Get Social Security Disability & SSI: Pulmonary Hypertension

Winning Your Case

Obtaining Social Security disability and SSI benefits with pulmonary hypertension from Social Security is relatively straightforward. First, you must comply with Social Security’s Non-Medical Criteria which means obtaining work credits for SSDI or having (mainly) low income and resources for SSI. Second, you must satisfy Social Security’s Disability Criteria which is the 5-Step disability process for adults and the 3-Step disability process for kids.

Satisfying the disability criteria means –

1. You understand how Social Security evaluates pulmonary hypertension (reviewed on this page)
2. You satisfy a Social Security Listing related to pulmonary hypertension (also reviewed on this page) or you have disabling Functional Limitations, and
3. You Submit Winning Evidence.

Disability, Pulmonary Hypertension Medical Records, And Social Security

Social Security will be looking very closely at your pulmonary hypertension which is high blood pressure in the pulmonary arteries that flow from the right side of the heart to the lungs caused by a narrowing or blockage. The high blood pressure (narrowing or blockage) typically causes the following common symptoms:

1. Fatigue;
2. Shortness of breath;
3. Chest pain;
4. Dizziness; and
5. Lower extremity swelling, pain, and numbness.

Objective evidence of your pulmonary hypertension will be necessary to win your Social Security disability case. It will serve as the basis of your diagnosis. It will also serve as the primary indicator of your pulmonary hypertension severity. The most common tests are as follows:

1. Lung scan,
2. X-ray,
3. Echocardiogram,
4. ECG heart testing,
5. Cardiac catheterization, and
6. Sometimes blood tests.

Treatment of your pulmonary hypertension will also be necessary to win your Social Security disability case which includes diuretics, blood-thinners, intropics (improves heart ability to function), and oxygen therapy. If your oxygen therapy includes a nebulizer, an oxygen tank, or a bilevel positive airway pressure machine (BiPAP), it is an indication that you have severe pulmonary hypertension. It will be important to Social Security that your doctor notes your need for these breathing devices in your medical records or in a statement (if the prescription is not in your medical records). Surgeries are rare and limited to clot removal or a lung or heart transplant.

Breathing problems are usually the most common and serious symptom. Fatigue results from breathing problems. Fatigue is usually the most common functional limitations. Fatigue, if severe, can preclude all work – you are disabled. Fatigue, if moderately severe, can preclude some work – you may be disabled with the grid rules over 50. We discuss functional limitations and how to be found disabled on the next page.

Pulmonary Hypertension Social Security & SSI Listings

There are three listings that may apply.

Social Security Pumonary Hypertension Listing

The listing for pulmonary hypertension is Adult Listing 3.09 and requires catheterization testing showing a mean pulmonary artery pressure at least 40 mm Hg.

Respiratory Failure

If your pulmonary hypertension causes respiratory failure, you meet Adult Listing 3.14 if you undergo mechanical ventilation, noninvasive ventilation with a BiPAP, or both.

Lung Transplant

If your pulmonary hypertension leads to a lung transplant, you will meet Adult Listing 3.11 for three years from the transplant date, and then thereafter, Social Security will evaluate whether you continue to be disabled.

TERI: Terminal Disease Case

In a severe pulmonary hypertension disability case, Social Security can deem the case a TERI case (death is expected). Social Security will render a decision quicker in a TERI case – Expedited Cases.