HEART FAILURE & DISABILITY – LISTING 4.02

WHAT IS HEART FAILURE?

Heart failure is a significant public health concern in the United States, because it affects 6.7 million adults. This chronic condition, which occurs when the heart cannot properly pump blood to meet the body’s needs, is a leading cause of disability nationwide.

Heart failure is the inability of the heart to pump enough oxygenated blood into your body. Another term for heart disease is cardiovascular disease. Or, diseases which affect the cardiovascular system. This system includes the heart and its arteries, veins and capillaries.

Heart failure has certain symptoms and signs. Those include pulmonary or systemic congestion or limited cardiac output. The SSA states certain findings of cardiac function and structural abnormality support the diagnosis of chronic heart failure. For the purpose of SSD benefits, there are two main types of chronic heart failure which are discussed below.

THE TWO TYPES OF CHRONIC HEART FAILURE

1. Predominant systolic dysfunction (the inability of the heart to contract normally and expel sufficient blood). This occurs when one has a dilated left ventricle with a low ejection fraction. An ejection fraction is the percentage of the blood in the ventricle actually pumped out with each contraction.

2. Predominant diastolic dysfunction (the inability of the heart to relax and fill normally). This occurs when one has a thickened ventricular muscle. Also, you will see poor ability of the left ventricle to distend, increased ventricular filling pressure, and a normal or increased ejection fraction.

The term cardiovascular disease is often used for coronary artery disease, which is the most common form of heart disease in the United States. That is the condition in which blood vessel blockages create heart attacks and other heart problems.

However, cardiovascular disease also refers to other conditions. For example, it refers to an abnormal heart beat, infections, and other heart defects. The causes of heart disease vary. Your diagnosis depends on your specific symptoms. Common symptoms include atherosclerosis, high blood pressure, and genetic factors such as birth defects.

HOW TO APPLY FOR SSD BENEFITS DUE TO HEART FAILURE?

If you have chronic heart failure, then you should apply for SSDI and SSI benefits. You can apply for SSD benefits on the SSA’s website. When you fill out SSA’s forms, do not forget to write about how your heart disease impacts your ability to work.

The easiest way to apply for benefits is using your computer. You can apply online for SSDI and SSI benefits by filing an application on Social Security’s website. The SSA has made it easy for those with access to a computer to apply for benefits. It is also easy to complete the forms online to begin the five step Social Security review process.

You can also apply for SSDI and SSI benefits over the phone. Once you have called the SSA, they will send you the forms you need to complete by mail. You will need to have a current mailing address to receive the forms. Even if you get the forms in the mail, the day you call the SSA is your “protective filing date.” In other words, the day you call the SSA is the day they will state that you filed your application. This date is important because it is the day the SSA uses to figure out when you should be paid benefits.

Finally, you can apply for benefits in person at your local SSA office. This is not a great option, because the lines at the SSA offices are long. However, every city has local Social Security offices which you can visit. However, you must now make an appointment to file an SSD application. Your local office can help you complete the forms to apply for SSD benefits.

SSA’S LIST OF THE VARIOUS KINDS IF HEART DISEASE

• Chronic heart failure – occurs when the heart is unable to supply enough blood to the body because it has become weak. The heart becomes weak due to heart attacks or heart defects. This includes faulty function of the heart’s ventricles. It also includes high blood pressure. Heart failure often leads to severe fluid retention and this is known as congestive heart failure.
• Ischemic heart disease – occurs when the heart muscle is unable to get a sufficient blood supply. The usual cause for this is a blockage or coronary heart disease.
• Recurrent arrhythmias – occurs when the heart rate is abnormal. It is either too fast or slow. This kind of arrhythmia can cause you to faint. It can also cause cardiac arrest.
• Symptomatic congenital heart disease – occurs when there are birth defects in the heart.
• Heart transplant – occurs when the heart stops working and surgeons replace the heart. Heart replacement due to heart disease qualifies as a disability for up to 1 year after the surgery.
• Aneurism of aorta or branches – occurs when there is swelling in the major arteries of the heart due to heart disease. For information about aneurisms, learn about Marfan syndrome.
• Chronic venous insufficiency – occurs when there are circulation problems due to damaged veins. You can see the damage when the legs swell. This causes skin pitting and discoloration of the legs.
• Peripheral arterial disease – occurs when there is poor function of outlying arteries.

If you have heart disease in the form of any of these conditions, then you may qualify for SSD benefits. You should seek the help of an attorney to help you file for SSDI and SSI benefits.

THE SYMPTOMS OF HEART FAILURE

Often the symptoms of heart disease come on suddenly, in the form of a heart attack or cardiac arrest. However, if your doctor finds your heart condition early enough, then you can get treatment. Treatment will prevent further heart damage. You can work on heart failure issues, such as weight loss, even if you already have a heart condition.

The most common symptoms of heart disease are chest pain. Additionally, if you have heart disease you may have trouble breathing. You may also have pain or numbness in your arms. Weakness and fatigue are also common problems. For example, many people with heart failure experience cold arms and legs due to lack of  blood flow.

Heart disease treatment includes diet and exercise, medications, and surgery. Additionally, you may need to take blood thinners to prevent heart attacks and strokes. Cardiovascular diseases can restrict all your activity. If you are suffering from a form of heart disease, you may not be able to work.

HOW YOUR DOCTOR DIAGNOSES HEART FAILURE

History and Physical Exam

During a physical exam, a doctor will listen to your heart and lungs, and review your blood pressure and weight. The doctor will also ask you about your:

• Family medical history
• Smoking or vaping
• Medications
• Personal medical history
• Symptoms

Blood Tests

Part of the heart failure exam is a series of blood tests to check for problems with your heart or other organs. These tests measure:

• Sodium and potassium
• Albumin (which helps determine how well your liver is working)
• Creatinine (which helps measure how well your kidneys are working)
• Biomarkers that indicate heart failure

Echocardiogram and Ejection Fraction

Echocardiography uses sound waves to create images of your heart. It can show how thick the heart muscle has become and how well the heart is pumping. Echo is also used to measure your ejection fraction (EF). That is  the percentage of blood the left ventricle of the heart pumps out with every heartbeat. It is a sign of how healthy your heart is. The healthy range for an EF measurement is 50 to 70 percent. An EF that is higher or lower can indicate an unhealthy heart. If your EF is below 30% you will experience fatigue on exertion.

Cardiovascular Imaging Tests

Your medical team may sugges cardiovascular imaging services including:

• Left heart catheterization: Your doctor inserts a small tube into an artery in your leg or arm and it passes through to your heart. A special dye that can reveal blocked arteries is injected into the tube. X-rays of your heart show blockages.
• Right heart catheterization: Your doctor inserts a small tube into a vein in your leg, arm or neck and passes it to your heart. The catheter measures pressure in different chambers of your heart and pulmonary artery. These pressures show how fluid accumulates. That information can be used to calculate how much blood your heart is pumping with every beat.
• Chest X-rays and MRI: These tests take pictures of the inside your chest. They can show whether your heart is enlarged or damaged. They can also show if you have extra fluid in your lungs. An MRI can reveal the causes of your heart failure.

THE FOUR STAGES OF HEART FAILURE

There four stages of heart failure are similar to the four classes of heart failure defined by the New York Heart Association. The first stage is the least severe and the fourth stage is the most severe.

The First Stage of Heart Failure – Stage A

The first stage of heart failure is Stage A. Stage A is prior to heart failure. It means you are at risk of heart failure because of your genetic history or your family history of heart failure. The medical conditions listed below also contribute to Stage A.

• hypertension
• coronary artery disease
• diabetes
• family history of cardiomyopathy
• rheumatic fever
• alcohol abuse
• taking drugs that damage the heart muscle

The Second Stage of Heart Failure – Stage B

Stage B is known as silent heart failure. This means you have systolic left ventricular dysfunction but do not have the symptoms of heart failure. Most people realize they have Stage B heart failure when they undergo an echocardiogram and it shows an EF of 40 per cent or less.

The Third Stage of Heart Failure – Stage C

If you have Stage C heart failure, then you have heart failure with specific signs and symptoms. Although there are many symptoms of heart failure, the following are the most common:

• shortness of breath
• fatigue
• low exercise tolerance
• swollen feet and ankles
• edema in the lower legs and abdomen

The 4th Stage of Heart Failure – Stage D

If you have Stage D heart failure, then your heart symptoms will not get better with treatment. This is the final stage of heart failure. You will have the symptoms listed above in the third stage. However, you will also have heart failure symptoms when you are sitting or at rest.

MEETING SSA’S LISTING 4.02 FOR CHRONIC HEART FAILURE

Listing 4.02 is SSA’s rule that you must meet to be paid benefits for chronic heart failure. In order to be found disabled by heart failure, you must have each element of the listing. For example, you must have the criteria under Part A and  Part B. Having only one aspect of the listing will not result in monthly disability payments.

4.02 Chronic heart failure while on a regimen of medical treatment, with symptoms and signs described in 4.00D2. The required level of severity for this condition is met when the requirements in both A and B are satisfied.

A. Medically documented presence of one of the following:

1. 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

2. 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);

AND

THE PART B CRITERIA UNDER LISTING 4.02

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 a doctor, 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 (ventricular tachycardia), 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 (see 4.00D4d) due to left ventricular dysfunction, despite an increase in workload; or

d. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.

YOUR RESIDUAL FUNCTIONAL CAPACITY IF YOU HAVE HEART FAILURE

If the SSA decides that you do not meet listing 4.02, you may still be found disabled considering your Residual Functional Capability (RFC). Given your physical limits, the RFC explains the most you can do on the job.

You will be given an RFC level of either seated work, light work, or medium work. This will be based on the restrictions your doctor has given you. If SSA determines you cannot perform full time work, then you will paid SSD benefits.

It is important that you send all of your medical records to the SSA. This includes medical evaluations and progress notes from your primary care doctor. Additionally, you will need all of the records from your heart doctor. Make sure you include medical tests like a heart biopsy, stress tests, chest X-rays, and EKGs. You should also include coronary angiography tests, cardiac MRIs, CT scans, and Holter Monitor tests. Additionally, you should submit blood tests.

Your medical records should document the symptoms you have. For example, heart disease may cause you severe fatigue, breathing problems, and angina. These symptoms need to be part of your RFC evaluation. You should ask your doctor to document your limitations. This should include problems in your ability to stand, sit, walk, carry, stoop, and climb stairs.

HEART FAILURE PREVENTION

The Center for Disease Control has several programs that address heart disease and stroke. Learn about DHDSP’s investments in heart disease and stroke prevention PDF. If you want additional information about keeping your heart healthy, then review the CDC heart site. Also, you can find out information about congenital heart disease.

It is up to each one of us to eat a heart healthy diet and exercise every day. Even just 10 minutes of walking can help prevent heart disease and many other physical health conditions. When you want to watch TV or you feel too tired to exercise, then go on a short walk. Just walk around your block. This simple ten minute walk increases your daily exercise. Over time, it can make a difference in your heart health.

WHAT OUR LEGAL TEAM DOES FOR YOU

At our SSD law firm, we can help you apply for benefits. Also, we can help you appeal a denial from the SSA. Likewise, we can represent you in court.  If necessary, we can also appeal your case to the Appeals Council. Additionally, we can file an appeal in Federal Court.

Typically, we do not appeal to Federal Court on cases that other attorneys have lost at the Appeals Council. However, we will review your case if you need to appeal to Federal Court. If we can help you, then we will. Also, we can represent you no matter where you live, whether it be Utah, Idaho, or Nevada. Learn information about Utah SSD benefits and Nevada SSDI and SSI benefits. Colorado SSD benefits information is also available. As is California SSD benefit information. Also, learn about Idaho SSD benefits.

We bring over 60 years of legal experience to your SSD case. For instance, Dianna Cannon has been helping her clients win SSD benefits for over thirty years. Brett Bunkall and Andria Summers also have many years of legal experience winning SSD cases.

Together, we have won over 20,000 SSD hearings. You can trust that we will do everything we can to win your SSDI and SSI benefits. Because that is what we do.

HIRE US WITHOUT PAYING AN UPFRONT FEE

We will use our skills to help you through the five step Social Security review process. It is always our goal to win your case. But, it also our goal to make it easier for you. We offer a free review of your case. There is no obligation to become a client if you call. You can simply ask us questions.

It doesn’t cost you any money to hire us. Why? Because you only pay us an attorney fee if we win your case. This means if we win, then you pay us out of your past due benefits. If you do not win, you do not pay an attorney fee. How much is the fee? It is 25% of your back benefit. Also, the SSA caps attorney fees at $9200. You never pay more than SSA’s cap. And, 25% of your back benefit is usually less than the cap. You pay the lesser amount.

If there are costs in your case, then you pay those. Attorneys cannot pay the client costs. However, costs are usually less than $100. Typically, the only cost for you is to pay for your medical records.

Most doctors don’t charge more than $25 to $50 for copies of records. You will owe those costs whether we win or lose your case. But, you pay attorney fees out of your back benefit. However, you do not pay anything from your future benefits. And, you only pay for an attorney fee if we win your case. To hire most lawyers, you have to pay upfront. We don’t work like that. When we win your case, you pay the attorney fee. That is fair for everyone. Hire us to win your SSD benefits for heart failure.