Applying for Social Security Disability after a Heart Attack
The Centers for Disease Control (CDC) report that around 735,000 Americans suffer heart attacks each year. Of those, more than 210,000 have had a previous heart attack. Damage from each attack compounds, increasing the likelihood of more severe heart complications, including heart failure.
While a heart attack is certainly a major health event, it alone is not enough to qualify for Social Security Disability benefits. This is because disability benefits are designed for people who are unable to work for a period of 12 months or longer, and many patients are able to return to work less than one year after experiencing a heart attack.
You may need financial help after a heart attack. Disability benefits can help pay everyday living expenses, cover medical costs, and provide you consistent income, if you are no longer able to work or earn a gainful living due to your long-term heart complications. If you have lasting impairments due to coronary disease, then you may be able to receive support through the Social Security Administration’s (SSA’s) disability programs.
The Financial Costs of Heart Attacks
A heart attack, even a less severe one, will put you out of work for weeks or months. If you are lucky enough to work for an employer through whom you can receive short-term disability payments, then your lost work time will at least be compensated at a percentage of your usual paycheck. If you’re not able to return to work due to heart complications though, you’ll be faced with the challenge of how to survive and pay the bills without income from employment.
In addition to dealing with lost wages, medical bills for a heart attack and for ongoing treatment are costly. Not to mention rehabilitation costs, if you experience reduced mobility, stamina, or fatigue due to cardiac surgery, permanent heart damage, or heart complications.
In 2010, CBS News reported the average cost of a less severe heart attack as $760,000 in total medical expenses during the year in which the heart attack occurs. Average costs annually thereafter were reported at about $38,000, again for a less severe heart attack. More severe cardiac events averaged an annual expense of about $50,000.
Although CNN Money reported lower national averages in 2013, ranging from $3,500 to $92,000, the immediate costs are still high, and medical bills continue to build up in many cases. If you’re insured, your medical coverage will pay a portion of the cost of treatment and ongoing cardiac care, but the bills you receive are still a shocking sum and difficult with which to contend when you’re also facing reduced or lost wages.
Medically Qualifying for Disability through the Blue Book Listing
Disabilities that are medically qualified for benefits are outlined in the SSA's own guide. The qualifying conditions are listed and how each can qualify are listed in this guide, known as the Blue Book. A heart attack, or myocardial infarction (which is the technical term) is not among the SSA’s standard disability list, but you may still qualify under another listed condition. This is because there are listings in the Blue Book for many of the common causes of heart attacks and for the cardiovascular complications that often result from heart attacks as well.
The John’s Hopkins School of Medicine notes that the most common cause of myocardial infarction is coronary artery disease. When the arteries are clogged or blocked, the heart muscles can be starved of sufficient blood flow and oxygen, causing a heart attack and irreversible heart muscle damage.
Coronary artery disease may qualify for disability under the listing for ischemic heart disease. This listing requires your medical records show:
- Narrowing of or blockage in the arteries
- Fatigue from exertion or exercise intolerance
- At least three episodes in a 12-month period in which a blockage or narrowing of the arteries required surgical intervention (like an angioplasty or stint)
If your heart attack results in severe heart muscle damage, then you may qualify with chronic heart failure. This listing requires your medical records contain evidence of dysfunction in one of more chambers of the heart. Additionally, the SSA must see that your heart failure significantly limits your everyday abilities or that you experience symptoms like:
- fluid collecting in your lungs (congestive heart failure),
- severe fatigue,
- or inadequate oxygen getting to your brain.
If heart failure is so severe that you require a heart transplant, you will qualify for benefits while awaiting a transplant and for at least one year after your transplant surgery.
It’s important to understand that the Blue Book is written for medical professionals. It can therefore be difficult for you to know which listing you may qualify under without seeking your doctor’s assistance. You’ll need to work closely with your doctor when you apply for benefits anyway, since the SSA needs to see very specific medical records and other documentation in order to approve your claim.
Medically Qualifying for Disability through an RFC Analysis
Not all people who have heart attacks are able to meet a disability listing, even if their heart problems and recovery prevent them from working for 12 months or longer. If you don’t qualify through the Blue Book, then you’ll have to show through medical records and other documentation that you are still eligible to receive disability benefits. This process is known as a “residual functional capacity” or RFC analysis and is the standard next step for any applicant that doesn’t meet a disability listing.
The SSA will send you forms to complete that ask for details on your everyday activities. They will seek additional information from your doctor through a functional report questionnaire. Coordinate with your doctor to ensure that you and your physician are both providing the details and insights the SSA needs to understand all of the physical and mental limitations caused by your heart attack and recovery.
If your RFC analysis shows your daily limitations prevent you from working in any job for which you are otherwise qualified, then you will be granted benefits under what's called a “medical vocational allowance.” This basically means that although you do not medically qualify via the Blue Book, the SSA sees that your heart attack has prevented you from preforming any work you are qualified for.
How to Apply for Benefits for a Heart Attack
When you apply for Social Security Disability Insurance (SSDI) benefits, you can submit your application at the local office or use the SSA’s online forms. If you’re applying for Supplemental Security Income (SSI) instead of or in addition to SSDI, then you’ll need to visit your local SSA office, because a personal interview is required.
Regardless of which disability program you apply to, the SSA will need:
- Medical history information, including any medical records you have and contact details for all your healthcare providers
- Financial records, including employment income, bank account balances, assets you own, and any other types of support or benefits you receive
- Personal information, including your education level, work history, and specialized job training
Whether you’re able to qualify by meeting a disability listing or have to go through an RFC analysis, the SSA needs detailed medical records. With cardiovascular disabilities, the SSA must generally see:
- A report from your doctor that documents a minimum of three months of detailed observations about your treatment, physical condition, medications, prescribed therapies, symptoms, and functional abilities.
- Imaging results, which may include x-rays, MRIs, CT scans, or other imaging tests that document physical defects in the heart, arteries, or veins
- Cardiovascular tests, like EMGs, heart scans, stress tests, or fatigability tests
- Surgical reports for any procedures you’ve undergone
The specific documentation required will vary, based on the listing under which you may qualify. Your doctor can help you understand what records are necessary. For any other assistance applying, consider contacting a disability advocate or attorney. He or she can help you file for benefits, and defend your claim in court if need be. Before applying, be sure to read our article on tips for success when applying for disability benefits after a heart attack.