If your blood tests show kidney impairment, then you can receive treatment before significant damage occurs.
CHRONIC KIDNEY DISEASE UNDER LISTING 6.05
The SSA evaluates chronic kidney disease under listing 6.00. Unfortunately, the listing isn’t particularly straightforward for those of us who are not doctors. The reason why the listing is hard to understand is that it focuses on the results of kidney function tests. These tests need to be done by a doctor. Below you will find listing 6.05 for chronic kidney disease. The listing goes into detail about the types of tests you need in order to prove your are eligible for disability benefits.
6.05 Chronic kidney disease, with impairment of kidney function, with A and B:
A. Reduced glomerular filtration evidenced by one of the following laboratory findings documented on at least two occasions at least 90 days apart during a consecutive 12-month period:
- Serum creatinine of 4 mg/dL or greater; or
- Creatinine clearance of 20 ml/min. or less; or
- Estimated glomerular filtration rate (eGFR) of 20 ml/min/1.73m2 or less.
B. One of the following:
- Renal osteodystrophy (see 6.00C3) with severe bone pain and imaging studies documenting bone abnormalities, such as osteitis fibrosa, osteomalacia, or pathologic fractures; or
- Peripheral neuropathy (see 6.00C4); or
- Fluid overload syndrome (see 6.00C5) documented by one of the following:
- Diastolic hypertension greater than or equal to diastolic blood pressure of 110 mm Hg despite at least 90 consecutive days of prescribed therapy, documented by at least two measurements of diastolic blood pressure at least 90 days apart during a consecutive 12-month period; or
- Signs of vascular congestion or anasarca (see 6.00C6) despite at least 90 consecutive days of prescribed therapy, documented on at least two occasions at least 90 days apart during a consecutive 12-month period; or
- Anorexia with weight loss (see 6.00C7) determined by body mass index (BMI) of 18.0 or less, calculated on at least two occasions at least 90 days apart during a consecutive 12-month period.
PERIPHERAL NEUROPATHY UNDER LISTING 6.05
Peripheral neuropathy disorder results when your kidneys do not properly filter toxic substances from your blood. These toxins can affect nerve tissue. The resulting neuropathy may affect peripheral motor or sensory nerves. Neuropathy causes pain, numbness, tingling, and muscle weakness in various parts of the body. Typically, neuropathy occurs in the hands and feet.
Under 6.05B2, peripheral neuropathy must be a severe impairment. A severe impairment means that it impairs your ability to do daily activities, like sit, stand, walk, and lift. The impairment must also last or be expected to last for a continuous period of at least 12 months.
FLUID OVERLOAD SYNDROME
If you have chronic kidney disease, you may have fluid overload syndrome. This condition occurs when the body retains excess sodium and water, and CKD causes vascular congestion. Under 6.05B3, the SSA requires a physical examination that documents the signs and symptoms of vascular congestion. These are congestive heart failure and pleural effusion (excess fluid in the chest). Other signs and symptoms include ascites (excess fluid in the abdomen), hypertension, fatigue, shortness of breath, and peripheral edema.
Anasacra is generalized massive edema or swelling. The SSA needs a medical description of the extent of edema from your doctor. The doctor’s records should include a description of the edema in the pretibial (in front of the tibia), periorbital (around the eyes), or presacral (in front of the sacrum). The SSA will also need a description of any ascites, pleural effusion, or pericardial effusion.
Anorexia is diminished appetite with weight loss. One of the frequent signs of chronic kidney disease is anorexia. The reason why is that CKD can often result in significant weight loss.
The SSA uses the body mass index (BMI) test to determine the severity of your weight loss under 6.05B4. Your BMI is the ratio of your measured weight to the square of your measured height. The formula for calculating BMI is in section 5.00G. You can also find a BMI calculator online. A BMI calculator will determine your BMI for you, after you enter your height and weight.
NEPHOTRIC SYNDROME UNDER LISTING 6.06
Another element of the listing for chronic kidney disease is nephrotic syndrome. SSA’s listing outlines the requirements for nephrotic syndrome under listing 6.06 of SSA’s “blue book.” This particular listing will require your doctor to test your proteinuria and serum albumin.
6.06 Nephrotic syndrome, with A and B
A. Laboratory findings as described in 1 or 2, documented on at least two occasions at least 90 days apart during a consecutive 12-month period:
- Proteinuria of 10.0 g or greater per 24 hours; or
- Serum albumin of 3.0 g/dL or less, and
- Proteinuria of 3.5 g or greater per 24 hours; or
- Urine total-protein-to-creatinine ratio of 3.5 or greater.
B. Anasarca (see 6.00C6) persisting for at least 90 days despite prescribed treatment.
Meeting the listing requires your test results to have the exact criteria in the listing. Your test results must be those in the listing or worse than the listing in order for the SSA to find you eligible for disability benefits.
COMPLICATIONS OF CHRONIC KIDNEY DISEASE
Another section of SSA’s listing focuses on hospital stays due to chronic kidney disease. As you can see, meeting the listing under 6.09 requires you to have 3 hospital stays, all of which are at least 48 hours long. You will need to submit proof of your hospital stays to the SSA. Learn more about how to obtain your medical records here.
6.09 Complications of chronic kidney disease(see 6.00C8) requiring at least three hospitalizations within a consecutive 12-month period and occurring at least 30 days apart. Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
KIDNEY TRANSPLANT UNDER LISTING 6.04
If you chronic kidney disease is so severe that you require a kidney transplant, then the SSA will find you are under a disability for one year following the transplant.
- 6.04 Chronic kidney disease,with kidney transplant. Consider under a disability for 1 year following the transplant; thereafter, evaluate the residual impairment (see 6.00C2)
- Kidney transplant.
- If you receive a kidney transplant, the SSA will consider you to be disabled under 6.04 for 1 year from the date of transplant. After that, they will evaluate your residual impairments by considering your post-transplant function, any rejection episodes you have had, complications in other body systems, and any adverse effects related to ongoing treatment.
- If you received a kidney transplant, your CKD may meet the SSA’s definition of disability before you received the transplant. The SSA will determine the onset of your disability based on the facts in your case record.
HOW CAN YOU PREVENT CHRONIC KIDNEY DISEASE?
To reduce your risk of developing kidney disease you should:
- Follow instructions on over-the-counter medications. When using nonprescription pain relievers, such as aspirin, ibuprofen and acetaminophen (Tylenol), follow the instructions on the package. Taking too many pain relievers can lead to kidney damage.
- Maintain a healthy weight. If you’re at a healthy weight, maintain it by exercise. If you need to lose weight, talk with your doctor about ways you can lose weight. Diet suggestions are below.
- Don’t smoke. Smoking can damage your kidneys and make kidney damage worse. If you need help to stop smoking, talk to your doctor about ways to quit.
- Work with your doctor. If you have medical conditions that increase your risk of kidney disease, work with your doctor to control them. Ask your doctor to perform tests to look for signs of kidney damage.
DIET FOR CHRONIC KIDNEY DISEASE
If you have chronic kidney disease, you need to control what you eat and drink. The reason you need to maintain a certain diet is because your kidneys cannot properly remove waste products from your body. Work with your doctor to come up with a kidney friendly diet. Then, stick to it.
LOWER SODIUM INTAKE
If you have CKD, then you need to watch your salt intake. Health kidneys can keep sodium levels in your body under control. But, if your kidneys are damaged, then extra sodium and fluids build up in your body. This can affect your blood pressure and it can also impair your body’s ability to maintain water balance. If your water balance is not under control, then you will have edema. This means that you can get swollen feet and ankles and high blood pressure. You could also have fluid build up in your lungs, which can cause difficulty breathing. Likewise, fluid could build up around your heart. This is bad for your health.
Take these simple steps to cut salt from your diet:
- Avoid table salt and seasonings that contain salt, like soy sauce and garlic salt.
- Don’t eat fast food because it contains a lot of salt.
- Avoid packaged foods.
- Choose low-sodium foods when shopping.
AVOID PHOSPHORUS AND CALCIUM
Phosphorus and calcium are minerals that keep your bones strong. When your kidneys are healthy, they remove phosphorus. But if you have chronic kidney disease, your phosphorus levels can get too high. Subsequently your calcium levels begin to drop. When this happens, your body pulls calcium from your bones. Then your bones become weak and they can break easily. Talk to your doctor to see if you should avoid calcium-rich foods
REDUCE YOUR POTASSIUM INTAKE
Potassium is another mineral that your body needs. It helps your nerves and muscles work properly. When you have chronic kidney disease, your kidneys cannot filter out extra potassium. Having too much potassium in your blood can result in serious heart problems and heart disease.
Potassium is found in fruits and vegetables. For example, potassium is in bananas, organs, broccoli, carrots, tomatoes, and potatoes. These foods can affect potassium levels in your blood. Talk to your doctor about whether or not you need to reduce your potassium intake to help your chronic kidney disease.
RESIDUAL FUNCTIONAL CAPACITY AND CHRONIC KIDNEY DISEASE
If your chronic kidney disease does not meet a listing, it is possible for the combination of your impairments to equal a listing. Under the equalling analysis, a judge looks at all of your medical impairments and determines whether they are severe enough to equal a listing. If not, then the judge will evaluate your residual functional capacity.
Your physical residual functional capacity is what you can physically do during an eight hour workday. However, it also takes into account your physical impairments. The judge will determine how many pounds you can lift and how long you can sit and stand. The judge will also consider how often you need to lie down due to pain or if you need to take extra breaks throughout the course of a workday.
There are many types of evidence you can submit to the SSA to prove your residual functional capacity. For example, you could have a physical therapist evaluate your ability to lift, sit, stand, walk, etc.. Another way to prove that you cannot work an eight hour day is to submit employer records that show you took extra breaks during you eight hour shift. Or, that you lost your job because you were absent due to your disability.
CHRONIC KIDNEY DISEASE AND THE VOCATIONAL EXPERT
The SSA will evaluate the severity of your chronic kidney disease and your residual functional capacity. Then, they will decide what category of work you can do. The categories of work are: sedentary, light, medium, heavy, and very heavy work. The SSA will look at your work history, your age, and education level. Then, they will determine whether or not you have skills you could use on the job. They will look to see if you can do your past work. If you cannot, then they will try to state that you can perform other work.
Chronic kidney disease can cause a number of work related limitations. For example, if you are on dialysis, you will have to miss work to attend your appointment. At your hearing, there will be a vocational expert who will determine if you can work. The determination of your ability to work will depend largely upon your residual functional capacity. It is your burden to prove that your CKD impairs your ability to work.
THE REPRESENTATIVES AT CANNON DISABILITY LAW
At Cannon Disability Law we can help you apply for benefits. Also, we can help you appeal an SSA denial. Additionally, we will represent you in court at your disability hearing. We will help you be a witness in your case. If necessary, we can appeal your case to the Appeals Council. Likewise, we file appeals in Federal Court. Finally, we can represent you where you live. For example, we can represent you if need a disability attorney in Utah or Nevada. Additionally, we can help you if you live in Idaho, Colorado, or California.
Your ability to receive Medicaid and Medicare depends upon whether or not you are successful with your disability claim. Even your future retirement is at risk if you do not win benefits. In order to fight the SSA’s denials, you need a representative with experience. Hire us. Dianna Cannon has been representing people with disabilities for over thirty years. Brett Bunkall and Andria Summers also have many years of litigation experience. We have won over 20,000 disability hearings. You can trust us. We will do everything we can to win your SSD and SSI benefits.
CANNON DISABILITY CAN HELP WIN SSD BENEFITS FOR CHRONIC KIDNEY DISEASE
Cannon Disability Law is one of the best disability firms in the country. We are known as one of the best Social Security Disability firms in Las Vegas, Nevada. Cannon Disability’s representatives are also members of the National Organization of Social Security Claimant’s Representatives. Learn more about Utah SSD benefits here. Nevada Disability Information can also be found on this website. We also represent claimant’s in Idaho. Find out more about Colorado disability benefits here. Likewise, if you are from California, California disability information can also be found on our website.
Over the last 30 years, Cannon Disability has won thousands of disability claims. Additionally, we have won over $100 million in ongoing and past-due SSD disability benefits. It has become more difficult to win Social Security cases. Also, the listing requirements are harder to meet. That is why you need an attorney who focuses on disability law.
We recommend that you do not go to your hearing without a representative. Why? Because a lawyer can prepare you for the judge’s questions. Preparation will help you win your case. Those who come to the hearing without counsel are typically not successful in winning benefits. You should hire an attorney with experience in disability law. Contact Cannon Disability Law today. We can help you win benefits for chronic kidney disease.