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1. L
isting 6.02: Chronic Kidney Disease (Adults)
Many medical disorders can cause chronic renal failure
(CRF), as noted above under General Information. Any type
of kidney disease can qualify under this listing as long
as it results in chronic kidney disease of the severity
required by the listing. Acute kidney failure, such as severe
dehydration, viral infection, or drug toxicity, cannot qualify
under this listing unless the damage becomes irreversible.
a. L isting Level Severity For your condition to be severe
enough to meet the listing, you must have decreased kidney
function, due to any chronic kidney disease that is expected
to last 12 months. Additionally, you must satisfy A, B,
or C, below.
A Chronic hemodialysis or peritoneal dialysis necessitated
by irreversible renal failure. Chronic dialysis is a condition
that qualifies you for benefits because permanent dialysis
is only done in irreversible kidney failure. Also, dialysis
is so time-consuming that most people cannot receive daily
dialysis and work. Some people on chronic
ambulatory peritoneal dialysis are able to work, but that
is a matter of choice. All forms of chronic dialysis qualify.
You have to actually be receiving dialysis—planned dialysis
does not qualify. Nor does short-term dialysis. B Kidney
transplant. SSA would consider you to be under a disability
for 12 months following surgery. A kidney transplant must
actually have been done, not simply planned or anticipated.
Benefits for 12 months after a transplant are automatically
granted, because of the possibility of complications. These
include infection, rejection of the transplanted kidney,
the side effects of drugs (steroids or other immune- suppressing
drugs), and other facets of kidney failure such as anemia
and damage to the peripheral nervous system. However, you
are not required to have any complications to qualify. After
the 12-month recovery period, you’ll be examined again to
determine if you have reached a stable state of improvement.
C Persistent increase of serum creatinine to 4 mg/100 ml
or greater (4 mg/dl) or reduction of the creatinine clearance
to 20 ml/minute (29 liters/24 hours) or less; these laboratory
abnormalities must be present at least three months. The
listing anticipates possible complications of chronic kidney
disease lasting at least three months evidenced by at least
two serum creatinine or creatinine clearance measurements.
If the serum creatinine or the creatinine clearance are
sufficiently abnormal, then you must also satisfy 1, 2,
3, or 4.
1. Renal osteodystrophy, manifested by severe bone pain.
Imaging (such as x-rays) must also show abnormalities that
can be associated with chronic kidney disease—such as pathologic
fracture, osteitis fibrosa cystica, or significant (more
than slight) osteoporosis. Not all bone abnormalities that
chronic kidney disease can cause need be present on an x-ray,
but a doctor must be able to conclude that the x-rays show
kidney-related bone disease.
2. Persistent motor or sensory neuropathy. Decreased ability
to feel touch, heat or vibration can suggest damage to sensory
nerves— complete numbness is not required. Damage to motor
nerves can produce muscle weakness, but not all muscles
need be involved. Complete paralysis of a muscle is unnecessary.
In other words, theseverity of the motor or sensory neuropathy
isn’t specified; it must be more than slight or mild. A
test called a nerve conduction velocity study is more accurate
than a physical examination. The SSA can order this test
done if it was not performed by your treating doctor.
3. Persistent fluid overload syndrome resulting from diastolic
hypertension (110 mm Hg or above) or signs of vascular congestion.
Poorly functioning kidneys do not adequately clear the body
of water through the formation of urine. This may be demonstrated
in everal ways: (1) edema, as shown on physical examination
or a chest x-ray showing pleural effusion or pulmonary edema,
(2) a high diastolic blood pressure resulting from overloading
the vascular system with water, or
(3) accumulation of fluid in the abdomen (ascites). Although
fatigue and shortness of breath are symptoms common in fluid
overload, they are too general to be diagnostic for purposes
of the listing. The persistence should be thoroughly documented
in your medical records.
4. Persistent anorexia with recent weight loss and current
weight meeting the values in Listing 5.08 (see Chapter 20),
Table III or IV. This listing recognizes the fact that malnutrition
from loss of appetite and abnormal metabolism is a serious
problem in chronic kidney disease.
2. L
isting 106.02: Chronic Kidney Disease (Children)
The discussion under Listing 6.02 applies here.
a. L isting Level Severity The child’s condition must satisfy
A, B, C, or D, below.
A Chronic hemodialysis or peritoneal dialysis necessitated
by irreversible renal failure. Chronic dialysis is a condition
that qualifies for benefits because permanent dialysis is
only done in irreversible kidney failure. Also, dialysis
is so time-consuming that most children cannot engage in
normal activities appropriate for their age and receive
daily dialysis. All forms of chronic dialysis qualify. The
child has to actually be receiving dialysis—planned dialysis
does not qualify. Nor does short-term dialysis.
B Kidney transplant. SSA will consider the child
to be under a disability for 12 months following surgery.
A kidney transplant must actually have been done, not simply
be planned or anticipated. Benefits for 12 months after
a transplant are automatically granted, because of the possibility
of postsurgery complications. These include infection, rejection
of the transplanted kidney, the side effects of drugs (steroids
or other immune- suppressing drugs), and other facets of
kidney failure such as anemia and damage to the peripheral
nervous system. However, the child is not required to have
any complications to qualify. After the 12-month recovery
period, the child will be examined again to determine if
he has reached a stable state of improvement.
C Persistent elevation of serum creatinine to 3 mg/100 ml
(3 mg/dl) or greater over at least three months. The SSA
will require at least two creatinine measurements over a
three-month period to show persistence of the kidney disorder.
D Reduction of creatinine clearance to 30 ml per
minute (43 liters/24 hours) per 1.73 m2 of body surface
area over at least three months. As with part C, the SSA
will require at least two creatinine measurements over a
three-month period to show persistence of the kidney disorder.
The SSA or your treating doctor will have to adjust the
results to your child’s body surface area.
3. L
isting 6.06: Nephrotic Syndrome (Adults)
Nephrotic syndrome is associated with kidney diseases that
permit an excessive loss of protein (albumin) into the urine.
See the discussion of nephrotic syndrome under “General
Information.” Granting benefits under this listing is rare
because most cases of nephrotic syndrome can be controlled
by treatment, and the requirement for persistent total body
edema is difficult to satisfy. The listing assumes that
three months of failed treatment are an indication that
impairment will be expected to last 12 months. If you have
nephrotic syndrome, your treating doctor should have done
all the necessary tests to make the diagnosis.
a. L isting Level Severity For your condition to
be severe enough to meet the listing, you must have nephrotic
syndrome with anasarca, which has been persistent for at
least three months despite prescribed therapy. Additionally,
you must satisfy A or B, below. A Serum albumin of 3 grams/100
ml (3 grams/dl) or less and proteinuria of at least 3.5
grams per 24 hours. This part requires a blood test and
a 24- hour urine collection.
4. L
isting 106.06: Nephrotic Syndrome (Children)
This listing requires only that some edema be present—and
therefore could be mild. Nevertheless, granting benefits
under this listing is unusual because most cases of nephrotic
syndrome in children can be controlled with treatment. Although
not stated by this listing, the SSA generally requires the
abnormalities to be present for a minimum of three months
before deciding that the child’s disability is likely to
last a year.
a. L isting Level Severity For the child’s condition
to be severe enough to meet the listing, the child must
have nephrotic syndrome with edema not controlled by prescribed
therapy. Additionally, the child’s condition must satisfy
A or B, below. A Serum albumin less than 2 grams/100 ml
(2 grams/dl). B Proteinuria of at least 40 milligrams (mg)
per square meter (m2) of body surface area per hour. This
would be a little less than 1 gram of protein spilled in
the urine over a 24 hour period. It is important to supervise
urine collections in children because incomplete collections
will give falsely low values that could result in erroneous
denial of the claim. The SSA or your treating doctor will
have to adjust the results to your child’s body surface
area.
5. L
isting 106.07: Congenital Genitourinary Impairments (Children)
The genitourinary tract (GU tract) consists of the urinary
tract and the genitals to the extent that they are involved
in urinary functions. The SSA recognizes that congenital
abnormalities of the GU tract are not rare. Congenital disorders
can either be genetic or arise from problems occurring during
development before birth. The most common congenital impairments
are: (1) absence of a GU organ, such as a kidney, ureter,
or bladder, (2) malformation of some part of the GU tract,
or (3) abnormal location of a GU organ, such as the bladder
being outside of the body.
a. L isting Level Severity For each part of the
Listing, the SSA must be able to obtain medical records
showing that at least three events have occurred within
the same 12-month period, along with periods of improvement
between those events. Events include GU surgical procedures,
hospitalizations, and treatment with parenteral antibiotics.
To be sure that separate events are being considered, the
SSA requires at least one month (that is, 30 days) between
each event.
After the presence of a GU disorder is established, then
the child’s condition must satisfy A, B, or C, below. A
At least three urologic surgical procedures, performed during
the same 12 month period. Direct visualization of the inside
of the bladder by a doctor for diagnostic purposes (diagnostic
cystoscopy) does not qualify as a surgical procedure. B
Documented episodes of systemic infection, each requiring
an initial course of parenteral antibiotics and occurring
at least three times in the same 12- month period. C Hospitalization
for episodes of electrolyte disturbance, occurring at least
three times in the same 12-month period. The SSA does not
specify numbers to represent the required electrolyte abnormalities.
The need to be hospitalized for treatment demonstrates that
the condition is medically severe.
a. L isting Level Severity
For each part of the Listing, the SSA must be able to obtain
medical records showing that at least three events have
occurred within the same 12-month period, along with periods
of improvement between those events. Events include GU surgical
procedures, hospitalizations, and treatment with parenteral
antibiotics. To be sure that separate events are being considered,
the SSA requires at least one month (that is, 30 days) between
each event.
To Win Your Case The evidence needed is:
1. SSA will need a longitudinal record of your medical
history that includes records of treatment, response to
treatment, hospitalizations, and laboratory evidence of
renal disease that indicates its progressive nature. The
laboratory or clinical evidence will indicate deterioration
of renal function, such as elevation of serum creatinine.
2. A longitudinal clinical record covering a period of
at least 3 months of observations and treatment, unless
we can make a fully favorable determination or decision
without it. The record should include laboratory findings,
such as serum creatinine or serum albumin values, obtained
on more than one examination over the 3-month period.
3. When you are undergoing dialysis, we should have laboratory
findings showing your renal function before you started
dialysis.
4. The medical evidence establishing the clinical diagnosis
of nephrotic syndrome must include a description of the
extent of edema, including pretibial, periorbital, or presacral
edema. The medical evidence should describe any ascites,
pleural effusion, or pericardial effusion. Levels of serum
albumin and proteinuria must be included.
5 If a renal biopsy has been performed, the evidence should
include a copy of the report of the microscopic examination
of the specimen. However, if you do not have a copy of the
microscopic examination in the evidence, SSA can accept
a statement from an acceptable medical source that a biopsy
was performed, with a description of the results.
How do the SSA consider the effects of treatment? They
consider factors such as the:
Type of therapy.
Response to therapy.
Side effects of therapy.
Effects of any post-therapeutic residuals.
Expected duration of treatment.
Your RFC needs to show If you have bone pain, neuropathy,
weight loss, or anemia, do you have the strength to stand
and walk six to eight hours a day? If not, your RFC should
be reduced to sedentary work. Does swelling in your feet
affect your ability to wear shoes? Do you have neuropathy
in your hands that affects your ability to handle small
objects, like picking up coins or buttoning your clothes?
Are you distracted by severe itching—for example, does it
keep you from getting restful sleep? Do you have side effects
from drugs? Do you get tired vacuuming, cooking, driving,
shopping, or engaging in social or other activities? Is
your treating doctor aware of your limitations and, if so,
are they recorded in your medical records?
If you have CRF with anemia and hematocrits in the 31–33%
range, it is doubtful you can do more than sedentary work.
If you are anemic, the SSA should take into account two
important factors when determining your RFC: • The fatigue
resulting from anemia. • Your heart rate. The more severe
your anemia, the faster will be your resting heart rate
as your body attempts to compensate for your anemia. Because
your heart has to work hard, it will have less reserve for
exercise.
a. L isting
Level Severity
For your condition to be severe enough to meet the listing,
you must have nephrotic syndrome with anasarca, which has
been persistent for at least three months despite prescribed
therapy. Additionally, you must satisfy A or B, below. A
Serum albumin of 3 grams/100 ml (3 grams/dl) or less and
proteinuria of at least 3.5 grams per 24 hours. This part
requires a blood test and a 24- hour urine collection.
B Proteinuria of at least ten grams per 24 hours.
This part requires only a urine collection, but with much
larger amounts of protein being lost in the urine than under
part A. To see if you qualify, you can check the test result
numbers in your medical records against those in the listing.
The SSA may need more up-to-date information than is in
your file, however, and require that the tests be done again.
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10.00 Impairments
that Affect Multiple Body Systems
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12.00 Mental Disorders
13.00 Malignant Neoplastic
Disease
14.00 Immune System
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