Social Security Disability: SSDI & SSI Benefits for Heart Failure

Filing for Disability Benefits with Heart Failure

Part I: Background Information on Heart Failure

It is estimated that nearly six million Americans suffer from heart failure, and that an additional seven hundred thousand individuals are diagnosed with heart failure each year. Hypertension, valvular heart disease, cardiomypathy, ischemic heart disease, and myocardial infarctions are common causes of heart failure.

In fact, a nineteen year study known as the National Health and Nutrition Examination Survey ranked ischemic heart disease as the number one risk factor for chronic heart failure in the United States; followed by cigarette smoking, hypertension, obesity, diabetes, and valvular heart disease.

Of course there are other causes for heart failure such as a viral infection of the heart muscle known as Myocarditis, obstructive sleep apnea, connective tissue diseases, arrhythmia, HIV cardiomyopathy, alcohol and drug abuse, and muscle infiltrations that damage the heart muscle. But no matter what the cause, chronic heart failure impairs the heart's ability to provide sufficient blood flow for the body's requirements.

Symptoms of heart failure might include shortness of breath, fatigue, swelling of ankles and feet, or even fluid collection in the lungs. Of course, a trained physician is the best person to make a diagnosis of heart failure. Treatment of heart failure depends upon the cause of the heart failure. Most treatment regimens involve getting the proper amount of rest, eating right, changes in life style, medications, devices, and in some instances surgical procedures.

Individuals with chronic heart failure might be treated with medications such as ACE inhibitors, vasodilators, diuretics, digitalis, and beta-blockers. Surgical interventions might include defibrillators (regulate arrhythmias), angioplasty, valve replacement, left ventricular assist devices, coronary artery bypass, stent placement, or even heart transplants. Heart transplants are generally the last resort for individuals whose hearts cannot be treated or repaired.

Life style changes are one of the most important components to successful treatment of chronic heart failure. Life style changes that are beneficial to the treatment of chronic heart failure are as follows:

1. Quit smoking (cigarettes, cigars, pipes, etc)
2. Physical activity
3. Monitor blood pressure
4. Stress management
5. Heart healthy diet that is low in saturated fats, trans fat, sodium, and cholesterol
6. Avoid excessive alcohol consumption --- recent studies do suggest that mild to moderate consumption of alcohol (two drinks per day) may even be healthy for an individual. However all individuals with chronic heart failure should follow their doctors treatment recommendations.
7. Limit or avoid caffeine consumption
8. Keep track of symptoms and report all health concerns to your treating physicians.
9. Work closely with your physicians

Individuals who have chronic stable heart failure can easily decompensate if they have another illness, heart attack, or have uncontrolled hypertension. Additionally, individuals who fail to maintain good heat healthy diets, control fluid retention, or maintain their medication regimen are likely to have an acute episode of heart failure decompensation that could result in their death.

Part 2: Social Security Disability Benefits for Heart Failure

Social security's disability evaluation book (the bluebook) deals with impairments of the cardiovascular system in Section 4.00 Cardiovascular System. This listing category has subsections that deal with different types of heart failure such as:

4.02 Chronic heart failure
4.03 Hypertensive cardiovascular disease
4.04 Ischemic heart disease
4. 05 Recurrent arrhythmias
4.06 Symptomatic Congenital heart disease
4.07 Valvular heart disease or other stenotic defects
4.08 Cardiomyopathies
4.09 Cardiac transplantation

Of the above- mentioned subsections, subsections 4.02 and 4.04 contain listing criteria that are used to evaluate not only chronic heart failure and ischemic heart disease but for other cardiac conditions as well. For the purposes of our discussion, we are going to explore the criteria listed in 4.02 and 4.04.

Subsection 4.02 of the Cardiovascular System impairment listing is Chronic heart failure while undergoing prescribed treatment with one of the of the following: (Individuals must meet both A and B criteria)

A. Chronic heart failure evidenced by one of the following:

1. Systolic failure with the left ventricular with end diastolic dimensions of more than 6.0 cm or an ejection fraction of thirty percent or less. This had to occur when the heart is stable not when there is an acute episode of heart failure; or

2. Diastolic Failure in which the left ventricular posterior wall plus septal thickness being 2.5 cm or more when imaged including an enlarged atrium of more than or equal to 4.5 cm with an elevated or normal ejection fraction during a stable heart period; and

B. Resulting in one of the following:

1. Persistent symptoms of heart failure that result in significant limitations that impair an individual's ability to independently perform normal activities of daily living. Additionally, the individual should have been determined unable to perform an exercise test due to significant risk to themselves; or

2. An individual has had three or more unique episodes of acute congestive heart failure within a twelve-month period. There must also be fluid retention that can be validated by clinical and imaging assessments at the time of the acute heart failure attack. Treatment of the acute attack must require extended physician intervention (hospitalization or emergency room treatment of twelve hours or more and that the acute chronic heart failure attacks have been separated by periods of heart stability; or

3. Individual cannot perform an exercise test with a workload of 5 METS or less because of:

a. Fatigue, dyspnea, palpitations, or chest discomfort; or
b. Three or more consecutive ventricular contractions (tachycardia) or more incidents of ventricular ectopy with six or more premature ventricular contractions per minute; or
c. Left ventricular dysfunction resulting in a decrease of 10mm HG or more in systolic pressure that is under the baseline systolic pressure or the preceding systolic pressure that was measured during exercise despite an increase in workload; or
d. Ataxic gait or mental confusion, signs that are attributable to inadequate cerebral perfusion.

Subsection 4.04 Ischemic heart disease, with symptoms due to myocardial ischemia while on prescribed treatment with one of the following:

A. Symptom or sign limited exercise tolerance test that shows at least one of the following symptoms at a workload that is equal or less than 5 METs:

1. A downturning or horizontal depression without deigitailis glycoside treatment or hypokalemia of the ST segment of at least 0.10 millivolts (-1.0mm) in three or more consecutive complexes that are on a level baseline in any lead but a VR, and depression of at least 0.10 millivolts lasting for one minute or more of the recovery; or

2. An ST elevation of at least 0.1 millivolt (1mm) above the established resting baseline in non-infarct leads during exercise and the first one or two minutes of recovery; or

3. A decrease of systolic pressure of 10mmHg or more below the baseline blood pressure or the preceding systolic pressure measurement during exercise due to left ventricular dysfunction even though there has been an increase in workload.

4. Documented ischemia at an exercise level equal to 5 METs or less on medically acceptable imaging methods such as stress echocardiography or radionuclide perfusion scans. OR

B. Three separate episodes of ischemia with in a consecutive twelve-month period that require revascularization or are not amendable to revasularization. OR

If there is no prescribed treatment regimen in place, Social Security will base their decision on current objective medical evidence and any other evidence they have. More importantly, if you do not receive treatment you cannot show that you have an impairment that meets this impairment and most other cardiovascular listings. You still may be found disabled if you have another condition or conditions that considered together with your cardiovascular condition might allow you to medically equal the severity of the an impairment listing or if Social Security considers your residual functional capacity, age, work history, and education they are able to find you disabled through a medical vocational allowance.

C. Coronary artery disease, documented by appropriate medically acceptable imaging or an angiography (independently obtained outside the Social Security disability evaluation process) or in the absence of a timely exercise tolerance test or drug induced stress test a medical professional who is experienced in the treatment of cardiovascular disease has determined that the performance of an exercise tolerance test would cause a significant risk to the individual, with both 1 and 2:

1. Angiographic evidence showing:

a. A nonbypassed left main coronary artery with a 50 percent or more; or
b. Another nonbypassed coronary artery with a 70 percent or more narrowing; or
c. A long (more than 1cm) segment of a nonbypassed coronary artery with a 50 percent; or
d. At least two nonbypassed coronary arteries with a 50 percent or more narrowing; or
e. A bypass graft vessel with a 70 percent or more narrowing; and

2. Resulting in serious limitations in the ability to independently initiate, per- form, or complete activities of daily living.