Facts about Congestive Heart Failure and Filing for Disability

These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.

  • If you have had a heart attack will you qualify for Social Security Disability?

  • Will Coronary Artery Heart Disease qualify you for disability?

  • How to apply for disability and the information that Social Security needs

  • Who will qualify for disability and what qualifying is based on

  • Requirements for disability - Qualifications Criteria for SSD and SSI

  • How to Prove you are disabled and win your disability benefits

  • Facts about the condition

    As a disability examiner working on SSD disability and SSI disability claims, I found myself working on cases involving heart failure quite often (though, for some reason, SSA likes to refer to it as chronic heart failure instead of congestive heart failure). Now, as I think about it, I'm amazed at how many heart failure allegations I saw. However, at the same time I'm not really surprised.

    Heart failure is a growing epidemic among Americans. It is estimated that almost five million Americans are living with heart failure today and that number is growing quickly every year.

    You may be one of the many people who think heart failure means that the heart fails to work, resulting in death, but it actually means that the heart is not pumping enough blood for the body to function properly. Instead of resulting in death, the body does many things to compensate for this shortage of blood flow, from beating faster and holding onto salt and water, to literally expanding to allow for more blood flow.

    Heart failure is a long-term condition that grows over time. Symptoms of heart failure can be mild, including shortness of breath, weakness, heart palpitations, dizziness and feelings of tiredness and exhaustion. Other symptoms may be wheezing, coughing, increased urination at night and swelling in the legs, feet and ankles.

    Heart failure can be due to genetics, but is also a disease that can be a result of risky lifestyle choices such as eating foods high in cholesterol, lack of exercise, smoking and excessive alcohol consumption. If heart failure is not diagnosed and treated, it can also lead to hypertension, lung disease and coronary artery disease.

    To decrease your risk of heart failure make sure to eat healthy foods, exercise regularly and temper you use of tobacco and alcohol. You may also want to look at diet modification in the sense of eating smaller portions and staying clear of sugary foods and even excess amounts of carbohydrate rich foods.

    Facts about the condition

    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.

    Qualifying 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 and treatment notes that 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 also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.

    In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.

    Qualifying for SSD or SSI benefits 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. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.

    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?

    There are several reasons but here are just two:

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

    Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.

    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. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.

    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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