Applying for disability with Congestive Heart Failure, CHF

Basic requirements for disability claims

If you are applying for Social Security Disability on the basis of chronic heart failure (this is the term SSA uses when they are speaking of congestive heart failure), you must meet two basic requirements.

1. You cannot be working and earning over the SGA monthly earnings limit.

2. You have to have a severe mental or physical condition that can be verified through medical evidence.

Filing for disability with Chronic or Congestive Heart failure

In order to establish that you have chronic heart failure you must have a medical history and physical examination that show characteristic symptoms such as pulmonary or systemic congestion or limited cardiac output. Signs of limited cardiac output may include shortness of breath, tiredness, chest discomfort, dizziness, or fainting. Signs of congestion might include liver enlargement, ascites, increased jugular venous distention or pressure, fluid retention and swelling in the legs and ankles, and rapid weight gain.

The two main causes of CHF are systolic dysfunction, which is due to the pump function of the heart failing, or due to diastolic dysfunction, which is caused by a stiff ventricle wall that is not relaxing properly. In the case of diastolic dysfunction the result is a low stroke volume. CHF is considered in the cardiac impairment listing as a single category whether due to cardiomegaly, congestive heart failure, atherosclerosis (narrowing of arteries), hypertension, rheumatic, congenital, or other heart disease.

Impairment listing 4.02 Chronic Heart Failure provides the criteria needed to meet or equal the severity requirements for Social Security Disability.

A. You must have a medically documented presence of one of the following: Systolic failure with left end diastolic dimensions of 6.0 cm or an ejection fraction of 30% or less during a stable period not an acute heart incident. Or, diastolic failure with left ventricular posterior wall thickening of 2.5 cm or greater and an enlarged atrium of 4.5 or greater with a normal or elevated ejection fraction. AND

  1. Persistent symptoms that cause severe limitations to the ability to sustain or initiate activities of daily living (e.g. dressing, bathing, cooking, driving, walking, standing, etc.) in a patient for whom an exercise test would cause as significant risk; or

  2. Three or more individual episodes of acute congestive heart failure within a twelve consecutive month period, with evidence of evidence of fluid retention verified by clinical and imaging at the time of the episodes, that require extended physician intervention (e.g. hospitalization or emergency room stays of 12 hours or more, separated by periods of stable condition; or

  3. Inability to complete an exercise test at a workload equivalent to 5 METS or less due to: a. dyspnea, fatigue, palpitations, or chest discomfort; or b. three or more consecutive premature ventricular contractions (tachycardia), or increasing of ventricular ectopy with at least 6 premature contractions per minute; or c. decrease of 10 mm HG or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measure during exercise due to left ventricular dysfunction, despite an increase in the workload; or d. signs attributable to inadequate cerebral perfusion, such as ataxic gain or mental confusion.
While this seems like a lot of technical jargon, Social Security Disability examiners use the medical criteria listed above to determine the severity of your heart failure. In order to be approved for Social Security Disability your disability claim must be supported by the medical evidence listed in 4.02 and your heart failure must cause significant limitation to your ability to perform your daily activities including your ability to perform work activity.

Social Security Disability is more about your functional ability, or rather your residual functional ability (what you are able to do in spite of your disabling condition) than your specific medical condition. Therefore it is extremely important to have clear documentation of your limitations. This can be accomplished through medical records , of course, but also through Functional reports completed by your treating physician, activity of daily living questionnaires and third party questionnaires (generally completed by a third party meaning someone besides doctor or yourself).

More about the condition

Congestive heart failure (CHF), also known as congestive cardiac failure (CCF) or simply heart failure, happens when the heart is unable to pump a healthy flow of oxygen-rich blood throughout the rest of the body. Although the name implies that the heart has failed or stopped, this is not actually the case; the heart continues beating and there is no chest pain associated with congestive heart failure. Instead, the blood flowing out of the heart is simply slowed down.

Congestive heart failure is the leading cause of hospitalization in those over 65 and can happen for a myriad of reasons, from heart defects, infection in the valves or lungs, high blood pressure or thyroid disease to narrowed arteries, disease of the heart muscle or valve, chronic anemia, coronary artery disease or scar tissue left from a past heart attack. Whatever the initial cause, the heart muscle becomes damaged and blood flow slows.

The cause of congestive heart failure is due to either systolic dysfunction, which is due to the pump function of the heart failing, or due to diastolic dysfunction, which is caused by a stiff ventricle wall that is not relaxing properly. In the case of diastolic dysfunction the result is a low stroke volume.

Signs of congestive heart failure are dependent upon which side of the heart is affected and can range from a shortness of breath, tiredness and poor circulation to dizziness and weight gain caused by fluid retention and swelling in the legs and ankles. To clinically diagnose congestive heart failure an ultrasound may be used to determine the amount of blood that is being pumped with each heartbeat, an X-ray may be used to detect the size of the heart, an electrocardiogram may be used to determine abnormalities or blood tests may be performed to show infection.

If congestive heart failure is diagnosed, doctors will normally suggest rest, a healthy diet, weight loss and less sodium and water intake. Depending upon the cause of congestive heart failure, they may also prescribe various drugs such as beta blockers, diuretics, vasodilators, angiotensin-converting enzyme inhibitors or digitalis. In some cases a valve may need replaced and if congestive heart failure is allowed to go unchecked and causes irreparable damage to the heart, it may result in a heart transplant.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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