The Social Security Administration recognizes that kidney failure and kidney disease can quickly lead to severe illness that will impair your capacity to work. Claimants afflicted with kidney disease frequently experience:
- dangerous levels of protein and creatinine in the blood
- uncontrolled high blood pressure
- high blood sugar, often leading to neuropathy
- water retention and swelling, especially in the legs
- imbalance of minerals in the blood, including excessive sodium (salt) urea
- excessive need to urinate and/or urinary incontinence
Diseased kidneys often do not filter your blood properly nor do they regulate fluid and mineral concentrations in the blood. When I represent clients with kidney problems I work with my clients to identify the symptoms that are most likely to cause job reliability issues and frequent absences from work.
The main issue in any Social Security disability case has to do with your capacity to perform work. In many cases, the question that the Social Security decision maker asks is whether you have the capacity to perform a simple, unskilled, sit down type of job 8 hours a day, five days a week.
Your capacity to work may be limited by physical issues – such as swollen and painful tissue in your legs and ankles that prevents you from walking, or by pain and discomfort that negatively affects your ability to focus and concentrate on a task at hand. Further, if your doctor has prescribed medications, those drugs may have serious side effects such as nausea, fatigue, dry mouth, frequent urination, constipation or sensitivity to heat, cold or light. These factors, individually or in combination, can interfere with your capacity to perform competitive work.
I often explain this concept to my clients by saying something like this:
"Imagine that the phone rings tomorrow morning and a potential employer is on the line with a job offer. The job involves sitting at a table in a quiet warehouse and your job is to pack 8 oz. boxes of ink pens into cartons. There is no interaction with co-workers or the general public and minimal interaction with a supervisor. You can sit or stand at the table as needed and you are permitted a 15 minute break in the morning, 15 minutes in the afternoon and an hour for lunch. Could you perform this job?"
Symptoms that Preclude Even a Simple, Sit Down Job
My clients with kidney disease often explain that even a simply, sit-down, unskilled job like this packing job would be impossible. Why? Because of a variety of symptoms that frequently arise, including:
- swelling in the legs and feet that limit sitting comfortably to 5 or 10 minutes
- a need to walk around for 5 to 10 minutes every half hour to restore circulation in the legs
- a need to keep their legs extended most of the day
- pain – often a throbbing, a “pins and needles” sensation in swollen legs or arms
- fatigue due to issues with blood chemistry
- headaches arising from high blood pressure
- neuropathy (pins & needles sensation, numbness, pain) in the arms and legs arising from uncontrolled blood sugar or poorly controlled mineral concentrations in the blood
- medication side effects
- frequent (multiple times per hour) need to take unscheduled restroom breaks due to poor fluid control
Claimants with these symptoms would most likely have problems performing any type of work or work-like activity. Since kidney diseases can be measured by blood chemistry tests, ultrasounds or other objective medical tests, most Social Security judges are receptive to approving kidney disease claims.
Potential Problems in Kidney Disease Disability Claims
When I do face problems in kidney disease claims it usually has to do with the relative youth of many kidney disease claimants. Kidney problems frequently arise in young adulthood and it is not unusual to see a claimant in his/her late 20’s or early 30’s. Some judges have an immediate concern about approving a 30 year old individual for disability regardless of the condition. It is therefore our responsibility to explain to the judge what kidney disease means and how it affects daily activities and potential work performance.
Further, Social Security judges expect that claimants with kidney disease will seek ongoing treatment with a nephrologist, or at least with an internist who has knowledge about kidney diseases. If you are not receiving regular medical treatment, the judge may conclude that your symptoms are not severe enough to interfere with performing simple work.
Winning Strategies in Kidney Disease Cases
There are basically three ways to win a kidney disease case. Click on the links for more detail:
- meet a kidney disease listing at 6.00 – note that this listing is called the “genitourinary impairment” listing, although the listing primarily talks about kidney disease. This listing focuses on elements of kidney disease that can be evaluated by objective testing. Social Security presumes that an individual with measurable decline in kidney function or structural damage to the kidneys would have significant function limitations.
- residual functional capacity – prove that your functional capacity for work has been so reduced by swelling, pain, your need to keep your legs raised and extended or your need to take unscheduled restroom breaks, you would not be a reliable employee
- meet a grid rule (generally limited to those over age 50 with a limited education and an unskilled work background)
In my experience, some of the other factors that judges look for when evaluating cardiac cases include:
- long, solid work history
- evidence from the medical record that prior medical or surgical treatment has not worked
- placement on a kidney transplant list
Here are some case studies from recent cases I tried that involved heart disease :
Kidney Disease Case Study #1: 33 year old female with Focal Segmental Glomerulosclerosis, a kidney disease that limits the blood cleaning capability of the kidneys.
Kidney Disease Case Study #2: 55 year old female with chronic kidney disease arising from longstanding high blood pressure. Symptoms include urinary incontinence and urinary frequency.