Get Social Security Disability & SSI: Congential Heart Defect

Two Criteria To Obtain Benefits

You must satisfy two Social Security criteria if you want SSDI and SSI disability benefits for a congenital heart defect:

1. Non-Medical Criteria, and
2. Disability Criteria.

Satisfying the disability criteria means –

1. You grasp how Social Security considers congenital heart defects (covered on this page),
2. You satisfy the Social Security congenital heart defect Listing (also covered on this page) or you have disabling Functional Limitations (covered on the next page), and
3. You Submit Winning Evidence (covered on the last page)

How Your Congenital Heart Defect Disability Case is Won

Social Security is very familiar with congenital heart defect disability and SSI cases. A congenital heart defect is a structural abnormality of the heart that develops before birth. The following are the most common kinds of congenital heart defects:

1. Aortic valve stenosis (valve does not fully open),
2. Atresia (deformed valve),
3. Regurgitation (valve does not close completely),
4. Coarctation of the aorta (narrowing of an artery or vein),
5. Patent ductus arteriosus (PDA) (abnormal blood flow between the aorta and pulmonary artery),
6. Atrial septal defect (hole in the septum which is a heart wall that separates the atria), and
7. Ventricular septal defect (hole in the septum which is a heart wall that separates the ventricles).

Commonly that one has a congenital heart defect, but the defect does not cause serious symptoms or a disability until later in life – even into late adulthood. If this is the case for you, it is not necessary to obtain your medical records from your youth. These records would be helpful, but medical facilities don’t keep records that long. If you do have them in storage, great; get them out, and send them to Social Security. If you don’t have the old medical records, that’s ok; modern diagnostic techniques (e.g. MRI, CT) will demonstrate a congenital heart defect. That is, a doctor will be able to do a diagnostic test now and know you had, and still have, a congenital heart defect.

Your diagnosis will be extremely important to Social Security. The review of your disability case essentially starts here. It will be nearly impossible to prove disability without a diagnosis that is based on a diagnostic test of which there are many:

1. Pulse oximetry or ultrasound in newborns/infants,
2. Echocardiogram,
3. Electrocardiogram,
4. Angiogram,
5. Cardiac catheterization,
6. Holter monitor,
7. Chest x-ray,
8. Cardiac stress testing, and
9. Blood tests.

In reviewing your medical records, Social Security expects to see typical symptoms: chest pain (angina), arrhythmias, fatigue, shortness of breath, weakness, lightheadedness, and edema. These are the symptoms that can equate to disability.

Treatment is also important. The more treatment you receive, and the more significant the treatment, the more likely you will be found disabled. Treatment typically includes ACE inhibitors, beta-blockers, anticoagulants, antiplatelets, and diuretics. Pacemakers are somewhat common. There are many surgeries available depending on the particular heart defect.

Step 3 – Social Security And SSI Congenital Heart Defect Listing

At Step 3, the congenital heart defect listing is Adult Listing 4.06 and Child Listing 104.06. You satisfy the listing by proving you have the following:

1. Cyanosis (bluish coloration of the skin) when resting,
2. Intermittent right-to-left shunting causing cyanosis with physical effort, or
3. Pulmonary vascular disease with increased pulmonary arterial systolic pressure.