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Peripheral Artery Disease and Social Security Disability

Social Security Disability for Peripheral Artery Disease

If you have been diagnosed with peripheral arterial disease (PAD) and it has left you unable to work, you may be eligible to receive Social Security disability benefits. PAD is a documented medical disorder that results from the narrowing in the arteries in the extremities, the legs in particular. It results in limited blood flow to tissues in the surrounding area.

While the blood is normally pumped from the heart to the tissues in the extremities and can bring the necessary nutrients and oxygen, it doesn’t work that way in someone with PAD. The arteries are narrow and the blood cannot flow through in the volume that is needed. The lack of blood flow is especially evident during exercise and motion because as the strain increases, the muscles and tissues need more oxygen to properly function.

When there is limited blood flow in an artery carrying oxygen, the muscles don’t get as much oxygen as they need. The most common symptom resulting from this is pain in the legs, particularly the calves, which is referred to as intermittent claudication. It can vary in intensity from being mild to excruciating. Rest usually calms the pain.

You can also experience numbness or weakness, a leg or foot that is noticeably colder than the other, sores on the foot or leg that don’t heal, and a pulse that is undetectable or very weak in the leg. Some symptoms can be warning of a heart attack or stroke and require immediate medical care. There is also the chance of requiring limb amputation because of critical limb ischemia, or loss of blood flow.

Your Peripheral Artery Disease may qualify you for disability benefits

The Cost of Treating PAD

Peripheral Arterial Disease (PAD) is a serious, chronic condition. According to the National Centers for Biotechnology Information, the average person diagnosed with PAD can expect medical bills that range from $2,000 to $20,000 during their lifetime. Of course if they require an amputation or suffer a stroke from the condition the bills will be higher.

Those with insurance pay copays and coinsurance that varies from 5% to 50% of the total medical expense. Those without insurance will pay out more of course. It is a common disease that imposes serious threats on those who suffer from the disorder.

Getting Medical Approval for Disability

The SSA recognizes Peripheral Artery Disease as a disabling disease under specific circumstances. The SSA uses a medical guide to determine if you are disabled. This guide, which called the Blue Book, has PAD listed under the cardiovascular system because it is a cardiovascular disease. There has to be significant disability or impairment keeping you from doing any kind for work even after undergoing disease treatment. The specific requirements for PAD can be found in Section 4.0, Cardiovascular – Adult.

You have to provide proof that you have been positively diagnosed with the disease by a doctor. There needs to be ongoing documentation of the diagnosis and your treatment plan for the disease. Documentation also needs to show your response to the treatments. At least three months of treatment is required to be documented before you apply.

Often, the SSA may require more extended treatment to determine if you are going to respond to it before your claim is evaluated. If your disease isn’t stable, or if you have switched to a new treatment plan which has no documented results, you may have to face a waiting period before SSA evaluates your case.

To qualify for benefits with PAD, you must have imaging documentation from a Doppler or angiography, experience pain in the legs, and have one of the following:

  • A resting ABI of less than 0.5.
  • A 50% decrease in systolic blood pressure at the ankles with exercise that needs at least 10 minutes or longer for recovery.
  • A resting toe systolic blood pressure of less than 30 mm HG.
  • Resting toe or brachial index of less than 0.4

Gaining Disability Benefits Using a RFC

A residual functional capacity (RFC) form completed by your doctor can also help you gain disability benefits approval if you don’t meet the medical criteria of the Blue Book. The form should be completed in detail noting any limitations or restrictions that you encounter because of your condition. As an example, because of the decreased blood flow and the severe leg cramps, you may have to be repositioned every hour which will impact your ability to work.

You may have experienced blood clots in your lower legs because of PAD, so you may be unable to sit for long periods because of the increased chances of another thrombosis occurring. If PAD has caused you to suffer severe pain that requires frequent elevation of your legs and feet, that should be clearly stated. It should also note how much you can lift, if you are unable to bend, and how your mobility has been impacted, such as your inability to walk long distances or carry items as you walk because you need to use a walker or crutches.

The RFC is used as part of the medical-vocational allowance, which also considers your work experience, transferrable skills, education, and age. After it has been determined that you cannot return to your regular work, Disability Determination Services has to confirm you cannot perform lighter duty work, such as sedentary work. After it has been confirmed that you cannot work at all full-time, you will be approved for your monthly benefits check.

Applying for Disability Benefits

The disability benefits process can be drawn-out and complicated. It requires thorough medical records, detailed tests that show your blood pressure of the legs and/or toes, scans that show evidence of your diagnosis of PAD, records that show the continuous issues with pain and mobility, and how you have responded to treatment plans. You can be denied benefits twice and then file appeals. The last step is a hearing before an administrative law judge.

You may start the process online at www.SSA.gov, over the phone at 1-800-772-1213 or in person at your nearest SSA office. A disability attorney can significantly increase your odds of being approved for benefits.