Getting Social Security Disability for Valvular Heart Disease (VHD)

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).

Getting Disability for Valvular Heart Disease

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:

• listing 4.02 for chronic heart failure
• listing 4.04 for ischemic heart disease
• listing 4.05 for recurrent arrhythmias
• listing 4.06 for congenital heart disease, and
• listing 4.10 for aortic aneurysm.

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.

How Social Security Evaluates Common Types of VHD

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).

• Congenital valve atresia happens when a valve in the upper chamber of the heart doesn't form at all during fetal development. Atresia of the aortic, mitral, tricuspid, and pulmonary valves can be evaluated under listing 4.06. Tricuspid valve atresia may also be evaluated under listing 4.02.
• Acquired valvular heart disease can be caused by infections or other cardiovascular disorders. Acquired VHD most commonly affects the aortic or mitral valves. If your acquired VHS is associated with an aortic aneurysm, you may qualify for benefits under listing 4.10.
• Bicuspid aortic valve disease is a congenital condition where one of the three flaps between the aorta and the heart is missing. Symptoms often don't develop until later in life, but can cause regurgitation, aortic aneurysms, or heart failure. The SSA can evaluate a related heart failure under listing 4.02 and an aneurysm under listing 4.10.
• Valvular stenosis happens when your valves become thick, stiff, and narrow. Early stages may not cause symptoms, but as the disease progresses, you may experience fatigue, dizziness, coughing fits, and fainting spells. Valvular stenosis that leads to heart failure is assessed under listing 4.02.
• Mitral valve prolapse occurs when an enlarged mitral valve flap fails to close properly, resulting in chest pain, heart palpitations, fibrillation, and shortness of breath. Symptoms are typically mild, but if the risk of a sudden cardiac event from mitral valve prolapse is serious enough to keep you from doing a sit-down job, the SSA can find you disabled.

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.

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 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.

What to Do If You're Denied Benefits for Valvular Heart Disease

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.)