If you have a severe heart condition you may eventually be in need of a heart transplant. We had a user on our disability forum ask if they would be eligible for Social Security Disability Insurance (SSDI) if they have had a heart transplant. First, let’s discuss who is eligible for SSDI benefits and when a heart transplant recipient can receive benefits.
Requirements for SSDI
SSDI is offered to disabled workers who have a severe health condition and who are unable to work due to this condition for at least 12 continuous months. What may confuse many SSDI applicants is that you not only have to have a severe condition, you also have to be "insured" for SSDI.
To reach an insured status a worker must have worked and paid employment taxes earning what the Social Security Administration (SSA) terms work credits. This is similar to what workers are doing for SSA retirement benefits. SSDI is not offered to workers who have not worked or who have worked but have not paid taxes. Unfortunately, even if you have a heart transplant and you are severely disabled, you will not be eligible for SSDI unless you have worked and paid taxes recently enough to be insured.
Getting SSDI for Heart Transplant
The Social Security Administration has several methods for determining whether your heart condition is severe enough to win SSDI benefits.
- Compassionate Allowance List
The Compassionate Allowance List is a list of conditions that the SSA believes are automatically disabling. If your condition is listed on the Compassionate Allowance List, assuming you meet the necessary nonmedical criteria of SSDI, your SSDI application will be expedited.
Heart transplants are listed on the Compassionate Allowance List and will be automatically approved if the patient is on the waiting listing to receive a transplant and they have been classified as priority as 1 or 2 on the donor list.
Patients may also be immediately approved if they have had a transplant but their body has rejected the heart. Graft rejection or dysfunction is one of the leading causes of death the first month after heart transplant surgery.
- Meeting a Listing on the SSA Listing of Impairments
If you have had a heart transplant and the surgery was successful but you are still unable to return to work you may also win SSDI benefits by meeting a listing on the SSA Listing of Impairments. Under listing 4.00 Cardiovascular System the SSA considers you automatically disabled following one year of heart transplant surgery. This means that if you are insured and have sufficient work credits for SSDI than you should be immediately approved for SSDI. But this is not the end of the story. The SSA will give you SSDI for 12 months, but after that time they will determine if you have the capacity to return to work.
- Winning SSDI through a medical vocational allowance
What happens after one year after your heart transplant surgery? Some heart recipients will be able to return to full-time employment and will no longer qualify for SSDI benefits. Some claimants, however, will be able to prove that they do not have the residual capacity to work through what the SSA terms a medical vocational allowance. Winning SSDI through a medical vocational allowance will be easier for older claimants and those who have been engaged in medium or heavy labor for most of their lives and do not have the work skills or education to retrain for new work. Under a medical vocational allowance it is much easier to win benefits if you are over the age of 55.
Disability benefits for Heart Transplants after returning to work
There are many heart transplant recipients that can, after a specified time, return to some type of full-time work. If you are a young worker and you are working sedentary or light work you may have difficulty proving that you cannot do any type of full-time work 12 months after a heart transplant.
Older workers, with limited education who have performed only physical labor their entire lives, are likely to have an easier time proving that they cannot return to work they have done in the past and their education and age limitations may make it difficult to find new work. If after the evaluation the SSA determines you cannot return to work you will continue to receive SSDI; otherwise, your SSDI benefits will be terminated.
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