Applying for social security disability benefits with kidney disease

Kidney disease causes expensive, painful and debilitating complications that prevent many people from working and earning an income. To support people in this difficult situation, the Social Security Administration (SSA) offers disability benefits as a financial resource.

What are Social Security disability benefits?

The SSA offers two forms of benefits for people with disabilities. The medical criteria that you must meet to be eligible for disability benefits are the same for both programs. Their technical requirements, however, are different. 

The first type of benefit, Social Security Disability Insurance (SSDI), has eligibility criteria that are based on your previous work history. To be eligible for SSDI, you must have worked recently and for a long enough time at a job that required you to pay Social Security taxes. This is because taxpayers fund SSDI, so only those who contribute to the system may receive benefits. The SSA calculates the amount you may receive each month by averaging your previous incomes. The average payment for SSDI recipients is $1,100 per month, with a maximum of about $2,600.

The second type of benefit, Supplementary Security Income (SSI), is needs-based. It is only available to people who have extremely limited income and resources. To be eligible, an individual may earn up to $733 per month and have assets valued up to $2,000. A couple may earn up to $1,100 per month and have assets valued up to $3,000. Applicable assets include cash, stocks and life insurance, but do not include one primary home and one vehicle.

Social Security Disability and kidney disease

The SSA Blue Book describes conditions that are eligible for disability benefits, as well as the associated test results or symptoms that are required for the condition to be considered a disability. You typically need to meet or exceed at least one of the criteria to qualify for disability benefits.

In the Blue Book, kidney disease can be found under Genitourinary Disorders in Section 6.00. For your kidney disease to be considered a disability by the SSA, at least one of the following statements must be true:

1. You have kidney disease and need dialysis.

2. You have kidney disease and have had a kidney transplant less than one year ago.

3. You have kidney disease with reduced kidney function and at least one of the following:

a. Renal osteodystrophy: a bone disease caused by failing kidneys, with severe bone pain and abnormalities.
b. Peripheral neuropathy: a nerve disease that causes pain, numbness, tingling and muscle weakness in various parts of the body from toxins the kidneys could not filter out.
c. Fluid overload syndrome: a condition where water and salt are retained in the body and causes abnormally large blood vessels with high blood pressure, swelling of the skin or a body mass index (BMI) of 18.0 or less from weight loss.
d. Anorexia with weight loss determined by BMI of 18.0 or less, calculated on at least two occasions at least 90 days apart during a consecutive 12-month period.

4. You have nephrotic syndrome (when protein is lost in urine), shown in testing twice in one year and at least 90 days apart, and with swelling of the skin for at least 90 days.

5. You have kidney disease and the complications have resulted in at least three hospitalizations in one year. The hospitalizations must occur 30 or more days apart and must last 48 hours, including hours in a hospital emergency department immediately before the hospitalization.

If you do not fall into any of these categories, you can still qualify for disability benefits if your kidney disease and treatments keep you from working. The SSA will give you a Residual Functioning Capacity (RFC) exam, which is a questionnaire that determines 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.

Applying for Social Security Disability with Kidney Disease

If you are applying for SSDI benefits, you can apply online on the SSA website, by phone at 1-800-772-1213 or at your local Social Security office. If you are applying for SSI benefits, you may start the application online, but must complete the application in person at an SSA office. The SSA has an office locator to help you find your nearest office. There are at least four SSA offices in every state.

Maintaining detailed records that illustrate the severity of your kidney disease will increase your chances of getting approved for benefits. The SSA will need copies of all of your lab reports, test results, treatment summaries and outcomes and descriptions of surgeries. You may also have to have an estimated glomerular filtration rate (eGFR) test and a kidney or bone biopsy. Each doctor who treats you should provide a note that describes your condition, your symptoms and your limitations.

If your initial claim is denied, you may appeal the decision online, at your local SSA office or even in court. Most denials result from lack of medical evidence or a technical error while applying. Take your time carefully completing your initial application to improve your chances for a speedy approval.

[Note: this post was updated 6/13/18 with additional information from the SSA Blue Book.]