How to Apply for Disability Benefits after Heart Failure


A critical illness that can prove fatal if not treated with special care and medication, congestive heart failure is a medical condition in which a person’s heart cannot pump enough blood. This results in the accumulation of blood in the vessels nearest the heart, often causing congestion or accumulation of fluid in other parts of the body. This debilitating condition results in a severely diminished capacity to exercise, perform physical work, or even exert effort in everyday living activities.

Many patients who suffer from congestive heart failure are forced to leave their job due to the effects of their heart condition. The good news is that should you suffer from congestive heart failure and have a year of treatment records, you may qualify for Social Security Disability Insurance benefits to help supplement or replace your lost income. Here is a brief rundown of the symptoms and causes of congestive heart failure, as well as what the Social Security Administration’s criteria are for qualifying for SSDI compensation.

Most Common Symptoms and Treatment

Persons suffering from congestive heart failure typically only experience mild to moderate symptoms such as shortness of breath, weakness during exercise, and overall fatigue even after mild exertion. In some cases, these are accompanied by palpitations and dizziness. Treatment plans are usually a program of extensive rest, healthy diet, modified daily activities, and a combination of medications such as ACE inhibitors, digitalis, beta blockers, or vasodilators. If your doctor suggests a treatment plan and medication, you need to follow their instructions faithfully and consistently. Failure to follow a medical treatment plan can disqualify you for SSDI benefits.

Potential Causes of Congestive Heart Failure

Congestive heart failure doesn’t just present overnight like a virus. Most of the time, congestive heart failure is caused by one of the following conditions and becomes aggravated over time.

-previous heart attack that has caused scar tissue to form around the heart, inhibiting muscle function

-coronary artery disease

-endocarditis/myocarditis (inflammation of the heart, valves, or surface tissue)

-congenital heart defects

Whatever the cause of your congestive heart failure, you need to make sure you have a sufficient treatment history and medical records documentation in order to proceed with an application to the SSA.

Social Security Disability Insurance Criteria for Congestive Heart Failure

The Social Security Administration lists congestive heart failure under the “chronic heart failure” category. In order to qualify for benefits, you must have a documented diagnosis of severe heart failure that has continued despite a treatment plan and medication. Your treatment history and medical records also must also document evidence of either diastolic or systolic heart failure.

Systolic failure of the heart means that your heart’s pumping strength has been weakened due to the congestive cardiac conditions. Systolic failure is also categorized by a cardiac ejection fraction (percentage of blood pumped with each heartbeat) of 30% or less, and/or a left ventricular end diastolic dimension exceeding 6.0 centimeters.

Diastolic failure occurs when the heart can no longer fill with blood properly, and is categorized by left ventricular wall and interventricular septum thickness of 2.5 cm. or larger, an enlarged left atrium measuring larger than 4.5 cm., and an elevated ejection fraction during periods of stability.

SSA’s Functional Limitations Criteria for Congestive Heart Failure

The following symptoms must be present and documented in order to qualify for SSDI or SSI benefits:

-Unable to successfully perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to symptomatic difficulties (shortness of breath, weakness, etc.)

-For those whose condition makes an ETT too great of a risk, there must be persistent symptoms of heart failurethat severely limit activities of daily living (ADLs)

-No less than three incidents of heart failure and fluid retention within the past year that required emergency room treatments or hospitalization for no less than 12 hours.

Qualifying for SSDI due to Functional Limitations

Should your condition fail to meet the above SSA criteria (most persons under age 65 will not meet these requirements), the SSA will then determine how much your congestive heart failure limits your ability to work and go about completing routine daily activities. They assign a rating known as your residual functioning capacity (RFC), which will define your ability to perform sedentary, light work, or medium work based on the severity of your condition.

For example, if your doctor has limited your lifting capability to no more than 10 pounds, your RFC would be for sedentary work. On the other hand, if your tolerance test results show that you are able to perform some physical exertion before developing symptoms (chest pain, palpitations, shortness of breath, etc.), then you would be given a light work RFC. If your RFC disqualifies you from performing normal tasks in your current job based on an SSA evaluation, then the SSA will look over your education and work experience in order to determine what other work you may be suited for given your RFC, or determine your eligibility for a medical-vocational allowance.

If you suffer from congestive heart failure and have been undergoing treatment for a year or more, you should definitely consider applying for SSDI or SSI benefits compensation due to the limitations this condition puts on your ability to maintain gainful employment. Due to the complex application process the requires significant paperwork and a complete collection and summarization of your medical records, it may be wise to consult with an advocate, attorney, or law firm that specializes in disability law to ensure that your application for benefits is as strong as possible when submitted.

The SSA’s bureaucracy and rules are vast and extremely strict, and you don’t need to go through the process without advice from experienced advocates. Make sure you are preparing the best application possible, and don’t hesitate to seek help if you need it.