CONGENITAL HEART DISEASE AND LISTING 4.06

WHAT IS CONGENITAL HEART DISEASE?

Congenital Heart Disease meets SSA’s listing 4.06. The term “congenital” means that it occurs at the time of birth. Congenital heart defects are one of the most common types of birth defects. However, not all heart defects are disabling, because medical treatment may fix the symptoms.

If you have mild symptoms after treatment, then you would be able to work. If you can work, then you do not qualify for SSDI or SSI benefits. However, if you heart disease is severe for more than 12 months, then you may qualify for benefits. It is your burden to prove to the SSA that you cannot work. Therefore, you need to find the best SSDI attorney to help you win your case. We are that law firm. Contact us now.

CONGENITAL HEART DISEASE AND MEETING LISTING 4.06

The SSA uses Listing 4.06 to determine if you have a heart condition that qualifies for benefits. To win benefits under Listing 4.06, you must have congenital heart disease diagnosed by cardiac catheterization or another medical test. You must also experience one of the following medical issues:

• Cyanosis (blue skin due) at rest, and one of the following:
• Hematocrit (volume of the blood, by percentage, that contains red blood cells) of at least 55%, or
• Oxygen saturation of less than 90% in room air or resting plasma oxygenation of 60 Torr or less.
• Occasional abnormal blood flow in the heart that causes cyanosis with physical effort (for example, when walking) and with arterial plasma oxygenation of 60 Torr or less with brisk movement.
• Secondary pulmonary vascular obstructive disease that causes elevated blood pressure.

FURTHER REQUIREMENTS UNDER LISTING 4.06

SSA listing 4.06 describes what you need to prove to win benefits for congenital heart disease. As you will see, the SSA looks for specific symptoms and testing. You must have testing from a doctor to show the elements of the listing. Please see below:

4.06 Symptomatic congenital heart disease (cyanotic or acyanotic), documented by appropriate medically acceptable imaging or cardiac catheterization, with one of the following:

A. Cyanosis at rest, and:

1. Hematocrit of 55 percent or greater; or

2. Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less.

OR

B. Intermittent right-to-left shunting resulting in cyanosis on exertion (e.g., Eisenmenger’s physiology) and with arterial PO2 of 60 Torr or less at a workload equivalent to 5 METs or less.

OR

C. Secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial

systolic pressure.

In order to prove you should be paid benefits, you must have testing to show the above elements. If you have congenital heart disease, then you will already be getting treatment for the above elements. Your medical records will prove you meet SSA’s rules under step three of the review process. It is crucial to have treatment for your heart disease in order to win benefits.

CONGENITAL HEART DISEASE SYMPTOMS PROVE YOU CANNOT WORK 

Even if you have a desk job, if your heart symptoms keep you from working for eight hours, then you might get fired. Likewise, if your heart symptoms require you to take frequent breaks from your job, then your employer won’t like it. Additionally, fatigue from heart disease can prevent you from finishing work tasks. Additionally, your heart disease may require you to lie down during the day. Heart symptoms can prevent all work. For example, you receive SSD benefits for one year if you require a heart transplant.

The medications that you must take for your heart condition may also affect your ability to work. For example, patients who suffer from cardiac arrhythmias are frequently treated with “beta blockers.” These drugs can cause severe fatigue in some patients. Reports of fatigue should be part of your medical record.

You need to document these limits so that if you do not meet a heart listing, you can prove you cannot work due to your heart symptoms. The SSA will consider a statement from your doctor about your fatigue. They will also consider statements from your family about your heart condition.

OBESITY AND EQUALING LISTING 4.06

One of the main issues of congenital heart disease, or any heart disease, can be obesity. Individuals with heart issues or who have had a heart attack may not be able to exercise. They may have trouble running, walking, or going up stairs. Fatigue can make it hard to exercise. Therefore, a lot of people with heart disease are obese. Under the SSA’s rules, obesity is a factor they must consider when looking at your ability to work.

Social Security Ruling 19-2p discusses how the SSA looks at obesity. Obesity, on its own, no longer meets an SSA listing. However, the functional limits caused by obesity, alone or in combination with another condition, may equal a listing. For example, obesity may increase the symptoms of another medical condition to the extent that the combination of conditions equals a listing. The SSA will evaluate each case based on the information in the medical record.

CONGENITAL HEART DISEASE, OBESITY, & YOUR RFC

If your congenital heart disease does not meet the listing, then you may be able to win benefits by proving  your residual functional capacity (RFC). If you have heart disease and obesity, then you may not be able to exert yourself. In order to work, we must be capable to do physical activity. For example, we must be able to sit, stand, walk, lift, and carry. If your conditions limit your ability to do these things, then it can prevent you from working.

Additionally, you may have limitations in other activities, such as your ability to climb, balance, stoop, kneel, crouch, and crawl. Obesity and heart disease increase stress on the body. Obesity may also affect your ability to handle objects. Likewise, heart disease can cause severe fatigue. If you have hypoplastic left heart disease, then learn about it.

In cases with both heart disease and obesity, fatigue may affect your ability to work. The combination of the two conditions may be greater than the effects of each condition alone. For example, someone who has obesity and lupus may have more joint pain than the person who has obesity alone. If the SSA finds you can’t work eight hours a day, then you win benefits using the Medical Vocational Guidelines.

WE HELP YOU WIN SSD BENEFITS FOR CONGENITAL HEART DISEASE

You do not need to try to win SSD benefits on your own. Our law firm can help file your SSD application. Also, we can help you file an appeal after every SSA denial. That way, you can focus on your health. Our attorneys and staff can:

• Send you the paperwork you need to become our client
• Help you file your application for SSD and SSI benefits
• Inform the SSA they should pay your benefits under the Compassionate Allowance Rules
• Request an appeal if you receive a denial
• Help you confirm your attendance at an SSA doctor exam
• Request a Hearing with an Administrative Law Judge
• Prepare you to testify at your ALJ hearing
• Represent you at your hearing and question the expert witnesses
• Read about job expert testimony
• Learn about medical expert testimony
• Request review of any SSA decision with the Appeals Council
• Request review of an Appeals Council denial in Federal Court

If you file your application for benefits on Social Security’s website, then you have 6 months to complete it. However, if you have a medical condition that automatically wins SSD benefits,  then you should finish your application quickly. Once you submit your application, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. If you don’t send it back in time, then the SSA may make you start the application process over again.

IS IT WORTH THE ATTORNEY FEE TO HIRE AN SSD LAWYER?

It isn’t easy to get Social Security benefits and the application process can be frustrating for most people. But, having an attorney throughout the appeal process can make it easier. When you have a law firm with experience handling your case, then the SSA follows their own procedures. Without an attorney, they might not.

Additionally, when you have an attorney with legal experience, they will have access to Social Security’s decisions throughout the process. They can also submit medical evidence that may be missing from your case.

There is evidence that hiring an attorney with experience triples your chances of winning SSDI and SSI benefits. It is also smart to hire an attorney to help you at your hearing. After all, you are the star witness at your hearing. If you hire an attorney with experience, then they can prepare you to testify. Learn how to prepare for your SSD hearing.

HOW WILL YOU PAY THE ATTORNEY FEE?

We will use our legal skills to help you through the Social Security appeal process. It is our goal to win your congenital heart disease case. But, it also our goal to make the appeal process easier for you.

We offer a free review of your case. If you call, there is no pressure to become our client. You ask questions, we answer. Even if we don’t accept your case, we will still try to help you.

It also doesn’t cost you any upfront money to hire us. Why? Because you only pay us an attorney fee if we win your case. If we win, then the SSA pays us out of your back benefits. Learn about past due disability benefits. If you do not win, then you do not pay an attorney fee.

How much is the attorney fee? The attorney fee is whatever is less between 25% of your back benefit and the fee cap. You can understand this through an example. If your back benefit is $10,000, then your attorney fee would be $2500.

However, if your back benefit is $100,000, you would not pay 25% or $25,000 in attorney fees. Instead, you would pay the amount of the fee cap. In November 2024, the fee cap will be $9200. Therefore, if you win your case after that date, then the cap on fees is $9200.

Regardless, you pay whatever is less between 25% of your back benefit and the fee cap. Additionally, you only owe an attorney fee if we win your case. Find out what it costs to hire our law firm.

OUR LEGAL EXPERIENCE WINS BENEFITS FOR CONGENITAL HEART DISEASE

At our law firm, we have 30 years of experience helping our clients win benefits in court. We have won over $100 million in SSDI and SSI benefits for our clients. Many of those cases have been for congenital heart disease. We can help you too. Don’t go to court without an excellent lawyer.  You need to hire a firm that is on your side. We can help you win the SSDI benefits you deserve.

Our law firm offers a free review of your case. However, we don’t take the case of every person who calls our office. We only accept the cases where your medical conditions prevent you from working. Also, we only accept cases where you are seeing a doctor and getting treatment. If you need help finding a doctor, then we have resources to help you. Review free and low cost health resources in Utah. If you have heart disease, then call our office and see if we can help you.

You can call us for free. Often, we can often tell you over the phone if we can help you win benefits. If you are unable to call, then you can contact us using our contact page. We represent clients in in many states. Therefore, you can review information about Utah SSI and SSDI benefits. Learn about Nevada SSD benefits. Also, we can help you file your application for benefits on Social Security’s website. Also, learn about California SSDI and SSI benefits.

Contact our law firm today. Hire us to be on your legal team. We work hard for our clients. And, we have the experience you need to win your benefits for congenital heart disease.