Living with congestive heart failure, or chronic heart failure (CHF), can make it impossible to work and support yourself. If you’re struggling with this serious condition and can’t work, you may qualify for Social Security Disability (SSD) benefits. To receive benefits, you must file a claim with the Social Security Administration (SSA).
Your application must contain evidence that highlights the severity of your condition. At Drozdowski & Rabin, PLLC, we help Tennessee residents understand their options and successfully navigate the disability claims process. Contact us today to schedule a free case evaluation and allow us to help you get the benefits you deserve.
Understanding Social Security Disability Benefits
The SSA offers two main types of disability benefits:
- Social Security Disability Insurance (SSDI): For workers who have paid into the Social Security system through payroll taxes
- Supplemental Security Income (SSI): For low-income individuals who are disabled, blind, or 65 or older
To receive SSDI, you must have enough work credits (based on your age and work history) to qualify. For SSI, you don’t need any work history but you must meet strict income and resource limits, as it is a needs-based program.
Can I Qualify for SSDI or SSI With Congestive Heart Failure?
Yes, congestive heart failure does qualify for disability benefits. However, to qualify for SSDI or SSI with any medical condition, including CHF, you must meet these basic requirements:
- Your condition must prevent you from working for at least 12 months or be expected to result in death
- You must be unable to perform Substantial Gainful Activity (SGA), including previous work and new types of work
- Your disability must be a qualifying impairment (or equal a qualifying impairment in severity)
How Is Congestive Heart Failure Eligible for Disability Benefits?
The SSA evaluates chronic heart failure under section 4.02 in the Blue Book. The Blue Book, or Listing of Impairments, is a guide of medical conditions that qualify for SSD. Each impairment listing contains medical criteria claimants must satisfy to qualify for benefits with that disability.
To qualify under listing 4.02, you must show:
- Systolic Failure: Your heart’s ability to pump blood is limited, shown by:
- The heart has become enlarged (left ventricle larger than 6.0 cm), or
- The heart has an ejection fraction of 30 percent or less at a period of stability, not during a heart failure episode
OR
- Diastolic Failure: Your heart cannot relax and fill normally, shown by:
- Left ventricular posterior wall and septal thickness (2.5 cm or more on imaging),
- Enlargement of the left atrium (4.5 cm or more), AND
- Normal or elevated ejection fraction during a period of stability
Additionally, your condition must result in one of the following:
- Persistent heart failure symptoms that greatly limit your ability to start, continue, or complete activities of daily living independently. A medical consultant should determine that with these symptoms you would be at serious risk if you were to take an exercise test.
- Three or more serious heart failure episodes within a 12-month period (separated by periods of stabilization) that involve:
- Evidence of fluid retention (from clinical and imaging assessments)
- Need for acute extended physician intervention, such as hospitalization or emergency room treatment for 12 hours or more
- You can’t complete an exercise tolerance test at a workload equivalent to 5 METs (metabolic equivalents) or less due to one of the following:
- Dyspnea, fatigue, palpitations, or chest discomfort; or
- At least three consecutive irregular heartbeats (ventricular tachycardia), or increasingly frequent abnormal heart rhythm with at least six extra beats per minute; or
- Systolic pressure dropping 10 mm Hg or more (below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise) because of left ventricular dysfunction, despite an increase in workload; or
- You experience symptoms that indicate your brain isn’t getting enough blood flow, such as ataxic gait or confusion.
Additionally, you must experience symptoms and signs outlined in 4.00D2 while you’re on a prescribed treatment plan.
What If I Don’t Meet Blue Book Requirements?
If your condition doesn’t exactly match Blue Book criteria, you can still qualify for benefits if:
- You can show your condition “equals” a listing (it’s just as severe as a listed impairment)
- You qualify for a Medical-Vocational Allowance (if you cannot meet or equal a listing)
For a Medical-Vocational Allowance, the SSA will evaluate your Residual Functional Capacity (RFC). Your RFC is what you can still do despite your condition and resulting symptoms. They consider:
- Age: Older workers may have more difficulty adapting to new work
- Education level: Your ability to work in different job rolls and learn new skills
- Work history: Skills you’ve developed that could transfer to less demanding work
- Physical limitations: How your symptoms restrict your physical abilities
- Mental limitations: How your condition affects things like concentration, following instructions, and decision-making
Medical Evidence
The SSA needs strong medical evidence to approve your claim. Important documentation for proof of severe CHF includes:
- Detailed medical history and physical exam reports
- Imaging and other test results, such as chest X-rays or ECG (electrocardiogram) results
- Laboratory test results
- Treatment records and medication history
- Results from current treatment plans
- Exercise tolerance test results
- Records of hospitalizations
- Physician observations about functional limitations caused by your heart condition
Symptoms That May Prevent You From Working
Congestive heart failure can cause many symptoms that result in an inability to perform basic work activities, such as:
- Severe fatigue and weakness
- Trouble concentrating
- Chest pain
- Shortness of breath, especially during physical activity
- Dizziness or fainting
- Unable to walk short distances
- Irregular heartbeat
- Swelling in legs, ankles, and feet
Contact Drozdowski & Rabin, PLLC, To File Your Claim
Applying for disability benefits can be overwhelming, especially when you’re dealing with a serious heart condition. Our Social Security Disability lawyers bring extensive experience and knowledge concerning Social Security Disability law to the table. We offer:
- 100 years of combined legal experience helping disabled individuals
- Personalized legal support tailored to your unique situation
- A comprehensive understanding of both the filing and appeals process
Get Help With Your Disability Claim Today
You don’t have to struggle through the disability application process alone. Contact Drozdowski & Rabin, PLLC, today for a free consultation about your congestive heart failure disability claim. Our knowledgeable attorneys will review your case and determine if you qualify for benefits.
Call us today at (865) 299-7080. Our skilled legal team is here to help you understand if you’re eligible for Social Security Disability with CHF.
