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Congestive Heart Failure and SSA Disability

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Heart failure is caused when the heart become inefficient, lowering the ability of the heart to pump sufficient blood throughout an individual’s body. What can happen as a result of congestive heart failure? The heart will fail to pump enough nutrients and oxygen throughout the body. One common result of congestive heart failure is fluid retention in the arms, ankles, feet and other vital organs.

What causes congestive heart failure?


Congestive heart failure can be caused by a variety of common conditions such as a heart attack, coronary artery disease, cardiomyopathy and high blood pressure, severe thyroid conditions, kidney disease, diabetes or birth defects.

If you have congestive heart failure you may be experiencing a variety of severe symptoms that make it difficult for you to maintain employment: dizziness, fatigue, rapid heartbeat, congested lungs or water retention.

Even with many of these severe physical health symptoms you must meet very specific criteria to qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Winning SSDI or SSI with Congestive Heart Failure


The Social Security Administration has two methods for determining if a worker is disabled and unable to perform substantial gainful activities: their condition is listed on the SSA Listing of Impairment or Blue Book (a list of conditions the SSA considers automatically disabling) or by proving that their condition is so severe they are no longer able to perform substantial gainful activity (this is done through a medical vocational allowance).

Regardless of how you are attempting to win SSDI or SSI, the Social Security Administration will be looking for “sufficiently detailed reports of history, physical examinations, laboratory studies, and any prescribed treatment and response to allow us to assess the severity and duration of your cardiovascular impairment including a longitudinal clinical record covering a period of not less than 3 months of observations and treatment is usually necessary, unless we can make a determination or decision based on the current evidence.” Medical evidence should include stress tests, angiograms and EKG reports.

The SSA also expects you to be getting medical treatment from a cardiologist who has documented your health condition.

Meeting a Listing for Congestive Heart Failure


The Social Security Administration will evaluate congestive heart failure under the listing 4.00 Cardiovascular System, Section 4.02 Chronic Heart Failure. Under this listing the SSA will evaluate whether or not you have severe systolic and diastolic failure (review the listing for specifics).

The SSA will expect this failure to either “limit your ability to independently initiate, sustain, or complete activities of daily living” or cause three or more separate episodes of acute congestive heart failure within a 12 month period. There must be evidence of fluid retention which resulted in the need for medical intervention either at the ER or through a hospitalization. Additionally, you could meet a listing if you are unable to perform an exercise tolerance test with a workload which equals 5 METs or less because or either fatigue, palpitations, chest discomfort or dyspnea. There are several other elements of the listing which should be discussed with your doctor.

Winning SSDI or SSI through a medical vocational allowance


What if your condition does not meet a listing? Claimants who do not meet the listing under 4.02 Chronic Heart Failure will have to prove that their condition is so severe they cannot perform substantial gainful activity which means they are unable to perform their current job, past relevant work or retrain for new employment.  While the SSA is making the determination for work they will use a process called a medical vocational allowance which will consider the claimant’s age, education, work experience, and health condition.
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