Social Security Disability: Congestive & Chronic Heart Failure

With chronic or congestive heart failure, you will win your case and receive Social Security and SSI disability benefits if you satisfy two Social Security criteria:

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

If you need a review of this criteria, please give it one (even just a read of the overviews).

On this page, we evaluate how Social Security assesses your chronic or congestive heart failure medical case. On the next page, we evaluate how Social Security assesses your Functional Limitations to determine if you are disabled. On the next, next page, we evaluate what Evidence you must provide to prove your medical condition, your limitations, and other aspects of your Social Security disability case.

Congestive & Chronic Heart Failure Disability Evidence

What Social Security Looks for

Congestive or chronic heart failure is a serious and common Social Security disability and SSI case that occurs when your heart is unable to pump enough blood to your organs and body systems. There are two types – 1) systolic dysfunction when your heart cannot contract and pump normally, and 2) diastolic dysfunction when your heart cannot rest and fill itself back up with blood. There is often overlap between congestive or chronic heart failure and other cardiac conditions as other conditions often cause congestive or chronic heart failure [e.g. coronary artery disease, heart defects, cardiomyopathy (damaged heart), myocarditis (heart inflammation) or hypertension]. If you have another heart impairment, Social Security will evaluate that impairment in your disability case as well. It may be that the combination of multiple heart impairments will result in a finding of disability.

Diagnosis

Social Security will ask for your medical records which must include a diagnosis that can be made by a number of different tests. Generally with testing, Social Security wants to see abnormal systolic or diastolic function, decreased ejection fraction (how much blood your left ventricle pumps), cardiomegaly (enlarged heart), or heart wall enlargement, or septum thickness. From worst diagnostic testing to first, the most common are as follows:

1. Chest x-ray,
2. Electrocardiogram (ECG),
3. Exercise stress (tolerance) test,
4. Echocardiogram (also called an echo) which is ultrasound of the heart,
5. MRI,
6. Single-photon emission computed tomography (more commonly called a SPECT) which is a 3D CT scan using radioactive material to aid in the visualization of the heart,
7. Nuclear stress test (also called myocardial perfusion imaging) which also uses radioactive material and is performed in combination with a stress test to obtain a view of the heart as well as determine the heart’s functioning, and
8. Cardiac catheterization (also called a heart cath or angiogram) which is a procedure wherein a catheter is inserted into an artery or a vein to determine the heart’s functioning.

A special note should be made at an exercise stress (tolerance) test; it is the one test specifically noted in the adult Chronic Heart Failure 4.02 Listing. While the test is not necessarily an excellent test to diagnose your heart condition, it is an excellent test to determine your heart functioning. Hence, it helps determine your overall functioning. And hence, it helps determine whether you are disabled.

Symptoms

Social Security recognizes your symptoms of congestive or chronic heart failure usually entail the following:

1. Fatigue,
2. Weakness,
3. Shortness of breath,
4. Chest pain, and
5. Arrhythmias with palpitations and lightheadedness.

Congestive or chronic heart failure may (because medications may control this) result in fluid build-up causing the following:

1. Enlarged liver,
2. Arterial or venous inflammation,
3. Abnormal lung sounds,
4. Edema or ascites (abnormal fluid build-up in the body), and
5. Significant weight gain.

Treatment

Social Security will determine the severity of your congestive or chronic heart failure disability, in part, on the type and frequency of your medical treatment which generally consists of –

1. Implantable cardioverter-defibrillator (ICD) which uses a mini-computer and electrical shocks to maintain a normal heart rhythm;
2. Pacemaker which uses a mini-computer and electrical pulses to maintain a normal heart rhythm;
3. Ventricular assist device (VADs) which is a pump implanted in your abdomen or chest and attached to your heart to help your heart pump blood to the rest of your body;
4. Surgery which generally consists of bypass surgery (clearing blocked arteries), heart valve repair or replacement, or in very severe cases, heart transplant; and of course
5. Medications.

Medications generally include the following:

1. Beta-blockers which lowers heart rate and blood pressure (e.g. carvedilol and metoprolol),
2. ACE inhibitors which reduces heart-damaging hormones and lowers blood pressure (e.g. lisinopril),
3. Aldosterone antagonists which reduces the hormone aldosterone that can damage your heart (e.g. spironolactone),
4. Hydralazine and nitrates which lowers blood pressure, and
5. Diuretics which eliminates unneeded fluid from the body (Lasix).

Heart Failure Classifications

The medical community classifies heart failure according to two common classification guidelines. The New York Heart Association classifies heart failure as follows: 1) no symptoms – Class I, 2) mild symptoms – Class II, 3) marked symptoms – Class III, and 4) severe limitations – Class IV. The American College of Cardiology classifies heart failure as follows: 1) at risk for heart failure – Stage A, 2) no symptoms – Stage B, 3) heart failure – Stage C, and 4) heart failure with need for advanced care – Stage D. Social Security does not address these classification guidelines. Social Security is more concerned about a diagnosis made by objective testing, and your overall level of functioning (based primarily on your medical records and secondarily on your statements). However, it is generally the case that if you are classified by your doctor at Class IV or Stage D, Social Security will find your symptoms severe enough to be found disabled. If you have a Class III or Stage C classification, your case will be a close-call with Social Security; because of this, you will need additional evidence to persuade Social Security you are disabled. The best additional evidence is a detailed physical evaluation from your doctor which will need to indicate you have disabling symptoms and functioning.

Congestive & Chronic Heart Failure: Social Security Disability And SSI Listing

Three listings may be applicable.

Adult Listing

For the congestive heart failure Adult Listing 4.02, an adult satisfies the listing if they are getting medical treatment, have severe heart-related symptoms, and both of the following:

1. Systolic or diastolic failure, and
2. One of the following –
   1. Your symptoms very seriously affect your life, and a doctor has determined it is unsafe to perform a heart exercise test;
   2. You have at least three occurrences of heart failure in a 12-month period; or
   3. You are unable to complete a heart exercise test with a workload of 5 METs or less.

Child Listing

For the congestive heart failure Child Listing 114.02, a child satisfies the listing if they are getting medical treatment, have severe heart-related symptoms, and one of the following:

1. Tachycardia,
2. Tachypnea, and
3. Failure to grow normally.

Heart Transplant Listing

If an adult or a child has congestive heart failure and undergoes a heart transplant, either will be found disabled for at least one year. Thereafter, Social Security will evaluate the heart and overall health conditions to determine if disability continues – Adult Listing 4.09 and Child Listing 104.09.