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Disability for Heart Failure

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Four Stages Of Heart Failure: When Can It Become Disabling?

Congestive heart failure (CHF), or chronic heart failure, is a potentially lethal condition in which the heart fails to pump sufficient blood around the body. It can cause blood to accumulate in the vessels that lead to the heart, as well as congestion or accumulation of fluid in various parts of the body. 

If the heart’s left chambers fail, blood can back up into the lungs, causing lung congestion. When the heart’s right chambers fail, blood can back up into the legs and the liver, causing congestion and swelling called edema. 

CHF is usually accompanied by an enlargement in the size of the heart. In the case of disability for heart failure, the Social Security Administration (SSA) can grant monetary help so that the disabled person can manage their medical and other expenses.

Is Congestive Heart Failure a Disability?

Symptoms of CHF can be mild or moderate, including fatigue, shortness of breath, and weakness. CHF can also cause dizziness and heart palpitations. The condition has four classifications under the New York Heart Association (NYHA) Functional Classification system: Class I, II, III, or IV. Class I patients often have few symptoms and generally do not experience any limitations in ordinary physical activity, while Class IV patients can have severe limitations and experience symptoms even while resting. 

Class III and IV patients usually have severe symptoms and are unable to work due to their condition. Treatment usually includes a strict diet, rest, modified daily activities, and medication (such as diuretics, ACE inhibitors, beta-blockers, or vasodilators).

Disability for Heart Failure

Primary Causes of Congestive Heart Failure

Most forms of heart disease, including valvular, cardiomyopathy, and pericardial disease, eventually lead to an enlarged heart and CHF. It is usually progressive and commonly develops for months or years.

The other causes of CHF may include:

  • Poorly controlled hypertension
  • Past heart attacks that lead to scar tissue development, which can interfere with heart muscle function
  • Congenital heart defects
  • Coronary artery disease, in which arteries that supply blood to the heart muscle are narrowed
  • Endocarditis or myocarditis, in which the heart muscle, valves, or surface tissue become inflamed

Can You Get Disability for Heart Failure?

When a person applies for disability benefits, the SSA compares their condition to a list of diseases known as the Blue Book. Each situation that could potentially qualify is listed in there, along with the criteria that an applicant must meet to be eligible for each specific condition.

Chronic heart failure is addressed in Section 4.02 of the Blue Book. According to the Blue Book, to qualify, an applicant with CHF must be able to prove that:

  • You have been diagnosed with this condition while undergoing prescribed treatment.
  • Persistent symptoms are present that seriously limit your ability to independently initiate, sustain, or complete activities of daily living; there are three or more separate documented episodes of acute CHF within the past 12 months; or you suffer an inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less.
  • There is medically documented evidence of systolic failure with left ventricular end-diastolic dimensions greater than 6 cm or ejection fraction of 30% or less during a period of stability; diastolic failure with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging with an enlarged left atrium greater than or equal to 4.5 cm with normal; or elevated ejection fraction during a period of stability.

Getting Disability Because of Your Functional Limitations

If you cannot qualify for benefits based on the list above, the SSA is required to consider the effect that your heart condition has on your capacity to work or perform routine daily activities. The SSA gives you a rating of the type of work it thinks you can do, called your residual functional capacity (RFC). Your RFC will rate your ability to do light work, sedentary work, or medium work.

Functional Limitations

You must also have one of the following symptoms to qualify: 

  • If an exercise tolerance test would be too risky, persistent symptoms that very seriously limit activities of daily living (ADLs) are required.
  • Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to specific difficulties.
  • At least three episodes of heart failure and fluid retention within the past 12 months, requiring ER treatment or hospitalization for at least 12 hours.

For instance, if your doctor has limited you from lifting more than 10 pounds, your RFC would likely be for sedentary work. Next, the SSA will determine whether you can do your prior job given the limitations of your RFC. 

If you cannot do your previous job, the SSA will look at your education level, age, and experience to determine whether there is any other kind of work that you could safely do. If your medical records show severe limitations, it can make it harder for the SSA to deny your disability.

Explore All Options for Heart Failure Disability Benefits

Before you apply for disability benefits stemming from your CHF, you should visit a doctor several times about your heart condition. The SSA will require that you submit medical imaging (such as cardiac ECHO or MRI), blood work reports, and the results of an exercise stress test to evaluate your condition.

The SSA has a few different options for SSI benefits eligibility. If you are not sure how to determine which benefits you may be eligible for, speak to a legal professional to learn more.