When Can You Get Disability Benefits for Coronary Heart Disease?

Coronary heart disease, also known as ischemic heart disease or coronary artery disease, is caused by the build-up of "plaque," or fatty deposits, inside the coronary arteries (atherosclerosis). This build-up of plaque causes narrowing and hardening of the arteries that supply blood and oxygen to the heart muscle (arteriosclerosis). As a result of atherosclerosis and arteriosclerosis, blood flow to the heart is slowed or stopped.

The most common symptoms of coronary heart disease are chest pain or discomfort ("angina") and shortness of breath. Coronary heart disease can also cause a heart attack (myocardial infarction).

Depending on the severity of their symptoms, people with coronary heart disease may or may not be able to work, and may or not qualify for SSI or SSDI disability benefits.

How to Qualify for Disability Benefits With Coronary Heart Disease

The Social Security Administration (SSA) has two ways you can qualify for disability benefits. You can qualify for benefits for coronary artery disease by either meeting the requirements of Social Security's listing for ischemic heart disease or by demonstrating that your heart condition has so reduced your functional capacity (your ability to work or exert yourself) that you're unable to hold a job.

Meeting Social Security's Official Listing for Coronary Heart Disease

Social Security will evaluate your coronary heart disease based on the current objective medical evidence in your medical record and any other evidence they may receive. In rare cases where there is no medical documentation of your condition in the medical record, or the documentation covers too short of a time period, the SSA may order a "consultative examination" to help evaluate your impairment.

If you haven't been on prescribed treatment or medication, you will have a difficult time showing that your coronary heart disease meets Listing 4.04 for ischemic heart disease. Ask your doctor for help determining if you meet the following listing requirements:

Symptoms of Myocardial Ischemia Required

Listing 4.04 states that you must have one of the following symptoms due to "myocardial ischemia":

• angina pectoris, which is chest discomfort that is caused by activity or emotion, and quickly relieved by rest (or rapidly acting nitrates such as nitroglycerin tablets)
• atypical angina, which is pain or discomfort that is located in places other than the chest, such as the inner left arm, jaw, neck, back, and upper abdomen
• "anginal equivalent," which is shortness of breath on exertion, but with no complaints of chest pain or discomfort
• variant angina, which refers to episodes of angina at rest due to spasm of a coronary artery (this should be demonstrated by transient ST segment elevation on an electrocardiograph (ECG)), or
• silent ischemia, which is the occurrence of myocardial ischemia or myocardial infarction without any pain or other symptoms.

Medical Evidence of Myocardial Ischemia Required

In addition to the symptoms described above, Listing 4.04 also requires that you have one of the following—an abnormal stress test, ischemic episodes, or abnormal imaging results—as follows:

Abnormal Stress Test

An exercise tolerance test at a workload equal to 5 METS or less, resulting in at least one of the following abnormalities:

• Horizontal or downsloping ST segment depression of at least -0.10 millivolts (-1.0 mm) (without the presence of digitalis glycoside treatment or low blood potassium), lasting for at least 1 minute into the recovery period
• At least 0.1 millivolt (1 mm) of ST segment elevation during exercise, which lasts 1 minute or more into the recovery period
• Decrease of systolic pressure of 10 mm HG or more below the baseline level or below the preceding systolic pressure recorded during exercise due to dysfunction of the left ventricle, despite a workload increase, or
• Ischemia documented at an exercise level of 5 METS or less on proper medically acceptable imaging, such as stress echocardiography.

Ischemic Episodes

Three separate ischemic episodes within a consecutive 12-month period. Each episode must require revascularization (or be unable to be revascularized). Revascularization usually refers to angioplasty or bypass surgery.

Abnormal Imaging Results

If a medical consultant who works for the SSA determines that an exercise tolerance test would be too risky for you, the SSA will accept an angiography or other medically acceptable imaging demonstrating coronary artery disease. The angiographic evidence must show 50 to 70 percent of narrowing of a coronary artery that has not been bypassed. For the specific angiographic evidence required, see Listing 4.04C(1) in the SSA's blue book. In addition to the angiographic evidence, your coronary heart disease must seriously limit your ability to engage in daily activities.

What Should Be in Your Medical Records if You Have Coronary Heart Disease

Social Security will be looking for a "longitudinal" clinical record of your coronary heart disease. This means you must have had at least three months of treatment, unless your current evidence is sufficient for the SSA to make a determination. The basic documentation you should supply to the SSA includes detailed reports of your history, physical examinations, laboratory tests, and any treatment that has been prescribed to you, as well as your response to such treatment.

Your longitudinal record should include ECG (electrocardiograph or electrocardiogram) results. An electrocardiograph records electrical impulses of your heart onto a strip of paper known as an electrocardiogram or tracing. An ECG may show that your heart muscle is not receiving enough oxygen, resulting in ischemia. An ECG may be performed while the patient is at rest or exercising.

Be sure that the SSA also receives the results of any exercise tolerance tests performed. Exercise testing is the most commonly used testing for determining the presence of myocardial ischemia and for providing an estimate of your aerobic capacity. If possible, recent exercise test results should be included in your records, since the SSA generally considers exercise test results to be valuable for only 12 months after they've been performed.

If you've been undergoing treatment, be sure to tell your doctor about all of the symptoms you've been experiencing due to coronary heart disease. Mention any chest pain or discomfort, where it's located, and whether it interferes with your ability to concentrate or complete tasks. If you have problems walking certain distances without shortness of breath or fatigue, be sure that information makes it into your doctor's notes. If you are on medication for coronary heart disease, note any side effects you may experience, such as lethargy, headaches, dizziness, nausea and vomiting, depression, memory loss, or blurred vision.

Reduced Functional Capacity Due to Coronary Heart Disease

If you don't meet the listing requirements for coronary heart disease described above, you might still be eligible for disability benefits. As part of the next step in the disability determination process, the SSA will consider whether your heart impairment has reduced your capacity to work. If the SSA determines that your capacity is so reduced that you're unable to perform your past job or any other job, you should be found disabled.

First, the SSA will consider all of the relevant medical evidence in your case file to determine what's called your "residual functional capacity" (RFC). Your RFC—which will be for sedentary work, light work, or medium work—is the most work activity that you can do on a regular and continuing basis, despite your limitations. In your RFC assessment, the SSA will rate your ability to perform work-related activities such as sitting, standing, walking, lifting, carrying, pushing, and pulling.

If your doctor says, for example, that you can't lift more than 20 pounds due to shortness of breath, but that you can stand or walk for 6 hours of an 8-hour workday, the SSA will give you an RFC for light work. Or, if your doctor finds that you can't lift more than 10 pounds and should walk or stand no more than 2 hours of an 8-hour workday due to fatigue, the SSA will give you an RFC for sedentary work.

After determining your RFC, the SSA will use this information to decide if you can do your prior job with your limitations. If you can't perform your prior job, the SSA will consider your RFC, along with your age, education, and work experience, to decide if there are other jobs that you can learn to do.

For more information on cardiovascular conditions, see our section on disability and heart problems.

When to Apply for Disability Benefits

Many disability applicants wait until after they've been denied at the initial level to hire legal help. For many applicants, this is a mistake. That's because a legal professional can help you get the right medical tests and help you complete your initial application for benefits in a way that's accurate but persuasive. Applicants who complete applications on their own often make major mistakes that their attorneys can't undo, from underestimating their physical limitations to overestimating their work responsibilities.

No matter when you hire a legal representative, the most you'll pay is 25% of past-due benefits, with nothing out of pocket other than small case-related expenses. That means you don't have much to lose by hiring a representative even before you file your application.

_{Updated January 3, 2022}