Will Coronary Artery Heart Disease qualify you for disability?
Coronary artery disease may qualify you for disability, but only if you are able to prove, through medical records, physician statements, etc., that as a result of coronary artery disease you are unable to participate in any type of gainful employment.
Disability Determination Services (DDS), the state agency that decides SSD and SSI claims, does not evaluate claims based on the particular impairments in question. Rather, it bases each decision on the impact a particular impairment has on an individual's ability to work and perform daily living activities, commonly referred to in Social Security cases as residual functional capacity.
Residual functional capacity encompasses the activities, both physical and mental, that a claimant is still able to perform. Residual functional capacity, or RFC, is rated by doctors who work alongside disability examiners in claims processing units within an agency known as DDS, or disability determination services.
This is done on something known as a residual functional capacity form, essentially a check-off list of the various physical or mental (there is a separate MRFC form for mental evaluations) capabilities.
In the case of coronary artery heart disease, an MI (myocardial infarction, or heart attack), coronary bypass, stent, etc., does not guarantee SSD or SSI approval. To be approved on the basis of heart disease, a claimant would need to either meet the requirements of a listing or make it through the process of sequential evaluation, a five step process that measures whether or not a claimant can engage in work activity that is at or below the limit for SGA, or substantial gainful activity.
Claimants who have suffered a myocardial infarction will likely be evaluated under listing 4.04 C, Coronary Artery Disease. This listing is predicated on significant listing-level occlusions (blockages) in bypassed or non-bypassed arteries, but also supposes that an individual has "very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living."
For this very reason, claimants who file for disability after suffering a heart attack might have to wait for a period of 3 months (from the date of the heart attack) before their claims are even evaluated. To the disability examiner, the level of recovery is more important than the heart attack itself.
Most claimants who apply for disability on the basis of having had a heart attack, even if they are approved, will usually not be approved on the basis of the listing for coronary artery disease, or any other subset of listing section 4.00, which includes chronic heart failure, congenital heart defects, aneurysms, arrythmias, peripheral arterial disease, and other forms of ischemic heart disease.
In fact, most approvals are made on the basis of a medical vocational allowance which takes into account a claimant's current limitations and compares this to the requirements of a claimant's past work. When a medical vocational allowance is granted, the social security administration has taken the position that the claimant can neither perform their past work, nor switch to some form of other work that their job skills and education might otherwise make them suitable for.
Claims for Social Security Disability are often successful, but only if they are backed up by solid medical evidence that shows the individual filing is no longer able to participate in substantial gainful activity (which basically means the ability to earn at least a subsistence wage each month). The SGA amount is set by Social Security each year, and disability benefits are awarded to those who can prove they are unable to earn at least this much money each month.
On the other hand, sometimes Social Security just makes bad, unfair decisions. The fact that so many claims denied by DDS at the initial application and reconsideration appeal level are later approved by an administrative law judge indicates that many denials are unwarranted.
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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