Valvular heart disease (VHD) happens when a heart valve is damaged by disease or doesn't develop properly before birth. Properly working heart valves allow blood to flow smoothly to and from your heart. If your valves are damaged, they may not open wide enough or close fully, causing symptoms such as fatigue, shortness of breath, and swelling in your limbs.
Milder symptoms of VHD can be effectively managed with medication, but more severe cases may require surgery. If symptoms and treatment of your VHD keep you from working full-time for at least one year, you may qualify for disability benefits from the Social Security Administration (SSA).
Once you've satisfied the financial criteria for at least one disability benefit program (SSDI or SSI), Social Security will review your medical records to determine if your valvular heart disease meets the requirements of a listed impairment. Listed impairments ("listings") are medical conditions that the SSA has decided are serious enough to justify awarding you benefits automatically, provided that your medical records include evidence of the specific listing requirements.
Although Social Security doesn't have a separate listing for valvular heart disease, the agency can evaluate your VHD under several related cardiovascular listings:
Below we'll discuss which listings Social Secuirty will use to evaluate certain types of VHD. Knowing whether you meet the requirements of one of these listings involves familiarity with complex medical terms and test results, so you may want to ask your doctor to review them to see if you qualify. Depending on your VHD diagnosis, your doctor may agree that your symptoms meet (or "equal") one of the cardiovascular listings above.
Valvular heart disease can be further classified into different diagnoses based on whether the VHD is present at birth (congenital) or develops later in life (acquired). Your diagnosis may also depend on where the affected valves are located and whether the damage involves valve narrowing (stenosis), blocking (atresia), or leaking (regurgitation).
Meeting the requirements of a listing can be challenging. You can increase your chances of success by making sure the SSA has all the information the agency needs—including clinical notes, medical imaging (such as MRIs or X-rays), and surgical records—to determine whether you qualify for disability under a listing.
Most people who file for disability won't meet the specific requirements needed to get approved automatically under a cardiovascular listing. If you don't meet a listing, Social Security will instead evaluate how symptoms from your VHD impact your ability to perform work-related activities like sitting, standing, lifting objects, and following instructions.
The agency does this by reviewing your medical records and activities of daily living to assess your residual functional capacity (RFC). Your RFC represents the most you can do on a regular and sustained basis at work, despite any limitations from your VHD symptoms.
Social Security compares the restrictions in your RFC with the demands of your past relevant work to see if you can still do your old jobs. If you can't, the agency will determine whether other, less demanding work exists that you can do instead.
Disability applicants younger than 50 generally need to show that they can't do even the simplest sit-down jobs before the SSA will award them benefits. But applicants 50 years of age and older might have an easier time getting benefits under the agency's medical-vocational grid rules. Using the grid rules, you can qualify for disability if you can't do your past work and you don't have any transferable skills you can use at a new job.
Just like with meeting a listing, medical records are key in helping determine whether you can still work. Any limitations you have in your records must be included in your RFC, so make sure to keep Social Security in the loop if you switch doctors or begin a new treatment.
Don't be too discouraged if you receive a denial for benefits. It's very common for disability applicants to be denied first at the initial application level and again at the reconsideration level. You'll have your best chances of approval once you reach the hearing stage and can speak directly with an administrative law judge. (You can also increase your odds if you get help from an experienced disability attorney.)
Updated January 30, 2024