Monday, January 28, 2013

Congestive Heart Failure and SSDI Benefits

If you suffer from congestive heart failure, you may be eligible for Social Security Disability benefits.  Congestive heart failure, occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body.  Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests.

The Social Security Administration generally calls congestive heart failure “chronic heart failure.”  In adult disability claims, Social Security uses the  five-step sequential evaluation in deciding whether the claimant is entitled to benefits.  Under the first two steps, the SSA will determine whether the claimant is working, and whether his or her impairment is considered “severe.”

Once the first two steps are decided in the claimant's favor, there are two basic ways that a person can qualify for Social Security benefits due to  congestive heart failure: 1. the individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or, 2.  show that he or she is unable to work.

Social Security uses the Listings of Impairments manual as their guide to determine whether a claimant meets or does not meet the Social Security Administration's requirements for total disability. The listing for congestive heart failure is found in Section 4.02. Section 4.02 states that in order to meet the lisitng of impairments, the claimant must suffer from one of the following
  • Systolic failure. This occurs when the heart has weakened pumping strength and can be shown by one of the following:

  • the heart’s ejection fraction (the percentage of blood pumped out of the heart with each heartbeat) is 30% or less during a period of stability (not during an episode of acute heart failure), or

  • the heart’s left ventricular end diastolic dimensions are larger than 6.0 cm.


  • Diastolic failure. This occurs when the heart is unable to fill properly, and must be shown by all of the following:

  • thickness of left ventricular wall and interventricular septum 2.5 cm or larger on imaging

  • an enlarged left atrium 4.5 cm or larger, and

  • normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure).
In addition, the claimant must also have one of the following symptoms.
  • Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to certain difficulties.

  • If an exercise tolerance test would be too risky, persistent symptoms of heart failure that very seriously limit activities of daily living (ADLs) are required, or

  • At least three episodes of heart failure and fluid retention within the past 12 months, requiring emergency room treatment or hospitalization for at least 12 hours.
If a claimant's condition is severe but not at the same or equal level of severity as a medical condition on the list, then the Social Security Administration must go to step 4 and 5 of the disability process and determine if  the condition interferes with the person's ability to do the work that he or she did previously (during the last 15 years). 
If the claimant cannot do the work performed in the past 15 years, the Social Security Administration will see if he or she is able to adjust to other work.  The Social Security Administration will consider the persons' medical conditions as well as his or her age, education, past work experience and any transferable skills that the claimant may have. If the claimant cannot adjust to other work, the claim will be approved. If the claimant can adjust to other work, the claim will be denied.