Getting Social Security Disability for Valvular Heart Disease

Properly working heart valves allow blood to flow smoothly to and from your heart. If your valves are damaged, they may not open enough (called stenosis) or they may leak (called regurgitation). Valvular heart disease (VHD) happens when a heart valve is damaged by disease or doesn't develop properly in utero.

The symptoms of VHD include heart murmur, fatigue, shortness of breath when you are lying down or during exertion, and swelling in your ankles, feet, stomach, and the veins in your neck. Treatment for VHD depends on which valve is affected and the cause of the disease. Medications can help some people with VHD, while others may need to undergo surgery.

Getting Disability for Valvular Heart Disease

Once you have met the basic requirements for disability, Social Security will look to see if your VHD can be approved automatically under a disability "listing." Listings are medical conditions that Social Security has decided are so severe that they should be approved automatically. Even if your medical condition has a listing, you still need to prove that it meets all of the specific criteria outlined in the listing.

Although there isn't a specific listing for VHD, there are several listings under which Social Security may evaluate your VHD, depending on the symptoms you experience and the specifics of your illness. They are:

• chronic heart failure (listing 4.02)
• ischemic heart disease (listing 4.04)
• recurrent arrhythmias (listing 4.05), and
• symptomatic congenital heart disease (4.06).

You can click on the links above to learn about what you need to prove to meet one of these listings. The requirements are complicated, so it is a good idea to review them with your doctor to see if you qualify.

Specific VHD Conditions

Here are some of the more common types of valvular heart disease and how Social Security will evaluate them.

Congenital Valve Atresia

Congenital (present at birth) valve atresia happens when a heart valve doesn't form properly while the fetus is developing in the mother's body. Atresia means the value doesn't open or is altogether absent. Congenital valve atresia can affect the aortic, mitral, tricuspid, and pulmonary valves. All four of these types of atresia may be evaluated under symptomatic congenital heart disease (listing 4.06). Tricuspid valve atresia can also be evaluated under chronic heart failure (listing 4.02).

Acquired VHD

Acquired VHD means that a person isn't born with the condition, rather it develops later in life. Acquired VHDs most commonly affect the aortic or mitral valves. They are sometimes caused by infections such as rheumatic fever, endocarditis, and syphilis. However, coronary heart disease, aortic aneurysms, and cardiomyopathy (heart muscle disease) can also result in acquired VHDs. Those with valvular disease involving the aortic valve have a better chance of getting approved for benefits after the initial application than those with other affected valves.

If your acquired VHD is associated with an aortic aneurysm, you may be approved under the aneurysm listing (4.10.) To learn more about the aneurysm listing, see our article on how to qualify for benefits because of an aneurysm. Depending on your symptoms, Social Security may evaluate your acquired VHD as a cardiomyopathy or coronary heart disease.

Bicuspid Aortic Valve Disease

Bicuspid aortic valve disease (BAVD) is a congenital condition where one of the flaps between the aorta and the heart is missing. Normally there are three of these flaps, but people with BAVD have only two. There are often no symptoms of BAVD until later in life. BAVD becomes a problem if one of the two valves doesn't close properly and blood regurgitates (goes back into) the heart. BAVD can lead to aortic aneurysms or heart failure. If you experience heart failure, the SSA will evaluate your BAVD under chronic heart failure (listing 4.02). If your BAVD results in an aneurysm, you may be approved under the aneurysm listing (4.10).

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a heart condition where a valve fails to close properly, usually because of an enlarged mitral valve cusp, which becomes displaced into the left ventricle during contraction. Symptoms of mitral valve prolapse can include chest pain, heart palpitations, and shortness of breath.

Mitral valve displacement can lead to serious heart problems, such as mitral regurgitation (blood flowing backwards) and fibrillation (quivering of the heart muscle leading to irregular heart beats). But for many people, the effects of mitral valve prolapse are relatively benign.

To be found disabled because of MVP, you have to prove that your risk of a sudden cardiac arrest is so severe that you can't even do a sit-down job (more on this below).

Valvular Stenosis

Valvular stenosis happens when the passageway in your valves becomes narrowed, thick, stiff, or blocked. Early valvular stenosis may not have any symptoms, but as the disease gets worse, sufferers may experience fainting, intense fatigue, dizziness, and serious coughing fits. If your valvular stenosis leads to heart failure, your claim may be assessed under chronic heart failure (listing 4.02).

Getting Disability for VHD When You Don't Meet a Listing

Most people who file for disability won't meet the specific requirements needed to get approved automatically under a cardiovascular listing. If this happens to you, Social Security will assess how the symptoms of your VHD impact your ability to do certain physical work-related activities like sitting, standing, lifting, and carrying. To do this, Social Security will use the evidence in the medical records you or your doctor has submitted and prepare a special report called a residual functional capacity assessment (RFC). Your RFC is the most you can do on a regular and sustained basis (basically full-time) in light of your VHD symptoms.

Once Social Security has established your RFC, it will then look to see if you still have the capacity to do your old job. If it thinks you can, you will be denied. If Social Security thinks that your VHD prevents you from doing your old job (say your job required heavy lifting and your doctor has limited you to lifting no more than 20 pounds), the agency will determine if there is any other less demanding work in your area or in the United States that you can still do. If Social Security decides there are no other jobs you can do without endangering your health, you will be approved; otherwise, you will be denied.

Examples

Here are some examples of how Social Security might evaluate a claim based on VHD that doesn't meet a listing.

• The disability applicant was a 45-year-old woman who filed for disability due to severe mitral valve prolapse. Her past work was as a house painter that Social Security concluded was light work (meaning she had to stand six out of eight hours a day and lift ten pounds frequently and up to 20 pounds occasionally). The symptoms of her MVP were an irregular heartbeat, dizziness, and shortness of breath that continued despite treatment. Based on her records, Social Security concluded that she could no longer perform her past work because she couldn't stand for six hours per day. But her medical records indicated that she could sit for long periods of time, and that in fact this helped moderate her symptoms. Based on this information, Social Security concluded that she had the RFC to do a sit-down job and she was denied.
• The disability applicant was a 56-year-old man with aortic valve stenosis who had worked in a warehouse as a packer. Social Security concluded his job was medium work (meaning he had to stand or walk for up to six hours a day, lift 25 pounds frequently, and 50 pounds occasionally). His medical records indicated that strenuous activity could cause a rupture in his aorta, so his RFC showed that he could no longer do the warehouse work but that he could still do a sit-down job. Because of his age, Social Security used the "grid rules" to see whether he was disabled. The grid rules are a series of tables that direct a finding of disabled or not disabled based on a person's age, education level, the skill level of the last job, whether those skills could be used in a new job, and the person's RFC. In this claim, the applicant had a high school education, and Social Security classified his warehouse job as unskilled. Based on this information, the grids directed a finding of disabled and he was approved for benefits, despite being able to do a sit-down job.

To learn more about how to win your claim using the grids, read our series of articles on how the medical-vocational grid rules determine disability.

If You're Denied Benefits

If you are denied disability despite your VHD, don't be discouraged. It's not uncommon for disability applicants to be denied at the initial application level and at the reconsideration level (the first level of appeal). Applicants with serious VHD who are denied initially are often approved when they appeal.

If you are denied, it may be helpful to talk with an experienced disability attorney in your area.