Filing for Disability Benefits for Chronic or Congestive Heart Failure

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Congestive heart failure (CHF) is not one disease, but the result of any number of heart problems. It is a chronic, long-term condition where the heart is no longer pumping enough blood for the body to function properly. To compensate for the inability to pump enough blood, the heart beats faster and becomes enlarged, and the lungs, liver, GI tract, and extremities retain fluid.

Symptoms of heart failure can be mild or moderate, including shortness of breath, fatigue, and weakness, especially with exercise. CHF can also cause heart palpitations, leg swelling, and dizziness. If chronic heart failure is not treated properly, or is not responsive to medications, it can lead to organ damage (kidney or liver), lung disease, irregular heart rhythms, heart attack, stroke, or total circulatory failure and death.

When Does Heart Failure Qualify for Disability Benefits?

CHF can be caused by heart attack (myocardial infraction, in which heart tissue is damaged by lack of blood flow), coronary artery disease, cardiomyopathy, high blood pressure, or heart valve problems. If any of these problems have led to heart failure, the Social Security Administration (SSA) will evaluate whether they qualify for disability under its listing for chronic heart failure. (One exception: if your CHF is the result of pulmonary hypertension (cor pulmonale) due to lung disease, the SSA will evaluate your impairment using the impairment listing for cor pulmonale, 3.09.)

The SSA calls congestive heart failure "chronic heart failure" because it doesn’t require that you have fluid retention at the time of evaluation to get disability (although your medical records should show that at some point in time, you suffered fluid retention, such as lung congestion or leg swelling from CHF).

Many older people have some form of congestive heart failure. Depending on its severity, it may or may not be debilitating. To qualify for disability benefits under the SSA’s listing for chronic heart failure, you must have been diagnosed with severe continuing heart failure despite being on heart medication, with both sets of the following objective medical symptoms and functional limitations.

Objective Medical Symptoms of Heart Failure for Disability

Your medical record must show evidence of either systolic or diastolic heart failure – basically, you’ll need to show that you either have an enlarged heart or documented low blood flow out of the heart.

Systolic failure. This occurs when the heart has weakened pumping strength and can be shown by one of the following:

  • your heart’s left ventricular end diastolic dimensions are larger than 6.0 cm, or
  • your 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

Diastolic failure. This occurs when the heart muscle becomes stiffened, impairing its filling capability, and must be shown by all of the following:

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

Limited Functional Capacity Required for Disability

In addition to the above medical symptoms, you must also have one of the following problems:

  • Three or more separate episodes of acute congestive heart failure and fluid retention within one year, requiring hospitalization or emergency room treatment for at least 12 hours.
  • Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to:
    • Shortness of breath, fatigue, chest discomfort, or heart palpitations
    • Symptoms of inadequate oxygen to the brain, such as abnormal gait or mental confusion
    • Rapid heartbeat with three irregular heartbeats in a row (ventricular tachycardia), or increasing frequency of irregular heartbeat with six irregular heartbeats per minute (ventricular ectopy)
    • Decrease in systolic pressure due to left ventricular dysfunction, despite an increase in workload, of 10 mm Hg or below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise, or
  • Where an exercise test would be too risky, persistent symptoms of heart failure, such as shortness of breath, that very seriously limit activities of daily living (ADLs).

Note that if you have had a recent heart attack, heart surgery (such as coronary artery bypass grafting (CABG)), or a newly prescribed drug regimen, the SSA may wait three months to evaluate your impairment.

Medical Evidence of Heart Failure for Disability

After you apply for Social Security disability, the SSA will request your medical records. The SSA will want to see the results of a physical examination, blood work, and medical imaging (including echocardiography, cardiac MRI, cardiac catheterization, cardiac radionuclide scans, or chest  x-ray). Your records should show that you’ve visited the doctor frequently for your heart problems since they began.

If your doctor hasn’t give you an exercise tolerance test, the SSA might send you for to help assess your functional capacity – unless it can make a determination without one. However, the SSA won’t require you to take an exercise test if your treating doctor or the SSA’s medical consultant believes that an exercise test would be too risky.

Getting Disability Because of Reduced Functional Capacity

Most people who apply for disability benefits don’t qualify under the above listing for chronic heart failure because the condition doesn’t usually cause disability until retirement age (in which case you don’t need a disability to collect Social Security benefits).  Assuming you don’t qualify under the listing above, the SSA is required to consider the effect of your heart condition on your capacity to perform routine daily activities and work. Most people who are granted benefits due to CHF get disability benefits this way. For more information, see our heart condition overview article on getting disability for a heart condition because of reduced functional capacity.

Applying for Disability Benefits for Heart Failure

For more information on getting disability for heart conditions in general, see our article on getting Social Security disability for heart problems. If you’re ready 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. In your application, include how your heart condition is affecting your ability to exercise, work, and take care of your daily needs.

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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