Can You Get Disability for Heart Failure? Heart Failure Disability Accommodations From the SSA

Heart failure can be devastating to your body, goals, and finances, but can you get disability for heart failure? The Social Security Administration provides disability accommodations for many types of illnesses and physical conditions, including cardiovascular disease. Individuals with cardiovascular disease, such as heart failure and arrhythmias, may qualify for disability benefits and accommodations at work by filling out applications with the help of their healthcare team.

Is heart failure a disability? Find out now what heart problems qualify for disability below.

Getting Social Security Disability for Heart Failure: Key Takeaways

• The SSA recognizes heart failure as a disability, especially when it severely limits daily activities or requires frequent medical intervention.
• There are two SSA disability programs: SSI, which is needs-based without requiring work history, and SSDI, which requires a certain number of work credits.
• To qualify for Social Security Disability benefits, you need comprehensive medical documentation, including diagnostic tests, treatment records, and proof of how your condition meets the specific medical criteria listed in the Blue Book or limits your ability to work.
• Symptoms like shortness of breath, edema, and concentration difficulties can significantly hinder your ability to perform both physical and sedentary jobs.
• Applying for SSDI or SSI involves gathering medical records, proving work limitations, and understanding eligibility criteria. Be prepared for a lengthy process and potential appeals.

What is Heart Failure? Symptoms and Side Effects

Heart failure, also known as congestive heart failure, is a condition that occurs when the heart is no longer able to pump enough blood to keep the body healthy. Because the heart is not working properly, blood and fluid build up in the body and lungs. This causes difficulty breathing along with other symptoms, significantly impacting the cardiovascular system.

But what makes the heart so weak? Heart failure can be triggered by a variety of causes. For example, plaque can build up in the arteries, making them narrower. Because they are now narrower than healthy arteries, they can’t transport blood as easily.

Other conditions can cause the arteries or muscles of the heart to become stiff. A stiff heart doesn’t pump as well because it loses flexibility. This is like trying to do bicep curls when you can only bend your arm halfway.

Congestive heart failure can be life-threatening in the most severe cases. Milder cases can benefit from making healthy lifestyle changes, but individuals with severe heart failure may need a heart transplant or an implant to help pump blood.

Disability Criteria From the SSA

There are actually two different programs for disability under the SSA. One is called Supplemental Security Income (SSI), and the other is called Social Security Disability Insurance (SSDI). They both have medical requirements, but there are several differences between the two programs.

SSI is based on the needs of an individual and does not require any work history at all to qualify. Instead, it is based on the household income and assets of the disabled individual. As of 2024, the individual cannot make more than $1,550 per month ($2,590 if you’re blind), and cannot have assets that are worth more than $2,000 ($3,000 as a couple) or they lose their ability to qualify.

Unlike SSI, the SSDI program does require a work history. This program may be better for someone who was once able to work and has since lost their ability to work due to their disability. To qualify for Social Security disability benefits under SSDI, an individual must meet specific eligibility criteria, including having sufficient work credits and meeting the medical criteria for their condition. The application process involves submitting detailed medical records and, if necessary, appealing any denials.

Does the SSA Consider Heart Failure a Disability?

The Social Security Administration absolutely considers chronic heart failure to be a disability. In fact, heart problems and respiratory problems are among the more common conditions that qualify for disability due to the severity and impact of chronic heart failure on a person’s ability to work. However, having a heart condition does not immediately qualify you for SSD benefits: rather, your condition must reach a defined level of severity in order for you to be eligible.

Requirements for Heart Conditions

If you apply for SSA Disability with a heart condition, there are certain requirements you need to meet. The SSA has a list of accepted conditions called the Blue Book.

The Blue Book talks about heart failure in Section 4.02. In order to qualify for SSA Disability for heart failure, these are the requirements that you must meet:

• You must have been diagnosed with heart failure AND
• There must be documented evidence of either systolic failure (weakened pumping strength) or diastolic failure (the heart can’t fill properly) AND
• You must have current and persistent symptoms of heart failure that place serious limits on your ability to live your day-to-day life independently OR
• You must have had at least three separate episodes of acute congestive heart failure within the period of a year (with documentation) OR
• You are unable to “perform on an exercise tolerance test at a workload equivalent to 5METs or less”

Does Your RFC Mean There’s No Work You Can Do?

One of the biggest questions is whether your RFC, or Residual Functional Capacity, means that you are unable to work. Your Residual Functional Capacity is the ability to which you are able to work with your disabilities. However, even if you are unable to perform certain tasks, that doesn’t necessarily mean that you are unable to work entirely.

Because SSA benefits are designed to aid people who are unable to work due to their disability, your RFC is a major factor. People who are somewhat limited, but still able to work, might not qualify for SSI or SSDI.

How Hard Is It to Get Disability for Heart Failure?

Heart conditions, including but not limited to heart disease, are the fifth largest category of disabilities approved for benefits. This category also includes conditions like:

• Coronary artery disease
• Strokes
• Aneurysms
• Deep-vein thrombosis
• Lymphedema
• Those who have received heart transplants
• And more

All of these conditions together make up a bit more than 7% of total approved claims. One of the requirements for a condition to be considered a disability by the SSA is that its duration is at least twelve months. Heart conditions often require surgeries or long recovery time, which is why they make up such a respectable portion of claims.

Medical criteria and tests, such as echocardiograms, are used to evaluate conditions like chronic heart failure, ischemic heart disease, and recurrent arrhythmias. Elevated ejection fraction is one of the specific criteria considered in these evaluations.

Fortunately, this means that heart disease is a well-established condition that is acknowledged and often approved for disability benefits. That doesn’t mean that anyone with heart disease will be approved, but it is easier than someone who has a less well-known condition.

Which Heart Failure Symptoms Might Limit Your Ability to Work?

There are several heart failure symptoms that might limit your ability to work. While the term “heart failure” makes it sound like the heart has stopped working entirely, heart failure just describes a heart that is not working at full capacity. This means that the blood is not getting all of the oxygen that it should.

This lack of oxygen results in shortness of breath, which can make certain physical tasks too difficult. Another symptom of heart failure is swelling of the legs, called edema. Edema occurs when fluid builds up in the body. In the case of heart failure, it’s because the heart can’t pump well enough to keep this fluid moving. This swelling makes it difficult, if not impossible, to walk without pain.

Even if your job does not require a lot of physical exertion, one of the more subtle symptoms of heart failure is an inability to concentrate. Even sedentary tasks, such as a desk job at a computer, are difficult when you can’t pay attention due to the lack of oxygen going to your brain.

And it’s not only the physical limitations that may make it difficult to find and hold down a job. If your condition is severe enough that you have to see many doctors and specialists, it can be difficult to hold a job because of how much time you have to take off for appointments. Managing these symptoms often requires a regimen of prescribed treatment, which includes regular medical visits and adherence to specific treatment plans.

Other Medical Conditions & Comorbitites That May Help You Get Disability for Heart Failure

Many people with heart failure also have other conditions like diabetes or depression that make it difficult to work consistently. Because of this, certain comorbidities paired with your heart failure may help you get SSA disability.

If you have several disabilities, the SSA will take them into account together. This is why it’s important to have documentation for all of your conditions, even ones that are minor on their own. If your other conditions combined with your heart failure prevent you from working, the SSA must consider them.

Medical Evidence You’ll Need for Your Heart Failure Disability Claim

As you prepare to make your heart failure disability claim, there is medical evidence you will need to prove the severity of your condition. One of the most time-consuming steps of applying for disability is simply gathering documents.

Naturally, the SSA will require proof that you have heart failure and that it is severe enough to prevent you from being able to work. Here are the types of documents that you’ll need to get started on your heart failure disability claim.

Medical Records

A big part of your claim will consist of medical records, as they are one of the most objective and clear tools you have for proof. In order to ensure that your medical records are complete and thorough, remember to report all symptoms–even small ones–to your doctor at every appointment.

Make sure that you also keep a detailed list of any prescriptions and side effects that you are dealing with. You should also do all diagnostics testing that your doctor recommends. The SSA wants to weed out people who do not actually need to be on disability, but you can’t argue with objective diagnostic testing.

Consistency is key. It may seem repetitive to always bring up the same issues at appointments or to make several appointments for the same condition, but it helps your case. It proves both that this is a long-term and invasive condition that you are dealing with, and that you are actively seeking to get better.

Medical Evidence

When you make a claim for disability, you will need to provide medical evidence. While this does include medical records, there are three broad categories of medical evidence: subjective, objective, and medical opinions.

“Subjective findings” refers to your own experience of what you are dealing with. This could be shortness of breath or pain. “Objective findings” refers to evidence that can be seen or diagnosed, like swelling in the legs that makes it difficult to walk. Finally, medical opinions is what it sounds like; the opinion of medical professionals regarding your limitations.

Evidence that Work Triggers Your Symptoms

The whole system of SSA Disability is designed to assist people who are unable to work because of their condition. Many disabled people are able to work with reasonable accommodations, but they are not typically the ones who seek SSA disability.

To that point, you will need to prove that working makes your heart failure symptoms worse. For example, if you struggle with edema, you can document the swelling with photos and doctor’s visits to prove that standing or walking for work is not feasible.

Proof of Other Conditions

You will need proof (like medical documentation) of your other conditions besides heart failure. That may sound obvious, but it is easy to forget or lose documentation for conditions that seem minor compared to your heart failure. Some people may not even see a doctor for these minor conditions when they are dealing with something more severe at the same time.

Even so, these minor conditions combined with heart failure can make it much more difficult for you to work, which is the main consideration of SSA Disability. Make sure you track down or obtain medical documentation for all of the other conditions to bolster your case.

How to Apply for Heart Failure Disability Benefits

Now that you have all of your medical evidence, how do you apply for heart failure disability benefits? You’ll need to decide whether you are applying for SSI or SSDI, have all of your documents together, and–most importantly–be patient.

Applying for SSA disability is a waiting game. Even if you have everything in order, it can take a while for a claim to be processed, but don’t lose hope!

Applying for Social Security Disability Insurance (SSDI) With Heart Failure

There are many ways to apply, including online, by mail, and in person. Your application will include all of your medical evidence up to this point. If you get onto SSDI, you may also qualify for other programs like the Supplemental Nutrition Assistance Program (SNAP), Medicare, or Medicaid.

SSDI stands for Social Security Disability Insurance, and it is designed as a wage replacement for people between 18 and 64 years old. In order to get SSDI benefits, you need to have a work history.

Generally, you need forty “work credits” when you apply for SSDI in order to get approved. For the year 2024, every $1,640 that you take home gets you one work credit. One credit is tied to one quarter of the year of work, so you would get four credits per year worked as long as you made at least $6,560 annually.

Applying for Supplemental Security Income (SSI) With Heart Failure

You can apply for Supplemental Security Income (SSI) with heart failure online, or you can call to make a phone appointment. Before you apply, you will want to make sure to check the eligibility requirements for SSI, which include an income limit of $1,550 per month and an asset limit of $2,000.

You’ll want to apply as soon as possible because backpay from the SSA is only available from the date of the application. No matter when the disability started or began to affect your life, it can only be backdated to this date.

If your application is rejected, remember that you have the right to make an appeal. There are no fees to apply, and anybody can apply for SSI benefits.

Work With a Disability Lawyer to Improve Your Odds of Approval

If you believe you’re eligible but don’t know where to start, we can help! Working with a good disability lawyer improves your chances of being approved for Social Security Disability Benefits (SSDI or SSI) for heart failure.

The process of applying for Social Security disability benefits can be time-consuming and overwhelming, but a good disability lawyer will ensure that everything is done correctly the first time. They can also work with you on the appeal if the claim is rejected, but you meet eligibility requirements.