How Disabling is a Blood Clot?

Close to 900,000 people suffer from a blood clot each year in the United States, with 274 people dying daily from the condition. Blood clots kill more people in the US than AIDS, breast cancer, and motor vehicle accidents combined.

The severity of a blood clot depends on its location. If a blood clot in the arms or legs is identified early, treatment can dissolve it. However, a clot that travels to the heart, lungs, or brain can quickly become life threatening.

If you have been diagnosed with a blood clot and are unable to work as a result of your disability, there could be financial help available to you. The Social Security Disability Insurance (SSDI) program was created to assist those who have become disabled due to an event such as a blood clot.

What Exactly Is a Blood Clot?

Blood clotting is an important life-saving mechanism that prevents too much bleeding. A blood clot, or thrombus, can form when the blood thickens too much or if there has been an injury to your vessels. Blood clots that occur in the veins are called Deep Vein Thrombosis (DVT).

The danger of a blood clot is that it can travel to other areas of your body. If a blood clot travels to your lungs, it is called a Pulmonary Embolism (PE).

The effects of a blood clot vary from person to person, depending on the area of blockage caused by the clot. A blood clot in the arm or leg tends to cause swelling, leg pain or tenderness, and warmth of the skin.

If the blood clot has traveled to the lungs or heart, symptoms include sudden shortness of breath, sharp and stabbing chest pain, and a rapid heart rate.

The primary treatment for a blood clot involves anticoagulation medication to thin the blood. In very rare cases, surgery is necessary. While there is no cure for a blood clot once it has occurred, there are many ways to modify your lifestyle to help avoid blood clots.

What Symptoms Do I Need to Qualify?

There is a range of symptoms that you might experience when you have a blood clot, and they all might affect your ability to work differently.

Blood clotting disorders can be found in the Hematological section, 7.08, of the Social Security Administration’s (SSA) “Blue Book.” Additionally, blood clots can cause a related condition, Chronic Venous Insufficiency, which can be found in Section 4.11 of the Blue Book.

This manual lists a variety of conditions, as well as the requirements needed to qualify for benefits under these circumstances.

Keep in mind that an isolated blood clot is unlikely to qualify you for social security benefits, as blood clots typically resolve within a short period of time. However, if you have recurring blood clots or a blood clotting disorder, it will increase your likelihood of being considered for benefits.

Additionally, if you are one of the estimated 1/3 of people to develop the long-term complication of post-thrombotic syndrome, you may have improved chances of receiving assistance from the SSA.

According to the Blue Book, here are some signs that you might qualify for disability benefits based on your blood clot:

  • If you have complications related to blood clots that require at least three hospitalizations within a 12-month period and occurring at least 30 days apart, you will likely qualify for financial assistance from the SSA. Each hospital stay must last at least 48 hours.
  • If you have a blood clot in your leg and it causes brawny edema (swelling that is dense, firm, and causes dark gray skin discoloration) on 2/3’s of the leg between the knee and ankle or the 1/3 of the leg between the hip and ankle, you will be considered for disability benefits.
  • If you experience ongoing cramping, burning, or pain in your legs, you might be eligible for SSDI.
  • If you have wounds that recur and do not heal over time, you might qualify for financial assistance.
  • If your blood clot has traveled and caused other complications in your lungs, heart, or brain, you will likely be considered for benefits under those related body systems.
  • If your blood clot does not fit the criteria laid out in the “Blue Book,” but you have limitations that prohibit you from working, you might qualify for benefits if you are evaluated for your Residual Functioning Capacity (RFC). In this case, the SSA will determine your level of functioning and determine your ability to work.

Do I Qualify for Social Security Benefits?

To be eligible for Social Security benefits, your medical records will need to show that your symptoms are severe enough to prevent you from working at a level which would support you. Additionally, your illness needs to be disabling for at least 12 months.

As noted above, an isolated blood clot will unlikely cause disability for that long. However, recurrent blood clots, any clotting disorders, or associated complications may create a disability that lasts at least 12 months.

What Information Will I Need to Provide?

When applying for Social Security, you may be asked to provide the following documentation:

  • Physical exam and progress notes from your doctor. These records should include any health deficits and your long-term prognosis
  • Emergency room progress notes and reports, including medications administered during emergency treatment
  • Inpatient hospital-stay records
  • Blood lab work including a D-dimer test, platelets, and blood clotting factors.
  • If you required an invasive procedure or surgery, you will need to provide all related notes
  • Venus ultrasound, venography, MRI, CT scan, or any other imaging from your initial hospital visit, as well as subsequent imaging
  • Echocardiogram, if applicable
  • VQ scans, if appropriate
  • Additional notes from any other health care providers helping you with your condition, such as documentation from your Psychologist, Physical Therapist, Social Worker, etc.

You should speak with your doctor’s office, hospital, or other health-care providers if you are missing any of the above medical reports. The more medical evidence that you have on your side, the better your chances of receiving SSDI benefits for your blood clot.

What’s Next?

If you have suffered a blood clot and you believe that you may qualify for Social Security benefits, you should contact a disability advocate or lawyer in your area immediately. While you focus on your health, a qualified attorney can help guide you through the Social Security application process.

Additional Resources

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