The genito-urinary system is
associated primarily with diseases of the kidneys and the male and female organs.
In my years of experience as a disability
examiner, I have never seen a case involving the sexual organs which has resulted in an
allowance decision.
For this reason, we will
concentrate our attentions on disorders of the urinary system exclusively.
General
Evaluation
Urinary impairments as with any
disorder which does not meet or equal the medical listings, should be evaluated as to the
degree of dysfunction it causes the claimant. Some
of the more common signs and symptoms of urinary disease are acute changes in urinary
habits, blood in urine, frequent or recurrent bladder infections, incontinence of urine,
chronic fever, weight loss, swelling, pain and malaise.
These symptoms in and of themselves would not constitute a total disability. However, the claimant with a urinary disorder
must be viewed as to the specific effects the symptoms are having on that individual.
Usually you will find that the claimant has other
impairments which are more disabling than the urinary disorder.
The most obvious restrictions
caused by the urinary system would be seen in a person with serious urinary incontinence.
In this situation the claimant cannot control the
release of urine from the bladder due to his underlying disorder.
If this type of problem is continuous (expected to
or has lasted for twelve months), this would interfere with the claimant's ability to
work.
Although
people in this situation can be fitted with an internal catheter, infections often occur.
Many of these individuals are forced to wear
diapers. Granted, wearing diapers and
urinating uncontrollably is not the worst restriction in the world, but for obvious social
reasons it should be argued as a profound restriction to work activity.
The progression of a urinary
disorder is an important factor to consider when evaluating the problem.
Many claimants with serious kidney disorders will
be denied benefits because it appears that their condition is improving.
Very often the disease will become worse over time
(progressive) and the claimant's health will deteriorate.
Stay alert to the possible worsening of an impairment in all disorders you
evaluate.
Other than pain, the symptoms of
urinary disorders are not that impressive.
Use
the symptoms as additional ammunition in a person with multiple impairments in order to
present a total view of the claimant's actual ability to function.
The tests used most often as
supportive evidence of a urinary impairments including those of the kidneys, are urine
analysis, urine output measurements, creatinine clearance test, plasma creatinine test,
IVP and renal biopsy.
The urinalysis is the
most common test used in the early evaluation of urinary tract disorders.
This test is easy to perform and gives a wealth of
important information about the condition of the urinary system.
A claimant simply gives a specimen of urine to the
nurse for evaluation.
This test will indicate
urine protein concentration, Ph, microscopic blood, sugar and ketone concentrations.
The urine and blood creatinine
clearance and
urine output
test are used as indicators of kidney and
bladder function.
If the claimant has an
elevation in serum or urine creatine, this can be an indication of a kidney malfunction.
If urine output is low, this could indicate poor
intake, renal failure or an obstruction in the urinary system.
Tests like the IVP
(intravenous
pyelogram) are used to evaluate the circulation and internal structure of the
kidney.
Normal values for the urine test can
be found in any medical text.
If tests like
the IVP were performed, the results will be part of the claimant's medical records.
The following is a list of some
of the most common urinary disorders seen by SSA.
The
above discussion will include the signs and symptoms for all of these disorders, so no
further comments will be offered.
Nephrotic syndrome
Chronic renal failure
Infections of the urinary tract
