Facts about Polycystic Kidney Disease and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. Polycystic kidney disease causes cysts, which are non cancerous fluid-filled sacs, to develop inside the kidneys. Cysts can develop anywhere inside the body, but the kidneys are the most affected.
2. Polycystic kidney disease can exist for a long time before any symptoms occur. When they do occur, symptoms may be high blood pressure, back and side pain, headache, swollen abdomen, frequent urination that may have blood in it, kidney stones, kidney infections and kidney failure.
3. A healthy kidney weighs about a third of a pound, but a kidney with a number of cysts can weigh up to 30 pounds.
4. Polycystic kidney disease is hereditary and three specific genetic defects have been identified. There are two types of polycystic kidney disease, where the condition is caused by either a dominant or recessive genetic defect.
5. When dominate, the condition develops and shows symptoms when an adult is in their 30s, although in some cases children have been known to develop the disorder. Most cases, about 90 percent, are autosomal dominant polycystic kidney disease (ADPKD).
6. When recessive, the condition is called autosomal recessive polycystic kidney disease (ARPKD) and causes symptoms to typically appear in infancy.
7. In very few cases, polycystic kidney disease occurs from spontaneous gene mutation in an individual, rather than being passed through family genetics.
8. Managing blood pressure levels is an important part of keeping polycystic kidney disease from leading to other serious health problems. Heart problems and aneurysm are two complications from high blood pressure.
9. Loss of kidney function and high blood pressure exacerbate one another. When the kidneys become increasing damaged and work less effectively, blood pressure rises. High blood pressure also increases the risk for kidney failure.
10. Those with polycystic kidney disease may also experience liver cysts, colon problems and chronic pain. Treatment is aimed at controlling the condition to prevent these conditions, and also at alleviating pain.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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