In the United States, there are about 661,000 Americans living with kidney failure, and as many as 26 million are estimated to have kidney disease, though many don't know it, the National Kidney Foundation reported. Kidney failure, or end stage renal disease (ESRD) is a permanent condition that can happen either suddenly (acute) or after being diagnosed with chronic kidney disease (CKD) for a long time.
If you or a loved one is suffering from kidney failure and can't work, the Social Security Administration (SSA) may be able to help. It offers two types of disability benefit programs to help you make ends meet.
The Financial Costs of Kidney Failure
Because kidney failure requires so much medical attention, the disease is very costly. Because the kidney has stopped working, you will either need dialysis or a kidney transplant, as well as doctor's visits, medication, and other hospitalizations. According to the National Kidney Foundation, Medicare alone spends $29 billion a year treating kidney failure.
There are two types of dialysis, the National Institute of Diabetes and Digestive and Kidney Diseases explained. Hemodialysis, which filters blood outside the body costs about $88,000 each year, and peritoneal dialysis, which filters blood in using the lining of your abdominal cavity, comes in at slightly less at $71,000 per year.
The National Kidney Foundation added that CKD and kidney failure are leading causes of hospitalizations in America. At an average of ten visits annually, CKD is secondly only to cancer. Additionally, they are leading causes of loss of productivity, because of the amount of necessary medical care and the toll it takes on your body..
Medically Qualifying for Benefits with the Blue Book
The Blue Book is the SSA's official list of conditions that qualify for disability benefits. The SSA uses the Blue Book to evaluate every disability application it receives.
Kidney Failure can be found under multiple entries in section 6.00—Genitourinary Disorders.
To qualify for benefits, the SSA requires medical evidence of chronic heart failure while on prescribed treatment that shows either:
- Chronic kidney disease with chronic hemodialysis or peritoneal dialysis.
- Chronic kidney disease with a kidney transplant. After 12 months following the transplant, the SSA will consider disability by evaluating any residual impairments.
- Chronic kidney disease, with impairment of kidney function, with A and B:
- Reduced glomerular filtration, which is the rate at which your kidneys filter waste and chemicals out of the blood stream, shown by laboratory findings on two occasions at least 90 days apart during a consecutive 12-month period showing abnormal levels of serum creatinine or creatinine, or a low glomerular filtration rate (eGFR), with at least one of the following:
- Bone degeneration occurring when the kidneys are unable to maintain the necessary levels of minerals, hormones, and vitamins required for bone structure and function, called renal osteodystrophy, with severe bone pain and imaging studies documenting bone abnormalities.
- Neuropathy or other nervous tissue damage that affects peripheral motor or sensory nerves, or both, causing pain, numbness, tingling, and muscle weakness due to toxins the kidneys can't adequately filter from the blood.
- Fluid overload syndrome causing vascular congestion, documented by one of the following:
- High blood pressure between heartbeats, despite at least 90 consecutive days of prescribed therapy, documented by at least two measurements of blood pressure at least 90 days apart during a consecutive 12-month period.
- Signs of vascular congestion, swelling, or fluid retention, 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.
- Anorexia with weight loss 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.
- Complications of chronic kidney disease requiring at least three 48-hour hospitalizations more than 30 days apart within a consecutive 12-month period.
If you've been diagnosed with kidney failure, or you're experiencing any other symptoms, talk to your doctor immediately. You may be eligible for disability benefits.
Qualifying Without Meeting a Medical Listing
There is another way to be approved for benefits if you don't meet or equal a medical listing. The SSA also awards disability benefits based on how the limitations your kidney failure creates. Like all disability applications, your conditions must be expected to last and keep you out of work for at least 12 months.
Under a medical-vocational allowance, the SSA determines your Residual Functioning Capacity (RFC), which is the level of work you can do (sedentary, light, medium, heavy, or very heavy) compared with your education and work history. This means if there are no jobs available within your work level and your education and you're unable to make $1,130 a month which is the substantial gainful activity minimum (SGA) in 2016, you may be approved for benefits.
Though the guidelines for RFCs start at 45 years old, you're likely to be approved for some form of benefits if you meet the financial requirements with kidney failure. Dialysis, according to DaVita Healthcare Partners, requires three visits a week for three or four hours, which can seriously limit your ability to work full time.
Other symptoms of kidney failure also making performing daily tasks hard, like fatigue, mental confusion, sleep problems, and chest pain. Bone pain, swelling of the lower extremities, and impaired motor skills can make it hard to walk, stand, and perform fine movements.
Older adults who didn't complete college or did non-sedentary or unskilled work have a higher chance of being approved with a medical-vocational allowance, because there are few sedentary jobs available without required training or education.
How to Apply for Social Security Disability Benefits
If you're kidney failure is interfering with your ability to work, talk to your doctor about your chances of being approved for disability benefits, either with the Blue Book or an RFC. Though, claims can take up to two years to be approved, so you should only apply if you and your doctor think you'll be approved. Otherwise, it may not be worth the time and stress of completing the application and being out of work.
If you provide all of the necessary medical evidence showing you meet a medical listing, you could be approved in your initial claim. For a list of every other documentation the SSA requires, check out the website. More than half of applications are denied in the initial claim, because there is important information missing.
Important medical evidence for kidney failure will include:
- Blood pressure test
- Blood tests that measure levels of chemicals and waste the kidney normally filter out
- eGFR (estimated glomerular filtration rate)
- Urine tests to show irregular chemicals, proteins, or blood
- Kidney biopsy to examine tissue
- Reports showing kidney function before dialysis and during
- History, length, and outcomes of all prescribed treatments
- Summaries of hospitalizations, operative reports, and any other related documents
- Detailed reports from your primary care doctor describing the limitations your kidney failure causes you
The SSA has a convenient online application you can use if applying for Social Security Disability Insurance. If you aren't comfortable, you can still apply at your local SSA office. When applying for Supplementary Security Income, you must make an appointment to apply in person at an SSA office. After you've completed the application, double check it to make sure you didn't leave any questions blank or make any typos. This information could be vital to your claim, and missing it can cause the SSA to delay or deny your claim.
If there are any changes in your condition after you've submitted your claim, make sure to notify the SSA immediately. If you've been hospitalized, prescribed new medications, or had new laboratory reports done, the additional information could help your case be approved.
If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance and Supplemental Security Income.