Social Security Disability with End-Stage Renal Disease

End Stage Renal Disease (ESRD), or kidney failure, is an irreversible condition most often caused by Chronic Kidney Disease (CKD), though it can occur suddenly or from other disorders. The National Institutes of Health estimates that over 26 million people have CKD, and many don’t realize until the damage to the kidneys is severe. According to the latest U.S. Renal Data System Annual Report, ESRD affects over 660,000 Americans of all ages.

The United States Renal Data System also found that Medicare spent over $500 billion on kidney disease, making it one of the most expensive disorders. On ESRD alone, Medicare spends $32 billion annually, along with an estimated additional $15 billion for non-Medicare patients.

Because ESRD puts a whole organ out of commission, the treatments are very costly. Most of the costs are from inpatient and outpatient medical care. Individuals waiting for a kidney transplant must often undergo dialysis. The National Kidney Foundation found that dialysis costs $83,000 each year for the average patient. When a kidney becomes available, the transplant will cost over $30,000.

Because the condition requires so much time at the hospital, ESRD is a leading cause of lost productivity. Dialysis requires three days a week for about four hours, which puts a toll on those trying to work, both on their physical abilities and available time.

The Social Security Administration (SSA) has several Adult Listings regarding CKD and ESRD. If you are out of work or earning less than SSA’s current substantial gainful activity amount, and if you meet or equal one of these listings, you will be found disabled. However, even if your CKD does not meet or equal any of the listings, you can be approved another way. The SSA may also award benefits based on a medical-vocational allowance.

To determine whether or not you can work, the SSA will determine your maximum Residual Functioning Capacity (RFC). The examiner takes into account your limitations, education level, and work history to first put you in a category of work (sedentary, light, medium, heavy, or very heavy), and then find jobs you’re qualified for with your work history. If the SSA can’t find a job you can do or decides you can’t even do sedentary work, you may be approved for benefits.

ESRD is a permanent and very debilitating condition, so it can cause many limitations that would keep you out of work. The National Kidney Foundation reported that CKD patients had an average of 10 doctors’ visits a year, second to only cancer. Additionally, dialysis patients need to spend at least 12 hours a week in the hospital for their necessary treatments. Fatigue, mental confusion, sleep problems, and chest pain can make normal tasks hard to complete. Bone pain, swelling of the lower extremities, and impaired motor skills can make it hard to walk, stand, and perform fine movements.

If you or someone you know is unable to work due to a medical condition, please contact us for a free case evaluation.

CKD Listings: SSA.gov/disability/professionals/bluebook/6.00-Genitourinary-Adult
SSA Publication on ESRD: SSA.gov/pubs/EN-64-107

By: Joyce Trudeau of Premier Disability Services, LLC®

Manipulative Limitations in a Disability Claim

Nearly every job requires a full and complete use of the hands. Anyone who has “manipulative limitations” caused by injury or pain needs to be aware that this can be an important component of a disability claim. While more obvious in situations involving a condition such as carpal tunnel syndrome or a specific hand injury, this limitation can also be important even when it is not the major disabling condition.

Social Security law says that in order to do even unskilled, sedentary work a person must have good use of both hands and the fingers – this is called “bilateral manual dexterity” in the regulations. Any significant limitation in a person’s ability to handle, pick up and finger small objects is important in the disability decision. Many claimants have conditions that restrict the amount of lifting they can do. Anyone person who can lift and carry even 10 pounds for most of the day may still be found capable of sedentary work, under Social Security regulations. The addition of a manipulative limitation, particularly of the dominant hand, can be enough to tip the scale in favor of the claimant.

More general medical conditions such as arthritic impairments, fibromyalgia, and chronic fatigue may also include hand, arm, and/or shoulder pain. Often when Social Security is collecting information on these illnesses from a claimant, the entire focus is on lifting, standing and sitting limitations. Careful medical record development of limitations on use of the hands is very helpful in the decision-making process. Soliciting this information from treating medical sources can be extremely important. These limitations may sometimes be viewed as a minor problem in the context of some larger disease process. As such, medical case records often do not specifically mention them.

When the right questions are asked of the medical provider, however, a clearer picture may emerge. Does the person have pain in the dominant hand? Does stiffness prevent full use of the hand, particularly for small motor tasks such as writing? Is the pain increased by repetitive use? Although someone may be able to lift five pounds, or use the painful hand for a task once or even five times, can this be done on a continuous, repetitive basis for an 8-hour work day, five days per week? What is the effect of such an activity level on the person’s ongoing condition?

Think of a manipulative limitation in combination with all other impairments. Often it can be overlooked, for example, when the presenting problem is psychiatric. When a condition such as anxiety or depression is not severe enough on its own to qualify a person for benefits, the claim can be strengthened by considering this and other physical limitations.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

By: Thomas A. Klint of Premier Disability Services, LLC®

Disability Determination Services’ Review Process

To determine whether you are disabled, and thus qualify for benefits, the Social Security Administration (SSA) will send your claim to a state agency of disability examiners. In many states, the agency is called “Disability Determination Services,” or DDS, but the agency goes by various names. For instance, Florida calls its agency the Division of Disability Determinations, California calls it the Disability Determination Service Division, and Pennsylvania calls it the Bureau of Disability Determination. Claims are reviewed by DDS at the initial and reconsideration stages of the application process.

This is what happens at DDS: A disability claimant’s file arrives from a Social Security office and is assigned to a disability claims examiner. The examiner begins to order medical records from all the treatment sources indicated by the claimant on their application. Once those medical records begin to arrive, the examiner can begin to go about the task of deciding whether or not a person will qualify for disability. These are the questions the claims examiner will ask:

1) Are you currently working?

The first test the examiner will apply to your file has nothing to do with your condition, but whether you are working, and, if so, how much you are working. For both the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program, a disability claimant cannot work and earn more than an amount equal to or greater than what is known as SGA, or substantial gainful activity. If you are currently working and are making this amount or more, DDS assumes you are not disabled.

2) Is your condition severe?

As the second step of the evaluation process, the DDS will assess the severity of your condition and how it limits you. For instance, if you have moderate hearing loss, but with hearing aids you are able to hear 95% of what people are saying, the DDS is not likely to consider your condition severe, and your claim will not move on to the next level of the evaluation process.

3) Does your condition meet a disability listing?

If your medical records indicate that you have a severe medical condition that matches the requirements of an official Social Security disability (“blue book”) listing, you qualify for disability and the claims examiner will immediately put you on “benefit receipt” status. The examiner will forward your file back to the SSA for further processing.

4) Are you able to work full time?

This test has to do with how your medical and/or psychiatric conditions limit your ability to work. If you have a medical impairment or disability that makes to impossible for you to work your prior job full time, or another type of work full time, you can get benefits. Typically, the vast majority of disability claims evaluated by DDS are denied, requiring disability claimants to have their cases heard by an administrative law judge at a disability hearing before they can be approved for benefits.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your case!

By: Joyce Trudeau of Premier Disability Services, LLC®