Compassionate Allowances - Fulminant Giant Cell Myocarditis

Fulminant Giant Cell Myocarditis (GCM) is a rare autoimmune heart disease that automatically qualified for disability benefits through either of both of the Social Security Administration's (SSA's) disability programs, though you must still complete the application process and meet all the SSA's eligibility criteria in order to be approved for benefits.

The SSA's Disability Programs

The Social Security Administration (SSA) has two disability programs for which you may qualify with GCM:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)

For both of these programs, you must also meet the technical eligibility rules in addition to qualifying medically. For SSDI, you must have sufficient work history to be eligible, while for SSI, there are income and asset or financial resource limitations.

The Compassionate Allowance Program

This program, which is also known simply as CAL, makes it possible for your application to be reviewed in just a few weeks time, where the typical applicant takes at least four months to proceed through the initial review.

CAL conditions are automatically eligible for disability benefits, but this does not get rid of the application and documentation requirements of filing a disability claim. It only simplifies or streamlines the review process.

Evidence Required for Proving Disability

The SSA must determine certain things in order to approve any application for benefits, including those filed under the CAL program. They must be able to discern from your application and medical records: reviews your medical records to confirm two key pieces of information:

  • A definitive diagnosis of Fulminant Giant Cell Myocarditis
  • That your GCM is severe enough to cause disability

To confirm your diagnosis, the SSA needs to see any or all of the following test results:

  • Blood tests results showing the presence of viral infection, if applicable
  • MRIs of your heart
  • Coronary angiography
  • Endomyocardial biopsy
  • The presence of biomarkers of heart injury, like troponins and creatine kinase

To document the severity level of your GCM, the SSA will also need to see any or all of the following that apply in your case:

At the minimum, before applying for SSD benefits, you must have these medical records available:

  • A detailed report of physical examination
  • Clinical history report
  • An MRI of the heart
  • A cardiac biopsy

Applying for Benefits

To apply for disability benefits, you can either:

  • Complete your application on the SSA's website
  • OR

  • Schedule an appointment with your local SSA office to fill out your application in person

Either way, you will need to submit as many of your medical records as possible at the time of application in order to avoid further delays in processing your claim. The fewer record the SSA must request from doctors, hospitals, and radiologists, the faster your application will proceed through the initial review stage.

Although it is uncommon for CAL conditions to be denied, it does happen. If you are denied benefits, it will most likely be due to a lack of the appropriate medical tests having been performed. It is crucial you meet the minimum medical records requirements when you submit your application.