Chronic Heart Failure (also known as congestive heart failure or, simply, heart failure) is a condition in which the heart muscle does not pump blood as well as it should and this can cause symptoms such as extremity swelling or shortness of breath. As with many conditions, some cases will be more severe than others. While medications and lifestyle changes can help certain patients, other patients may require a heart transplant or a ventricular assist device.
How Does Heart Failure Qualify for Social Security Disability Benefits?
The Social Security Listing defines chronic heart failure while on a regimen of prescribed treatment, with associated symptoms and signs. The necessary severity of this condition for Social Security Administration would require medical documentation of either systolic failure or diastolic failure.
Systolic failure is defined by Social Security as “left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure).” Diastolic failure is defined by Social Security as “left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure).” The severity requirements also include that the systolic or diastolic failure results in one or more of the following:
Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance on an exercise test would present a significant risk to the individual;
Or...
Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e), with evidence of fluid retention (see 4.00D2b(ii)) from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization (see 4.00D4c);
Or...
Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to: a. Dyspnea, fatigue, palpitations, or chest discomfort; or b. Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or c. Decrease of 10 mm Hg or more in systolic pressure below the baseline blood pressure or the preceding systolic pressure measured during exercise (see 4.00D4d) due to left ventricular dysfunction, despite an increased workload; or d. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.
What if Your Heart Failure Doesn't Meet This Strict Definition of "Disabled"?
For a patient who does not meet or equal this listing, Social Security may still find that a person is disabled due to an inability to sustain gainful employment. Social Security will review the medical evidence and use that information to assess a “residual functional capacity.” A residual functional capacity (or RFC) is a function-by function assessment of an individual’s maximum ability to do sustained work-related activities and includes limitations and restrictions for the individual’s medically determinable impairments. Social Security will use the RFC to make two determinations: first, whether the individual can return to any prior work, and second, whether the individual – as limited – would be able to adjust to other work. At a hearing, the Social Security Administration will request input from a vocational expert about whether work is available to a person with the same RFC as the individual claimant.
How Our Social Security Attorneys Can Help
Since 1936, the Social Security attorneys of Keller & Keller have been defending the rights of people just like you. It's no secret that most claims for disability are denied; having an experienced attorney who knows the disability process can be a tremendous advantage.
If your heart failure is preventing you from working, or preventing you from participating in your daily activities, our attorneys may be able to help. Complete the form on this page today to get in touch with our team. We'd love to learn more about you. As always, our Zero-Fee Guarantee means that you pay us nothing until we win your case.
