What Genitourinary (Kidney) Disorders Qualify for Social Security Disability Benefits?
When someone is diagnosed with a kidney disorder or other disorder impacting the genitourinary system (i.e., your kidney, genitals, and urinary tract), the impact can be devastating. These disorders often involve expensive and long-term medical treatment, painful complications, and a general inability to function normally (including an inability to work). If you are struggling with a disorder in your genitourinary system (i.e., your kidneys, genitals, and urinary tract), you may qualify for disability benefits through the Social Security Administration (SSA).
Types of Genitourinary Disorders that Qualify for Social Security Disability Benefits
The SSA relies on a manual (typically referred to as the “Blue Book”) that details the specific medical conditions that enable an individual to receive disability benefits. Section 6.00 of the SSA’s Blue Book breaks down Genitourinary Disorders that qualify for disability benefits.
If you are struggling with a kidney disease that has impacted your ability to work, the SSA will assess your qualifications for benefits based on the following factors. You only need to meet one of the factors listed below to potentially qualify for disability benefits:
- You were diagnosed with chronic kidney disease and require dialysis (more on this below)
- You were diagnosed with chronic kidney disease and underwent a kidney transplant less than one year ago before you applied for disability benefits
- You were diagnosed with nephrotic syndrome (i.e., when you lose protein in your urine). This syndrome can be established with medical records reflecting tests conducted twice in one year and at least 90 days apart.
- You were diagnosed with chronic kidney disease and the complications from the disease led to at least three separate visits to the hospital in a given year. Please be advised that the hospital visits must have taken place 30 or more days apart and you must have spent at least 48 hours in the hospital.
Applying for Disability Benefits with Chronic Kidney Disease
If you have a chronic disease that impacts your kidney function, it is important to note that the SSA will deem you disabled automatically if one of the following factors are met:
- You are undergoing continuous peritoneal dialysis
- You are undergoing hemodialysis
- You underwent a kidney transplant (more information on this below)
- You are struggling with reduced glomerular filtration. To substantiate your reduced glomerular filtration, the SSA will look for the following types of information in your records: (i) you are struggling with a combination of renal bone degradation and pain, (ii) you are struggling with peripheral neuropathy, and/or (iii) you were diagnosed with fluid overload syndrome as a result of diastolic hypertension.
Even if your kidney condition does not meet any of the above-described factors, you may still be eligible for disability benefits if your kidney condition directly impacts your ability to work. However, there will be heightened scrutiny by the SSA when analyzing your disability benefits application. For example, you will likely have to undergo a Residual Functioning Capacity (RFC) exam in order to qualify for benefits. The RFC is an intensive, detailed questionnaire that is used to assess your capacity to perform certain key functions that will influence your ability to work in a professional setting. For example, the RFC will assess your ability to stand, sit, walk, lift weight, and perform other day-to-day activities. If your kidney disease keeps you from working at even a sedentary job, you meet the medical criteria to qualify for disability benefits.
Disability Benefits for Claimants Who Underwent a Kidney Transplant
If you underwent a kidney transplant recently, the path towards receiving disability benefits is simpler. This is because an individual who underwent a kidney transplant qualifies for 12 months of disability benefits automatically. After 12 months, the SSA will conduct an evaluation of your ongoing disability eligibility and residual impairments.
If the SSA determines you had a medical improvement post-kidney-transplant, it does not mean your benefits will be cut off. Instead, the SSA will assess factors such as:
- Your body rejecting the kidney;
- Frequency of renal infections;
- Any side effects related to immunosuppressants; and
- The development of any systemic infections, organ system failure, or neuropathy
Nephrotic Syndrome Due to Glomerular Disease
If you are struggling with Nephrotic Syndrome due to an underlying Glomerular Disease, there is a specific set of prerequisites that must be met in order to be eligible for disability benefits. The evidence typically reviewed by the SSA when an applicant has a genitourinary condition includes:
- Medical history. This should include all treatments and your response to them. The laboratory and/or clinical record need to show that your condition is getting worse. They will particularly look at your levels of serum creatinine. In most cases, the SSA requires at least three months’ worth of records to approve a disability claim.
- Records of your renal function before starting dialysis.
- Medical evidence of nephrotic syndrome.
- Copies of any related biopsies and the examination of all related specimens. A statement by the medical professionals who conducted the tests can be substituted if the actual examination findings aren’t available but should contain a thorough description of the procedures’’ results.
- A complete accounting of all types of therapy attempted, your response to the therapies, and all side effects of the therapies or treatments. This should include how long the treatments and their effects are expected to last.
Maintain Detailed Medical Records
No matter your basis for pursuing disability benefits, it is extremely important to keep detailed medical records that clearly describe the severity of your kidney disorder. When you have detailed and organized medical records, you will improve the likelihood of getting approved for disability benefits by the SSA. The types of records that generally should be included with your application include:
- Lab reports
- Test results
- Treatment summaries
- Treatment outcomes
- Detailed surgery summaries
You may also need to undergo further testing if requested by the SSA. For example, it is possible you may be asked to undergo an estimated glomerular filtration rate (eGFR) test, along with a kidney or bone biopsy.
Unable to Work Due to a Kidney Disorder? Take Action Today
If you are struggling with a kidney disorder that is impacting your ability to function and work, you may qualify for disability benefits through the Social Security Administration. To get a better idea of your eligibility, fill out the free evaluation form on this page.