It is your heart's job is to filter blood and send it out to the rest of the body. The heart does this action by first pumping it through the four valves inside. Heart valve disorder occurs when the valves are not working properly, either by being too narrow or allowing leakage backwards, both of which restrict healthy blood flow to the rest of the body. About 8 million Americans are diagnosed with heart valve disorder every year, and many have lived with the disease without knowing, according to the American Heart Association.
With advanced valve disorder, working may be impossible. If you or a loved one are having trouble going to work and keeping up with bills, the Social Security Administration may be able to help. The government agency offers financial benefit programs for those suffering from a disability.
The Financial Costs of Heart Valve Disorder
There are many different types of invasive and non-invasive treatment for valve disorder, like surgery, prescription drugs, and a healthy lifestyle.
By far the most expensive, valve replacement surgery costs about $164,000 on average, the American Heart Association reported, though costs range from about $80,000 to $200,000, and can even exceed $200,000 if there are any major complications or you have other disorders as well. Your expenses may also be much less, depending on how well the surgery goes and where the surgery is done.
Valve disorder can cause other serious heart problems like heart failure and other conditions that could end up costing tens of thousands more in medical expenses. Heart failure, for example, can cost up to $25,000 per episode, a study in Clinical Cardiology found.
Medically Qualifying for Benefits with the Blue Book
When an application is submitted for Social Security disability benefits, the SSA evaluates it using the Blue Book. The Blue Book has all of the conditions and requirements that the SSA considers to be a disability. If you meet or equal a listing, you may be approved for benefits.
There is no specific listing for heart valve disorder, but you may apply with multiple listings in section 4.00—Cardiovascular disorders.
- Section 4.02 - Chronic heart failure with at least three episodes of acute heart failure in a 12-month period, symptoms that seriously limit your ability to perform daily activities without assistance, or the inability to do an exercise tolerance test at 5 METs because of difficulty breathing, fatigue, premature ventricular contractions, low systolic pressure, or decreased blood flow to the brain causing symptoms like mental confusion or trouble walking.
- Section 4.04 – Ischemic heart disease, that despite prescribed treatment occurs with, the inability to perform an exercise tolerance test at 5 METs due to depression, low systolic pressure, or documented ischemia, three or more separate episodes of blocked blood vessels requiring surgery to open (i.e. vascular bypass), or coronary artery disease, with at least 50 to 70 percent narrowing in one main artery.
- Section 4.05 – Non-reversible recurrent arrhythmias shown in clinical testing at least three times in a 12-month period resulting in multiple fainting episodes or periods of altered consciousness (cardiac syncope or near syncope respectively), despite standard prescribed treatment.
- Section 4.06 – Symptomatic congenital heart disease, with documented low blood oxygen levels causing discoloration of the skin, shunting, or obstructions in the blood vessels of the lungs.
If your heart valve disorder is affecting your ability to work, talk to your doctor about applying for disability benefits.
Qualifying Without Meeting a Medical Listing
If your heart valve doesn’t meeting any of the listings above, there is another way to qualify for benefits. If you can show the SSA that the limitations caused by your condition make you unable to earn at least $1,130 per month, which is the SSA’s minimum monthly income, you may be approved with a medical-vocational allowance.
A medical-vocation allowance is given based on your Residual Functioning Capacity (RFC), which is determined by a series of grid rules. The SSA takes your limitations into account and puts you in a category of work ability, ranging from sedentary to very heavy. Next, the SSA looks at your education level and work history to find a job within your work category. If they can’t find a job you can be reasonably trained for, you may be eligible for benefits.
Valve disorder can cause many symptoms that limit your ability to work, such as difficulty breathing or shortness of breath, weakness, fatigue, dizziness, chest pain or discomfort during regular activities, heart palpitations, swelling in the feet, ankles, or abdomen, unexplained rapid weight gain, fainting, or lightheadedness. In severe cases, the lack of blood flow can cause a heart attack, heart disease, or stroke.
How to Apply for Social Security Disability Benefits
There are many possible requirements for heart valve disorder, so you should talk to your doctor to find the one that fits you best. You will not be approved with just valve disorder unless your condition is very severe. Therefore, if your doctor is not confident you will be approved, it may not be worth the months or years the application process may take.
If you do meet a listing, or you’re applying with an RFC, it’s crucial you include all of the necessary medical evidence. Of the 70 percent of application denied in the initial claim stage, many would have been approved with the right information.
Important medical evidence for heart valve disorder may include:
- A physical examination, where your doctor should be able to hear valve disorder with a stethoscope.
- Echocardiography and Doppler echocardiography, which measure the thickness of your heart’s walls, valve’s shape, action, and size of openings, and how severe the narrowing or backflow of blood is.
- Electrocardiography (EKG), to determine if any chambers of the heart are enlarged or if you have an irregular heartbeat.
- Cardiac catheterization, to determine how well your heart is working.
- Coronary angiography, to determine if you need surgery and what kind.
- Imaging tests, like MRI, chest X-rays, and others to view images of the heart.
- A summary of any other tests, operative reports, treatments, and hospitalizations.
- A detailed statement from your doctor explaining the severity of your valve disorder and the ensuing limitations.
The SSA offers a convenient online application for those applying for Social Security Disability Insurance (SSDI), but you can still make an appointment at your local SSA office if you choose. If you’re applying for Supplementary Security Insurance (SSI) you must do so in person. Before you apply, make sure to check the SSA’s online application checklist.
Make sure to double check your claim carefully before you submit it, because any missed questions, typos, or spelling errors could hurt your chances of approval. The small mistakes can lead to the SSA not being able to find your information, which may cause the SSA to delay or deny your benefits.
If your valve disorder worsens after you apply, make sure to report any changes in symptoms, treatment, or test results to the SSA as soon as possible. The additional information will help show the SSA your need of assistance and your limitations.
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 the SSA website at www.ssa.gov or call SSA directly at (800) 772-1213
Need for a Social Security Disability Attorney
The majority of the claims for Social Security benefits are rejected at the initial claim and reconsideration level. This is often due to unqualified applicants and improperly filed applications.
Most claimants lack the knowledge of the correct way to put forward their applications. They tend to submit incomplete or unacceptable records that lead to their immediate rejection.
With years of experience in filing applications, a Social Security disability attorney knows the process and can therefore successfully take you through the procedure of correctly filing applications for benefits, thereby increasing your chances of consideration.
The advantages of hiring an attorney include:
- Correct filing of application
- Better representation at hearings
- Payment on contingency
Since the attorney is paid only when he wins a case, he puts in his best efforts into bringing forth all available medical evidences and test results, helping you file your paperwork, and defending you in court if need be.
Qualifying for benefits for heart valve disorders may not be easy due to lack of listing in the Blue Book. However, with the help of a good attorney and correct representation, your chances of claiming benefits greatly increase.