Meeting Ssa Listing 402a For Heart Failure
You will meet Part A of Listing 4.02 if you have chronic heart failure while on a regimen of prescribed treatment and
A. Medically documented presence of one of the following:
1. Systolic heart failure, with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability or
2. Diastolic heart failure, with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability
Part A.1: Systolic Heart Failure
Part A.1 requires systolic heart failure. Assuming that chronic heart failure is otherwise reasonably documented as a general requirement of the listing, part A.1 requires an objective determination of either cardiomegaly or left ventricular dysfunction.
Cardiomegaly can be demonstrated with echocardiography showing a left ventricular end diastolic diameter of greater than 6.0 centimeters. This is actually the inside diameter of the left ventricular cavity during diastolethe left ventricular inside diastolic diameter . In diastole the heart is relaxed and filling with blood .
Figure 4: The relaxed heart during diastole.
It is critical that the cardiac measurements be done during a period of stability after treatment for acute heart failure.
Part A.2: Diastolic Heart Failure
Congestive Heart Failure And Social Security Disability Benefits
- This image courtesy of Pexels
Congestive heart failure, also called chronic heart failure, is a condition in which your hearts ability to pump blood properly to the rest of your body decreases due to weakness or stiffness, often as a result of high blood pressure, narrowing of your arteries, or history of heart attack . Other conditions can also cause it.
Roughly five million people in the US currently live with congestive heart failure. Nearly 1.5 million people of those diagnosed are under the age of 60. And each year, another 550,000 million cases of congestive heart failure are diagnosed.
In some cases, the condition can be reversed in other cases, the damage is too severe and patients can only focus on reducing symptoms for a better quality of life.
Treatment Options For Congestive Heart Failure
While heart failure or congestive heart failure can be life-threatening, there are a number of treatment options that can be used to treat this condition and ultimately heal the muscle of the heart.
To start, doctors may prescribe drugs known as ACE Inhibitors or Vasodilators to open up narrowed blood vessels and improve blood flow. Beta-Blockers can also be used to reduce blood pressure and treat arrhythmias that may be contributing to the development of congestive heart failure. Diuretics are also commonly used in the treatment of congestive heart failure, as the condition causes patients to retain too much fluid in the body.
Cardiologists will also recommend lifestyle changes to help the patient heal from congestive heart failure, including the cessation of drinking alcohol and smoking, the discontinuation of stimulants such as caffeine or illegal drugs, tracking ones daily fluid intake, diet change and weight loss, managing stress, treating any sleep disorders, getting plenty of rest and staying physically active with appropriate exercise.
Finally, surgery may be necessary if medications or lifestyle interventions are not effective. Surgical procedures used to treat congestive heart failure include angioplasties to open up blocked arteries and heart valve repair surgery.
Also Check: How To Calculate Disability Retirement Pay
Qualifying For Long Term Disability Because Of Your Functional Limitations
The insurance company will consider the effect of your heart condition on your capacity to work or perform routine daily activities. The adjuster handling your claim will give you a rating of the type of work he or she thinks you can do, called your residual functional capacity .
Your RFC will rate your ability to do sedentary, light, or medium duty work. For example, if your doctor has limited you to no lifting more than 5 or 10 pounds at a time, your RFC will be for sedentary work. Or, if your exercise tolerance test shows you can only perform very little physical exertion before you experience symptoms , you will probably be assessed with a light RFC.
Next, the insurance company will determine whether you can work given the limitations of your RFC. For example, if you are unable to sit, stand and walk for at least eight hours a day, then you will be assessed with a less than sedentary RFC and disability will be granted.
When Light Rfc Is Appropriate
If you had a documented episode of CHF in the past due to chronic heart disease and still have a significantly enlarged heart with a cardiothoracic ratio of 55% or more, it would be difficult to justify an RFC higher than light work. Depending on your relevant symptoms on daily activities, as well as other abnormalities, the RFC could be lower.
You May Like: How Do You Change Your Va Disability Direct Deposit
Qualifying For Disability Under The Chronic Heart Failure Listing
The Social Security Administration will evaluate whether a patient with CHF qualifies for disability under its listing for “chronic heart failure.” To qualify for disability benefits under the SSA’s listing for chronic heart failure, you must have been diagnosed with severe continuing heart failure despite being on heart medication. The SSA’s listing doesn’t require that you have fluid retention at the time of evaluation to get disability benefits, but your medical records should show that you had fluid retention at some point in time. You must have the required objective symptoms and functional limitations below.
What Are The Causes Of Disabling Heart Failure
Heart Failure usually develops secondary to weakness of the heart muscles or increased peripheral resistance resulting from constriction of blood vessels. The weakness of heart muscles is caused by decreased blood flow to the heart muscles and increased peripheral blood vessel contraction is observed in-patient suffering with hypertension.
The causes of disabling heart failure is as follows-
Disabling Heart Failure Due To Hypertension or High Blood Pressure-
Hypertension causes increased blood pressure and increased peripheral vascular resistance. Heart then has to pump blood against increased resistance. Heart has to work harder to pump the blood against resistance, which causes thickening of the heart muscles during initial phase and later weakness. Thick heart muscles eventually become less efficient and weak heart muscles pumps less blood to peripheral tissue.
Disabling Heart Failure Due To Coronary Artery Disease And Heart Attack-
Coronary artery supplies blood to heart muscles. Blood carries glucose and oxygen to muscles. Decreased blood flow to heart muscles results in decreased oxygen and glucose supply. The condition eventually weakens the heart muscles or causes severe damage. The narrowing of the coronary artery is caused by obstruction of lumen by a cholesterol plaque.
Disabling Heart Failure Due To Arrhythmia Or Irregular Heart Beats-
Disabling Heart Failure Due To Aortic Valve Stenosis-
Disabling Heart Failure Due To Endo-Myocarditis-
Recommended Reading: How To Calculate Short Term Disability Benefits
When Your Congestive Heart Failure Meets A Listing
Congestive heart failure is included in the SSAs Listing of Impairments. If your congestive heart failure meets or equals a Listing, your Social Security disability benefits will be awarded at Step 3 of the Five-Step Sequential Evaluation.
Your medical records must establish that you meet every element of the Listing for your congestive heart failure to be considered disabling. SSA will review your medical records and look for a diagnosis of severe continuing heart failure despite being on medication with fluid retention at some point.
SSA requires objective symptoms of either systolic or diastolic heart failure.
A showing of systolic heart failure occurs when the heart has weakened pumping strength, which can be shown by one of the following:
Your hearts ejection fraction, which is the percentage of blood pumped out of the heart with each heartbeat, is 30% or less during a period of stability, or your hearts left ventricular end diastolic dimensions are larger than 6.0 cm.
A showing of diastolic failure occurs when the heart is unable to fill properly, and must be shown by all of the following:
- Thickness of left ventricular wall and interventricular septum 2.5 cm or longer on imaging,
- An enlarged left atrium 4.5 cm or larger, and,
- Normal or elevated ejection fraction during a period of stability.
Once you have shown objective evidence of either systolic or diastolic dysfunction, you must have one of the following functional limitations:
When Is Congestive Heart Failure Considered A Disability Making You Eligible For Disability Benefits
The Social Security Administration has detailed criteria in its Blue Book listing that must be met in order for CHF to be considered a disability. A person must have one of these types of CHF:
- Systolic failure. This is a type of CHF where the heart has weakened pumping strength. To qualify for SSDI, the percentage of blood pumped out of the heart with each heartbeat, which is referred to as the hearts ejection fracture, must be 30 percent or less or the hearts left ventricular end-diastolic dimensions must be larger than 6.0 cm.
- Diastolic failure. Diastolic failure occurs when the heart cannot fill properly. To meet the SSDIs definition of disability, the thickness of the left ventricular and interventricular septum has to be 2.5 cm or larger, the left atrium must be enlarged at 4.5 cm or larger, and there must be a normal or elevated ejection fraction during a period of stability.
In addition, a person must show that he has one of these symptoms:
- Inability to perform an exercise tolerance test at a workload equivalent to 5 EMTs or less
- Continuing symptoms of heart failure that limit activities of daily life
- Three or more episodes of CHF in the last 12 months that required treatment in an emergency room or hospital for at least 12 hours
If an applicants medical condition does not meet these requirements, he may still be eligible for SSDI benefits if he can show that his congestive heart failure is so disabling that it prevents him from performing the duties of any job.
Also Check: How Do You Change Your Va Disability Direct Deposit
How Does Heart Failure Affect Your Ability To Do Sedentary Labor
Sedentary jobs are less physical than other work situations, but they often require a high degree of manual dexterity. Some sedentary jobs, particularly those involving management or sales, are also known for being high-stress careers. If your heart failure has caused a loss of manual dexterity or precludes you from working in high stress environments, you will want to make sure you document this on your Social Security Disability benefits claim.
Often, heart failure is caused by factors such as stress and depression. You will want to make sure your doctor and any mental health professionals you are working with thoroughly document any non-physical causes believed to be responsible for your heart failure, as well as any restrictions these conditions cause.
What Are Some Causes Of Heart Failure
There are many underlying issues that a person may not recognize at first. Heart failure can slowly develop in the early stages, yet it wont be evident until the symptoms happen over and over again. If the heart is stiff, the pumping action will be challenging to have blood flow continuously throughout your body. When the heart is thick, the blood will no correctly fill in between the heartbeats.
The following conditions are causes of heart failure:
Read Also: How To Calculate Disability Retirement Pay
Ssas 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 at a workload equivalent to 5 METs or less due to symptomatic difficulties
-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
-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.
If You Have Congestive Heart Failure Yet Your Medical Condition Does Not Match Social Securitys Impairment Listing You May Still Be Eligible For Social Security Disability Benefits If You Have Another Impairment For Example Kidney Or Thyroid Disease
Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Securitys Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicants ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work , taking into account your age, level of education and work experience.
Recommended Reading: Reserve Component Retirement Pay Calculator
What Are The Symptoms Of Congestive Heart Failure
The symptoms can be mild to severe and can come and go. Common symptoms include:
- Congested lungs that cause shortness of breath at rest or with exercise, wheezing or a hacking cough,
- Fluid and water retention that can result in swelling, weight gain, bloating, nausea and increased need to urinate,
- Dizziness, fatigue, weakness and confusion, and
- Rapid or irregular heartbeat.
Blood tests, B-type natriuretic peptide , chest x-rays, echocardiograms, EKG or ECG, cardiac cauterization and stress tests are used to make a diagnosis and determine the severity of your congestive heart failure.
Your physician rates the stages of heart failure using the New York Heart Association classification, which rates your symptoms and functional limitations.
Evidence Of Heart Conditions
Test results are very important to the SSA’s determination. An EKG can indicate that your heart muscle is not getting as much oxygen as it needs , that your heartbeat or heart rhythm is abnormal , or that there are other abnormalities of your heart, such as left ventricular enlargement . Results of an exercise tolerance test , also called a stress test, are also important because they tell the SSA how much work/exertion you can do before having heart symptoms like shortness of breath, angina , or exhaustion.
Also Check: How To Calculate Disability Retirement Pay
What Foods Should Be Avoided With Congestive Heart Failure
- Salt When you have heart failure, you absolutely must avoid salt.
- Potato Chips. Potato chips represent a classic âworst foodâ for people with heart failure because they’re high in both fat and sodium.
The most common causes of congestive heart failure are:
- Coronary artery disease.
- Disorders of the disorders of the heart valves.
- Unknown causes, such as after recovery from myocarditis.
Meeting Ssa Listing 402b For Heart Failure
You will meet Part B of Listing 4.02 if you have chronic heart failure while on a regimen of prescribed treatment
B. Resulting in one of the following:
1. Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual or
2. Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period, with evidence of fluid retention from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization or
3. Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
a. Dyspnea, fatigue, palpitations, or chest discomfort or
b. Three or more consecutive premature ventricular contractions , or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute or
c. Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload or
Recommended Reading: Us Naval Reserve Retirement Calculator
Tests & Treatments For Congestive Heart Failure
To be treated you need a thorough physical examination which involves the doctor listening to your heart and looking for signs of heart failure. Other tests include blood tests, BNP blood test, chest x-ray, and an EKG test measuring the electrical impulses travelling through the heart. There are also medications available as well as lifestyle choices to improve heart failure. It is important to keep your blood pressure low so that your heart pumps more effectively. Monitor your weight to notice any unexplained weight gains which may be caused by fluid retention. Limit your sodium intake to avoid water retention, and take the necessary medication to improve your hearts ability to pump blood.
Veterans Need Help With Claiming Congestive Heart Failure
VA Claims Insider has all the resources for you to process your claim promptly. VA Claims Insider has a robust team of Veteran Coaches streamlining the process.
VACI has all the tools necessary for you to file the claim medical documents scrutinized by our coaches and the independent medical professionals you will get access to. Ready to get started? to get in touch with our team!
Thank you for reading and looking forward to hearing from you!
Become an Insider
Were Veterans helping Veterans Worldwide, and since 2016 weve helped 10,000+ Veterans just like you INCREASE their VA disability rating!
Don’t Miss: How To Calculate Disability Retirement Pay
What Is Congestive Heart Failure
Heart failure means that the heart is pumping weaker than usual and it is not pumping enough oxygen and nutrients throughout the body. This can cause the kidney to retain fluid and salt, which can lead to a buildup of fluid in the body. This can be caused by damage to the heart muscle, including a heart attack and the heart being overworked. A heart attack damages the heart muscle, whereas things like high blood pressure cause the heart to overwork.