Medical Criteria Needed to Qualify with Atrial Fibrillation

Cardiac conditions are serious, life-altering illnesses. Atrial Fibrillation (A-Fib) is the most common type of irregular heartbeat, also called an arrhythmia. It occurs when the upper chambers of the heart beat chaotically, or out of rhythm.

A-Fib can cause symptoms, such as fainting, exhaustion, and dizziness that makes it impossible to work. Thankfully, there are financial safeguards for those who need assistance.

The Social Security Disability Insurance Program (SSDI) offers financial help for individuals with conditions such as Atrial Fibrillation.

Unfortunately, not everyone who has atrial fibrillation will be awarded financial assistance for their disability. In fact, every year millions of individuals apply for financial support from the Social Security Administration (SSA).

However, over 70 percent of applications are initially denied disability, often due to their inability to provide sufficient medical documentation. Applicants who understand the Social Security process greatly enhance their chances of being approved for disability benefits.

Is Atrial Fibrillation a Disability?

Atrial fibrillation (A-Fib) is listed as a disability by the Social Security Administration (SSA) in its comprehensive Blue Book under section 4.05 (arrhythmias). If your symptoms prevent you from working for at least the next 12 months, your symptoms are severe enough and meet the criteria listed in the Blue Book, then you may be able to obtain disability benefits from the SSA under either the SSDI or SSI programs. 

Many applications for disability benefits, even for disabilities that are clearly listed in the Blue Book, are initially rejected. This is often because the applicant has not been able to clearly demonstrate their inability to work or has not supplied sufficient medical evidence to show that their symptoms are serious enough to qualify for benefits or match the criteria in the Blue Book listing.

You can improve your chances of obtaining disability benefits by ensuring you have sufficient evidence to support your benefits application. For example, you need to provide the following:

  • when the atrial fibrillation first started;

  • what history of cardiac disease you may have had up to then;

  • what may have caused the arrhythmia onset;

  • at least the previous 3 months of clinical records for your arrhythmia condition;

  • full physical examination results;

  • results of a residual functional capacity assessment (RFC), which can establish whether you can still work and what you can or cannot do.

A disability attorney can help you prepare your application and ensure you have sufficient evidence to support it.

The Importance of the “Blue Book”

Given the vast array of disorders and conditions that could potentially lead to disability, the SSA developed a guide to assist Social Security representatives, physicians, and applicants in determining whether or not a specific condition qualifies for financial assistance.

This guide is referred to as the Blue Book. The Blue Book is the list of conditions that qualify for disability.  Also included in the Blue Book are the different clinical and laboratory tests that are required for each condition.

Atrial Fibrillation is a cardiac disorder that is covered in the Recurrent Arrhythmia section, 4.05, of the Blue Book. To help you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

Evidence Needed Related to Your Atrial Fibrillation Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your atrial fibrillation. You should be able to provide the following evidence:

  • Date of onset of your atrial fibrillation
  • Documentation of any prior cardiac history
  • Documentation of any suspected events that may have precipitated your entry into the abnormal rhythm
  • Results of a full physical examination
  • Your cardiac clinical record for at least 3 months

Your physician should make very careful note of any episodes of fainting (syncope) or near-fainting that you may have experienced. These incidents should be documented as they relate to your A-fib.

In other words, your cardiologist should make sure to record that your fainting episodes are related to your heart condition, and not another cause.

The Blue Book indicates that your fainting or near-fainting events must have occurred at least 3 times within a 12-month period, despite medication or related treatments.

Several tests will help to confirm your diagnosis, and the following test results should be included in your records:

  • 12- lead Electrocardiogram (ECG or EKG): An ECG is a recording of the electrical impulses of your heart. An original or legible copy of the ECG must have been obtained at rest and must be appropriately dated and labeled, with the standardization inscribed on the tracing.
  • Holter monitor: A Holter monitor is a portable ECG device that a person wears for 24-48 hours.
  • Cardiac event recorder: A cardiac event recorder is a portable device that allows you to tape-record your heart’s activity when you feel symptoms.
  • Echocardiogram: An echocardiogram is an ultrasound that takes pictures and helps to evaluate the function of your heart.
  • tress Test (Exercise Test): Exercise tests have you perform physical activity and then records how well your cardiovascular system responds.

Sometimes a stress test is followed by an echocardiogram, which is called a stress echo. Exercise tests usually involve walking on a treadmill, but other forms of exercise, such as an exercise bicycle or an arm exercise machine, may be used.

Imaging tests that may show damage to your heart and lungs, such as a chest x-ray or CT scan. While blood tests don’t diagnose A-fib, your doctor should run a full set of labs to rule out any contributing problems, such as thyroid issues or electrolyte imbalances, that if addressed may fix your atrial fibrillation.

Records of hospitalizations should be carefully documented, including Emergency Room visits. While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists. Therefore, it is crucial that you work with your cardiologist to gather this medical documentation.

Evidence Needed Related to Your A-Fib Treatments

The treatment of atrial fibrillation depends on how long you have had the arrhythmia, your quality of life, and the severity of the disease. Possible treatments include:

  • Medications
  • Heart rate controlling medications
  • Heart rhythm controlling medications
  • Medications to prevent blood clots, which happen to be the most common side-effect of A-fib
  • Cardioversion: A procedure where the patient receives an electric shock with the goal of resetting the heart’s rhythm
  • Ablation: A procedure where your physician alters your heart’s electrical framework
  • Surgical maze procedure: This open-heart surgery is used when all other interventions fail

It is critical that your cardiologist has documented the following:

  • Medications that you are receiving, as well as your response to the medications
  • Cardiac rehabilitation that you may be undergoing
  • Any surgeries or procedures that you may have had, including operative notes or procedure notes, if applicable
  • Any related medical complications, such as blood clots, neurological deficits, lung problems, or complications related to your fainting spells

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

Not every patient who has A-Fib will qualify for disability benefits under the Blue Book listing. As a result, these patients will need to provide additional evidence regarding how their cardiac condition limits their ability to work.

Your cardiologist should provide physician notes documenting his or her opinion regarding your limitations and inability to function without unscheduled breaks or days off.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits. For example, A-fib can cause extreme exhaustion. Exhaustion is not listed as part of the criteria in the Blue Book listing.

However, it can have a significant impact on your ability to work. If you are unable to work due to limitations from your disease, you may still qualify for disability through a residual functioning capacity assessment.

Steps You Can Take to Win Your Disability Claim

If you haven’t applied yet, or if you have applied and were denied, it is helpful to understand that the majority of disability applications are initially denied.

It is essential that you provide substantial medical evidence as listed in the Blue Book when filing your Social Security disability claim for atrial fibrillation.

The entire Blue Book is available online, and the section on cardiac illness is quite detailed. It might be beneficial for you to review section 4.00 with your cardiologist to determine what medical records you have on hand, as well as what medical documentation you are missing.

Organization is key during the SSDI process. As such, when you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

This will ensure that you touch on all of the key points during your appointment, as well as help your physician to document your case accurately.

There are several ways that your cardiologist can help including:

  • Ensuring that your full medical history related to your heart is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Performing any additional blood tests or procedures that you are missing

Social Security disability attorneys are well-versed in the disability claim process from start to finish. In fact, hiring a Social Security disability attorney or advocate has been shown to improve your chances for approval dramatically.

Consultations are always free, in fact, Social Security attorneys are only paid if you win your atrial fibrillation claim.

Additional Resources

Find Out If I Qualify for Benefits!