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Heart Failure and Social Security Disability

Heart Failure - Condition and Symptoms

When a person’s heart is unable to pump enough blood to the body, the person is said to be suffering from Heart Failure. Heart Failure is also known as “Congestive Heart Failure.” Heart Failure is not the same as a heart attack, but a heart attack can cause Heart Failure, as can other types of heart disease. Heart Failure can also occur when an illness or toxic substance weakens the heart muscle (cardiomyopathies), and as a result of hypertension, obesity, smoking, valvular heart disease, and ischemic heart disease.

Heart Failure is almost always a chronic, long-term condition which tends to worsen over time, although it can sometimes develop suddenly. For tips on how to apply for disability benefits read our tips article. It can affect either or both sides of the heart. When the heart is unable pump the blood out to the body, the condition is known as systolic Heart Failure. When the heart chambers cannot fill up with blood, the condition is called diastolic Heart Failure. In either situation, there is real danger of blood backing up into other body systems and producing congestion in the lungs, liver, gastrointestinal tract, and the extremities. It is possible to have both systolic and diastolic Heart Failure at the same time.

Heart Failure is diagnosed with a physical exam, in addition to one or more of the following: chest x-ray, ECG, echocardiogram, stress test, heart catheterization, MRI, or nuclear heart scan. The physician may also ask for certain blood tests, a urinalysis, creatinine test, or liver function tests, as well as a complete blood count.

Symptoms of Heart Failure can include shortness of breath (especially when performing routine tasks, or even lying flat), persistent coughing, buildup of bodily fluids, fatigue, increased heart rate, nausea, swelling of the feet, ankles, or belly, weight gain, palpitations, and confusion. Some people have no symptoms, or symptoms that show up in conjunction with other conditions, such as abnormal heart rhythm, anemia, or kidney disease.

Treatments include lifestyle changes, such as avoiding salty foods, increasing exercise levels, stopping smoking, and cutting out fats in your diet. In addition, there are numerous medications that may be prescribed which work to decrease the workload on the heart, rid your body of excess fluid, and aid your heart in pumping rhythmically. In some cases, valve replacements, pacemakers, or repair coronary bypass surgery or angioplasty may help with Heart Failure. Sometimes Heart Failure is itself a symptom of an underlying condition that will require additional treatment.

Filing for Social Security Disability with a Heart Failure Diagnosis

Heart Failure is found in the Social Security Administration’s disability evaluation book under Section 4.00. This section deals with all the different types of Heart Failure mentioned above as well as symptomatic congenital heart disease and cardiac transplants. Subsection 4.02 addresses chronic Heart Failure, and is the subsection discussed here.

In order to qualify for Social Security Disability benefits as a result of chronic Heart Failure, you must be undergoing prescribed treatment. In addition, you must meet the criteria of both Paragraph A and Paragraph B below.

  1. You must have been diagnosed with chronic Heart Failure, as evidenced by one of the following:
    1. Systolic failure with the left ventricular with end diastolic dimensions of more than 6.0 cm or an ejection fraction of thirty percent or less. This must occur when your heart is stable, and not when you are having an acute episode of Heart Failure
    2. OR

    3. Diastolic Failure in which the left ventricular posterior wall plus septal thickness is 2.5 cm or more when imaged, including an enlarged atrium equal to or more than 4.5 cm, with an elevated or normal ejection fraction during a stable heart period
  2. AND

  3. The condition in Paragraph A results in one of the following:
    1. Persistent symptoms of Heart Failure that result in significant limitations which impair your ability to independently perform normal daily activities, and, in addition, you should be unable to perform an exercise test without significant risk to your health
    2. OR

    3. You have had three or more unique episodes of acute congestive Heart Failure within a twelve-month period. There must also be fluid retention that can be validated by clinical and imaging assessments at the time of the acute heart failure attack. Treatment of the acute attack must require extended physician intervention. Extended physician intervention is defined as hospitalization or emergency room treatment of twelve hours or more and acute chronic heart failure attacks separated by periods of heart stability;
    4. OR

    5. You cannot perform an exercise test with a workload of 5 METS or less because of:
      1. Fatigue, dyspnea, palpitations, or chest discomfort; or
      2. Three or more consecutive ventricular contractions (tachycardia) or more incidents of ventricular ectopy with six or more premature ventricular contractions per minute; or
      3. Left ventricular dysfunction resulting in a decrease of 10mm HG or more in systolic pressure that is under the baseline systolic pressure or the preceding systolic pressure that was measured during exercise despite an increase in workload; or
      4. Ataxic gait or mental confusion, signs that are attributable to inadequate cerebral perfusion.

Your Heart Failure Disability Case

If you are disabled because of a Heart Failure disability that prevents you from working, you are probably entitled to benefits under Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Be sure to obtain medical records which provide information pertaining to all hospitalizations and office visits relating to your Heart Failure, the time at which you were diagnosed with Heart Failure and what caused you to develop it, the medications that have been used to treat your Heart Failure and how you have responded to treatment, how well you have complied with the treatment prescribed, and a description of your ability to function despite your Heart Failure condition.

By working closely with medical professionals and a qualified Social Security Disability attorney or advocate to collect and present the appropriate documentation to support your disability claim in front of the Social Security Administration and state-run Disability Determination Services (DDS), you can be sure that your Heart Failure disability case will have the highest possible chance of success.