This post discusses heart failure and Social Security Disability. If heart failure is preventing you from working, read on for how Social Security will evaluate your claim for disability benefits.
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Types of Social Security Disability Benefits
The first step to attaining disability benefits is to apply for them. Before you apply, you need to know what type of benefits Social Security offers.
In general, SSA offers two types of benefits for chronic heart failure patients: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Social Security Disability Insurance (SSDI):
SSDI (Social Security Disability Insurance) is based on the credits from the work you have done in your life. You must be found disabled before your date last insured (DLI) to be found eligible for SSDI. Your DLI is calculated by counting your “quarters of coverage” from your earnings record. You must have 20 “quarters of coverage” of the last 40 quarters. Simply put, you must have worked 5 years of the last ten years (in general). In addition, Adult Disabled Children can be eligible for benefits off their parent’s account.
Supplemental Security Income (SSI):
SSI (Supplemental Security Income) is a need-based program, and you must meet income/asset standards in addition to being found disabled under the five steps below. In 2024, SSI is $943 a month for an individual and $1,415.00 for an eligible couple. SSI will be reduced by 1/3 if you are receiving financial help from others. In NC, SSI recipients are also entitled to Medicaid.
You can apply for Social Security Disability benefits online or at your local Social Security office (we suggest you call ahead).
What is Heart Failure?
Heart failure (or congestive heart failure) occurs when your heart fails to pump as well as it should. Your body depends on the heart's pumping to deliver blood to your body's cells. When the heart fails to supply your body with enough oxygenated blood, you suffer from fatigue and shortness of breath. Found here.
Acute heart failure only lasts for a short time and improves rapidly, while chronic heart failure symptoms occur gradually and worsen over time (HeartFailureMatters).
According to the Mayo Clinic, heart failure often develops after other conditions have damaged or weakened your heart. Heart Failure can be difficult to live with. Shortness of breath, swelling and fatigue are just a few of the symptoms you must endure.
Coronary Artery Disease, Peripheral Vascular Disease and Myocardial Infarction (heart attack) are all concerns in those with congestive heart failure.
Also Read: Disability for Edema, Coronary Artery Disease & Peripheral Vascular Disease
According to the AHA, lifestyle changes, medications and devices/surgical procedures can be used in a treatment plan for heart failure.
Medications can include ACE Inhibitors (Lisinopril), ARBs (Cozaar) or aldosterone antagonists like Spironolactone. Furosemide (Lasix) is a frequently prescribed diuretic for heart failure patients.
Defibrillators, Cardiac Resynchronization and Left Ventricle Assist Devices also can be used to keep the heart working or to prevent abnormal heart beat (also via AHA).
Heart Transplants are also an option when other treatments have not worked. Heart transplants involve a lengthy healing process and the use of anti-rejection drugs (Yale). Social Security does have a specific listing for those that require a heart transplant, 4.09 Heart Transplant.
Following your doctor's advice and prescribed treatment for your heart failure is paramount to your health and your Social Security Disability claim.
Social Security Disability for Heart Failure
Medical records from your doctor will be used by SSA to evaluate your heart failure. Blood tests, nuclear stress test (exercise tolerance test), electrocardiogram, echocardiogram, breathing tests, x-rays or MRI can all be used to diagnose heart failure.
SSA will need to see this objective testing in your medical records.
Social Security uses a Five Step Sequential Evaluation Process to determine if you are disabled:
- Step 1 – Are You Working? The Social Security Administration defines work as “Substantial Gainful Activity” (SGA). SGA is roughly defined as work from earnings that average more than $1,550 (2024) a month. If you are making that amount you generally will not qualify for disability.
- Step 2 – Is Your Condition “Severe”? Severity is key when it comes to what qualifies as a disability. Severe is defined by the Social Security Administration as: your condition must interfere with basic work-related activities for your claim to be considered.
- Step 3 – Is Your Condition on the List of Disabling Conditions? The Listings are very hard to meet in most cases and not always interpreted as a common reading would suggest. If you meet a listing, you are gravely ill. The listings are found here. Residual Functional Capacity is determined here.
- Step 4 – Can You Do the Work You Did Previously? The Social Security Administration will look at your past work and determine if it was sedentary, light, medium, or heavy. They also will evaluate the skill level: unskilled, semi-skilled and skilled. For instance, an attorney would be sedentary skilled work. The Dictionary of Occupational Titles is found here.
- Step 5 – Can You Do Any Other Type of Work? If the Social Security Administration finds that you cannot do what you used to do, they then look to see if you can do anything else. This is where the “grids” come into play. The grids are the Medical-Vocational Guidelines. The grids are only for exertional impairments. Non-exertional impairments are not considered by the grids. If you are found to be capable of any other work, you will be found not disabled. Read The Grids and Your Social Security Disability Case.
At Step 3, the Social Security Administration evaluates heart failure under Listing 4.02, Chronic Heart Failure. This listing is difficult to meet and is confusing as well. Many doctors use the NYHA (New York Heart Association) classifications to determine what stage your heart failure is in. The NYHA classifications are found here:
Class I - Patients with cardiac disease but resulting in no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain.
Class II - Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain.
Class III - Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.
Class IV- Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases.
As you will see in Listing 4.02, the Social Security Administration does not use the NYHA classes and focuses on diastolic and systolic failure instead.
Ejection Fraction is a key component in the SSA listing. An ejection fraction is a measure of how much blood the left ventricle pumps out with each contraction (LVEF). It should be noted that a normal LVEF is 55-70%. The LVEF is established by a review of an echocardiogram.
Listing 4.02 requires a LVEF of 30% of less during a period of stability. You will have serious symptoms long before your ejection fractions hits 30%.
If you do not meet the above listing or any other SSA listing, Social Security will establish your residual function capacity. SSA defines residual functional capacity as "the most you can do despite your limitations."
In addition to Listing 4.02, SSA can use the Medical Vocational Guidelines (Grids) if you are over 50 years of age and are limited to sedentary work by your residual functional capacity due to your heart failure symptoms.
Unfortunately, there is a list of diseases that frequently occur with heart failure such as respiratory illness, renal dysfunction, anemia, arthritis, and cognitive dysfunction/depression. If you have been diagnosed with diseases in addition to your heart failure, Social Security can find you disabled based on the combination of your impairments.
Also read Social Security Disability Conditions
Do you need a Social Security Disability Lawyer?
Applying for Social Security Disability and Supplemental Security Income can be a tough process, but you have to stay determined. For my clients going through this process, Social Security Disability is their last resort. A Social Security Disability Lawyer can improve your chances of winning your case by knowing what the SSA needs to find you disabled.
We represent Social Security Disability clients in Raleigh, Durham, Fayetteville, Cary, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids , Winston Salem, Garner, Greensboro, Greenville and surrounding areas in North Carolina. Call us today for a free case review, (919) 615-3095 or start online now.
As always, the severity of your symptoms is more important than your diagnosis. If your heart failure stops you from working, you should apply for disability as soon as possible and call the Bishop Law Firm. We want to help!
