Disability Benefits for Heart Attack or Heart Disease

Heart disease can be a catchall term that refers to various disabling heart conditions, but most often it refers to coronary artery disease (CAD), also called coronary heart disease (CHD). CAD is the narrowing or hardening of the coronary arteries -- those supplying the heart with blood. This happens when arteriosclerosis causes plaque to build up in the artery walls. The plaque interferes with the normal flow of blood to your heart muscle, causing a reduced flow of blood (and oxygen) to the heart (this is called ischemia).

Coronary artery disease can cause myocardial infarction (a heart attack), which happens when the blood flow to the heart is totally interrupted, causing heart muscle tissue to die as a result of oxygen deprivation. Lack of oxygen to other organs, such as the kidneys and brain, can also cause damage and organ failure. CAD can also cause congestive heart failure.

What Is Ischemic Heart Disease?

Coronary artery disease is often referred to as ischemic heart disease (myocardial ischemia); this is how the Social Security Administration refers to the condition. Ischemic heart disease can be caused by ischemic cardiomyopathy, but it can also be caused conditions unrelated to coronary artery disease: narrowed heart valves and vasospasm (spasm of blood vessels).

The main symptom of coronary or ischemic heart disease is chest pain, called angina pectoris. This is discomfort in the chest described as aching, dull, squeezing, or tight. It is brought on by physical exertion or intense emotion, and only lasts three to five minutes (longer episodes are called unstable angina). Other symptoms of ischemic heart disease are shortness of breath, rapid or irregular heartbeats, fatigue, and weakness, especially with exercise.

Risk factors for coronary artery disease and ischemic heart disease include diabetes, obesity, high blood pressure, and lung disease from smoking. Coronary artery disease is one of the leading causes of death in the United States.

When Does Coronary or Ischemic Heart Disease Qualify for Disability Benefits?

Many older people live with ischemic, or coronary, heart disease. Symptoms like angina, shortness of breath, and fatigue can be mild, only showing themselves on extreme exertion, or they can be moderate to severe, appearing with little exertion, or even at rest in the most severe cases.

Depending on its severity, coronary heart disease may or may not be debilitating. To qualify for disability benefits under the SSA’s listing for ischemic heart disease, you must have been diagnosed with ischemic heart disease despite being on cardiovascular or heart medication, you must have a documented history of angina, and you must fulfill the requirements of one of the following sections.

Ischemic Episodes

You can qualify for disability benefits automatically if you have had three separate ischemic episodes (a temporary blockage of the blood supply) within the past year,  each requiring balloon or stent angioplasty or coronary artery bypass surgery (unless revascularization could not be done for some reason).

Poor Exercise Stress Test

To qualify under this section, you must have had an exercise stress test with one of the following abnormalities at 5 METs or less:

  • Horizontal or downsloping ST segment depression at least 1.0 mm on an EKG, lasting for at least one minute post-exercise.  
  • At least 1 mm ST segment elevation, lasting at least one minute post-exercise.
  • 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
  • Documented ischemia at an exercise level of 5 METs or less on imaging, such as stress echocardiography or radionuclide perfusion scans.

Abnormal Imaging Results and Functional Limitations

If an exercise test would be too risky, you can qualify if you have had a cardiac catheterization (angiography) that shows coronary artery disease. The angiographic evidence must show one of the following:

  • At least 50% narrowing of a left main coronary artery (that hasn’t been bypassed).
  • At least 70% narrowing of another coronary artery (that hasn’t been bypassed).
  • At least 50% narrowing of a segment of a coronary artery longer than one centimeter (that hasn’t been bypassed).
  • At least 50% narrowing of two coronary arteries (that haven’t been bypassed), or
  • At least 70% narrowing of a bypass graft vessel.

In addition, your coronary artery disease must seriously limit your activities of daily living (ADLs).

Medical Evidence of Coronary/Ischemic Heart Disease 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 (EKG), cardiac catheterization, cardiac radionuclide scans, cardiac MRI, and/or chest  x-ray).

The SSA will require a detailed description of your chest pains as documented by your doctor, what brings them on, and their frequency, so that it can evaluate them. Your records should show that you’ve visited the doctor periodically for your heart problems since they began.

Exercise tests can be very important to a disability determination. EKGs during exercise and radionuclide imaging showing abnormal motion of the heart’s walls during exercise can also be very helpful for a disability determination. If your doctor hasn’t give you an exercise tolerance test, the SSA might send you for one 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.

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

Getting Disability Because of Reduced Functional Capacity

Many people who apply for disability benefits don’t qualify under the above listing for ischemic heart disease. However, before denying your application, the SSA is also 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 CAD get benefits this way. For more information, see our article on getting disability for a heart condition because of reduced functional capacity.

Applying for Disability Benefits for Coronary/Ischemic Heart Disease

For more information on getting disability for heart conditions in general, see our article on disability for heart conditions. If you’re ready to apply for disability for coronary heart disease, 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 disease is affecting your ability to exercise, work, and take care of your daily needs.

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