How Social Security Evaluates Heart Transplant Recipients for Disability

Heart transplants don't come without risk and can cause additional impairments to the body. The Social Security Administration (SSA) will automatically approve you for disability benefits for one year following the transplant. You can apply for benefits as soon as you get on a heart transplant waitlist, and Social Security will fast-track your application under the Compassionate Allowance program if you have congestive heart failure that meets certain criteria.

After one year, when the agency re-evaluates heart transplant recipients for continuing disability benefits, the amount of time since the transplant and any impairments that continue after the transplant are considerations.

Risk Factors for Heart Transplant Recipients

The type of complications that can arise after a heart transplant have a bearing on the way Social Security will evaluate your disability application after your heart transplant. Having a heart transplant comes with significant risks.

The New Heart Fails to Work

Once a heart transplant is completed, it's possible that the donor heart won't work properly. That can happen for two main reasons:

• Primary graft dysfunction occurs shortly after the transplant and is the leading cause of death within 30 days of a heart transplant. This complication occurs when the donor heart doesn't function properly and can't provide the necessary pumping actions to support the body.
• Cardiac allograft vasculopathy (CAV) is a hardening of the arteries in the donor heart, which destroys circulation in the heart. CAV develops over time and can lead to issues like:
• heart attacks
• heart failure, and
• arrhythmias (abnormal heart rhythm).

Your Body Rejects the New Heart

Rejection of the organ is the biggest concern with any transplant. It occurs when your body attacks the new organ as a foreign object and threat. There are three types of rejection:

• Hyperacute rejection occurs when the donor organ isn't a proper match with the recipient's body. If this occurs, the organ must be removed immediately.
• Acute rejection occurs to some extent with every transplant. These types of rejections can be treated with medications to prevent the failure of the donor organ.
• Chronic rejection occurs when there are continuous and multiple acute rejections of the donor organ. These types of rejections slowly damage the donor heart and can lead to that organ failing. Sometimes a rejection takes months or years, which is called late graft dysfunction.

Complications From Anti-Rejection Medications

After receiving a transplant, you'll need to take medications that prevent your body from rejecting the donor heart for the rest of your life. However, these "anti-rejection" medications can have significant effects on your body. Taking anti-rejection medications puts you at increased risk for the following:

• kidney damage (this is the most common effect of long-term medication use)
• infection (can often be severe and lead to hospitalizations; they're the leading cause of death from heart transplants in the first year)
• thinning of the bones
• high blood pressure
• high cholesterol
• diabetes, and
• cancer (the most common types of cancers seen in heart transplant recipients include skin cancer and non-Hodgkin's lymphoma).

Problems From Not Properly Following a Care Plan

After a heart transplant, you need to follow lifelong medical treatments to ensure your new heart isn't rejected. These treatments include the following:

• taking multiple medications on a strict schedule
• attending follow-up visits with your doctors
• carefully monitoring your health for signs of organ rejection, and
• living a heart-healthy lifestyle.

If you don't follow the necessary treatments, you risk rejection of the donor heart or other impairments to the heart.

Rejection or Failure of the Heart Transplant

If your body rejects the donor heart at any time following a transplant, Social Security will evaluate your impairments under the Compassionate Allowance program, which is a process that allows your disability determination to be made within a matter of days.

You'll also qualify for a Compassionate Allowance if you're put on the waitlist to receive another heart transplant.

Meeting the Disability Listing for Heart Transplants

Social Security's "Blue Book" lists impairments that can automatically qualify for disability benefits. Heart transplants are covered under listing 4.09. Because of the risk of rejection and infection, Social Security automatically treats all heart transplant recipients as "disabled" for one year following the transplant surgery.

So, if you've had a heart transplant and meet the technical benefits requirements (see below), your disability application will be automatically approved.

Keeping Your Disability Benefits a Year After Your Heart Transplant

One year after a heart transplant, Social Security will conduct a continuing disability review (CDR) to decide if you still meet the medical requirements for disability benefits. Social Security will look at your residual (remaining) symptoms and limitations, including side effects from medication, and compare them to the cardiovascular listings.

A year after a heart transplant, some transplant recipients will meet one of the following listings:

• Listing 4.02- Chronic heart failure
• Listing 4.04- Coronary artery disease, or
• Listing 4.05- Arrhythmia.

Not all of the disabling effects of having a heart transplant are specifically cardiovascular. You might continue to have impairments that meet other listings like:

• Listing 1.06/.07- Bone fractures (due to bone thinning)
• Listing 6.02- Kidney problems
• Listing 9.00- Diabetes
• Listing 13.03- Skin cancer, or
• Listing 13.05- Lymphoma.

Continued Eligibility If You Don't Meet a Listing

A year after transplant surgery, even if your medical condition doesn't meet the requirements of a listing, Social Security can't stop your benefits unless the agency can prove that you've had medical improvement since your transplant. Medical improvement means a decrease in the severity of your impairment. But the medical improvement must allow you to do basic work activities. (20 CFR 404.1594.)

So the SSA will determine whether or not your condition still prevents you from working. If you can't work enough to earn a living (what the SSA calls substantial gainful activity or SGA), you'll qualify for continuing disability benefits.

As part of the CDR (review) process, Social Security will conduct a residual functional capacity (RFC) assessment to determine what you can and can't do given your medical condition. Your RFC provides a picture of your functional limitations—the daily and work-related activities you have trouble doing or can't do because of your medical condition.

For example, if thinning bones have caused you to have multiple femur fractures, your mobility might be limited. Your RFC will include the limitations you have doing things like:

• standing
• sitting and standing up from a seated position, and
• walking.

If you can't be on your feet for more than an hour a day, that would significantly limit the kind of work you could do. Social Security will use your RFC to see if you can still do your past jobs, given your limitations, or if there's any other work you could do (or learn to do).

To end your disability benefits, Social Security will have to identify jobs that you can do with your physical limitations and RFC.

What Type of Disability Benefits Are You Eligible to Receive?

Social Security offers two types of disability benefits:

• Social Security disability insurance (SSDI), and
• Supplemental Security Income (SSI) disability.

You might be able to receive one or both types of benefits. But to be eligible for either disability program, you can't be working enough to earn more than the SGA limit ($1,550 per month in 2024). And each benefit program has additional eligibility requirements.

SSDI offers disability benefits for people who've worked and paid into the system (by paying FICA or self-employment taxes). To be eligible for SSDI, you must have worked long enough and recently enough to be "insured."

If you don't meet the SSDI work requirements, you might still qualify for SSI disability benefits. But SSI is a needs-based program with strict income and asset limits.

Learn more about the technical (non-medical) requirements for SSDI and SSI.

How to Apply for Disability Benefits After a Heart Transplant

You can apply for SSDI and/or SSI disability benefits by phone by calling Social Security's national office at 800-772-1213 to make an appointment. Or contact your local Social Security office to make an appointment to apply in person.

But the fastest way to apply for SSDI benefits is by filing an online application, which you can do anytime from the comfort of your home. But you can't apply for SSI online. Instead, you'll have to request an appointment to apply for SSI benefits. You can do that by:

• completing an online questionnaire
• calling the national office number above, or
• contacting your local Social Security office.

Learn more about the disability application process, including the information Social Security will require.

_{Updated December 1, 2023}