Compassionate Allowances - Nephrogenic Systemic Fibrosis

Nephrogenic Systemic Fibrosis (NSF) is typically a debilitating and often progressive condition that the Social Security Administration (SSA) recognizes as “automatically” qualified for disability benefits. One of the cornerstones of NSF is renal dysfunction and there are a number of complications that can result from the condition as well. The severity level that is typically seen with NSF has led the SSA to include the condition in the Compassionate Allowances (CAL) program.

CAL Designation

The CAL designation for NSF ensures that your application is reviewed more quickly and that you receive a decision on your eligibility as quickly as possible as well. CAL conditions are also rarely denied benefits, though you must still provide the SSA with the appropriate medical evidence to prove the severity level of your NSF.

Medical Evidence Requirements

The SSA needs to see specific medical evidence in order to find your NSF severe enough to prevent you from working. A definitive diagnosis is the first critical piece of data they must establish through the review of your medical records.

Diagnostic tests that are typical in an NSF application include:

  • Antinuclear antibody tests
  • Lab tests showing Hepatitis B or C infection
  • Renal insufficiency test results that may range from mild to severe and persistent
  • Collagen bundles and other clinical signs of NSF skin thickening, documented through biopsies

The minimum evidence required for the SSA to approve an application with a diagnosis of NSF includes:

  • Records showing the presence of chronic kidney disease, whether mild, moderate or severe
  • Clinical history documentation showing the fibrotic changes in skin and other tissues, including detailed descriptions of the limitations those changes have induced
  • Lab test results that show serum creatinine blood levels consistent with NSF

In determining the severity level of your NSF, the SSA may additionally use the Blue Book listing for impaired kidney function. That listing appears in section 6.02. Section 106.02 may also be consulted when the SSA evaluates your claim, especially if you are not on dialysis.

If fibrotic changes have affected your heart and/or lungs, the SSA may also utilize the following listings from the Blue Book:

  • Section 1.02 – Major dysfunction of a joint
  • Section 14.04 – Systemic sclerosis

These listings are not exact matches for your NSF, but are instead used by the SSA to determine if your NSF medically equals these conditions in severity level.

SSD Benefit Programs

There are two disability programs through which you may qualify for benefits from the SSA:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)

You must medically qualify for benefits to receive SSD through either or both of these programs. You must also meet the technical/financial requirements to receive SSD through either program.

  • For SSDI, you must have the work credits necessary and must also have income that does not exceed the SGA, or substantial gainful activity threshold.
  • For SSI, you must have very limited financial resources, including income and assets.

Applying for Benefits

Applications for SSD can be submitted online, with the SSA’s website, or in person, at your local SSA office. If you apply in person, schedule an appointment in advance to avoid further delays. Online application requires no wait, and you can fill out the full application online and submit it electronically. Whichever way you decide to apply however, you should follow up by submitting copies of as many of your medical records as possible to your local SSA office.