What Heart Conditions Qualify for Disability?
Robert C. Fisher
Over 40% of the deaths in the United States are due to heart disease, much higher than any other health condition- including all forms of cancer combined.
In this article, we'll take a closer look at these health conditions to learn more about what causes them, signs/symptoms to look for, how to treat and prevent them, and which ones qualify for Social Security Disability benefits or SSDI.
Defining Heart Disease
The term heart disease is another word for cardiovascular disease. This is a group of medical conditions that affect the cardiovascular system, including the heart.
Coronary artery disease is the most common form of cardiovascular disease. In this cardiac condition, blockages in the blood vessels create the potential for various heart issues, including myocardial infarction, commonly known as a heart attack.
Cardiovascular diseases cover other disabling conditions, including heart defects, abnormal heartbeat, and infections.
There are several potential causes of heart disease, including:
Hardening of arteries due to plaque buildup
High blood pressure
Genetics, including congenital disabilities
What are the Symptoms of Heart Disease?
The signs and symptoms of heart disease often come on quickly, like cardiac arrest or heart attack. However, if detected early, these symptoms can be treated to avoid further damage and reduce your risk of heart failure.
The most common signs and symptoms of heart disease include:
Shortness of breath
Coldness in extremities due to blood flow issues
The most common treatments include:
Changes to diet
Surgery to treat defects or remove blockages
If left untreated, these conditions can be extremely disabling. If you or someone you know has a heart condition, you may qualify for disability insurance benefits.
8 Heart Conditions that Qualify for Disability
The Social Security Administration, or SSA, has a "Blue Book," which lists the medical conditions that qualify for SSDI. Section 4.00 is entirely made up of "cardiovascular ailments" eligible for disability benefits.
According to the SSA, a “cardiovascular ailment” is any disorder that prevents the heart or circulatory system from functioning properly.
The listing of impairments that qualify for SSI benefits includes:
1. Chronic Heart Failure
Chronic heart failure is characterized by the heart's inability to provide adequate blood flow to the body because it has weakened. The underlying cause of this weakening includes heart defects, faulty functioning of ventricles, high blood pressure, or heart attacks.
In many cases, this leads to significant fluid retention, or edema, which is why this condition is also often referred to as congestive heart failure. Chronic Heart Failure is listed under Section 4.02 of the Blue Book.
According to the SSA, heart failure is when the heart cannot provide enough oxygenated blood to the rest of the body.
If you have been diagnosed with heart failure and cannot work for 12+ months, your application will be matched with the chronic heart failure listing. If the SSA determines that your heart failure is severe, you will qualify for disability.
There are two kinds of heart failure that qualify for disability benefits:
Predominant Diastolic Dysfunction
Predominant Diastolic Dysfunction is a heart condition characterized by stiffening of the heart, primarily due to aging.
Research indicates that over 50% of adults over 70 have this condition. Some other common causes include kidney dysfunction, uncontrolled diabetes, high blood pressure, genetic disorders, and some cancers.
Predominant Systolic Dysfunction
Predominant Systolic Dysfunction is a heart condition resulting from dilated cardiomyopathy, myocardial infarction, and myocarditis.
Typically, it affects either the left ventricle or the right ventricle, and left ventricle failure also often results in right ventricle failure.
2. Ischemic Heart Disease
Ischemic heart disease often referred to as cardiac ischemia, is a condition in which the heart muscle isn’t getting sufficient blood flow.
This is typically due to coronary heart disease.
3. Symptomatic Congenital Heart Disease
Symptomatic congenital heart disease is a condition characterized by malfunctions in the heart due to congenital disabilities.
Recurrent arrhythmia is characterized by abnormal heart rates that cause fainting or cardiac arrest.
5. Chronic Venous Insufficiency
Chronic venous insufficiency is characterized by damaged veins - usually in the legs - which cause problems with circulation.
6. Peripheral Arterial Disease
Peripheral arterial disease is a condition characterized by impaired functioning of the peripheral arteries.
Aneurism is characterized by swelling of the major arteries due to heart disease.
8. Heart Transplant
If you have had a heart replacement because of heart disease, you will be eligible for disability insurance benefits for up to 1 year.
This section also defines what they look for when you apply for benefits due to heart disease. You will need to provide test results and medical proof that your heart condition is disabling enough that you'll be unable to work for at least 12 months.
When you send in your disability claim, the SSA will take that application and medical evidence of a heart condition and match it to one of the listings in the Blue Book. If the information does match one of the listings and you’ve earned enough work credits, you’ll qualify for Social Security Disability Benefits.
You may also want help from a disability attorney to help you make sure you have all of the appropriate medical documentation and increase your chances of winning your case.
Are Heart Stents a Qualifying Condition for Disability?
Heart bypass surgery alone is not a qualifying factor for disability benefits - but if you do have heart stents and cannot work because of them, you may qualify for benefits.
When you apply for disability, the SSA may be able to match your application with one of the other heart disease listings in the Blue Book, and your application will be approved if you match one of those and meet the work history requirements.
You may also have your medical provider fill out a Residual Functional Capacity Assessment or RFC. An RFC will show what you can and cannot do based on your health status. If this assessment indicates that you cannot work full-time, you may qualify for disability.
More On Residual Functional Capability Assessment
If your application is denied because the SSA feels that you do not meet the criteria of the Blue Book listings, you may still qualify based on your RFC. This assessment will show the most you can do based on your physical limitations.
Your RFC will indicate whether you are capable of:
If your RFC indicates that you cannot work full-time, you may receive what is known as a medical-vocational allowance. Therefore, you must include all your medical documentation, including all evaluations from your primary physician and cardiologist, proving the severity of your condition.
The amount of physical activity that triggers your symptoms is critical for your RFC, which includes:
Shortness of breath
Ask your medical providers to specify your work-related limits, especially your ability to climb, sit, stand, lean, walk, stoop, and carry.
How Do You Apply For SSDI Benefits?
To qualify for Social Security Disability, you can visit the SSA's website.
To avoid denial of your claim, include how your heart disease affects your ability to take care of your daily needs, exercise, and work. If you have other medical problems, make sure to include those on your application as well.
For example, people with heart disease or heart failure often also have high blood pressure, diabetes, and obesity. Make sure that you include your medical records with your application. This will help to make your case that you need SSDI.
You may also wish to request that your medical provider conduct a stress test as well as an exercise tolerance test and include those results with your disability claim. Any medical evidence of your heart condition, as well as other health conditions, will help.
After having a heart attack, many people also develop anxiety disorders. If you've had a panic attack, consult with a therapist or psychologist and include information about your anxiety on your application, and this may improve your eligibility for benefits.
If you are denied SSDI benefits and have not already, consult with a disability lawyer who can help you polish up your application and help you through the process. There is a lot to do when it comes to applying for SSI, and it helps to have someone on your side that can explain it all to you.