We have been seeing more cases where people file for EEOICPA benefits for Chronic Kidney Disease and Chronic Renal Failure. Here is what you need to know about these conditions as it relates to the EEOICPA program.
Chronic Kidney Disease (CKD) or Chronic Renal Failure (CRF) is a collection of medical condition(s) many former workers pursue under EEOICPA. Some worker claims are successful and approved, with a majority of claims being denied. The reasons for success largely are attributed to 1) the job function(s) a worker held, 2) length of time in job function, 3) known and confirmed exposures to chemicals associated with forms of kidney disease, and then ultimately, 4) having the support of their Nephrologist or PCP during the claim process.
Denied claims, in our review, are largely due to 1) workers not having sufficient evidence of chemical exposure, (either based on job function or the absence of detailed information as to work processes), 2) because they rely on Department of Labor Physicians (Contract Medical Consultant) to weigh evidence and provide their medical opinion, and 3) Claims Examiners are not often familiar with various subtypes of CKD/CRF, don’t identify the condition within SEM searches, and issue denials because of lack of knowledge on this subject.
The purpose of this blog is to provide workers and physicians with relevant background for consideration of causation opinions where there is a reasonable likelihood that occupational exposure caused, contributed to, or increased the risk for, development of CKD. Background and facts you may want to reference in your claim and medical opinion from your doctor follow.
It is accepted that causation of CKD/CRF conditions are multifactorial in “cause”. Diabetes, Obesity and Smoking histories often have significant roles in “cause, contribution or increased risk” for a development of CKD/CRF. Whether you have diabetes, a smoking history, or carry a bit more weight than at your high school prom, paramount in the claim process is to inform your physician that when DOL requests a medical opinion, they are NOT asking for the physician to state with absolute certainty your kidney disease was solely caused by workplace exposure. You should inform your physician as to your work history, types of chemicals you recall working with, and then, make sure they are aware that the minimum DOL is seeking in a medical opinion as to whether workplace chemical exposure contributed to or increased risk for the development of the condition.
First, some housekeeping and terminology – CKD is a term used to describe the plethora of clinical manifestations that usually worsen as kidney function declines [Mitch 2020]. CKD has a number of diverse causes, both intrinsic and extrinsic to the kidney [Mitch 2020]. There are several forms of CKD/CRF. Medical professionals often interchangeably reference CKD, CRF, in medical records, or they may provide detailed reference to specific forms of CKD on specific diagnostics. Medical professionals, staff, and computer dictation often use different terminology, but they are referring to the same underlying condition of CKD/CRF.
Forms of CKD/CRF include:
Diabetic glomerulosclerosis, Hypertensive nephrosclerosis, Glomerulonephritis
Amyloidosis, Systemic lupus erythematosus, Reflux nephropathy (chronic pyelonephritis)
Analgesic nephropathy, Obstructive nephropathy (kidney stones, benign prostatic hypertrophy)
Myeloma kidney, Scleroderma, Vasculitis, Renovascular renal failure (ischemic nephropathy)
Atheroembolic renal disease, Autosomal dominant polycystic kidney disease
Medullary cystic kidney disease
Second, it is estimated that 13% of adults worldwide have CKD [Mitch 2020]. There are 5 stages of CKD [Mitch 2020]:
- Chronic kidney damage – normal or increased glomerular filtration rate >90 mL/min/1.73 m2; affects 3.5% of US adults
- Mild GFR loss – GFR 60-89 mL/min/1.73 m2; affects 3.9% of US adults
- Moderate GFR loss – 30-59 mL/min/1.73 m2; affects 7.6% of US adults
- Severe GFR loss – 15-29 mL/min/1.73 m2; affects 0.4% of US adults
- Kidney failure- GFR <15 mL/min/1.73 m2 or dialysis; affects 0.1% of US adults
Those with stages 3 to 5 CKD make up the largest group. The prevalence of adults with stage 3 CKD is rising due to aging populations and the rising prevalence of type 2 diabetes and obesity. These two conditions are associated with over 70% of CKD in the US: diabetes accounts for 44% and hypertension accounts for 28% [Mitch 2020]. In addition, obesity without coexisting diabetes is associated with CKD [Somar et al. 2013; Mitch 2020]. Obesity is one of the strongest risk factors for new-onset CKD [Kovesdy et al. 2017]. In addition, obesity increases the risk of diabetes and hypertension, and other risk factors for CKD.
A meta-analysis including 15 prospective cohort studies, with 65,064 incident CKD cases found evidence for cigarette smoking as an independent risk factor for developing CKD [Xia et al. 2017]. Compared with never-smokers, the summary relative risk of incident CKD were 1.27 (95% CI 1.19-1.35) for ever-smokers, 1.34 (95% CI 1.23-1.47) for current smokers and 1.15 (95% CI 1.08- 1.23) for former smokers. A relative risk greater than 1 is elevated, and this elevation is significant if the 95% CI does not include 1.
When providing a medical opinion, it is important for your doctor to address these significant causation factors in your case, acknowledging when diabetes, smoking, or obesity contributed to your CKD/CRF. If you have it, you cannot deny it. That said, it is still possible exposure to heavy metals (or solvents) from occupational sources over sustained periods had the potential for causation, contribution, or increased risk to development of CKD/CRF. If you did NOT smoke, do NOT have diabetes, or are not Obese, these factors should be noted in the medical opinion (include in the “differential opinion”) as non-causes, which increases the likelihood workplace exposures DID play a role.
For workers who are eligible under this program, the most common chemicals associated with CKD/CRF are heavy metals in the workplace (Lead, Mercury, or Cadmium), and industrial solvents, such as Trichloroethylene (TCE), Carbon Tetrachloride, and other organic solvents.
Technical narrative and references in this blog have been compiled through medical opinions from successful claims under this program. The narrative is generalized by AtomicWorkers® based on publicly available reference material, and links found under Reference have been reviewed, tested, and corroborated.
If you have questions about a current claim or a claim you are considering, you can reach out to us through this website, by phone, or by email. We would be happy to discuss what you are trying to do and offer our assistance.
References
Mitch WE [2020]. Chronic kidney disease. Chapter 121. In: Goldman L and Schafer AI, eds. Goldman-Cecil medicine, 26th ed. Philadelphia, PA: Elsevier Saunders Publishers, pp. 833-840.
Kovesdy CP, Furth SL, Zoccali C, and on behalf of the World Kidney Day Steering Committee [2017]. Obesity and Kidney Disease. Hidden Consequences of the Epidemic. Can J Kidney Health Dis. 2054358117698669.
Sommar JN, Svensson MK, Bjor BM, Elmstahl SI, Hallmans G, Lundh T, Schon SM, Skerfving S, Bergdahl IA [2013]. End-stage renal disease and low-level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden. Environ Health 23;12:9. doi: 10.1186/l476-069X-12-9.
Xia J, Wang L, Ma Z, Zhong L, Wang Y, Gao Y, He L, Su X [2017]. Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies. Nephrol Dial Transplant 32(3):475-487. doi: 10.1093/ndt/gfw452.