Blood Clots and Social Security Disability

Blood clots are a universal condition that can affect anyone, sometimes for no apparent reason at all. According to Stop the Clot, almost one million people are estimated to be affected by deadly blood clots per year. Common conditions, such as Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) cause 274 deaths daily on average in the United States, which is more than breast cancer, traffic accidents, and AIDS combined.

If you or a loved one is suffering from complications due to blood clots and can’t work, the Social Security Administration may be able to help. The SSA provides financial benefits to those who are unable to work due to a disabling condition.

The Financial Costs of Blood Costs

Blood costs can be very costly, depending on how the severity and recurrence of your clots. For some less serious clots, the ABIM Foundation reported that blood thinners can cost around $3,000 for blood thinners, or anticoagulants, while inferior vena cava (IVC) filter can cost double or more to put in and remove after the clot has dissolved.

Clot Connect, part of the University of Chapel Hill Clot Outreach program, explained the cost of DVT or PE can go much higher. On average, DTV costs $20,000 per episode, and PE can be much more than that. Multiple episodes are common, with a 5 percent chance for DVT and 14 percent for PE, according to the Journal of Managed Care Pharmacy, which can tack on $15,000 for each additional hospitalization.

Furthermore, The Centers for Disease Control reported that one third of those suffering from DVT will contract long-term complications, such as post-thrombotic syndrome. The syndrome can cause swelling, pain, discoloration, and scaling in the affected limb, itching, varicose veins, ulcer formation by the ankle, and venous hypertension, which will prolong medical expenses.

Totally, it’s estimated the United States spends about $10 billion on blood clot related expenses. This doesn’t indirect costs of taking time off work, traveling, or paying for childcare for any of the surgeries or hospitalizations, which can cause patients to lose thousands of dollars.

Medically Qualifying for Benefits with the Blue Book

The Blue Book is the SSA’s official list of specific disabilities that qualify for benefits. When an application is sent to the SSA, they first use the Blue Book to determine if it meets any of the listed conditions and requirements.

Blood clots are evaluated under the body system they affect, so they’re found under multiple sections: section 3.00—Respiratory Systems and Section 4.00—Cardiovascular Systems.

In order to qualify for benefits via the Blue Book, you need medical evidence of showing the following:

  • Chronic pulmonary insufficiency, with chronic obstructive pulmonary disease due to any cause, including blood clots. Your highest Forced Expiratory Volume (FEV1) must be equal or less to the SSA’s height-FEV table. You can speak to your doctor about whether or not you’ve taken the FEV1 exam before.
  • Chronic impairment of gas exchange due to clinically documented pulmonary disease, with persistent low artery blood gas at rest or low single breath.
  • Chronic and irreversible enlargement of the right side of the heart, secondary to chronic high blood pressure, with either a high mean pulmonary artery pressure or low blood oxygen.
  • Recurrent and uncontrolled heart arrhythmias. They must be shown in tests at least three times in a 12-month period with intervening time in between and must not respond to regular medical treatment.
  • Heart defects with one of the following:
    • The appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface having low oxygen, called “cyanosis,” while at rest
    • Intermittent right-to-left shunting resulting in cyanosis on exertion with low oxygen blood flow during strenuous activity.
    • Secondary pulmonary vascular obstructive disease causing high blood pressure
  • Bulge of aorta or other major branches, due to any cause, not controlled by prescribed treatment

If your blood clots cause any other effects not listed here, you can still apply for benefits based on the symptoms of the clots or their effect to that body system. If you have any questions about the Blue Book listings or your likelihood of approval, talk to your doctor, especially if you find that your blood clots interfere with your ability to perform daily tasks or a full day of work.

Qualifying Without Meeting a Medical Listing

If your DVT, PE, or other complications don’t meet the any of the Blue Book’s listings or you haven’t had enough medical attention to qualify for a listing, you can be approved for benefits another way. The SSA also judges claims on an applicant’s Residual Functioning Capacity (RFC). Your RFC is determined by the limitations your condition causes you and your ability to do substantial gainful activity, which is work that earns $1,130 per month or more in 2016.

Because RFC approvals based on workplace limitations, they tend to happen more often than Blue Book. As with all disability applications, your disability has to be expected to persist for at least 12 months or end in death. If you are approved, the SSA reviews cases regularly.

When deciding your RFC, the SSA looks at your symptoms, limitations, work history, and education. It determines the level of work you can perform that may be eligible for benefits—sedentary, light, and medium—and put that against the jobs you’ve worked before and any training or schooling you’ve received. With the RFC, they can figure out if there are jobs at or below your level that you can work.

Blood clots that don’t meet the Blue Book can still cause very debilitating complications, such as Post-Thrombotic Syndrome, which occurs after valves in your legs have been damaged by clots. The valves, which normally make sure blood flows in the right direction and don’t leak, become damaged and allow blood and other fluids to pool in the arms and legs. Long-term symptoms include pain, swelling, heaviness, and cramping, making it hard to walk or stand for long periods of time, as well as discomfort while sitting. Recurrent clotting that requires too much time off work due to hospitalizations can also be a problem.

Though the SSA has grid rules for determining RFCs for applicants 45 and older, if you can show the SSA that you can’t do sedentary work, or that you can’t do your job and don’t have the education to work in an office, you may be approved as well. Generally, those without a college degree or those who have work physical jobs are more likely to be approved; however, blood clots affect a wide range of people.

How to Apply for Social Security Disability Benefits

Your doctor should be the first person you talk to when considering to apply for disability benefits. Because of the sheer number of applications the SSA receives and how much work goes into evaluating them, most applications take up to two years for approval, if at all. If your doctor doesn’t think your chances of approval are high, it may not be worth the time.

Important medical evidence will include:

  • Forced Expiratory Volume test results
  • Results from a single breath DLCO test
  • Electrocardiogram (ECG) test results to determine your heart’s electrical activity over a course of 12 months
  • Results from continuous readings from a heart rate monitor for 24 hours
  • Medical imaging test results, including, but not limited to, x-ray, MRI, and CT scan
  • Tests results that measure your arteries’ oxygen saturation, like a pulse oximeter reading or an Arterial Blood Gas (AGB) test
  • Results from a blood pressure cuff reading
  • Results from a cardiac catheterization
  • Other blood and urine tests
  • Records of all hospitalizations, surgeries, and doctor’s visits for 12 months
  • History, length, and outcomes of all prescribed treatments
  • Detailed reports from your doctor explaining your condition and your limitations

The SSA allows you to apply for benefits online or in person at your local SSA office. Double check to make sure you have all of the documentation that’s necessary, because missing information or unanswered application questions can force the SSA to delay or deny your application. A full list of materials needed for the application can be found on the SSA’s website including medical, personal, and tax information.

If you meet a Blue Book listing, you can be approved in the initial claim stage if you have all of your information at the time of submission.

If there are any changes in your condition or you are hospitalized while the application is processing, let the SSA know as soon as possible, because the move evidence they have of the severity of your condition, the more likely you are to be approved.

If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance and Supplemental Security Income.

If you'd like more information on applying for disability benefits with blood clots, be sure to read our page on tips for success.