Does it feel like your heart is breaking on a daily basis? When it comes to congestive heart failure (CHF), that might literally be true.
This condition, which stems from your heart not pumping enough blood for your body, is chronic and potentially fatal. Advanced congestive heart failure can seriously impair your ability to partake in even basic daily activities, not to mention work.
On that note, we recently got the following question from a reader:
“Will Social Security grant disability benefits for congestive heart failure? I was told it might be harder for me because I’m only 45.”
The baseline answer to this question is yes. Congestive heart failure is absolutely on the list of conditions that may garner a person disability benefits. However, qualifying isn’t automatic upon diagnosis, especially since early detection and treatment can improve a person’s life expectancy.
Keep reading to learn what’s necessary to satisfy the Social Security Administration’s (SSA) definition of congestive heart failure as a disability.
What Are the Symptoms of Congestive Heart Failure?
Congestive heart failure is not a one-size-fits-all diagnosis. But what it doesn’t mean is that the heart’s not working at all. It is still trying to do its job.
However, CHF compromises the ability of the heart to efficiently pump blood through the other organs of the body. Failure may be systolic (unable to push blood out of the heart), or diastolic (the heart chambers don’t fill properly). Or both. And sometimes it may present as an enlargement of the heart as well.
In a person with CHF, the walls of the heart become too weak or stiff to function correctly. This leads to an accumulation of fluids in the body and congestion in the heart’s tissues.
Symptoms of congestive heart failure may include:
- Build-up of bodily fluids
- Swelling in the feet and ankles
- Bloating (especially in the belly)
- Chest pain/heart palpitations
- Shortness of breath
CHF may manifest as a mild to moderate impairment at first but may worsen over time without proper treatment. Though it is not curable, lifestyle changes, medication, and frequent monitoring can slow its advancement.
What Does it Take to Get Disability for Congestive Heart Failure?
When it comes to the 10 most approved conditions for disability, heart and circulatory system disorders take the #3 spot. In fact, 11% of successful disability claims in 2020 were in this category, which includes congestive heart failure.
In other words, it is very possible to receive a positive verdict when filing a disability claim for CHF. But you will have to work for it as the requirements are strict.
Circling back to our reader’s question, please note that chronological age ultimately has nothing to do with approval. What does matter is symptoms and severity.
As with many conditions, there are “degrees” of congestive heart failure. One assessment doctors often use to categorize a patient’s impairment is the New York Heart Association (NYHA) Functional Classification System. In this system, there are four levels of progression:
- Class I (no symptoms/limitations)
- Class II (mild)
- Class III (marked)
- Class IV (severe)
The SSA is more likely to approve disability for applicants who are already Class III or Class IV. This is because their condition must also be serious enough to prevent them from working for at least 12 months. You will not have a successful claim if you’re still able to participate in substantial gainful activity (SGA). Remember that part of the definition of disability means being incapable of working.
In addition, the SSA evaluates claims under their “Blue Book” definition of chronic heart failure (Section 4.02 under Cardiovascular System). To qualify there are a plethora of medical records and tests one must supply to the SSA.
What Does the Social Security Administration Require as Proof of CHF?
To begin with, a disability applicant for congestive heart failure must show the SSA a doctor’s diagnosis of heart failure. And this condition must be persistent despite ongoing prescribed treatment. Then, they must also provide additional test results and information.
An applicant must support their diagnosis with medical records showing evidence of either systolic or diastolic heart failure.
Systolic failure. To prove this, you must show the heart’s weakened pumping strength with a test illustrating one of the following:
- The heart’s ejection fraction (the amount of blood the ventricle pumps out) is 30% or less with each heartbeat. This is during a stable episode and not under duress.
- The heart’s left ventricular end diastolic dimensions are larger than 6.0 cm.
Diastolic failure. To prove this, you must have tests confirming the heart is not filling properly by showing all the following:
- The thickness of the posterior left ventricular wall plus septum must be 2.5 cm or more on heart imaging tests.
- The left atrium of the heart is 4.5 cm or more. This is larger than normal.
- The ejection fraction must be normal or elevated during a period of stability (not during acute heart failure).
An applicant must also show at least one of the following in addition to the above criteria:
- Consistent limitation or inability to initiate, sustain, or complete activities of daily living.
- Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period with evidence of fluid retention.
- Poor performance or failure of an Exercise Tolerance Test at a workload of 5 METs.
To get these types of images and medical records, you will have to visit a cardiologist. Common heart tests may include an electrocardiogram or cardiac catheterization to confirm your condition.
What Else Might Help My Congestive Heart Failure Disability Claim Be Successful?
If you don’t meet the “Blue Book” requirements, there is still hope. You might be able to qualify through the Medical-Vocational contingency. This allows an applicant disability consideration based on their symptoms, age, educational experience, past work record and any transferable skills.
To qualify through this option, your doctor must also complete a Residual Functioning Capacity (RFC) evaluation and form. This form will detail how CHF has impacted your life. They will note if you have severe symptoms such as mental confusion or swelling with fluid seepage that prevents walking. These symptoms along with other criteria that keep you from working might still allow you disability benefits for CHF. Even if you’re only 45.
However, the process can be tricky, and you should keep written accounts of all procedures and symptoms. Also consider consulting with an experienced disability attorney who can help you navigate the abundant required paperwork and tests.
The bottom line is that when it comes to securing disability benefits, it can take a lot of heart. But it’s worth it to protect yours.
Ready to see if you may qualify? Click the button below to start your free, no-obligation benefits evaluation now:
Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter/X @KimberlyNeumann.