Living with a congestive heart condition creates a lot of challenges, from a personal, medical, and financial level. Your daily symptoms may prevent you from working, yet you need ongoing medical care and income to meet your financial needs. The Social Security Administration has specific requirements that determine who may qualify for Social Security Disability benefits (SSDI) or Supplemental Security Income (SSI), but how do you know if you are eligible?
At Sigman Janssen, we are deeply committed to helping Wisconsin residents with severe heart conditions secure the benefits they need and deserve. Our knowledgeable SSDI lawyers in Appleton are prepared to guide you throughout the application process. Working with a seasoned SSDI lawyer can help you avoid many of the critical mistakes applicants make. If your claim has been denied, we may also be able to assist you with an appeal.
Seeking SSDI or SSI benefits in Appleton? Call our trusted law firm today. (920) 335-1394
Can I Get Disability Benefits for My Heart Condition?
If you have a heart problem that makes it hard to work, you might qualify for disability benefits. There are two main programs that can help: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Some people can get both types of benefits if they meet all the rules.
What Your Heart Condition Must Prove
No matter which program you apply for, your heart condition needs to be considered severe. The requirements specifically say it must be bad enough to prevent you from working for at least 12 months or be serious enough that doctors expect it will be fatal.
The Social Security Administration also looks at how much money you can earn while working. This amount changes every year. If your heart condition lets you earn more than this limit, you probably won’t qualify for benefits.
Different Rules for Each Program
- SSDI Benefits: You need to have worked and paid Social Security taxes for enough years to have enough work credits to qualify. The exact number depends of work credits you need depends on your age when you became disabled.
- SSI Benefits: This program helps people who don’t have much money or property. You can only have a small amount in your bank account and limited assets to qualify. The maximum amount changes each year.
How Social Security Reviews Your Case
When you apply, Social Security will carefully look at your medical records. They want to see proof from doctors about your heart condition. This includes test results, X-rays, and notes from your doctor visits.
But medical records aren’t the only thing that matters. Social Security also wants to know how your heart condition affects your daily life. Can you walk up a flight of stairs? Do you get tired easily? Can you lift things or stand for long periods?
Trained workers at your state’s disability office will review everything. They work with doctors who specialize in disability cases. Together, they decide if your heart condition is severe enough to prevent you from working.
The key is showing that your heart condition doesn’t just cause symptoms – it actually stops you from doing the tasks you need for work..
Is Heart Disease and Congestive Heart Failure the Same Thing? The Distinction Matters for Disability Claims
Heart disease and congestive heart failure are related medical conditions. However, there are distinct differences to how the SSA evaluates each of these conditions for the purpose of disability.
Heart Disease
Heart disease is a broad term used to cover many different cardiovascular medical problems. Heart disease includes various medical conditions that affect your heart’s overall structure or how it functions.
Congestive Heart Failure
Congestive heart failure is a specific type of heart disease. Congestive heart failure, which is a specific condition, occurs when your heart cannot pump blood fast enough to meet your body’s needs.
Why the Distinction Matters
This distinction between applying for benefits with a heart disease as opposed to the more specific term, “congestive heart failure” is critical. It can make a difference to the outcome of your claim due to the evaluation criteria the SSA uses for different heart conditions in the Blue Book listings.
What Heart Conditions May Qualify for Disability Benefits?
Social Security recognizes multiple heart conditions that may qualify you for disability benefits if they severely limit your ability to work. The SSA evaluates cardiovascular conditions included under Section 4.00 of the Blue Book. This listing includes specific disorders that impact your heart functionality and circulatory system. Each condition has specific medical criteria you must meet to qualify disability. Regardless which heart condition you may suffer from, you must be able to provide medical documentation that supports your claim and application for benefits.
Specific qualifying heart conditions listed in Section 4.00 of the Blue Book include:
Chronic Heart Failure
- This listing includes congestive heart failure and other forms of heart failure that limit your heart’s ability to pump out blood effectively. This condition causes fluid buildup and can severely limit your daily activities if your ejection fraction (EF) or, more simply, your heart’s pumping power, is less than 30 percent.
So what exactly does that mean? Let’s break that down a bit more:
- Your heart is the pump, and the left ventricle is your heart’s primary pumping mechanism.
- Every squeeze or contraction of your heart sends blood back into your body.
- The EF tells us how efficient your heart is and how much blood inside your heart’s pumping chamber gets pushed out in one heartbeat. A higher percentage indicates your heart is working better. A lower percentage means the opposite – your heart has a weaker contraction.
Ischemic Heart Disease
Indicates you have reduced blood flow going to your heart muscle due to coronary artery disease. This condition is determined and documented following stress tests and cardiac catheterization.
Recurrent Arrhythmias
Abnormal heart rhythms that cause fainting episodes or cardiac arrest despite medication and device treatment like pacemakers or defibrillators.
Symptomatic Congenital Heart Disease
Birth defects affecting heart structure. Can cause cyanosis, reduced oxygen levels, or pulmonary hypertension in adulthood.
Heart Transplant Recipients
Automatic qualification for 12 months following transplant surgery, with ongoing evaluation based on post-transplant complications and function.
Aortic Aneurysms
Dangerous enlargement of the aorta requiring surgical intervention or causing severe functional limitations due to rupture risk.
Peripheral Arterial Disease
Blocked arteries in arms or legs causing severe walking limitations and tissue damage despite medical treatment.
Cardiomyopathy
Disease of the heart muscle that weakens pumping ability and causes progressive heart failure symptoms affecting your ability to work.
Medical Evidence You Need to Prove Your Heart Condition Prevents Work
Social Security requires you to provide comprehensive medical evidence that shows the severity of your heart condition and how it limits your ability to work. The documentation should come from acceptable medical sources, like cardiologists, internists, and other treating physicians who have examined you. These medical professionals can provide detailed reports about your condition and functional limitations.
- Cardiology Records: Complete treatment records from your cardiologist showing ongoing care, medication adjustments, and response to treatments for your heart condition.
- Diagnostic Test Results: Echocardiograms showing ejection fraction measurements, stress test results, cardiac catheterization reports, and EKG readings that document your heart function.
- Hospital Records: Emergency room visits, inpatient admissions, and discharge summaries related to heart failure episodes, chest pain, or other cardiac events.
- Physician Function Reports: Detailed statements from your doctors explaining how your heart condition limits your ability to walk, lift, stand, sit, and perform other work activities.
- Medication Lists: Current prescriptions for heart medications, dosages, side effects they caused, if any, and how well the medications control your symptoms.
- Exercise Tolerance Testing: Formal exercise stress tests or functional capacity evaluations showing your reduced ability to perform physical activities.
- Imaging Studies: Chest X-rays, cardiac MRI, or CT scans that show structural heart problems, fluid buildup, or other complications from your condition.
- Laboratory Results: Blood tests showing BNP or NT-proBNP levels, kidney function tests, and other lab work that supports your heart failure diagnosis and severity.
Heart Failure Symptoms That Affect Your Ability to Work
Congestive heart failure creates debilitating physical symptoms that can make performing even basic work tasks extremely difficult or impossible. The SSA evaluates how these specific heart failure symptoms limit your capacity to perform the physical and mental demands of a job over a long-term basis.
- Shortness of Breath: Difficulty breathing during minimal physical activity or even at rest that prevents you from walking, climbing stairs, or performing tasks that require sustained effort.
- Extreme Fatigue: Overwhelming tiredness that makes it impossible to maintain focus, concentration, or energy levels needed to complete an eight-hour workday.
- Fluid Retention and Swelling: Buildup of fluid in your legs, ankles, feet, or abdomen that makes standing, walking, or sitting for extended periods painful and difficult.
- Persistent Coughing: Chronic cough that may produce frothy or blood-tinged sputum; disrupting work activities and causing frequent interruptions throughout the day.
- Exercise Intolerance: Inability to perform routine physical activities without becoming severely short of breath or experiencing chest discomfort that would interfere with most job duties.
- Sleep Disruption: Difficulty sleeping lying flat due to breathing problems, requiring you to sleep propped up, which leads to daytime drowsiness and reduced cognitive function at work.
- Rapid Weight Gain: Sudden fluid retention causing weight increases that indicate worsening heart failure and create additional physical limitations and discomfort.
- Mental Confusion: Reduced blood flow to the brain causing difficulty concentrating, memory problems, and confusion that interferes with your ability to follow instructions or complete tasks accurately.
What If Social Security Already Denied My Congestive Heart Failure Claim?
Social Security denies many initial heart condition claims, including those for congestive heart failure. Reasons for a denied claim may be due to a lack of medical evidence or a failure to meet specific Blue Book requirements. It may also be because the examiner believes your symptoms do not prevent you from working.
Common denial reasons include missing diagnostic test results like echocardiograms showing reduced ejection fraction, lack of documentation proving your symptoms severely limit daily activities, or medical records that do not demonstrate your condition has lasted or will last at least 12 months.
Even if your claim is initially denied, all may not be lost. After being denied, you still have a four-level appeals process to overturn the SSA’s original decision.
Why Call Sigman Janssen When You Need Legal Help for Your SSDI or SSI Claim?
At Sigman Janssen, our trusted law firm understands the complex medical requirements for congestive heart failure cases. Our legal team can guide you throughout the application process – or help you with an appeal if your claim has been denied.
Worried about cost? Our firm accepts Disability cases on contingency, which means we only get paid if you do. There are no out-of-pocket costs or upfront fees to pay.
Our Appleton Social Security Disability attorneys know how to navigate the appeals process effectively and work diligently to maximize your chances of approval.
Call Sigman Jansse in Appleton for help with your disability claims. (920) 335-1394