Heart conditions are among the leading causes of disability in the United States. The question of what heart conditions qualify for disability boils down to the severity of that condition(s). When the Social Security Administration (SSA) determines whether a heart or circulatory condition is severe enough to qualify a claimant for disability benefits, they use Section 4.00 of the Blue Book.
Section 4.00 of the Blue Book is broken down into eight subsections. Each of these subsections deals with a particular type of heart condition, disease, or disorder, and provides the SSA with guidelines regarding how to evaluate each one. So, to answer the question of what heart conditions qualify for disability, we have to take a look at the eight subsections of the Blue Book's Section 4.00, and the criteria for eligibility for Social Security disability benefits for each, which are as follows:
- Aneurysm of the Aorta or Major Branches - Regardless of the cause, you will be considered disabled if appropriate medical imaging confirm an aneurysm of the aorta or any major branch.
- Chronic heart failure. To qualify and potentially get on disability, your heart condition must have systolic or diastolic heart failure. Additionally, your heart condition(s) must fall within the given parameters while it is stable. Additionally, you must meet one of the following conditions: Poor performance on an exercise tolerance test, two or more occurrences of heart failure within one year (must have fluid retention and require hospitalization), and/or symptoms which would limit your ability to work and which would suggest that an exercise test would present a danger to you.
- Chronic Venous Insufficiency - You will be considered disabled if you have an obstruction and meet one or more of the following: brawny edema which involves 2/3 or more of your leg from the knee to the ankle or 1/3 from your ankle to your hip OR persistent or recurrent ulcerations which fail to heal after being treated for three months.
- Heart Transplant - You will automatically be considered disabled for at least one year after a heart transplant. Thus, heart transplants are a heart condition that qualifies for disability.
- Ischemic Heart Disease - To have this heart condition qualify for disability, you must meet one or more of the following: Coronary artery disease (CAD) (this requires an angiography, medical imaging, and either an exercise test or medical documentation showing why an exercise test would be too dangerous to your health), three distinct ischemic episodes, with each of them needing revascularization (or in which revascularization is not possible), or an exercise test which shows that you fall within the SSA’s guidelines for complete disability.
- Peripheral Artery Disease (PAD) - Must be shown by medical imaging and fall within the SSA’s guidelines for your blood pressure.
- Recurrent Arrhythmia - For recurring arrhythmias to be a heart condition that qualifies for disability benefits, the medical evidence must show that the condition is not reversible and that it results in near syncope or syncope.
- Symptomatic Congenital Heart Disease - For symptomatic congenital heart disease, the SSA considers evidence from medical imaging or a heart catheter. They will look to see whether your hematocrit levels and O2 saturation meet with their criteria. This heart condition may also qualify for disability if you have right to left shunting or if your systolic pressure is significantly elevated (70% of systemic or higher).
Other medical conditions evaluated under Section 4.00 of the Blue Book:
- Blood Clots
- Budd-Chiari Syndrome
- Chest Pain
- Chronic Pulmonary Hypertension
- Cor Pulmonale Secondary Chronic Pulmonary Hypertension
- Heart Attack
- Heart Failure
- Heart Valve Disorder
- High Blood Pressure
- High Cholesterol
- Left Ventricular Assist Device
- Marfan Syndrome
- Mitral Valve Prolapse
- Sinus Bradycardia
- Venous Insufficiency