Disability Determination for Heart Problems & Cardiovascular Disease

Social Security looks at various tests to determine the severity of your heart condition and whether your doctor has restricted your activities.

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Various types of heart disease and cardiovascular problems qualify for disability through the Social Security Administration (SSA). For most common heart problems, the SSA doesn't evaluate disability according to the underlying heart problem, such as cardiomyopathy, arteriosclerosis, cardiac arrest, myocardial infraction (heart attack), or pericarditis. Rather, the SSA focuses on whether your ability to work or exercise is limited by your heart's reduced capacity to pump blood or by your heart muscle's not getting enough blood.

The SSA will look at various tests, including exercise tests, EKGs, and cardiac imaging, to see if your heart condition meets the requirements of an SSA impairment listing. If not, the SSA will look to what exertional restrictions your doctor has put on you (such as no heavy lifting) to see if there are jobs remaining that you can do.

SSA Disability Listings for Heart Problems

You can qualify for disability by meeting the SSA's impairment listings for:

  • Chronic (congestive) heart failure (heart's pumping action is compromised)
  • Ischemic (coronary) heart disease (reduced blood flow to the heart muscle)
  • Recurrent arrhythmias (abnormal heart rhythm causing syncope -- loss of consciousness)
  • Symptomatic congenital heart disease (structural defects leading to malfunction, causing cyanosis – bluish skin from oxygen deprivation)
  • Aneurysm of aorta or major heart branches (swelling due to weakness in blood vessel wall)
  • Chronic venous insufficiency (leg veins cannot pump enough oxygen poor blood back to the heart)
  • Peripheral arterial disease (obstruction of large arteries to the extremities), or
  • Heart transplant (to remedy end-stage heart failure or severe coronary heart disease).

Unless you're a doctor, it can be difficult to determine which SSA impairment listing your heart condition falls under. For example, coronary artery disease is usually evaluated under the listing for ischemic heart disease, though it can also cause congestive heart failure (CHF).

Dilated cardiomyopathy can lead to congestive heart failure, but ischemic cardiomyopathy leads to ischemic heart disease. Arrhythmias are most often caused by ischemic heart disease but have their own listing.

Most people who apply for disability for heart conditions are evaluated under ischemic heart disease or chronic heart failure. Specifically, most patients who've had a heart attack or have heart disease are evaluated under ischemic heart disease because their doctor has diagnosed them with coronary artery disease. But if you have chronic or congestive heart failure, which means your heart is not pumping out enough blood properly, whether it's from high blood pressure, atherosclerosis, cardiomyopathy, or congenital heart disease, you would use the chronic heart failure listing.

The SSA used to have an impairment listing for high blood pressure, but now if you have severe hypertension you simply are evaluated under the condition your hypertension has caused, such as congestive heart failure, coronary artery disease, stroke, or kidney damage.

Evidence of Heart Conditions

Test results are very important to the SSA's determination. An EKG can indicate that your heart muscle is not getting as much oxygen as it needs (ischemia), that your heartbeat or heart rhythm is abnormal (arrhythmia), or that there are other abnormalities of your heart, such as left ventricular enlargement (which can be indicative of heart failure). Results of an exercise tolerance test (ETT), also called a stress test, are also important because they tell the SSA how much work/exertion you can do before having heart symptoms like shortness of breath, angina (chest pain), or exhaustion.

Qualifying for Disability Because of Reduced Functional Capacity

Many adults have serious heart conditions that make it difficult for them to work, but they don't meet the stringent requirements of the SSA's impairment listings above. For instance, maybe you have coronary artery disease and had one ischemic episode in the past year but not three. Or maybe you have systolic heart failure but your ejection fraction is 40%, not 30%, and the results of your exercise test is poor but not as bad as the SSA requires.

You still may be eligible for disability benefits (unless your heart medication or completed heart surgery returned you to full functional capacity). When you don't automatically qualify for disability benefits under the SSA's official listings, as the next part of the disability determination process, the SSA is required to consider the effect of your heart condition on your capacity to perform routine daily activities and work. The SSA will then determine whether there is any kind of job you can safely be expected to do.

What Is Your Residual Functional Capacity (RFC)?

If you have had an episode of heart failure or ischemia, or you have shortness of breath, exhaustion, or angina (chest pain) when you do physical work, the SSA should give you a rating of the type of work it thinks you can do. This is called your residual functional capacity (RFC). The SSA will consider your lab tests, your exercise tests, your imaging tests, and your doctor's notes on your functional limitations and restrictions, as well as your reports of angina and other symptoms.

An RFC will rate your ability to do sedentary work, light work, or medium work. For instance, if your doctor has limited you to standing and walking no more than four hours per day, your RFC will be for sedentary work. If your doctor has limited you to no lifting more than 20 pounds, but okays standing or walking for six to eight hours per day, your RFC will be for light work. If a CT scan shows you have an enlarged heart due to congestive heart failure, despite several months of treatment, you should get an RFC for light work. If you've had a heart attack or have a partial blockage in a coronary artery, or have had coronary bypass surgery or angioplasty (balloon or stent), your RFC should be medium or lower, depending on your symptoms.

It's important for the SSA to know how much physical exertion you can do before you develop symptoms. Exercise tests are very important in this regard. For instance, if you have an exercise stress test that's close to what the impairment listings require for heart failure or coronary heart disease, you should probably get a light RFC.

What Jobs Can You Do With Your RFC?

Next, the SSA will determine if you can do your prior job given the limitations of your RFC. If you can't, it will look at your education level, age, and experience to determine if there's any other kind of work you can safely be expected to do. If you were given a sedentary RFC, for instance, the SSA will see if there are any desk jobs you can do. If you can read and write, the SSA is likely to find that there are desk jobs you could do, and won't find you disabled. But for those who are over 55 and have little formal education and skills, chances at getting disability benefits through what's called a "medical-vocational" allowance are much greater.

Applying for Disability Benefits for Heart Conditions

To apply for disability, call 800-772-1213 to set up an appointment to submit an application for SSI or SSDI through your local SSA office. If you're applying for SSDI only, you can do so online at ssa.gov. In your application, include how your heart condition is affecting your ability to exercise, work, and take care of your daily needs. Include details such as your needing to use the bathroom more than once per hour because of congestive heart failure or side effects of your heart medication, or your needing to sleep on pillows because of lung congestion.

If you have other physical problems as well, include these on your application. For instance, diabetes, obesity, and high blood pressure are common in people with heart failure or heart disease. In addition, it's not uncommon for people who've had a heart attack to develop anxiety disorders. If you have panic attacks, you should see a psychologist or psychiatrist and include details about your anxiety on your application.

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