There are a number of heart conditions which often qualify for Social Security Disability benefits. While you may apply for Social Security Disability benefits for any heart problem which causes you to be unable to work, there are a number of heart conditions which are specifically listed by the Social Security Administration.
These heart problems have specific guidelines regarding how the SSA will determine whether or not to consider you totally disabled. Qualifying heart conditions can be found in section 4.00 Cardiovascular System of the Blue Book. Some heart conditions that qualify for disability benefits include, but are not limited to, chronic heart failure, Ischemic heart disease, heart transplant and many more.
What You Need to Know Before Applying
If you are applying for Social Security benefits with a heart problem, be sure that you have all the necessary medical documents.
Like most disabilities, the severity of your heart problem carries as much or more weight than what kind of heart problems you have. Even if your heart problem does not meet the criteria for total disability as listed by the SSA, you may still qualify for Social Security Disability if you can show how your heart problem precludes you from doing any kind of work which you have done or for which you could be trained.
In addition to medical records, meeting a Blue Book listing and employability, the Social Security Administration will examine how your heart problems affect your daily activities.
Different Conditions that Could Qualify
While not exhaustive, here are some of the more common heart problems which often qualify sufferers for Social Security Disability:
- Chronic Venous Insufficiency. The hearts of those with chronic venous insufficiency are unable to pump blood from the legs back to the heart. This generally results in swelling, difficulty standing, and painful ulcers.
To qualify for Social Security Disability with chronic venous insufficiency, you need to have ulcers that don’t heal in 3 months.
- Recurrent Arrhythmias. This condition causes your heartbeat to be irregular; to race; or to beat slowly. To qualify for Social Security Disability due to recurrent arrhythmias, you must demonstrate that your condition causes you to pass out or to have frequent spells in which you come close to passing out.
- Chronic Heart Failure. Also called congestive heart failure, there are medical tests administered to measure the flow of blood from your heart. Your heart needs to be performing at 30% capacity to qualify as totally disabled. Additionally, you need to demonstrate that your heart problem causes you pain, even while not exerting yourself. This sort of heart failure can stem from cardiomyopathy, including dilated, hypertrophic, or restrictive cardiomyopathy.
- Ischemic Heart Disease. This is a pre-heart attack condition which is caused by problems with your arteries. Those who have this condition have poor oxygen flow within their blood stream. This condition is normally diagnosed as a result of a particularly poor stress test or angiography.
- Hypertensive Heart Disease. In order to qualify for Social Security Disability, your hypertension must be so serious that you would also meet the criteria for disability from ischemic heart disease or chronic heart failure.
You can find more information and tips for qualifying with a heart condition here: Tips for Applying for Disability with Heart Problems
There are some heart complications that many experience and then wonder if they will qualify for disability benefits. If you experienced a heart attack, the heart attack itself will not qualify you for disability benefits. But if the heart attack was a result of one of the conditions listed in the Blue Book, you then may qualify. Similarly, if you had open heart surgery, you will need to reference the Blue Book to see if you qualify under the condition that caused the need for surgery.
Finding Out If Your Heart Condition Qualifies
The SSA has all medical qualifying criteria listed in their Blue Book. All heart conditions can be found under section 4.00 Cardiovascular System. This section is broken down into subsections:
- Category of Impairments, Cardiovascular System
- Chronic Heart Failure
- Ischemic Heart Disease
- Recurrent Arrhythmias
- Symptomatic Congenital Heart Disease
- Heart Transplant
- Aneurysm of Aorta or Major Branches
- Chronic. Venous Insufficiency
- Peripheral Arterial Disease
Each of these sections explains what is needed to qualify for disability benefits if you are experiencing that condition. This includes things like test results, treatments, symptoms, limitations, and much more.
Even if the condition you are experiencing is not listed as a section, you may still qualify for benefits. Look over the Blue Book with your doctor to see if you meet a Blue Book listing. Your doctor can help you organize any tests that need to be done to meet a listing.
Some heart conditions will also automatically qualify for disability benefits under the Compassionate Allowance Program. For example, if you had a heart transplant or are experiencing Hypoplastic Left Heart Syndrome, you may qualify as a Compassionate Allowance.
When applying, review the listing to make sure you have all the medical evidence that can help support your claim. Many claims are initially denied for a lack of medical evidence.
Medical Records Needed to Qualify
If you are unable to work because of a heart condition, you may qualify for disability benefits. To be approved for disability benefits, the Social Security Administration (SSA) requires that specific medical criteria be met. Supporting documentation is essential to your claim.
Disability Determination Services (DDS), which reviews the claims filed for Social Security Disability benefits, must be able to confirm the severity of your condition and the diagnosis.
Your medical records should be as detailed as possible, and your records must be able to support your claim and confirm the severity of your condition. As an example, you will need to provide copies of medical tests that confirm your diagnosis.
These tests must show that your heart muscle doesn’t function normally and that you suffer discomfort because of activity or emotion, you experience myocardial ischemia, or you suffer from atypical angina.
To do this, you will need to provide the result of an abnormal stress test, ischemic episodes, or abnormal imaging results, and the results of an exercise test. Your exercise test should be a tolerance test with a workload at 5 METS or less, and it must reveal at least one of the following issues:
- At least .1 millivolt of ST segment elevation during exercise, which lasts 1 minute or longer into your recovery period
- Horizontal or downsloping ST segment depression of at least -.10 millivolts without the presence of digitalis glycoside treatment or low potassium lasting for at least a minute or longer into the recovery period
- Decrease of systolic pressure of 10 mm HG or more below the baseline level or below the preceding systolic pressure recorded during the exercise because of dysfunction of the left ventricle despite there being a workload increase
- Ischemia documented at an exercise level of 5 METS or less using medically accepted imaging like stress echocardiography
You can also be approved if you can provide medical records that detail three separate ischemic episodes within 12 consecutive months. Each of those episodes must require revascularization, which refers to bypass surgery or angioplasty.
If you are unable to take an exercise tolerance test because of the risks, a medically acceptable imaging test, such angiography that demonstrates coronary artery disease is permitted. The test results must show that there is a narrowing of a coronary artery. That narrowing must be the equivalent of one of the following:
- 50 percent or more narrowing of a non-bypassed left main coronary artery
- 70 percent or more narrowing of another non-bypassed coronary artery
- 50 percent or more narrowing involving a segment longer than 1 cm of non-bypassed coronary artery
- 50 percent or more narrowing of at least two non-bypassed coronary arteries or
- 70 percent or more narrowing of a bypass graft vessel
Any of these must result in serious limitations in the claimant’s ability to independently initiate, sustain, or complete activities involved with daily living.
To be approved with a recurrent arrhythmia, the only approved testing would be a resting or ambulatory Holter electrocardiography or by appropriate medical testing that reveal occurrences of syncope or near syncope.
As you go through treatments and diagnosis for your heart condition, keep copies of all medical documents. The tests above as well as doctors’ notes, prescriptions, treatment plans, copies of scans, etc. will help support your claim that you are unable to work due to the condition you are experiencing.
Qualifying For Disability With Heart Problems Under Reduced Functional Capacity
If you cannot get approved by meeting the criteria of a listing in the Social Security Blue Book, you can still be approved using a residual functional capacity (RFC). If your treating physician will complete one of these forms, it can be very beneficial to your case as your regular healthcare provider is more familiar with your overall health and all your medical problems.
An RFC will detail all your medical conditions, the treatment plan, if the treatment was effective, any medications that you take, the symptoms of the condition, your side effects from treatment, and any limitations and restrictions.
The RFC is very precise, so it basically spells out your condition and how it affects you. As an example, it may state that you cannot stand for longer than one hour because of fatigue and because of swelling of the extremities.
It may say that you must reposition yourself every thirty minutes, or that you cannot lift more than 5 pounds. Because of shortness of breath and chest pain, you may not be able to walk more than 500 feet without having to stop and rest. It will detail if you can bend, squat, reach, and carry items.
It will help the disability reviewer understand what kind of work – if any – you can do and if you are able to work a full-time job.
The RFC may paint a clearer picture of the severity of your condition than the reviewer will see just from the medical file and the claim form. If the cardiologist who treats your heart problems fills out the form, it may be more beneficial than having your primary care provider (PCP) complete it. However, both your PCP and cardiologist can complete an RFC for you and that may help you with your claim.
Other Requirements For Disability Benefits
Not only will you need to medically qualify for disability benefits, you will need to meet other qualifications. For those applying for Supplemental Security Income (SSI), you will need to be within specific income limits. Those that are unmarried will need to have less than $2,000 in assets while those that are married will needed less than $3,000 in assets.
If you are applying for Social Security Disability Income (SSDI), you will need to have obtained enough work credits. These are earned by working and paying into Social Security. Though the number of credits changes depending on your age, typically if you have worked five of the last ten years you will have enough work credits.
Get a Free Case Evaluation
Bear in mind that you may still qualify for Social Security Disability benefits even if your heart problems do not fall strictly within the guidelines for total disability, so long as you can convince the Social Security Administration that your heart problems make it impossible for you to engage in any work.
In addition, you must show them that your heart problem makes training for a job other than your original impossible. A qualified disability advocate can help you determine whether you should pursue a Social Security Disability claim.
If you think you might qualify for Social Security Disability benefits based on a heart problem, the two people you should get in your corner are your doctor and a Social Security Disability attorney.
Your doctor will need to substantiate the medical information, as well as document what attempts are being made to control or improve your heart condition.
An attorney who specializes in Social Security Disability gives you the best chances of having your disability claim accepted, as well as helping you through the appeals process, if it should become necessary.