Chronic Heart Failure and Qualifying for Disability Benefits

The Social Security Administration lists chronic heart disease as a disability under Section 4.02, but most applicants under age 65 do not qualify. To be eligible for Social Security Disability with a diagnosis of chronic heart failure an applicant must be diagnosed with chronic heart failure while under treatment.

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Does My Congestive Heart Failure Qualify for SS Disability Benefits? The SSA has specific criteria to evaluate whether your CHF is a disabling medical condition or not. In order to prove you meet the criteria your medical records must show that you suffer from severe, continuing heart failure even after treatment. Call 512-454-4000 for help today.

Chronic heart failure affects almost six million people in the United States with approximately 670,000 cases diagnosed each year.

Also known as congestive heart failure, chronic heart failure (or CHF) is a progressive condition that affects the pumping power of heart muscles. CHF is the leading cause of hospitalization of people over age 65.

The heart has four chambers; the upper half of the heart consists of two atria and the lower half has two ventricles.

Atria receive blood returning to the heart from the body and ventricles pump blood from the heart to the body. Chronic heart failure occurs when the ventricles fail to pump enough blood through the body and fluid builds up inside the lungs, abdomen, lower body, and other organs. Blood moves through the heart and body at a slower rate and pressure in the heart increases. As a result, the heart can’t pump enough oxygen and nutrients to supply the body’s needs.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from Chronic Heart Failure. If you have been denied disability don’t give up!

There are two types of heart failure: systolic and diastolic.

Systolic heart failure occurs when heart muscle doesn’t contract with enough force, reducing oxygen-rich blood pumped through the body. In diastolic heart failure the heart contracts normally, but the ventricles do not relax properly and less blood enters the heart. Congestive heart failure usually begins in the left side of the heart and can travel to the right atrium and ventricle if untreated.

Chronic heart failure is caused by a variety of conditions that overwork and damage heart muscle including:

•    Coronary artery disease – arteries that are narrow or blocked decrease blood flow to the heart muscle.
•    Heart attack – damages heart muscle and results in scarring.
•    Cardiomyopathy – damage to heart muscle caused by infections, alcohol or drug abuse.
•    Hypertension/high blood pressure.
•    Heart valves that don’t open or close correctly.
•    Birth defects.
•    Diabetes.
•    Thyroid disease.
•    Kidney disease.

While an individual with CHF can experience mild to severe symptoms, symptoms that come and go, or no symptoms at all, the following are common signs of chronic heart disease.

•    Congested lungs evidenced by a shortness of breath and/or a dry hacking cough
•   Rapid or irregular heartbeat
•   Fluid retention (swollen ankles and legs, bloating, weight gain)
•   Increased need to urinate, especially at night
•   Fatigue, weakness
•   Dizziness, fainting
•   Loss of appetite, nausea
•   Skin that appears blue

To diagnose congestive heart failure, a doctor will ask a patient several questions about conditions that cause heart failure during an exam.

A doctor will want to know if the patient smokes or has ever smoked or if they have had high blood pressure or high cholesterol.

They will also ask about drug use and alcohol consumption, any medications the patient is taking and order a number of tests:

•    Blood tests to measure cholesterol, evaluate kidney and thyroid function, and identify BNP (a hormone that is elevated in cases of CHF)
•   Chest x-rays
•   Echocardiogram to show the heart’s movement, structure and function
•   Electrocardiogram to measure electrical impulses traveling through the heart
•   MRI
•   Stress test

Chronic heart failure requires lifelong management, but with the number of treatments available today, symptoms can be reduced and a person’s quality of life can be improved.

In some cases, a heart valve can be repaired or an abnormal heart rhythm controlled. Most treatment involves a combination of medications and devices that assist the heart in beating and contracting properly. Treatment may even allow a person to live longer.

The Social Security Administration lists chronic heart disease as a disability under Section 4.02, but most applicants under age 65 do not qualify.

To be eligible for Social Security Disability with a diagnosis of chronic heart failure an applicant must be diagnosed with chronic heart failure while under treatment. The applicant’s medical records must also indicate that at some point the applicant experienced fluid retention (although Social Security does not expect a person to have fluid retention when their claim is evaluated).

Your medical records must be able to document that you have either systolic or diastolic failure. For systolic failure, medical evidence must indicate:

•   Ejection fraction (the percentage of blood pumped with each heart beat) must be 30% or less during a period of stability (not during acute heart failure); or
•    The heart’s left ventricular end diastolic dimension is larger than 6.0.

For diastolic failure, the medical evidence must document:

•   A left atrium of 4.5 cm or larger;
•   Normal or elevated ejection fraction during a stable period; and
•    Thickness of left ventricular wall and interventricular septum 2.5 cm or larger on imaging

Additionally, you must exhibit one of the following functional limitations:

•   The inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs (metabolic equivalent) or less; MET is the amount of oxygen consumed while sitting at rest; one MET is the energy it takes to sit quietly; or
•    Persistent symptoms of heart failure that severely limit activities of daily living; or
•   A minimum of three episodes of heart failure and fluid retention within the past 12 months that necessitated emergency room treatment or hospitalization for at least 12 hours.

If you have congestive heart failure, yet your medical condition does not match Social Security’s impairment listing, you may still be eligible for Social Security Disability benefits if you have another impairment; for example, kidney or thyroid disease.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work (called a medical-vocational assessment), taking into account your age, level of education and work experience.

If you have chronic heart failure, you may be eligible for Social Security Disability benefits.

In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.

The first category is the Work Requirements which has two tests.

1.   The Duration of Work test.   Whether you have worked long enough to be covered under SSDI.
2.   The Current Work Test.   Whether you worked recently enough for the work to actually count toward coverage.

The second category is the Medical Eligibility Requirement.

1.   Are you working?   Your disability must be “total”.
2.   Is your medical condition severe?    Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
3.   Is your medical condition on the List of Impairments?   The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
4.   Can you do the work you did before?   SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
5.   Can you do any other type of work?   If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.

More details can be found on our Qualifying for Disability page.

Lonnie Roach, a partner in the Austin law firm Bemis, Roach & Reed, has successfully assisted hundreds of clients including those suffering from Chronic Heart Failure who have been denied long term disability benefits.

A client of ours from Round Rock had congestive heart failure, uncontrolled arrhythmias, and a surgically implanted pacemaker.

This previous heart condition was later complicated by a paralyzed diaphragm that caused chronic Pulmonary Insufficiency. The client was determined to have a Class 5 physical impairment by her treating physician, a Board Certified Cardiologist. She was similarly certified as suffering a Class 5 physical impairment by a Board Certified Pulmonologist. She satisfied Social Security’s criteria for total disability under at least three separate sections. Her pathology was demonstrated by multiple, objective tests and she had been certified as totally disabled by a cardiologist and a pulmonologist. Despite all of this, Sun Life denied her claim. We handled her appeal got her benefits reinstated.

The former president of a company in Houston had been receiving disability benefits, and then was denied.

The Social Security Administration concurred with his physicians that he was disabled from any gainful activity, much less his former occupation as president of a multi-national corporation. At the time of denial, over ten years after the initial disability determination, he was placed on a heart transplant list. The physician on whom Hartford allegedly relied to deny benefits stated that the client could not work at any occupation. Nonetheless, The Hartford denied his claim. After filing suit, we were able to get his benefits reinstated.