Tips on Applying for Disability Benefits with Congenital Heart Disease

Congenital heart disease develops before birth and occurs when the structure or function of the heart is impaired. Congenital heart disease can range from barely noticeable to very severe.


Medical Evidence

The Social Security Administration (SSA) will automatically approve your disability if you are officially diagnosed with congenital heart disease through a test called cardiac catheterization, and that you also show one of the following three symptoms:

  • Cyanosis, which is when your skin turns blue while resting due to a lack of oxygen in your blood
  • Occasional cyanosis with physical activity
  • A disease called secondary pulmonary vascular obstructive, which results in high blood pressure

Non-Medical Evidence

If your medical history for congenital heart disease does not automatically qualify you for disability benefits, you still have options. Your doctor can provide the SSA with a physical Residual Functional Capacity assessment, which provides evidence that your disease causes too many limitations for you to work full time.

The SSA will be more likely to consider the opinion of a specialized doctor, so it is best to have your cardiologist prepare the RFC. Congenital heart disease causes extreme fatigue, so make sure your doctor notes that you will need to take frequent breaks and miss work on a regular basis, which would affect your productivity if required to work. If your productivity is reduced by 20%, your disability will be approved.

Your RFC should also include blood tests, EKG results, hospital visits, surgeries, and any other related information that supports your claim. You should also provide records of your medications and their side effects, which provides further evidence that you are unable to work.

Another available option is having your psychologist or psychiatrist perform a mental RFC. If your congenital heart disease causes depression or anxiety, it could affect your memory, ability to concentrate, and more factors that prevent you from being able to work.