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Social Security Disability Benefits for Congestive Heart Failure

Social Security Disability Benefits for Congestive Heart Failure

Congestive Heart Failure is the inability of the heart to meet the needs of organs and tissues for nutrients and oxygen. Congestive Heart Failure is a potentially hazardous condition which can prove lethal if the heart is unable to pump adequate blood to all the organs of the body to meet body's needs. Many factors lead to congestion in the arteries which cause congestive heart failure. The condition can prove fatal when the accumulation of blood in the vessels or fluids in various parts of the body can lead to sudden cardiac arrest.

Since the heart has two chambers separated from each other through valves, congestion of each chamber results in different types of congestions. Failure of the left chamber of the heart causes the blood to back up into the lungs, causing lung congestion. Whereas failure of the right chamber of the heart causes the blood to back up into the leg and lungs, which causes congestion and swelling leading to edema. The Congestive Heart Failure is thus accompanied by an enlargement of the heart.

Symptoms of Congestive Heart Failure

The symptoms of congestive heart failure may vary from person to person. However, there are some common symptoms which may affect the daily functioning of a person, such as, difficulty breathing (shortness of breath), extreme fatigue, diminished exercise capacity or swelling (edema). In some cases, Congestive Heart Failure may also cause heart palpitations and dizziness.

The SSA follows the same level of classification for Congestive Heart Failure as the New York Heart Association (NYHA) Functional Classification system. The NYHA classification system is divided into four classes: Class I, II, III and IV. Patients with Class I patients are found to have little to no symptoms while patients with Class IV classification symptoms have severe impairments/limitations and may experience symptoms even while resting. Thus, the Social Security Administration is more likely to find Class III and IV patients unable to perform substantial gainful activity (SGA) due to these limitations.

Diagnosis & Treatment of Congestive Heart Failure

Fatigue is an early symptom of congestive heart failure. While fatigue is a sensitive indicator for possible underlying congestive heart failure, it may just be an underlying symptom for many other conditions.

The treatment of congestive heart failure depends on the knowledge of the individual's medical history, a carefully made physical examination and selected laboratory tests.

Since the diagnosis of congestive heart failure is very difficult to make, the SSA would probably require strong medical documentation proving that your condition is 'disabling' enough to prevent you from working. For some people, the treatment of CHF can be improved through lifestyle modifications, through taking medications (such as beta blockers, digitalis, ACE inhibitors, diuretics, or vasodilators), mechanical therapies or in some cases, heart transplant. The course of congestive heart failure condition can vary for each patient, proving fatal in extreme conditions.

Causes of Congestive Heart Failure

The Social Security Administration has listed various forms of heart diseases in its Blue Book of Impairments including chronic heart failure, ischemic heart disease, recurrent arrhythmias, symptomatic congenital heart disease, heart transplant, peripheral arterial disease, and chronic venous insufficiency, Aneurysm of aorta or major branches. Since CHF can be caused due to various underlying conditions or causes, the disability examiner will always look for the extremity of the condition that led to your CHF and how it impacts your daily functioning.

Almost all forms of heart disorders, including valvular and pericardial and cardiomyopathy disorders ultimately lead to the weakening of the heart muscles, damage to the arteries or veins eventually leading to an enlarged heart and congestive heart failure. Other underlying conditions leading to congestive heart failure may include:

  • -Poorly controlled hypertension (that is high blood pressure);
  • -Congenital heart disease;
  • -Coronary artery disease (where the arteries supplying blood to the heart muscles are blocked or weakened or damaged altogether);
  • -Past heart attacks (which can lead to the development of scar tissue that interferes with heart muscle function);
  • -Myocarditis or endocarditis (in this case, the heart muscles, valves, or surface tissue may be scarred or inflamed)

Winning SSDI for Congestive Heart Failure

The disability examiner at the Social Security Administration will look for classification of symptoms for congestive heart failure among its listing for "chronic heart failure". The DE will look for both medical and non-medical documentation proving the severity of your heart failure proving not only the diagnosis of severe heart failure but also its continuity despite being on heart medication. The SSA would not necessarily require that you have fluid retention at the time of the application for disability benefits or evaluation, but it does require you to prove that you had fluid retention at some point of your disease. The SSA has compiled a list of objective symptoms and medical limitations that you must meet (atleast one) to qualify for disability. These include:

  • -Ventricular dysfunction or chronic heart failure;
  • -Discomfort or pain due to myocardial ischemia, with or without necrosis of heart muscle;
  • -Reduced oxygen concentration in the arterial blood, central cyanosis due to right-to-left shunt, or pulmonary vascular disease;
  • -Syncope, or near syncope, due to inadequate cerebral perfusion from any cardiac cause, such as obstruction of flow or disturbance in rhythm or conduction resulting in inadequate cardiac output;

Other than that, your medical record must show one of the two (either systolic or diastolic heart failure) of the following symptoms:

  • i.Diastolic Heart Failure: This happens when the heart is unable to fill up blood properly and may have the following common symptoms:
  • -normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure);
  • -thickness of left ventricular wall and interventricular septum 2.5 cm or larger on imaging;
  • -an enlarged left atrium 4.5 cm or larger;

  • ii.Systolic Heart Failure: This happens due to weakened pumping strength of the heart and may have the following common symptoms:
  • -the heart's left ventricular end diastolic dimensions may be larger than 6.0 cm;
  • -the heart's ejection fraction (the percentage of blood pumped out of the heart with each heartbeat) is 30% or less during a period of stability (not during an episode of acute heart failure);

Other Functional Limitations of Congestive Heart Failure for SSDI

Other than the above listed symptoms and underlying conditions for congestive heart failure, you must meet one or all of the following functional limitations:

  • A.At least three episodes of heart failure and fluid retention within the past 12 months, requiring emergency room treatment or hospitalization for at least 12 hours,


  • B.Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to certain difficulties,


  • C.In case an exercise tolerance test may be too risky, persistent symptoms of heart failure that very seriously limit activities of daily living (ADLs) are required;

Applying for SSDI for Congestive Heart Failure

Before you apply for Social Security Disability Insurance for Congestive Heart Failure, you must make sure you make frequent and regular visits at your physician's or medical doctor. The SSA will need reports of history, blood works, laboratory studies, physical examinations, and any prescribed treatment and response to allow us to assess the severity and duration of your cardiovascular impairment. 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.

You can seek counsel of our professional disability attorneys for guidance in filing for SSDI for Congestive Heart Failure.

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Friday, 14 May 2021