Heart disease is the leading cause of death in America and will affect over 40 percent of the population by the year 2030, projects the American Heart Association (AHA). Chronic heart failure (CHF) is a syndrome that occurs when the heart is unable to pump enough oxygenated blood to body tissues. Because CHF causes fluid retention and impairs cardiac function, people living with the condition often experience very debilitating symptoms.
Many people with CHF can qualify for Social Security disability benefits when they meet certain severity criteria. To determine if you are eligible for Social Security disability for chronic heart failure in Pittsburgh, call Berger and Green and request a free case evaluation: 412-661-1400.
How severe does my CHF need to be for the Social Security Administration to consider me disabled?
In its Blue Book under Listing 4.02, the Social Security Administration (SSA) provides very detailed criteria for claimants with CHF. The guidelines stipulate that for the SSA to consider you disabled, you must meet both of the following severity requirements:
- You must have medically documented systolic or diastolic heart failure. Systolic failure occurs when the heart’s ejection is 30 percent or less during a period of stability or when the heart’s left ventricular end diastolic dimensions are larger than 6.0 cm. Diastolic failure occurs when the heart is unable to fill properly, the left ventricular wall and interventricular septum is 2.5 cm or thicker, the left atrium is enlarged to 4.5 cm or thicker, and you have normal or elevated ejection fraction during a period of stability.
- Your CHF must also result in one of the following: a) Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period that required at least 12 hours of hospitalization, b) Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living, or c) Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less.
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What documentation do I need to support my disability claim for chronic heart failure?
The SSA scrutinizes each applicant’s medical files to make sure his/her condition meets its guidelines and is truly severe enough to merit a disability determination. You will need to provide details about your medical providers so your case’s adjudicator can obtain the records the SSA needs to validate your disability.
The SSA will be looking for records from your doctor, cardiologists, specialists, clinics, and hospitals. These records might include:
- Imaging tests such as chest x-ray, echocardiography (e.g., M-Mode, 2-dimensional, and Doppler), radionuclide studies, or cardiac catheterization
- Exercise tolerance test (ETT), sometimes necessary to assess your functional capacity
- Your medical history and physical examination that describes characteristic symptoms and signs of pulmonary or systemic congestion or limited cardiac output
Some of the signs and symptoms the claims examiner will be looking for include fatigue, weakness, dyspnea (i.e., shortness of breath), cough, chest discomfort, cardiac arrhythmias, and signs of congestion, such as hepatomegaly, increased jugular venous distention or pressure, peripheral edema, or rapid weight gain. Of course, you do not need all of these symptoms to verify your CHF. The SSA will look at the whole picture when evaluating your condition.
Berger and Green can help you with your claim and ensure you have all the required documents in order.
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Can I still collect disability if I do not meet the listing criteria?
If your CHF does not meet the criteria under the listing, you can still qualify as disabled if your records indicate that your signs and symptoms are so limiting that there is no job you can currently do.
The claims examiner will determine your residual functional capacity (RFC) by determining how capable you are of performing basic tasks such as standing, walking, and lifting.
Taking your functional limitations, age, education, and work skills into consideration, the SSA will determine if you are disabled. If the examiner finds that you cannot perform your old job and you cannot adjust to new work, s/he will deem you disabled and eligible for benefits.
What are the other requirements for disability benefits?
There are several basic, but strict requirements in order to qualify for Social Security disability benefits:
- You must meet the SSA’s definition of disabled by either satisfying the listing requirements for CHF, or by having a very low RFC rating.
- Your condition must have lasted or be expected to last a year or more or result in death.
- You must be unable to engage in substantial gainful activity, which the SSA defines as earning $1,170 or more a month. If your income exceeds that figure, you are not disabled.
You must also meet other requirements, depending on which disability benefit you are applying for. For example, Social Security Disability Insurance (SSDI) applicants need to have a certain number of work credits on their record, which you earn by working at a job where you paid Social Security taxes. The older you are, the more credits you need. Supplemental Security Income (SSI) applicants must have a very low income (less than $735) and have very few assets (totaling less than $2,000 in value for individuals).
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How do I get started with my disability claim based on CHF?
Before applying for benefits, it is prudent to discuss your claim with a disability lawyer in Pittsburgh at Berger and Green. We can explain the claims process, help you fill out pertinent paperwork, and help the SSA collect the records it needs.
The SSA denies far too many claims simply because people make mistakes on their applications or fail to submit adequate medical evidence. We can help prepare you claim so there are not accidental omissions or errors. And should the SSA deny your claim, we can help you appeal your case. Contact us today to schedule a free consult with a Social Security disability lawyer in Pittsburgh: 412-661-1400.