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Social Security Disability Benefits For Congestive Heart Failure

I have been diagnosed with congestive heart failure. Can I get Social Security Disability benefits (SSI/SSDI), Disability Insurance Benefits (DIB), or Supplemental Security Income benefits (SSI)?

Have you received a diagnosis of congestive heart failure? This is just the start. You can expect that the main focus in your Social Security disability claim will be on the symptoms you experience from congestive heart failure and how those symptoms affect your ability to engage in physical and mental work-related activities eight (8) hours per day, five (5) days per week.

Can you get disability if you have heart failure?

“Congestive heart failure” is actually an umbrella term that refers to various forms of heart failure involving the congestion of fluids in the body. The congestion happens when the heart weakens and fails to pump blood efficiently, causing the kidneys to retain more fluid.

As a result, you may experience symptoms such as shortness of breath (especially when you lie down), fatigue, swelling in your legs and feet, irregular heartbeat, and increased need to urinate. While these seem like mild inconveniences, there are more severe symptoms of heart failure that may require emergency treatment such as chest pain, severe weakness or fainting, and coughing up pink mucus.

Severe heart failure can be life-threatening by itself, but it may also lead to complications like kidney damage and liver damage.

It is clear that this condition can affect your daily activities, but to confirm that it disables you, the Social Security Administration (SSA) uses a five-step evaluation process:

Step 1. Are you working?

Your work activity is the first thing the SSA considers. If you are engaged in Substantial Gainful Activity (SGA) you will not be found disabled. The amount you must earn to be working at SGA changes each year. For 2018 it is $1,180 per month if you are not blind and $1,970 per month if you are blind. If you are working, and your earnings average more than the SGA limit, then you will not be found disabled. If you are not working, or your earnings are less than SGA, the process proceeds to Step 2 where your congestive heart failure and any other conditions are considered more closely.

Step 2. Is your medical condition “severe”?

A disability entails that your medical condition significantly limits your ability to do basic work activities such as sitting; standing; walking; lifting; carrying; understanding, remembering, and carrying out simple instructions; making simple work-related decisions; responding appropriately to supervision, co-workers, and work stress; and dealing with changes in a routine work setting.

By SSA standards, to be found disabled, you must have a medically determinable physical or mental impairment (or a combination of impairments) that is severe and has lasted or is expected last one (1) year or end in death. If your medical condition is not that severe, you will not be found to meet the requirements for Social Security disability benefits. But if your condition is that severe, you can proceed to the next step.

Step 3. Does your medical condition meet or equal the severity of a Listing?

There is a list of medical criteria maintained by the Social Security Administration. These criteria are considered to be so severe that you will be found disabled if your medically determinable physical or mental impairment(s) matches them. The Adult Listing for heart failure can be found here.

If you do not have an impairment that meets or equals one of the listings, or if the duration requirement is not met, the SSA determines instead your Residual Functional Capacity (RFC).

In simple terms, the RFC is what you’re capable of doing despite your impairments. The SSA conducts a function-by-function assessment of your maximum ability to do sustained work-related physical and mental activities on a regular and continuing basis (8 hours a day, for 5 days a week) despite the limitations and restrictions resulting from your medically determinable impairments.

Step 4. Can you do any of the jobs you have performed in the past fifteen (15) years?

The SSA checks if your medical condition prevents you from being able to work full-time at jobs you have done in the past fifteen (15) years. If the SSA decides you can perform any of your past relevant work (PRW), you will be found not disabled. To be PRW, the work must have been substantial gainful activity (SGA); performed in the fifteen (15) year relevant period; and performed long enough to learn the job. If the SSA decides you cannot perform your past relevant work, or if you have not worked in the past fifteen (15) years, the process moves on to Step 5.

Still here at Step 4, you are required to present evidence – or in legal terms, you have the “burden of proof”. Two of the strongest types of evidence at this stage are medical records and the opinions of the doctors who are treating you for the conditions that are affecting your ability to work. The strongest medical evidence is what is known as objective medical evidence, or evidence that does not rely upon what you tell your doctors. The strongest opinions are opinions that are offered by doctors who specialize in the condition that is keeping you from working and which are supported by objective medical evidence.

Some types of objective medical evidence that can support a claim for disability based upon congestive heart failure include:

  • Cardiovascular test results – May include electrocardiograph or electrocardiogram (ECG), exercise tests, magnetic resonance imaging (MRI), angiography, and ultrasound.
  • Detailed reports of history
  • Physical examinations
  • Laboratory studies
  • Any prescribed treatment and response
  • Longitudinal clinical record – This must cover not less than three (3) months of observations and treatment.

Doctors who specialize in treating heart failure include:

  • Internists – These doctors are specially trained on the body’s internal organs.
  • Cardiologists – These highly-trained doctors focus on the heart and blood vessels.
  • Cardiac electrophysiologists – They specialize in heart rhythm issues and can prescribe cardiac devices like pacemakers.
  • Cardiac surgeons – They are doctors who perform various types of heart surgery.

For your health and for the sake of your claim, don’t just rely on a primary care doctor or your family doctor to treat your heart failure. Specialists are crucial for this condition. If you don’t treat with a specialist, the SSA may interpret this as meaning that your condition is not that serious (otherwise you would be treating with a specialist). An experienced Social Security disability lawyer can help you locate sources of treatment (even if you don’t have health insurance).

Step 5. Can you do any other type of work?

Now, the “burden of proof” shifts to SSA. If you cannot do your past relevant work, the SSA looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience, and any skills you may have that could be used to do other work. If you can do other work, the SSA will determine you are not disabled. If you cannot do other work, the SSA will find you disabled.

If you are older than 50, there are special rules that may apply to your claim that can result in a finding of disability even if there is some other work you could perform on a full-time basis. An experienced Social Security disability lawyer will be familiar with these rules and can ensure that they are considered during your evaluation.

Heart failure is no easy burden. The physical suffering you experience likely impairs other aspects of your life such as your finances, and you may truly deserve assistance. Receiving disability benefits can be a valuable relief for you and your loved ones.

Contact Gillette Law Group

To ensure that you have an effective disability application, let the Gillette Law Group help you. Over the years, we have served many claimants like you and enabled them to successfully receive benefits from the SSA, regardless if it was their first time applying or if they had a previously-rejected claim. Our in-depth experience can work for you and help you get the approval you need.

Don’t hesitate to talk to us, as we provide you with a free consultation. Call us at (855) 873-2604 today.

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