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Social Security Disability for Heart Failure

If your heart is not pumping enough blood for your body, you are suffering from heart failure. Heart failure is a chronic condition that will worsen throughout time. On rare occasions, it can develop more suddenly. Sometimes it is called congestive heart failure. It can impact either one side or both sides of the heart.

When your heart is unable to pump blood out to your body, it is a condition known as systolic heart failure. If your heart’s chambers do not properly fill with blood, it is diastolic heart failure. Regardless of the kind of heart failure from which you are suffering, there is a real danger of blood backing up into other systems of the body and causing congestion to the liver, lungs, gastrointestinal tract, or even the extremities. You can have both systolic and diastolic heart failure at the same time.

Heart failure can impact your ability to function in daily activities as well as impair your ability to work. Congestive heart failure can involve shortness of breath, the build-up of bodily fluids, swelling of the feet and ankles, swollen belly, confusion, increased heart rate, persistent coughing, and other symptoms. It is usually a long-term condition that will worsen over time, so it requires frequent medical treatment and monitoring.

The Costs for Treating Congestive Heart Failure

Because heart failure is a long-term, chronic illness that can have a variety of symptoms, it can involve frequent visits to doctors, require extensive testing, and involve several prescription medications that can treat a variety of the symptoms. If you are insured, you will have co-pays and deductibles for doctor visits and prescriptions.

The regular treatment over a long period of time will definitely add up. According to the February 22, 2014 issue of Clinical Cardiology, the annual cost of heart failure in the U.S. is $39.2 billion with total direct costs reaching $60.2 billion for those with primary diagnosis and $115.4 billion for those who had the diagnosis as part of another disease.

Heart Failure Social Security Benefits

The average hospital stay for an individual with heart failure was listed at 4.77 days with more than 1 million stays having been recorded, which resulted in professional services costs totaling about $4.46 billion. The disease is very costly to treat, and there are no cures for this condition. As the population ages, it is expected the number of people diagnosed with the problem will increase and the costs will continue to climb.

For the average individual with insurance, the costs are anticipated to be around $1,200 to $5,000 out-of-pocket each year to cover co-pays and coinsurance for medications, testing, and doctor office visits.

The SSA Evaluation and Medical Qualifications

The SSA has its own disability evaluation book, which is called the Blue Book.

Heart failure is listed under Section 4.00, which deals with the various kinds of heart failure and symptomatic heart disease as well as cardiac transplants. Section 4.02 address heart failure that is chronic.

In order to be qualified for SSDI due to chronic heart failure, you must be continuously undergoing prescribed treatment. In addition, you must meet these criteria:

You must have been diagnosed with chronic heart failure, and it should have been evidenced by one of the following:

  • Systolic failure of the heart with left ventricular having end diastolic dimensions of more than 6.0 cm or have an ejection fraction reaching 30% or less when the heart is stable and not during an acute episode.
  • AND

  • The previously mentioned condition results in the persistent symptoms of heart failure that cause serious limitations impairing your ability to independently take care of daily tasks. Also, you cannot perform any exercise tests without having significant health risks.
  • OR

  • You have experienced three or more unique congestive heart failure episodes within a year. There must also be fluid retention that can be validated using clinical and imaging assessments at the time of the attack and extended physician intervention was required.
  • OR

  • You cannot perform an exercise test with a workload of 5 METS or less because of severe symptoms, three or more episodes of tachycardia, left ventricular dysfunction causing a decrease of 10mm HG or more systolic pressure, or ataxic gait or mental confusion, or one of several other problems.

Meeting Disability Criteria with an RFC

If you don’t meet the disability requirements per the Blue Book, you may still be able to qualify using the vocational medical allowance. This process considers your conditions, your symptoms, your age, your educational level, your past work experience, and any transferable skills.

Your doctor will be asked to complete a residual functioning capacity (RFC) form that will completely detail how your ailment has impacted your life. It will indicate if you have to reposition yourself every two hours, if your mental confusion impacts your memory and ability to do repetitive work, if you have severe swelling that causing weeping of the skin that renders you unable to walk or stand, and how any other symptoms come into play in regards to your ability to work or care for yourself.

Providing as much documentation as possible for your case can help you more easily win your benefits because they have evidence of your condition and how your life is severely impacted. Make sure your physician maintains thorough notes and documents any problems that arise from your condition so they can be used to support your disability claim. Check out other tips on how to apply for heart failure Social Security disability benefits here.

Applying Specific Medical Tests to Your Case

A disability claim can be very complicated and time consuming. You can be denied benefits twice and you would have to appeal those rulings. The final step is a hearing before an administrative law judge to make a ruling on your case.

There are several medical tests used to diagnose heart failure. Those tests include chest x-rays, ECGs, echocardiograms, stress tests, heart catheterization, MRIs, and nuclear heart scans. Your physician may also order creatinine tests, liver functioning panels, complete blood counts, and a urinalysis.

If you are interested in applying for SSDI benefits, you should visit the SSA website or call 1-800-772-1213 to start the process over the phone.