Heart disease is a leading cause of disability. If your heart condition prevents you from working, you may qualify for SSI or SSDI. Here's what you need to know.
In this article, we'll cover:
- Heart conditions that qualify
- SSA's cardiovascular listings
- Evidence required
- Tips for approval
1. Heart Conditions That Qualify
Common qualifying conditions:
- Chronic heart failure
- Coronary artery disease
- Heart attack damage
- Cardiomyopathy
- Arrhythmias
- Heart valve disease
- Congenital heart disease
- Peripheral arterial disease
When they qualify:
- Despite treatment
- Significantly limit activity
- Prevent substantial work
- Expected to last 12+ months
What SSA looks for:
- Objective test results
- Functional limitations
- Response to treatment
- Overall cardiac health
2. SSA's Cardiovascular Listings
Section 4 of the Blue Book:
- Specific criteria for heart conditions
- Must meet precise requirements
- Based on test results
- Different listings for different conditions
Listing 4.02 - Chronic Heart Failure:
- Systolic or diastolic failure
- With specific test results
- Despite treatment
- Limiting symptoms
Listing 4.04 - Ischemic Heart Disease:
- With angiographic evidence or positive stress test
- And functional limitations
- Despite treatment
- Angina, shortness of breath
Listing 4.05 - Recurrent Arrhythmias:
- Documented by EKG
- Not controlled by medication
- Causing syncope or near-syncope
- Despite treatment
Key tests:
- Ejection fraction (EF)
- Stress test results
- Angiography
- Echocardiogram
- Holter monitor
- EKG/ECG
Important: Objective test results are critical. SSA relies heavily on cardiac testing, not just symptoms.
3. Evidence Required
Medical records:
- Cardiologist treatment notes
- Hospital records
- Procedure/surgery records
- ER visits
Test results:
- Echocardiogram with EF
- Stress test (with specific results)
- Cardiac catheterization
- EKG/Holter results
- Blood work (BNP levels, etc.)
For heart failure:
- Ejection fraction measurements
- NYHA classification
- Symptoms documented
- Treatment response
Functional limitations:
- How far can you walk?
- What activities cause symptoms?
- How often do you need to rest?
- What physical limitations?
Doctor's statement:
- Specific cardiac diagnosis
- Test results and their meaning
- Functional limitations
- Work restrictions
4. Tips for Approval
Get objective testing:
- Echocardiogram with EF
- Exercise stress test if safe
- Cardiac catheterization if needed
- Regular EKGs
Document symptoms:
- Chest pain frequency and triggers
- Shortness of breath
- Fatigue levels
- Edema (swelling)
Track activity limitations:
- How far you can walk
- Climbing stairs
- Household activities
- What causes symptoms
Follow treatment:
- Take all medications
- Attend all appointments
- Follow dietary restrictions
- Cardiac rehabilitation if recommended
Report all symptoms:
- Not just primary heart issues
- Fatigue
- Sleep problems
- Mental health effects
- Side effects of medications
Explain work impact:
- Why you can't sustain work
- Physical limitations
- Need for rest
- Unpredictable symptoms
Common Challenges
"Stable" condition:
- Stable doesn't mean able to work
- May be stable at rest but limited with activity
- Document activity limitations
- Explain what "stable" means for function
Improved after procedure:
- Some improvement doesn't mean work-ready
- Document remaining limitations
- Continued restrictions
- Ongoing symptoms
Age considerations:
- Under 55: Must show can't do any work
- Over 55: Rules more favorable
- Over 60: Even more favorable
- Age affects determination
After Approval
Continue care:
- Keep seeing cardiologist
- Document ongoing condition
- Prepare for CDRs
- Maintain treatment
Monitor benefits:
- Track payments
- Report changes
- Stay compliant
- Understand your program
How Purple Helps
Purple supports those with heart conditions:
- Track medical expenses
- Manage benefit deposits
- Simple financial management
- Less stress
- Easy banking