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High Cholesterol and Social Security Disability

Applying for Social Security Disability Benefits for High Cholesterol

The Centers for Disease Control (CDC) note that high cholesterol can contribute to heart disease, heart attacks, stroke, and other serious and life threatening conditions. According to the CDC, more than 73 million Americans have high cholesterol and therefore have double the risk of developing heart disease.

Despite the risks high cholesterol carries, the condition alone is not enough to qualify for Social Security disability benefits. But elevated blood cholesterol levels are often seen in conjunction with other disabling conditions that can qualify for benefits, including diabetes, atherosclerosis, heart disease, stroke, and kidney impairments, among others.

Though you may not be able to get benefits for your high cholesterol, you may qualify by meeting the Social Security Administration’s (SSA’s) listing for a related health condition. Even if you’re unable to meet a listing, the SSA may still grant benefits, if you’re able to show that your high cholesterol and other medical conditions prevent you from working and earning a gainful living.

Whether you meet a disability listing or must qualify for benefits through additional reviews of your overall limitations, Social Security disability can provide ongoing income, allowing you to pay bills and cover everyday living expenses.

The Financial Costs of High Cholesterol

Cholesterol problems can often be treated with medications and dietary and other lifestyle adjustments. The costs of reducing and controlling cholesterol therefore include frequent visits to the doctor, lab work for monitoring cholesterol levels, and medication co-pays and co-insurance, among others.

According to the CDC, cholesterol medications known as “statins” are among the most commonly prescribed. Cost of these medications varies significantly, with Consumer Reports stating national averages that range from $4.00 per month for generic statins to more than more than $600 per month for newer medications in this class of drugs.

Many people with cholesterol problems require multiple medications to control their symptoms. If you have other medical conditions, then your monthly drug costs may quickly become one of your largest bills. According to Georgetown University, more than 33 percent of the American population uses prescription medications, and about one half of the cost of prescription drugs is an out-of-pocket expense.

Prescriptions and life style changes may not control cholesterol levels however, and you may require surgical intervention for narrowed or blocked blood vessels. The average cost laser surgery, angioplasty, or arterial bypass varies from one hospital to the next, but the Stroke Center and Reuters’ News report average vascular surgery costs in the U.S. of between $13,000 and $15,000 per procedure.

Medically Qualifying for Disability through the Blue Book Listing

The SSA maintains a list of impairments that can qualify medically for disability benefits. This list is known as the Blue Book and not only outlines recognized disabilities but also the medical tests and other documentation necessary to get approved for benefits.

Although high cholesterol isn’t among the conditions listed in the Blue Book, you may still qualify by matching one of the SSA’s vascular or heart disease listings:

  • Chronic venous insufficiency (4.11) – if your high cholesterol severely disrupts the blood flow to your hips, legs, knees, or ankles, then the SSA may use this listing to review your claim.
  • Peripheral artery disease (4.12) – if you experience symptoms of high cholesterol and plaque deposits in the veins and arteries that supply blood to your arms, legs, hands, or feet, then your application for benefits may be reviewed under this listing.
  • Ischemic heart disease (4.04) – if your high cholesterol has lead to the development of complications with the primary arteries to and from your heart, then the SSA will utilize this disability listing for your claim.

If you’re unable to match one of these listings, the SSA may review your high cholesterol claim under its guidelines for hyperlipodemia, which is a condition that causes abnormally high lipid or lipoprotein levels in the blood. Although there is also no listing for hyperlipodemia, the SSA reviews claim for this condition by looking at the areas of the body that are most severely affected.

When you go through this kind of review, you may not meet any single disability listing, but you may match the severity level of one. If so, then the SSA can grant you benefits under that Blue Book listing because your medical condition is a close match.

High cholesterol is also commonly seen in combination with other serious medical conditions. If you have other impairments, then you may qualify under the listing for a different disability, like heart failure, diabetes, or kidney disease.

Work closely with your doctor to understand the SSA’s medical eligibility rules and whether your medical history meets the requirements. You can also get help from a Social Security advocate or attorney that is familiar with how the SSA reviews claims in which high cholesterol issues are a primary health concern.

Medically Qualifying for Disability through an RFC Analysis

To get approved for benefits without satisfying a Blue Book standard, you must go through additional eligibility reviews, including a “residual functional capacity” (RFC) analysis.

During an RFC, the SSA looks at your “activities of daily living” or ADLs and how your medical condition(s) limits your performance of these activities. ADLs include everything from changing clothes, bathing, and preparing food to taking care of your home, running errands, and getting back and forth to doctor appointments.

You’ll receive forms from the SSA that ask for detailed information on your everyday activities and limitations. Your primary care physician will also receive functional report forms to complete. The information provided on these documents is crucial to your eligibility. The SSA takes into account your education level, age, work history, and job skills in addition to your functional limitations during an RFC review. If the SSA finds that you cannot work in any job, then you’ll be granted disability benefits.

How to Apply for Benefits with High Cholesterol

You may be entitled to Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or both.

  • You can apply for SSI at your local SSA office
  • For SSDI, you can apply online, or at the local office.

Whether you apply for SSI, SSDI, or both, you will need to provide information regarding your:

  • Financial situation, including employment income, bank accounts, assets, and any other benefits you receive from state, federal, or private sources
  • Contact information and work history, education, and job training records
  • Healthcare providers, medical history, and your complete medical records, which the SSA can obtain directly from your doctors, hospitals, and others, with your consent

When reviewing your medical records, the SSA will look for specific details. The medical tests, test results, and other documentation required depend on disability listing under which you may qualify. With a claim related to high cholesterol issues however, the SSA must generally see:

  • A detailed report from your doctor, noting all of your symptoms and complications, treatments, and your functional limitations.
  • Diagnostic test results and clinical exam notes, documenting the affects of your high cholesterol, like high blood pressure or low or decreased blood flow to certain areas of the body.
  • Imaging results, which may include MRIs or CT scans with contrast, documenting the buildup of plaque in your blood vessels causing narrowing or blockage of veins or arteries.
  • Reports from any surgical or laser procedures you’ve had performed to address vascular issues.

Your doctor can help you understand the SSA’s Blue Book listings and required documentation. He or she can also assist by ensuring your medical records contain the types of tests and other diagnostic details the SSA needs in order to accurately evaluate your eligibility for disability benefits.