Ischemic Heart Disease Disability – You may Qualify
Can I get disability benefits if I am suffering from the effects of ischemic heart disease?
Author: Attorney Greg Reed
Heart disease affects people in all racial and ethnic groups and is the leading cause of death for men and women in the United States. Ischemic heart disease refers to heart conditions caused by the narrowing or blocking of the coronary arteries, the most common being coronary artery disease. Men are more likely to develop ischemic heart disease than women, but that gap closes after women reach menopause. Women over the age of 35 who take oral contraceptives and smoke are at high risk.If you are suffering from the effects of ischemic heart disease you may qualify for disability benefits.
What is ischemic heart disease?
Ischemic heart disease occurs when blood flow to the heart is reduced, preventing the heart from receiving enough oxygen.
Reduced blood flow is caused by a waxy substance called plaque building up inside the coronary arteries; this affects not only the heart, but the supply of oxygen to other vital organs such as the brain, kidneys and liver. Reduced blood flow can lead to abnormal heart rhythm, a heart attack or heart failure.
If you are suffering from ischemic heart disease and have been denied disability don’t give up! Most are initially denied. Just call 512-454-4000 for a free, no obligation consultation to learn your options and have your questions patiently answered.
Symptoms of ischemic heart disease appear suddenly or develop gradually over time.
In some cases, there are no symptoms, as in silent ischemia, where a person may not be aware of ischemic episodes because they do not experience any pain. The most common symptoms include:
- Chest pain
- Difficulty breathing or shortness of breath
- Fast heartbeat
- Neck or jaw pain
- Extreme fatigue
- Shoulder or arm pain
- Swelling of extremities
- Nausea and vomiting
Treatment for ischemic heart disease focuses on improving blood flow to the heart.
Doctors will recommend medications, surgery or a combination of both. A person with ischemic heart disease may or may not be able to work and may or may not qualify for Social Security Disability Income, depending on their symptoms.
How do I qualify for Social Security Disability Income if I have ischemic heart disease?
The Social Security Administration includes ischemic heart disease as an impairment in its Blue Book specifically under Section 4.04.
If you have ischemic heart disease, there are basically two ways you can qualify for SSDI: 1) you must meet the requirements of the impairment listed in the Blue Book; or 2) you can prove that your heart condition has reduced your functional capacity so severely that you are unable to hold a job. Social Security will consider the evidence in your medical records to evaluate your disability. In situations where there is little or no medical documentation, or the medical evidence covers only a short period of time, Social Security may order a consultative exam, a physical exam conducted by a physician contracted by Social Security.
To meet the requirements of Section 4.04 you must have one of the following symptoms:
- Angina pectoris – severe pain in the chest caused by inadequate blood flow often spreading to the shoulders, arms and neck.
- Anginal equivalent – shortness of breath on exertion, but no complaints of chest pain.
- Variant angina – chest pain at rest due to spasms of coronary artery.
- Silent ischemia – the heart doesn’t receive enough blood flow, but the person doesn’t have symptoms and requires a diagnostic test to detect.
In addition to the above symptoms, Social Security also requires you to show proof of one of the following:
- An abnormal stress test at workload equal to 5 METS or less. MET is a measurement of the metabolic equivalent of energy used by a person at rest and during activity. For example, MET 1 is the amount of energy used when a person is at rest. For more specific information on this requirement, see https://www.ssa.gov/disability/professionals/bluebook/4.00-Cardiovascular-Adult.htm#4_04
- Three ischemic episodes (temporary periods of symptoms) within 12 consecutive months. Each episode must require revascularization, a procedure that restores blood flow in blocked arteries or veins, such as angioplasty or bypass surgery.
- Abnormal imaging results from an angiography or other imaging showing 50% – 70% of narrowing of a coronary artery that has not been bypassed.
Social Security will be looking for a clinical record that shows your symptoms are so severe they limit your ability to engage in daily activities.
It will be very difficult to meet the requirements of this listing if you haven’t been receiving prescribed treatment or medication. Your medical records should include the following:
- Records of three months treatment
- Complete medical history
- Detailed physical exam reports
- Laboratory test results
- Electrocardiograph or electrocardiogram
- Exercise tolerance tests
- Any prescribed treatments you received and your responses to those treatments
- Medications and side effects
Discuss all your symptoms with your doctor and make sure they are included in your doctor’s statement; for example, chest pain that interferes with your concentration or if you have difficulty walking certain distances without shortness of breath.
Medications for heart disease can cause dizziness, nausea, blurred vision, lethargy and memory loss, so be sure to mention those side effects.
If your disability doesn’t meet Social Security’s ischemic heart disease listing requirements, you may still be eligible for disability benefits if you can show that your medical condition has reduced your functional capacity to such an extent that you can no longer do your job.
Social Security will review your medical records and doctor’s opinion and conduct a residual functional capacity (RFC) assessment to determine if you can perform your last job or any job, taking into account whether or not you are able to drive, your age, and level of education. In this case, your doctors’ opinions are critical in getting approved for SSDI. Social Security may find that your old job is too strenuous, and depending on your age and experience, Social Security may not expect you to learn a new job. Social Security follows a set of medical-vocational grid rules to determine when the agency expects an applicant to learn a new job. Disability applicants who are older than 50 or 55 often fall under a grid rule, which means they don’t have to learn a new job. If you can’t go back to your old job and you don’t have to learn a new one, Social Security will likely grant you disability benefits.
You may also be eligible for Social Security Disability benefits if you have another impairment.
Applicants with heart disease often suffer from other medical conditions such as kidney disease. One disorder alone may not meet the requirements of a Social Security impairment listing, but if you have more than one medical condition, Social Security must consider how those combined health issues limit your ability to hold a job and perform routine tasks.
What are the basic financial requirements for SSDI?
Assuming you meet all the medical criteria for a listed impairment, you must also meet Social Security’s basic financial requirement or you won’t be approved for SSDI.
In addition to having a disability that has lasted, or is expected to last 12 months, you must have worked in a job where you paid Social Security taxes long enough and recently enough, and you must not earn more than Substantial Gainful Activity (SGA), which is $1,470 per month in 2023 for nonblind applicants and $2,460 per month for blind applicants.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
Do not be discouraged if your application is denied; most initial applications are and you will have the opportunity to appeal. There are four steps to the appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case again.
- If your request for hearing is denied, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for Social Security who review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney, you should obtain legal counsel at this critical point to raise your chance for success.
- If an AJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to accumulate enough work credits, you may be eligible for disability benefits through Social Security Income (SSI).
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. It is based on income, not work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
If you have long-term disability insurance, you should file a claim with your insurance carrier right away.
Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work, or for the number of years stated in the policy. Your coverage is good only as long as you are employed. Do not quit your job before you file a claim and be sure to check the policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Note that some LTD companies can require claimants to also apply for SSDI, and it’s possible to receive both long-term disability insurance benefits and SSDI.
Do I need a disability attorney?
If you have ischemic heart disease and it has prevented you from working, you may be eligible for Social Security Disability benefits, but applying for Social Security Disability benefits is a complicated process that can take months to years.
An experienced Social Security disability attorney can assist you in getting the right medical tests and complete your initial application, avoiding delays and serious mistakes. At the request for reconsideration and hearing levels, an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. If you receive a denial, your chances of approval are increased significantly if you have legal representation. Fees charged by disability attorneys are regulated by federal law, so the most you will pay is 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
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Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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