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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 SSDI or SSI benefits. However, if you heart disease symptoms are severe you may qualify for benefits. Therefore, you need to find the best SSDI attorney to help you win your case. Contact our law firm today.

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 heart condition that qualifies for benefits. To win benefits 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 medical issues:

  • 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 symptoms to show the severity of your condition. 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 (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 you should be paid benefits, you must have testing to show the above elements. If you have congenital heart disease, you will already be getting treatment for one or more of the above elements. Your medical records will prove you meet SSA’s rules. It is crucial to have treatment for your heart disease in order to win benefits.

SYMPTOMS THAT SHOW YOU CANNOT WORK DUE TO CONGENITAL HEART DISEASE

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 you may not be able to work. Likewise, if they require you to take frequent breaks from your job, such as having to get up and step away from your work, then you cannot keep up with work tasks. Additionally, your heart disease may require you to lie down during the day. This prevents work.

The medications that you must 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.

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 and also statements from your family and friends 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 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 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, is not a listed impairment. However, the functional limits caused by obesity, alone or in combination with another impairment, may medically equal a listing. For example, obesity may increase the severity of another medical condition to the extent that the combination of conditions 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 your ability to handle 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 with both heart disease and obesity, fatigue may affect your ability to sustain work activity. The combination of the two conditions may be greater than the effects of each condition alone. For example, someone who has obesity and arthritis affecting a weight-bearing joint may have more pain and limits than the person who has arthritis alone. If the SSA finds you have a reduced ability to complete an 8 hour workday, then you could be found vocationally disabled.

WHAT WE DO TO HELP YOU WIN SSD BENEFITS FOR CONGENITAL HEART DISEASE

You do not need to try to win SSD benefits on your own. Cannon Disability Law can help file your disability 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 that the SSA should automatically pay your benefits under the Compassionate Allowance Rules
  • Request reconsideration if you receive an initial denial from Disability Determination Services
  • Help you confirm your attendance at a Consultative Examination
  • Request a Hearing with an Administrative Law Judge (ALJ)
  • Prepare you to be a good witness at your SSA hearing
  • Represent you at your hearing and question the vocational and medical witnesses.
  • Read more about vocational experts here
  • Learn more about medical expert testimony here
  • Request review of an unfavorable decision with the Appeals Council
  • Request review of an Appeals Council denial in Federal Court

If you file your application for benefits online at Social Security’s website, then you have 6 months to complete the application. However, if you have a medical condition that automatically wins SSD benefits, you should not wait to finish your application. Once you submit your application online, 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, the SSA may make you start the application process over again.

CANNON DISABILITY HAS THE EXPERIENCE TO WIN 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 physical and medical condition prevents you from working. Also, we only accept cases where you are seeing a doctor and getting treatment. If you need help finding a doctor, we have resources that can help you. Read about free and low cost health resource in Utah here. 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 benefits. If you are unable to call, you can also contact us using the contact page on this website. We represent clients in in many states. Utah disability information can be found here. Nevada disability information is here. Also, we can help you file your application for benefits on Social Security’s website. If you need information about California disability benefits read here.

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

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