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CONGENITAL HEART DISEASE AND LISTING 4.06

Congenital Heart Disease can be a disabling impairment under 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. So, not all heart defects are disabling, because treatment may fix the symptoms.

If you have mild symptoms after treatment, then you would be able to work. If you can work, you do not qualify for disability benefits. However, if you heart disease symptoms are severe you may qualify for disability benefits. Therefore, you need to find the best disability attorney to help you win your case.

Your disability attorney will look closely at your symptoms of heart disease. Symptoms of congenital heart disease include abnormal heart rhythms, blue-tinted skin, especially in the lips or fingertips. Symptoms also include shortness of breath and swollen body tissue or organs. For a baby, symptoms can include failure to feed or develop normally. The medical treatments for this disease include medication to lower blood pressure and control heart rate. Additionally, treatments may include a pacemaker, catheter procedures and surgery. The most serious cases may require a heart transplant.

3d image of heart

CONGENITAL HEART DISEASE AND MEETING THE DISABILITY LISTING UNDER 4.06

Listing 4.06 is the listing the SSA uses to determine if you have a disability that qualifies for benefits. To be approved under Listing 4.06, you first must be diagnosed with congenital heart disease by cardiac catheterization or another established test. You must also experience one of the following three complications:

  • Cyanosis (blue skin due to oxygen deprivation) 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 (right to left shunting) 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 (also called Eisenmenger syndrome) that causes elevated blood pressure.

FURTHER SEVERITY REQUIREMENTS UNDER LISTING 4.06

This is SSA’s listing for congenital heart disease. As you will see, the SSA looks for specific criteria to show the severity of your condition. You must have testing from a physician 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 (see 4.00A3d) 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 disability, you must have testing to show this criteria. If you have congenital heart disease, you will already be getting treatment for one or more the of the above elements. Your medical records will prove your disability. It is crucial to have treatment for your heart disease in order to obtain benefits.

MEDICATION SIDE-EFFECTS AND OTHER SYMPTOMS THAT MAY DEMONSTRATE DISABILITY

Even if you have a desk job (“sedentary work”), if your palpitations, pre-syncopal, or syncopal episodes prevent you from concentrating on your work and staying on task, then they may be disabling. Likewise, if they require you to take frequent breaks from your job, such as having to get up and step away from your work, or require you to lie down, then they may be disabling.

The medications that you are required to take for your heart condition may affect your ability to work. For example, patients who suffer from cardiac arrhythmias are frequently treated with “beta blockers,” such as metoprolol, which may cause considerable fatigue and tiredness in some patients. That should also be documented in the medical records.

OBESITY AND EQUALING LISTING 4.06

One of the main side-effects of congenital heart disease, or any heart disease, may be obesity. Individuals with heart issues may not be able to exercise. They may have trouble running, walking, or going up stairs. Fatigue when exercising can make it hard to burn calories. Therefore, a lot of people with heart disease are overweight. Under the SSA’s rules, obesity is a factor they consider to determine disability.

Social Security Ruling 19-2p discusses how the SSA looks at obesity. Obesity, on its own, is not a listed impairment. However, the functional limitations caused by obesity, alone or in combination with another impairment, may medically equal a listing.For example, obesity may increase the severity of a coexisting or related impairment to the extent that the combination of impairments medically equals a listing. The SSA will evaluate each case based on the information in the medical record.

CONGENITAL HEART DISEASE, OBESITY, & RESIDUAL FUNCTIONAL CAPACITY

If your congenital heart disease does not meet or equal the listing, then you may be able to win benefits by proving you cannot work due to your residual functional capacity. If you have congenital heart disease and obesity, then you may not be able to exert yourself. In order to work, we must be capable of exerting ourselves. For example, we must be able to sit, stand, walk, lift, and carry. If your conditions limit your ability to do these things, it can prevent you from working a full-time job.

Additionally, you may have limitations in the non-exertional functions of climbing, balancing, stooping, kneeling, crouching, and crawling. Obesity and congenital heart disease increase stress on the body. Obesity may also affect a person’s ability to manipulate objects. Likewise, heart disease can cause severe fatigue. If you have hypoplastic left heart disease, then learn more about it on our site.

In cases involving heart disease and obesity, fatigue may affect the person’s ability to sustain work activity. The combined effects of the two impairments may be greater than the effects of each of the impairments alone. For example, someone who has obesity and arthritis affecting a weight-bearing joint may have more pain and limitations than the person would have due to the arthritis alone. If the SSA finds you have a reduced ability to complete an 8 hour workday, then you could be found vocationally disabled.

CANNON DISABILITY LAW HAS THE EXPERIENCE YOU NEED TO WIN DISABILITY BENEFITS

At Cannon Disability Law, we have 30 years of experience representing our clients in court. We have won over $100 million in disability benefits for our clients. We can help you too. Don’t go to court without excellent representation.  You need to hire a firm that is on your side. We can help you win the disability benefits you deserve.

Our law firm offers free consultations. However, we don’t take the disability case of every person who calls our office. We only accept representation in the cases that we believe the claimant has a disability that prevents them from working. If you have heart disease, call our office and see if we can help you.

You can call us for free and we can often tell you over the phone if we can help you win your disability benefits. If you are unable to call, you can also contact us using the contact page on this website. We represent clients in Utah, Nevada, Idaho, California, Washington, Colorado, Arizona, and Oregon. Also, we can help you file your application for benefits on Social Security’s website.

Contact Cannon Disability Law today and hire us to be on your disability team. We work hard for our clients and we have the experience that you need to win your benefits.

 

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