Filing for Disability Benefits for Chronic Heart Failure

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body’s need for blood and oxygen.  The heart is unable to keep up with its workload.  Chronic heart failure is a serious long-term condition and an estimated 5.7 million Americans are living with this condition daily. 

Symptoms and Impairments

Symptoms

Heart failure can involve the heart’s left side, right side, or both.  However, it usually affects the left side first and there are generally two different types of left-sided heart failure.  Systolic failure occurs when the left ventricle loses its ability to contract normally; and Diastolic failure is where the left ventricles loses its ability to relax normally.  The heart can’t properly fill with blood during the resting period between each beat.  Some symptoms of chronic heart failure are:

• Congested lungs
• Fluid and water retention
• Sudden weight gain due to retention of fluid
• Shortness of breath while at rest
• Increased swelling of the lower limbs (legs or ankles)
• Swelling or pain in the abdomen
• Dizziness, fatigue and weakness
• Trouble sleeping (awakening short of breath, using more pillows)
• Frequent dry, hacking cough
• Loss of appetite
• Rapid or irregular heartbeat

If you have heart failure, you may have one or all of these symptoms. 

Impairments

In the condition of chronic heart failure, the heart tries to make up for the deficiency by the following, which can cause serious impairments:

Enlarging—When the heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood

Developing more muscle mass—The increase in muscle mass occurs because the contracting cells of the heart get bigger.  This lets the heart pump more strongly, at least initially.

Pumping faster—This helps to increase the heart’s output. 

The body also tries to compensate in other ways where the blood vessels narrow to keep blood pressure up in trying to make up for the heart’s loss of power.  The body will also divert blood away from less important tissues and organs to maintain flow to the most vital organs; the heart and the brain.  These temporary measures mask the problem of heart failure, but they don’t solve it.  Heart failure continues and becomes worse when these substitute processes no longer work.  Eventually the heart and body can’t keep up and the person experiences fatigue and breathing problems.  The body’s compensation mechanisms help explain why some people may not be aware of their condition until after their heart begins to decline.

Getting Disability Benefits for Congestive Heart Failure

You must have a diagnosis of chronic heart failure with symptoms and signs that limit your ability to function and work.  You must be on prescribed treatment (medication) to meet the approved “listings” as outlined by the Social Security Administration (SSA).  You must have medically documented presence of systolic or diastolic failure and persistent symptoms of heart failure, which seriously limit the ability to independently initiate, sustain, or complete activities of daily living for a period of at least 12 months.  It is important to submit detailed activities of daily living showing how you are significantly limited by your heart disease.  As with any disability, your chances of being approved increase if you have consistent medical records of your condition.

Reasons for Denials and How to Appeal

Claimants are typically denied at the initial stage of their claim.  However, there are four levels in the appeals process that you can follow in order to get your claim approved.  They are:

Reconsideration

Reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be reevaluated and a new decision will be rendered. If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process.  SSA uses form SSA-561-U2 for reconsideration requests. 



Hearing

A hearing will be conducted by an Administrative Law Judge (ALJ). The individual, and/or his or her representative if he or she has one, may come to the hearing and present his or her case in person. The ALJ will evaluate all the evidence on record, including any additional evidence brought to the hearing, and will render a decision.

Appeals Council

The Appeals Council may decide to issue its own decision, remand the case to the ALJ to issue another decision, or allow the ALJ's decision to stand. The appellant will receive a copy of the Appeals Council's action.  SSA uses form HA-520-U5 to appeal an Administrative Law Judge's decision.

Federal Court Review

If the claimant disagrees with the Appeals Council's action, he or she has the right to file a civil suit in Federal District Court.

Getting Help from a Disability Lawyer

Individuals who hire a disability attorney who specializes in this area of law have a much better chance of getting their disability claim approved.  The statistics proved that those who are represented by a competent attorney are found disabled at the hearing level nearly twice as often as those who are not represented by legal counsel.  This legal representation does not involve any out-of-pocket expenses, as most attorneys will accept your case on a contingency basis.  The attorney is paid 25% of the past due benefits if they win your case and the amount must be approved by the Social Security Administration.