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We explain how you may be eligible for disability benefits for heart disease, what to do to qualify and prove your inability to work, and how Social Security reviews your medical history and tests your job function ability.
To collect disability benefits for heart disease, the two most important factors SSA considers are how serious your disease is and whether with treatment your condition will improve before you have been disabled twelve months. There are a number of different heart problems, but the final assessment is whether or not your condition affects you so much that you have been or will be are unable to work at a level that it is substantial gainful activity for period of twelve months or more. The twelve months can be interrupted by short work attempts if you have to stop work again due to your cardiac illness.
Types of Heart Disease
Many types of heart disease qualify for Social Security disability benefits if their manifestation is serious enough to cause disability. In years past, chronic heart disease meant the patient might never return to work; however, with today’s advancements in treatments, along with new medications, more and more heart patients are returning to the workplace. Although many people respond favorably to effective treatment for a variety of cardiac conditions and go on living actively and working; others may not be able to.
Heart Diseases that Could Meet SSA’s Blue Book Standards
A number of heart diseases meet the criteria for Social Security Disability (SSDI) based on the medical condition and its severity without the need for an analysis of your vocational history. This is called “meeting the listings.” These listings appear in a manual called the Blue Book.
- Aorta Aneurism or an aneurism in a major arterial branch
An aneurism is a bulge or a weakening in the aorta, the largest blood vessel in the body. In some cases, a graft of a man-made material can be put in place to correct this problem.
- Chronic Venous Insufficiency
A person’s heart is not able to pump blood to the legs and back to the heart. The symptoms of this disease are leg ulcers, swelling, and problems with standing. The SSA could grant disability if the painful ulcers do not heal within 3 months or if you suffer from brawny edema in at least two-thirds of the leg from the ankle to the knee or one-third from the ankle to the hip.
- Congestive Heart Failure (chronic heart failure)
To meet the benefit standard based on medical condition alone without considering your work history or education, you need to show you have pain, even without any exertion and your heart is pumping at a 30% capacity or less.
- Heart Transplant
You will be judged to be disabled for the first year after this operation.
- Hypertensive Heart Disease (High Blood Pressure)
This disease by itself is not sufficient to qualify for disability benefits. If it is serious enough to fall under Congestive Heart Failure or Ischemic Heart Disease you may meet the threshold for benefits.
- Ischemic Heart Disease
Usually this heart problem is found after an angiography or a stress test. The arteries are narrowed and thus unable to carry enough oxygen rich blood throughout the body; this is considered to be a pre-heart attack condition.
- Peripheral Artery Disease
This is a narrowing of the peripheral arteries, most often to the legs although arms, head and organs can also be affected. Usually causes difficulty in walking. Your symptoms must be confirmed with image testing and fall within the SSA criteria.
- Symptomatic Congenital Heart Disease
This would need to be confirmed with a catheter to the heart or a medical imaging test. Your oxygen and hematocrit levels need to fall within the SSA’s guidelines in order to receive SSD based on listings and without reference to your vocational history or education. An elevated systolic blood pressure or insertion of stents or shunts might also qualify for a disabled status.
- Recurrent Arrhythmias
This category of heart condition covers the state in which your heart does not beat at a regular rate. Coupled with this diagnosis, you must show that occasionally the arrhythmia causes you to almost or completely lose consciousness.
These examples are just general guidelines and your specific condition may not fall neatly into one of the categories. What is important is you submit enough information so that the disability examiner can understand why you are unable to do your previous work or work in a new job if you were to receive on-the-job training.
Disability Benefits for Heart Disease – Employment History
If your condition does not meet the listings, SSA will review your employment history to determine your previous job experience and the physical requirement for your past occupations. They will compare those requirements with your physical limitations stemming from your heart disease and any other conditions you might have to see if it is possible for you to return to work and do a type of work you have done in the past. If not, the claims examiner will consult vocational expert resources to look to see if there are new occupations that you could perform given your transferable skills, education, and medical limitations. Once a person reaches two bench marks—ages 50 and 55—the expectation for the ability to start a new occupation is lower. If no occupations are identified, your claim will be approved.
To make disability judgments, the disability examiner will study the medical history that you provide during on your initial application and any medical records or physician opinions that you submit. Because this is a key component of your disability application, it is vitally important your medical records are complete. Make certain the results of all your tests, examinations, treatments and medications are included.
In addition, your complaints of symptoms such as pain, shortness of breath, inability to think or focus because of the pain or lack of oxygen should also be noted in the record. If you are on medication, there may be side effects such as nausea, headaches, fatigue, depression, vomiting, vision problems, or problems with your memory. If these sorts of entries have been left out, contact your doctor to have your record updated with all the information available.
Hopefully, your doctor has recorded your reports of symptoms in your medical record including detailed observations of your condition and what your limitations are. For example, your doctor could note you are unable to walk more than one block without becoming out of breath, you are unable to stand more than 15 minutes, or you are unable to lift a certain amount of weight.
Residual Functional Capacity Test
A different method of gathering medical information is a Residual Functional Capacity (RFC) test. This test measures your ability to perform actions common to various jobs during a regular eight-hour shift, five days a week.
The RFC will measure your ability to sit, walk, stand, carry objects, lift objects, push, and to pull. The results of this test will show your capacity for work in jobs that are classified as Heavy, Medium, Light, or Sedentary. The RFC could also result in an analysis of less than sedentary capacity.
If your doctor says that due to shortness of breath you should not stand and walk for more than three hours a day and you can only lift ten pounds, the SSA will give you a rating of Sedentary. If you are not able to do that much or cannot work throughout a workday, then your rating would be sub-sedentary and approval would be likely.
Here are the definitions of the different strength levels:
- Sedentary – Sitting most of the work day with no lifting or carrying or regular ongoing use of the arms. Occasional lift to ten pounds.
- Light – Lift 20 pounds occasionally and carry ten pound objects. Expected to walk or stand for most of the day.
- Medium – Lift 50-pound objects occasionally and carry 25-pound objects throughout the day.
- Heavy – Lifting 100-pound items and carrying 50-pound objects.
With the RFC rating in hand, the SSA will determine which strength category you belong in and determine whether you are able to perform the daily and weekly tasks of your past occupations. If not, they will seek to find a job which is less taxing than your past work, either something that you are qualified to do or that you could do with normal on-the-job training.
Will you get approved for SSD benefits?
Even though heart disease is a very serious medical condition, it does not mean an automatic approval for Social Security Disability benefits. Your exact condition must be evaluated to determine whether your limitations prevent you from working as described above.
Presenting a heart disease benefit application to the SSA can be a complicated chore. Due to the complexities of such a situation, if your application is denied and you are certain that you cannot work regularly or more than a very limited number of hours, it is advisable for you to contact an attorney who specializes in Social Security Disability cases to help file an appeal. With their training and experience, they can advise you regarding the likelihood of success with your claim and will be able to present your case in the best manner for a positive outcome.