If you have a severe heart condition that prevents you from performing full-time work, you may be eligible for Social Security disability benefits. Some cardiac impairments, such as congestive heart failure, coronary artery disease, recurrent arrhythmias, and heart transplants, may automatically qualify you for disability benefits via Social Security's "Blue Book" Listings of Impairments. More commonly, individuals with serious heart problems receive disability benefits via a "medical-vocational allowance," which Social Security grants when it determines that you're unable to perform any full-time jobs in the national economy.
The "Blue Book" Listings for Common Heart Conditions
If the medical evidence in your case establishes that you meet the requirements of a cardiac impairment listed in Social Security's "blue book," your case should be approved without much difficulty. Unfortunately, only the most severe cardiac conditions are found in the blue book, and even some individuals who have received stents or undergone heart attacks don't meet any of the listings.
The listings for cardiac conditions are found in Section 4.00 of the blue book under The Cardiovascular System. Because these particular listings are rather complex and technical, you should work with your disability attorney and your cardiologist to determine if you meet or "equal" any of the listings.
Here are some common cardiac conditions that may qualify you for disability benefits under a listing (or a medical-vocational allowance -- more on this below).
Congestive Heart Failure
If the heart is unable to pump sufficient quantities of blood to the body's organs, the blood returning to the heart will start to accumulate, resulting in congestion in the heart's tissues. Symptoms of congestive heart failure often include shortness of breath, weakness, dizziness, and fatigue. Edema (swelling) is also common, as the kidneys may be unable to rid the body of excess sodium and water.
Social Security evaluates congestive heart failure under the blue book listing for "chronic heart failure." To meet the listing, you must have experienced diastolic or systolic heart failure and either be consistently unable to perform activities of daily living, have three or more episodes of acute congestive heart failure over 12 months, or fail an exercise tolerance test.
Coronary Artery Disease
A type of coronary artery disease called atherosclerosis occurs when fat and calcium deposits build up in the arteries, causing decreased blood flow to the heart. A related condition, arteriosclerosis, arises when those plaque deposits cause the arterial walls to harden. A heart attack, or myocardial infarction, is generally caused by a combination of both conditions.
Coronary artery disease, also referred to as ischemic heart disease, typically causes chest pain (angina) and shortness of breath, especially on exertion. Coronary artery diseases may be diagnosed with coronary angiography (catheterization), an electrocardiogram, or stress tests.
Coronary artery disease is evaluated under Listing 4.04 for ischemic heart disease, which requires one of the following:
- an abnormal exercise tolerance test
- three separate ischemic episodes (loss of blood flow) requiring angioplasty or bypass surgery over a 12-month period, or
- angiographic or other imaging showing 50 to 70% narrowing of a non-bypassed coronary artery, and serious limitations in activities of daily living.
Individuals who have undergone a heart transplant are considered disabled for one year following surgery under Listing 4.09. After a year, it's possible they may remain disabled under another listing or a medical-vocational allowance.
Aorta or Major Branch Aneurysm
Weakness or damage to a blood vessel can cause the vessel wall to bulge at its weakest point. This is known as an aneurysm. While aneurysms can occur almost anywhere in the body, they are often found in the wall of the aorta, the large artery responsible for delivering oxygenated blood from the left ventricle of the heart to the branch arteries. When an aneurysm ruptures, whether in the aorta, the brain, or elsewhere, the results can quickly turn fatal.
Social Security's Listing 4.10 for aorta or major branch aneurysms is satisfied when an aneurysm in the aorta or major branch artery is demonstrated by appropriate medical imaging and when "dissection" of the artery occurs (the inner lining of the artery starts to separate from the arterial wall) and cannot be controlled by prescribed treatment.
Recurrent Heart Arrhythmias
An arrhythmia, or abnormal heartbeat, is the result of a disruption to the heart's internal electrical system. Whether the heart beats too fast (tachycardia) or too slowly (bradycardia), arrhythmias can cause fluttering in the chest, fainting, dizziness, or shortness of breath. While some arrhythmias are harmless, severe cases can cause insufficient blood flow to the brain and other vital organs.
Listing 4.05 for Recurrent Arrhythmias is satisfied when all of the following criteria are met:
- You've had loss of consciousness (syncope) or altered consciousness (near syncope) on three separate occasions over 12 months, despite following your doctor's treatment.
- The arrhythmia must be unrelated to reversible causes, and
- The relationship between arrhythmia and the syncope must be documented by EKG or other appropriate medical testing.
In practice, it is rare for an individual to receive disability benefits based on heart arrhythmias alone.
Receiving a Medical-Vocational Allowance for a Cardiac Condition
If Social Security determines that you don't meet or equal the requirements of a listing, you may still be found disabled based on your Residual Functional Capacity (RFC). Your RFC describes the most you can do in spite of your functional limitations. Based on your symptoms and the restrictions your doctor has given you, you will be given an RFC level of sedentary work, light work, or medium work. If SSA decides that the physical limitations in your RFC prevent you from performing any level of full-time work, you will receive a medical-vocational allowance.
Without a sedentary or light RFC level, it's very unlikely you'll be granted disability benefits, and then only if you're older than 50 (because then the medical-vocational grid rules apply). It's not uncommon for those with heart conditions to be given RFCs for sedentary or light work, however. For instance, the SSA might give a light RFC to someone with:
- heart failure and a CT ratio of 55% or more
- a history of severe heart attack, or
- angina and a positive stress test positive for ischemia.
It is critical that you submit all your relevant medical records, including diagnostic testing, from your primary care physician and your cardiologist, to prove the extent of your physical limitations. The level of exertion that produces symptoms for you, like fatigue, shortness of breath, or angina is important to your RFC analysis, so you should ask your treating doctors to provide opinions as to your work-related limitations, especially regarding your ability to stand, walk, sit, lift, carry, bend, stoop, squat, and climb. Your disability attorney should be able to provide your physician with a form that will address the major limitations in your RFC.
Will Social Security Find Me Disabled If I Have a Pacemaker?
Not necessarily. While you certainly won't be found capable of performing jobs that require heavy lifting or proximity to electromagnetic radiation, the SSA routinely finds that individuals with pacemakers can do sedentary or light work. And only older people with certain work histories and educations with sedentary or light RFCs are likely to get disability. Of course, it's possible that you may have additional cardiac or other impairments that would limit you further, making it more likely that you could get disability benefits. For more information, see this post on pacemakers and disability on Nolo's Disability Blog.