A congenital heart defect is a problem with the structure of the heart that a child is born with. Congenital heart defects can be harmless or they can cause long-term problems that require extensive treatment.
The most common congenital defects fall into one of these categories, but the defect can involve multiple problems:
Symptoms of a congenital heart defect vary depending on the type and severity of the defect. Symptoms of a cyanotic heart defect can include pale or bluish skin, shortness of breath, fainting, and fatigue. Symptoms of an acyanotic heart defect can include rapid breathing and abnormal heart rhythmic or rate, and getting tired easily during exercise.
Congenital heart defects may be treated with medication, open-heart surgery, heart catheterization, and in more serious cases, a heart-transplant. The prognosis for a child with a congenital heart defect depends on the type of defect.
Supplemental Security Income (SSI) is available to children who are disabled according to the Social Security Administration’s (SSA) definition. However, whether or not a child can get SSI also depends on the parents’ income and assets. This means that if you make too much money or if you have too many financial resources (like stocks, pensions, or property other than your house), your child may not be able to get SSI even if the SSA decides she is disabled. If you want to learn more, you can read our article on SSI benefits for children. (Or read our article on congenital hearts defects in adults.)
If your child has a physical or mental impairment that results in severe functional limitations and the condition has lasted, or is expected to last, at least a year or result in the child’s death, your child may be eligible for disability benefits through SSI. There are several ways for Social Security to find that your child has severe functional limitations (is disabled).
Some medical conditions are so serious that Social Security usually approves for benefits automatically. These conditions are written up in “ impairment listings.” Social Security has several impairment listings for heart problems. Each listing has a specific set of criteria, all of which must be met in order to get automatically approved for benefits under that listing.
104.06 Congenital heart disease
To be approved automatically for benefits under this listing, your child must be diagnosed with congenital heart disease and experience one of the following sets of symptoms. Remember that all of the criteria for the condition must be met.
Cyanotic heart disease with chronically low blood oxygen, demonstrated by one of the following:
Symptomatic acyanotic heart disease, with ventricular dysfunction that interferes very seriously with your child’s ability to initiate, sustain, or complete activities on his or her own.
Secondary pulmonary vascular obstructive disease, with pulmonary arterial systolic pressure 70% or more of the systemic arterial systolic pressure.
Infant needing surgery for congenital heart defect. If your child is under 12 months old and has a life-threatening congenital heart defect, he or she will be considered disabled until the age of one if:
104.02 Chronic heart failure
If your child experiences chronic heart failure because of her congenital heart defect, he or she will be approved if she has an enlarged heart or ventricle dysfunction (despite treatment) with one of the following:
Visit Social Security's childhood heart failure listing to see the exact parameters for tachycardia, tachypnea, and growth impairment.
104.05 Recurrent arrhythmias
If your child suffers from recurring abnormal heart rhythms due to a congenital heart defect, he or she can be approved for benefits under this listing if all of the following criteria are met:
These listing requirements are complicated. It may be a good idea to speak with your child’s cardiologist to see if her condition meets the criteria. Your doctor can review the full requirements for each listing on the SSA’s website.
If your child’s heart defect doesn’t meet the requirements of one of the above listings, he or she may still be approved for benefits if Social Security decides that the symptoms caused by the heart defect are so severe that they "functionally equal" the listings. Specifically, your child's symptoms must result in a “marked” limitation in two areas of functioning or an “extreme” limitation in one area. Areas of functioning include moving about and manipulating objects, learning and using information, and caring for his or her personal needs.
Social Security will use information from your child's medical records, school records, therapist reports, and other documents to decide whether your child has marked or extreme limitations. For more information, see our article on functionallyequaling the listings.
The disability requirements for a child with a congenital heart defect are complicated and the disability process long and stressful. If your child is denied benefits on the first try, it may be helpful to speak with a disability attorney who is experienced at handling childhood disability claims. To find an attorney in your area, fill out our consultation form.