Compassionate Allowance - Ventricular Assist Device Recipient

While awaiting a heart transplant, a Ventricular Assist Device (VAD) may be required. A VAD may also be used while recovering from surgery and by individuals with heart failure that are not eligible for a heart transplant.

A VAD may work to pump blood through the left or right ventricle or both. Regardless of what type of VAD is required, the Social Security Administration (SSA) knows dependence on such a device leaves an individual disabled and therefore qualified medically for Social Security Disability (SSD) benefits.

Disability Benefit Programs

The SSA has two disability programs through which a VAD Recipient may qualify:

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

Both of these programs require applicants meet the medical eligibility criteria, which VAD dependence does. Each program also requires applicants meet the technical eligibility rules:

  • For SSDI, applicants must have a work history and accumulated work credits.
  • For SSI, applicants must have very limited income and other financial resources, but no work history or credits are necessary to qualify.

Compassionate Allowances

VAD recipients qualify for expedited review of their claims under the SSA’s Compassionate Allowances (CAL) program. This program is designed to get benefits to those who need them most in a shorter than average timeframe. Applications that are part of CAL take only a few weeks rather than the months it typically takes the average application to pass the first review stage for SSD benefits.

The CAL program additionally minimizes the medical evidence needed to support a disability claim. The SSA may still consult its Blue Book manual when reviewing CAL claims, but the listings for disabilities found in the Blue Book are only used to substantiate the severity level.

The listings that apply to VAD recipient applications are:

  • For Adults – Section 4.09
  • For Children – Section 104.09

Both of these listings indicate that 90, consecutive days on a VAD is all that is necessary to meet the severity level requirement to medically qualify for disability benefits.

Required Medical Evidence as a Ventricular Assist Device Recipient

Although VAD recipients are considered “automatically” medically qualified for SSD under the CAL program, they must still submit medical evidence to support their claim for benefits. They must additionally ensure they complete the full application and provide all the necessary details to prevent any delays in the processing of their claim.

Medical evidence required for supporting a VAD recipient claim includes:

  • A clinical history report, detailing the recipient’s medical conditions, treatments, and prognosis
  • Hospital admission and discharge report summaries
  • Operative reports, including the placement of the VAD
  • Consultation reports from a cardiologist
  • Imaging test results, including EKGs or echocardiographs

Submitting an Application

Applications for SSDI benefits can be made in person at the local SSA office or online, via the SSA’s website. SSI applications however, must be completed during a personal interview with an SSA representative.

Whether you apply online or in person, ensure you submit copies of your medical records and other documentation to support your application. To schedule an application interview, call 1-800-772-1213.