If your congestive heart failure has left you unable to work for 12 months or longer, then, yes, you may be eligible for disability benefits.
More than 6.2 million adults in the United States have been diagnosed with heart failure. While proper treatment can improve symptoms of heart failure, more severe or advanced cases may significantly limit a person’s quality of life and their ability to work. In this situation, it may be necessary to apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) through the Social Security Administration (SSA).
To qualify for disability benefits, you will need to file an application and submit proof of your diagnosis, symptoms, and how they affect your ability to work. An experienced NJ disability attorney can help you with the application process.
At Bross & Frankel, we have helped thousands of people with disabilities get the monthly benefits that they are entitled to under the law. We offer free claim reviews and will work collaboratively with you to help you apply for benefits or appeal a denial of benefits.
Can You Get Disability for Congestive Heart Failure?
To be approved for benefits, you must be able to prove that you meet the disability qualifications established by the SSA. In the early stages of chronic heart failure, you may only experience mild symptoms, such as fatigue, a reduced ability to exercise, or a rapid or irregular heartbeat. If you can still work – or engage in substantial gainful activity (SGA) by earning over a certain amount each month – then you won’t qualify for benefits.
As congestive heart failure progresses, however, your symptoms may become more severe and difficult to control with lifestyle changes, medication, and other treatments. Signs of more advanced chronic heart failure may include:
- Sudden, severe shortness of breath with activity or when lying down
- More pronounced fatigue and weakness
- Swelling in the lower extremities (legs, ankles, and feet)
- Persistent cough or wheezing with white or pink blood-tinged mucus
- Very rapid weight gain from fluid buildup
- Difficulty concentrating
- Chest pain
- Nausea and/or lack of appetite
For more severe forms of heart failure, typical treatments – including medications such as beta-blockers and diuretics – may no longer work. Surgery, hospitalization, or even a heart transplant may be necessary. Heart failure may also cause related conditions, such as kidney damage or failure, heart valve problems, liver damage, and heart rhythm problems.
Once congestive heart failure has progressed to this point, it may not be possible to hold down a job. If your symptoms are so severe that you cannot work, then you may be approved for SSDI and/or SSI benefits.
How to Get Disability for Heart Failure
To qualify for Social Security disability benefits, you will need to meet the SSA’s definition of disabled. Broadly speaking, you will have to prove that you have a medical condition or mental health condition and that the symptoms of these condition(s) are so severe that you expect to be unable to work for a period of 12 months or longer. You may also qualify if your condition is terminal.
The SSA uses a process known as the five-step sequential evaluation to make the decision as to whether or not someone is disabled:
- If you are working, then you cannot earn more than a set amount, known as substantial gainful activity (SGA). For 2022, SGA is $1,350 for people who are not blind.
- Your impairment or combination of impairments must significantly limit your ability to perform basic work and is either expected to last for a year or longer or to result in death.
- Your impairment must either meet or exceed all of the requirements on the SSA’s listing of impairments (blue book), or it must have other factors that equal a listed impairment.
- If your impairment does not meet or exceed these criteria, then it must prevent you from performing any of your past work.
- You must not be able to perform any other type of work, based on your condition, age, education, past work experience, and job skills.
Heart failure is evaluated under the listing for cardiovascular impairments. Specifically, you must meet the criteria for chronic heart failure. While on a regimen of prescribed treatment, you must have the following signs and symptoms:
- Cardiomegaly or ventricular dysfunction must be present and demonstrated by appropriate medically acceptable imaging, such as chest x-ray, echocardiography (M-Mode, 2-dimensional, and Doppler), radionuclide studies, or cardiac catheterization.
- Abnormal cardiac imaging showing increased left ventricular end diastolic diameter (LVEDD), decreased EF, increased left atrial chamber size, increased ventricular filling pressures measured at cardiac catheterization, or increased left ventricular wall or septum thickness provides objective measures of both left ventricular function and structural abnormality in heart failure.
- An LVEDD greater than 6.0 cm or an EF of 30 percent or less measured during a period of stability (that is, not during an episode of acute heart failure) may be associated clinically with systolic failure.
- Left ventricular posterior wall thickness added to septal thickness totaling 2.5 cm or greater with left atrium enlarged to 4.5 cm or greater may be associated clinically with diastolic failure.
- However, these measurements alone do not reflect your functional capacity, which we evaluate by considering all of the relevant evidence. In some situations, we may need to purchase an ETT to help us assess your functional capacity.
- Other findings on appropriate medically acceptable imaging may include increased pulmonary vascular markings, pleural effusion, and pulmonary edema. These findings need not be present on each report, since CHF may be controlled by prescribed treatment.
- To establish that you have chronic heart failure, your medical history and physical examination should describe characteristic symptoms and signs of pulmonary or systemic congestion or of limited cardiac output associated with the abnormal findings on appropriate medically acceptable imaging. When an acute episode of heart failure is triggered by a remediable factor, such as an arrhythmia, dietary sodium overload, or high altitude, cardiac function may be restored and a chronic impairment may not be present.
- Symptoms of congestion or of limited cardiac output include easy fatigue, weakness, shortness of breath (dyspnea), cough, or chest discomfort at rest or with activity. Individuals with CHF may also experience shortness of breath on lying flat (orthopnea) or episodes of shortness of breath that wake them from sleep (paroxysmal nocturnal dyspnea). They may also experience cardiac arrhythmias resulting in palpitations, lightheadedness, or fainting.
- Signs of congestion may include hepatomegaly, ascites, increased jugular venous distention or pressure, rales, peripheral edema, or rapid weight gain. However, these signs need not be found on all examinations because fluid retention may be controlled by prescribed treatment.
This can be proved by showing:
- Medically documented presence of one of the following:
- Systolic 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 (not during an episode of acute heart failure); or
- Diastolic 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 (not during an episode of acute heart failure);
- Resulting in one of the following:
- Persistent symptoms of heart failure 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
- 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
- Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
- Dyspnea, fatigue, palpitations, or chest discomfort; or
- Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
- 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
- Signs attributable to inadequate cerebral perfusions, such as ataxic gait or mental confusion.
It can be difficult to meet the disability rating for heart failure, particularly if you are under the age of 65. A seasoned disability benefits lawyer can help you gather the medical records, test results, and other documentation that you need to prove that you meet the blue book listing for chronic heart failure.
Even if you don’t meet a blue book listing for chronic heart failure, you may still qualify for disability benefits if your symptoms are bad enough that you are unable to perform your past work or any other sedentary work. A residual functional capacity (RFC) exam is used to determine if there is some other type of work that you can perform given your symptoms and functional limitations.
For example, if your test results show that you cannot do much physical activity before you experience symptoms like shortness of breath, heart palpitations, or confusion, then the RFC may state that you are unable to do your past work. The exam will then determine if you can perform any other type of work based on your education level, age, and experience.
Chronic heart disease is often linked to other heart issues, such as heart attacks, coronary artery disease, heart murmurs, and heart disease. If you have one or more of these related conditions, then you might qualify for disability benefits. The blue book also contains listings for a range of other cardiovascular impairments, including:
- Ischemic heart disease
- Recurrent arrhythmias
- Symptomatic congenital heart disease
- Heart transplant
- Aneurysm of aorta or major branches
- Chronic venous insufficiency
- Peripheral arterial disease
An experienced disability attorney will thoroughly examine your medical records to determine if there is any evidence of these other heart conditions. If so, then they may include these or other medical conditions to bolster your application for disability benefits.
Applying for Disability Benefits for Congestive Heart Failure
If you are unable to work due to your symptoms of heart failure, then you may be able to apply for Social Security disability benefits. The application process requires you to gather certain evidence, including medical records and proof of citizenship. Once you have the necessary information, you can file an application claim online through the SSA’s website, over the phone, or at a local Social Security field office.
You will need to submit medical evidence that demonstrates that you have been diagnosed with either systolic failure or diastolic failure of your heart. Documentation may include:
- Results of tests, including cardiac imaging
- Notes of diagnosis
- List of medications and how you responded to them
- Records of hospitalizations
- Documentation of surgeries and procedures
If you don’t meet the disability rating for congestive heart failure, then you will also need to provide proof that you are unable to either perform your past work or any sedentary work.
It is possible to apply for SSDI/SSI benefits on your own. However, many people find the process challenging, particularly when they are dealing with the symptoms of heart failure. Many initial disability claims are denied by the SSA because of paperwork errors or a failure to meet the burden of proof necessary to qualify for benefits.
Having a skilled disability lawyer by your side can make it easier to apply for disability benefits – and it may improve your chances of having your initial application approved. An attorney can assist with the application, and can also represent you on any appeal if your claim for benefits is denied.
Is Congestive Heart Failure Considered a Disability?
For purposes of Social Security disability, congestive heart failure may be considered a disability if (1) a person’s symptom’s meet the blue book listing for chronic heart failure; and/or (2) they cannot work because of the symptoms and limitations of the disease. Generally, you will have to show that you have systolic or diastolic failure of the heart to qualify. You can also show that the functional limitations of your heart failure make it impossible for you to engage in substantial gainful employment.
If you have been diagnosed with heart failure, call Bross & Frankel to schedule a free claim review with a New Jersey disability benefits lawyer.
What Happens If I Am Denied Disability for My Heart Failure?
A high percentage of applications for SSDI and/or SSI benefits are denied. Fortunately, there are four levels of appeal that you can pursue: a request for reconsideration, a hearing before an administrative law judge (ALJ), a Social Security Appeals Council Review, and a federal court lawsuit. Even if you did not have legal representation for your initial application, you can still hire a lawyer for an appeal.
The legal team at Bross & Frankel is well-versed in all levels of SSA appeals. Give our law office a call today to schedule a free initial consultation about your claim.
How Can I Afford a Lawyer for My Disability Benefits Claim?
Social Security disability lawyers work on a contingency fee basis. This means that you pay nothing upfront to hire an attorney. Instead, if your claim is successful, your lawyer will be paid a portion of any back pay award that you receive. The SSA limits the amount of attorneys’ fees to the lesser of $6,000 or 25% of your award.
In other words, it won’t cost you anything out of pocket to hire a disability lawyer for your SSA claim. In New Jersey and Pennsylvania, call Bross & Frankel to schedule a free claim review.
Suffering from Heart Failure? Reach Out Today.
Over time, many people with congestive heart failure find it difficult to participate in their usual daily activities and to continue working. If you have reached the point where you aren’t capable of working because of your heart failure, then it may be time to apply for SSDI and/or SSI benefits. Our legal team can help.
At Bross & Frankel, we work hard to help our clients get the benefits that they need to maintain financial stability. We have extensive experience representing clients at all stages of the disability benefits process. To learn more about how we can help you or schedule a free claim review with a New Jersey disability benefits lawyer, call our office today at (866) 694-7952 or contact us online.