Peripheral arterial disease (PAD) occurs when plaque builds up in the arteries that carry blood to your head, limbs, and organs. Over time, plaque consisting of fat, cholesterol, calcium, and other substances can harden in the arteries and narrow them, making it more difficult for blood to get through. PAD generally affects the arteries in the legs, but can also affect the arteries that flow from the heart to the head, arms, kidneys, and stomach.
Symptoms of Peripheral Arterial Disease
Some individuals who suffer from PAD have no or mild symptoms, but for those who do suffer symptoms, the symptoms may include:
Pain or tiredness in the legs after walking. This is caused by the leg muscles' increased need for oxygen while walking or climbing stairs. Symptoms include pain, numbness, aching, cramping, and heaviness in the legs and calfs.
- Leg pain, weakness, or numbness at rest. As PAD progresses, pain may occur at rest and when lying down. It may be severe enough to disrupt sleep.
- Coldness in the affected leg/foot compared to the other leg/foot.
- Sores on the toes, feet, or legs that heal slowly, poorly, or not at all.
- Change in the affected leg’s color.
- No or weak pulse in the affected leg.
- Slower nail and hair growth in the affected leg, and/or
- Erectile dysfunction in men.
Complications and increased risk for other diseases can occur with PAD, including:
- gangrene, the death of tissue
- ulcerations, which occur when sores do not heal properly
- heart disease
- heart attack, or
Qualifying for Disability Benefits for PAD
Social Security sometimes approves disability benefits for applicants whose use of their legs is limited due to PAD. In order to qualify for Social Security disability or SSI disability benefits, you must provide medical evidence that proves that you either meet Social Security's criteria for PAD to automatically qualify as a disability or are unable to work any job due to the limitations PAD causes you.
Meeting the Disability Listing for PAD
Peripheral arterial disease has a specific listing in the Social Security “blue book” that requires you have PAD with intermittent claudication (pain, discomfort, and fatigue after using the legs) with low blood pressure in your legs. The listing requires you have one of the following pressure rates:
- Resting ankle/brachial systolic blood pressure ratio that is less than .50.
- Decrease in systolic pressure at the ankles after exercise of 50% of more than it was before exercise and taking at least ten minutes to return to the before-exercise level.
- Resting toe systolic pressure of less than 30 mm Hg, or
- Resting toe/brachial systolic blood pressure ratio of less than .40.
If you meet the above requirements, you qualify automatically for disability benefits without Social Security even needing to see how your PAD affects your activities. However, not many disability applicants with PAD meet the above requirements.
Medical Evidence Required for the PAD Listing
In assessing the severity of your PAD, Social Security will look at Doppler studies, angiographic findings (x-ray done with contrast), and blood pressure readings as follows.
Ankle blood pressure: Ankle blood pressure is measured at the posterior tibial and doesalis pedis arteries, and the higher measurement is used. These measurements can be taken by Doppler, plethysmographic studies, or other accepted techniques. If there are tracings that were done as part of taking the measurements, they should be included with the medical evidence.
Ankle/brachial systolic blood pressure ratio: To measure this ratio, ankle and brachial artery systolic blood pressures are taken at the same time while you are lying on your back; they do not need to be taken on the same side of the body. The higher of both measurements are used in the ratio.
If your ratio is greater than .50 and less than .80, Social Security will pay for an exercise Doppler test to be completed. However, the agency will not pay for this test if you have a preexisting disease that causes abnormal calcification in your arteries or small vessel disease, because these will increase ankle pressure readings. You must first be cleared by the medical consultant to ensure that you can safely perform the test before you are tested.
Exercise Doppler Test: When Social Security orders an exercise Doppler test for you, you will be required to exercise on a treadmill at a speed of 2mph with an incline of 12% for up to five minutes. The exercise report will record your before and after exercise blood pressures at points in your lower extremities.
Toe systolic pressure: This measurement is used for those who have intermittent claudication and abnormal calcification in their arteries or small vessel disease (as toe pressure is not affected by these ailments). Toe pressure are generally taken at a vascular laboratory and can be measured using one of the four methods below:
- toe or neonatal blood pressure cuffs
- plethysmography using a strain gauge cuff, or
- Doppler ultrasound.
Toe/brachial systolic blood pressure: To measure this ratio, the same method is used as is for the ankle/brachial systolic blood pressure ratio. As with toe systolic pressure, this measured will be used on anyone who has intermittent claudication and abnormal calcification in your arteries or small vessel disease.
If you have had a peripheral graft, which is a surgery done to bypass the narrowed section of the artery, the test results from after the peripheral grafting will be used only to assess the severity of your impairment. Test results done before the peripheral grafting will be considered in determining the severity and duration of your PAD only before the surgery.
Inability to Work Due to PAD Limitations
If you don't meet the blood pressure requirements of the PAD listing, you may still qualify for Social Security disability benefits if you can prove that your limitations make you unable to perform any job. Social Security uses a Residual Functional Capacity (RFC) form to assess how your ability to work is affected by your physical impairments. Your age, education level, and work experience will also be considered when determining if you can work.
Those with PAD often have pain in their legs after exerting themselves by walking or climbing stairs. Jobs that require constant use of the leg muscles without rest would not be possible for someone with PAD. A job sitting at a desk, however, may be possible. Similarly, if accommodations can be made (such as allowing frequent rest breaks), the limitations may not be considered a job limiting factor.
For individuals who have sores on their feet or legs that do not heal due to PAD, there may be some restrictions on the environment in which they work, especially if the sores need to be kept dry or left uncovered to heal. Environments that may have various particles in the air (such as at a factory) may not be suitable for those individuals.
It will be your job, or your disability lawyer's job if you hire one, to prove on appeal that there are reasons why you can't do even sedentary or light work because of your PAD. For more information on how Social Security assesses your limitations and abilities, see our section on RFCs and the level of work you can do. For information on how a lawyer can rule out jobs, see our article on what lawyers do at disability hearings.