Do I Qualify For Social Security Disability Benefits If I Have Congestive Heart Failure?
The Social Security Administration (SSA) doesn’t always make it easy for those with congestive heart failure to get the Social Security Disability Insurance (SSDI) or Supplemental Security Income benefits they deserve. Many claims are denied because SSA says:
(1) Your congestive heart failure doesn’t meet the requirements of or is the equivalent of a Medical Listing,
(2) You can return to the lightest job you held in the 15 years before you became disabled, or
(3) There is other work you can do in the mythical national economy based on your age, education, transferable skills and your residual functional capacity.
Not all cases of congestive heart failure are severe enough to make you eligible for Social Security Disability benefits, but Nancy Cavey has successfully represented many SSA applicants with congestive heart failure. She works to overcome the claims denial by working closely with you and your physician to show that you:
- Meet the requirements for a disability listing, or that
- Your limitations are too great for you to work at your old job or any other job in the national economy in view of your age, education and transferable work skills.
She offers a free initial consultation and welcomes the opportunity to speak with you about your Social Security disability claim.
What Is Congestive Heart Failure?
When your heart’s pumping power is weak, blood moves through your heart and body at a rate slower than normal. Your heart just can’t pump enough oxygen. The chambers of the heart stretch to hold more blood to pump throughout the body or become stiff and thickened.
As your heart muscles weaken and become less efficient, your kidneys can respond by retaining water and salt. As the fluid builds up in your arms, legs, feet and lungs, the body becomes congested.
There are two types of heart failure, called systolic or diastolic dysfunction. An echocardiogram is used to measure how well your heart pumps with each beat and will determine what type of heart failure you have.
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 (BNP), 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.
When Your Congestive Heart Failure Meets A Listing
Congestive heart failure is included in the SSA’s “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 heart’s 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 heart’s 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:
- An inability to perform an exercise tolerance test at a workload equivalent to 5 METS or less during certain difficulties,
- If an exercise tolerance test would be too risky, persistent symptoms of heart failure that seriously limits activities of daily living are required, or
- At least three episodes of heart failure and fluid retention within the past 12 months, requiring emergency room treatment or hospitalization for at least 12 hours.
If you don’t meet or equal a listing, SSA then will determine your entitlement to benefits based on medical and vocational criteria at Steps 4 and 5.
When Your Congestive Heart Failure Makes It Impossible to Work
If your congestive heart failure doesn’t meet a listing, you will have to prove that you:
- Can’t return to the lightest job you held in the 15 years before you became disabled (PRW), and
- There isn’t any other work you can do in the mythical national economy based on your age, education, transferable skills and your residual functional capacity (RFC).
SSA or, ultimately an Administrative Law Judge, will answer those questions by determining your residual functional capacity. Your RFC is what you can do despite your congestive heart failure.
Residual Functional Capacity For Congestive Heart Failure
The SSA will review your medical records at the Initial Application and Reconsideration stage of the claims process and determine your functional capacity to perform sedentary, light, medium and heavy work.
SSA medical consultants often opine that a Social Security Disability applicant can do light and sedentary work, and that will result in a claims denial. The lower your RFC the more likely that you can’t return to the lightest job you held in the last 15 years or perform other work. SSA doesn’t tell applicants or physicians about the existence and importance of properly completed RFC forms that will explain that because of shortness of breath, chest discomfort, and heart palpitations:
- How far you can walk,
- How long you can stand and sit at one time and for an eight-hour day,
- How much and how often you can lift, stoop, squat, bend during an eight- hour day,
- Whether you have to alternate sitting and standing,
- Whether you have good days and bad days and how many days per month you would miss from work, and
- Whether you have psychological problems that would interfere with your ability to work.
This is not an exhaustive list of all of the questions on a congestive heart failure RFC form. But you can see that having an explanation of what you can do physically, cognitively and emotionally is key to winning your case.
Many SSA cases are lost because the applicant did not obtain an RFC or the right RFC form, or because their treating physician didn’t properly complete the RFC form. That is one of the many reasons you should have an experienced Social Security attorney like Nancy L. Cavey represent you in your claim.
How Your Residual Functional Capacity Is Used At A Social Security Hearing
Many claims are denied both at the Initial Application and Request For Reconsideration stages of the claims process.
At the hearing stage, the Administrative Law Judge will determine your RFC and give hypotheticals to the vocational evaluator (VE) who will testify at your hearing. The judge will ask the VE to take into consideration your RFC, as determined by the judge, your age, education and prior work experience in determining:
- Whether you can return to the lightest job you held in the last 15 years,
- Whether there is other work you can do or could learn to do.
It is crucial that you are represented at a hearing to make sure the right questions are asked of the VE.
How Do I Get The Social Security Disability Benefits I Deserve?
If you no longer can work because of congestive heart failure or your doctor has told you to apply for Social Security disability, you should hire Nancy Cavey to help you:
- File your initial Social Security Disability application. The application process is confusing and designed so you make mistakes that can result in a delay or even a denial of your benefits.
- Appeal a wrongful denial of your Social Security disability application or Request for Reconsideration.
- File an Application for Hearing and represent you at the hearing with the Administrative Law Judge who will decide if you get benefits. She will have your physician, if possible, complete the right RFC(s), prepare you for the hearing, prepare a hearing brief, and be prepared to cross-examine the VE.
The SSA is in the business of denying claims and will use any reason to deny your benefits. The odds of getting your Social Security benefits are greater when you are represented by an experienced Social Security Disability attorney like Ms. Cavey.
Contact Social Security Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live in Florida
Congestive heart failure can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Ms. Cavey can explain the Five-Step Sequential Evaluation process used in every claim, the claims process and how to get your disability benefits. Call today for a free consultation at 727-894-3188.