Kidney Disease and Social Security Disability

By Pitt Dickey

This month’s column will look at how the Social Security Administration (SSA) evaluates disability claims that involve people with kidney problems. In order to understand how the SSA reviews these claims it is helpful to examine how the kidneys function in the body.

One of the main function of the kidney is removing unusable waste from the blood stream. Kidneys are referred to by the term renal. The body collects waste from the blood stream in a soluble form called urea. The kidneys are a part of the urinary system which removes waste from the body to prevent the waste from building up in the body to the point that it becomes poisonous. The liver makes urea from ammonia which is created by the body by breaking down simple proteins in the body’s cells. The urea goes through the blood picking up waste products and delivers the waste to the kidneys. In the kidneys the urea is mixed with water and acids and passes into the kidney tubules as urine. The urine then passes from the kidneys into the bladder and out of the body.

The kidneys also are endocrine organs. The kidneys secrete chemicals into the blood that help regulate other body functions such as blood pressure and the production of red blood cells.

The kidneys also have a role in keeping the proper balance of chemicals such as salts and potassium and water in the blood stream. These are referred to as electrolytes as they help the body conduct small charges of electricity. The kidneys regulate the amount of electrolytes and water in the body by either secreting or withholding chemicals into the blood stream.

There are two kidneys located in your lower back. The kidneys are about the size of your fist and weigh around a half a pound each. Each kidney is attached by a ureter to the urinary bladder. The ureter is a muscular tube that passes the urine processed by the kidneys into the bladder. The urinary bladder is a hollow sac in the abdomen where urine is stored temporarily. The urine is passed out of the bladder and out of the body through a muscular tube called the urethra.

Blood enters each kidney through the renal artery into the central depression in the kidney itself called the hilum. The arteries branch into much smaller blood vessels called capillaries. These capillaries group together in little balls known as the glomerus. The blood passes through the glomerus and waste products are removed in a three step process consisting of filtration, reabsorption and secretion. The waste products such as water, salts, urea and other chemicals pass from the blood stream into the glomerus. The kidney recaptures water, salts and sugar taken during the filtration process to be reused by the body as these substances pass through the renal tubule. The unneeded waste products pass into the renal pelvis which is a part of the kidney that collects the waste products. Ultimately the waste passes from the renal pelvis into the urethra and into the bladder.

The SSA listing for renal problems is based upon the history, physical examination and laboratory evidence of kidney disease coupled with a showing that the illness is progressive in nature or has deteriorated as shown by laboratory evidence. The tests for disability based on kidney disease are set out below.

A patient meets the SSA disability standard if he suffers from an impairment of kidney function due to any chronic kidney disease expected to last 12 months such as hypertensive vascular disease ( damage to the function of the kidneys resulting from high blood pressure); chronic nephritis (a disease in which the kidney loses excessive protein through the urine); nephrolithiasis ( kidney stones); polycystic disease (Multiple fluid filled sacs within the kidney, cysts develop within the kidneys leading to a variety of health problems). In addition to one of these diseases the patient must have irreversible kidney failure and be undergoing chronic hemodialysis (in which a mechanical kidney filters the waste filled blood from the patient and returns it to the patient) or peritoneal dialysis (a tube is placed into the abdomen of the patient and fluid is forced into the patient’s body and this fluid makes the waste in the patient’s blood stream enter the fluid which is then withdrawn by another tube from the patient’s abdomen.

If a patient has undergone a kidney transplant he will be considered to be disabled for 12 months after the transplant and then will be reviewed under a number of clinical tests to see if he still meets the disability standard.

It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. In short the Judge has the discretion to decide if a person’s health problems are serious enough to warrant an award of disability benefits despite not meeting the technical requirements of one of the SSA listings for disability.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims since 1978.