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Social Security Disability Definitions

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Facts about Congestive Heart Failure and Filing for Disability

How to prove you are disabled
and win disability benefits

1. Congestive heart failure is a condition in which the heart pumps too little blood for the body's needs. Many conditions can lead to heart failure, including high blood pressure, heart damage from a heart attack, and heart diseases like cardiomyopathy.

2. Heart failure can be long-term with more mild but persistent symptoms, or it can occur as a sudden medical emergency.

3. Chronic heart failure causes fatigue and weakness, irregular heartbeat, shortness of breath, coughing, weight gain from fluid retention, lack of appetite, nausea, and swelling in the abdomen, legs, ankles and feet.

4. Signs of acute heart failure occur with the same symptoms as chronic heart failure, only more severe and more sudden. There is sudden fluid buildup, irregular heartbeat including cessation of beating, difficulty breathing, coughing with mucus that is foamy and pink, and chest pain if a heart attack occurs.

5. Heart failure is also called congestive heart failure due to the build up of blood in the lungs, liver, abdomen, and lower extremities.

6. Risk factors include high blood pressure, coronary artery disease, heart attack, irregular heartbeat, diabetes and some diabetic medications, sleep apnea, congenital heart defects, viral infections that can damage the heart, alcohol use and abuse, and kidney problems.

7. While heart failure can occur as a sudden medical emergency, it is usually a chronic condition that requires treatment to manage. Medications are the primary treatment path, but surgical procedures are increasingly being attempted as doctors seek new and better ways to treat the condition. Most effective is often a combination of the proper prescription drugs, lifestyle changes such as decreasing salt intake, and sometimes devices that regulate heart beat.

8. Heart failure can sometimes be reversed if treatment occurs early and the underlying cause is eliminated. Typically heart failure needs lifelong management. However, the individual's quality of life can be improved with medical treatment and lifestyle changes.

Can you qualify for disability benefits with this condition?

Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records. This includes whatever statements may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis).

It will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).

Why are so many disability cases lost at the disability application and reconsideration appeal levels?

Speaking as a former Disability Claims Examiner, I can state that there are several reasons:

1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant and his or her disability attorney will generally obtain and present this type of statement to a judge;

2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. At the hearing level, of course, this is exactly what happens. And a number of disability representatives will also take such steps even earlier, at the reconsideration appeal level;

3) Disability judges, unlike disability examiners who decides cases at the first two levels of the system, can make independent decisions without being overturned by immediate supervisors--which happens frequently.

Return to:  Social Security Disability Resource Center, or read answers to Questions

Information on the following topics can be found here: Social Security Disability Questions

Social Security Disability SSI decisions | The Disability Decision Process and What gets taken into Consideration | Getting Denied for Disability Benefits | Questions about Social Security Disability Approvals and Being Approved | Social Security Disability Hearings | Social Security Medical Examinations | Social Security SSI Doctors | Social Security Disability Representation | Social Security Disability SSI Reviews