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Social Security Disability Benefits For Heart Transplant
I have undergone a heart transplant. Can I get Social Security Disability benefits (SSI/SSDI), Disability Insurance Benefits (DIB), or Supplemental Security Income benefits (SSI)
Undergoing heart transplantation is just the start of pursuing a claim. The main focus in a Social Security disability claim is usually on the symptoms you experience from your heart transplant 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.
Heart transplantation (also known as cardiac transplantation) is the surgical procedure of replacing a person’s damaged heart with a healthy heart from a donor. This is needed when the patient’s heart failure is so severe that it doesn’t respond to other treatments, but the patient has otherwise good health. Some leading conditions that lead to heart transplants are dilated cardiomyopathy, scarred heart tissue, and birth defects of the heart.
The majority of patients who have a heart transplant experience a generally good quality of life, without becoming an invalid. However, there are restrictions and problems that could potentially arise after transplantation. Patients may have a restriction on physical activities such as exercise. More serious risks include infection, organ rejection, and coronary artery disease. Patients who have to take transplant-related drugs are also at risk for a variety of diseases such as kidney damage, osteoporosis, and high blood pressure. In severe cases, post-transplant complications may lead to death.
Can you get disability if you have heart failure?
The Social Security Administration (SSA) considers all heart transplant recipients disabled for one year after their surgery. If a patient suffers organ rejection or failure, he/she may qualify for the Compassionate Allowances program, which has a faster evaluation process than the regular disability program. Otherwise, the patient will have to go through the regular evaluation process after a year, for the SSA to see if he/she has continuing disability. The agency has a 5-step process to decide if you are still disabled a year after your surgery.
Step 1. Are you working?
At the first step, the SSA considers your work activity. 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 $1,970per 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 heart transplant and any other physical or mental conditions are considered.
Step 2. Is your medical condition “severe”?
By SSA standards, disability means 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.
To be found disabled, you must have a medically determinable physical or mentalimpairment (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. If your condition is that severe, SSA goes to Step 3.
Step 3. Does your medical condition meet or equal the severity of a Listing?
The SSA has a list of medical criteria that are considered to be sosevere that you will be found disabled if your medicallydeterminable physical or mental impairment(s) matches them.The Adult Listing for heart transplantation can be found here.
If your impairment does not meet or equal one of the listings, or the duration requirement is not met, SSA determines what you’re capable of doing despite your impairments – your Residual Functional Capacity (RFC) – and will proceed to Step 4.
Your RFC is a function-by-functionassessment of your maximumability to do sustained work-related physicaland mental activities on a regular andcontinuing basis (8 hours a day, for 5 days aweek) despite the limitations and restrictionsresulting from your medicallydeterminable impairments.In short, it is an evaluation of your capacity for full-time work.
Step 4. Are you able to do any of your jobs in the past fifteen (15) years?
At this step, SSA decides 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 SSA decides you can perform any of your past relevant work (PRW), you will be found not disabled. To be PRW, the workmust have beensubstantial gainful activity(SGA); performed in the fifteen (15) year relevant period; and performed long enough tolearn the job. If SSA decides you cannot perform your past relevant work, or you have not worked in the past fifteen (15) years, SSA goes on to Step 5.
Still here at Step 4, 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 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 heart transplant include:
- Results from the Heart Transplant Breath Test
- Results from the Heart Transplant Rejection Test
- Results from the test for Graft vs. Host Disease
- Any treatment and response
Doctors who specialize in handling heart transplants include:
- Cardiothoracic surgeons – specialize in surgeries involving chest organs
- Transplant cardiologist – specialize in heart conditions.
If you are only treating with your family doctor or primary care doctor for your heart transplant 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. Are you able to do other work?
The “burden of proof” shifts to SSA at Step 5. If you cannot do your past relevant work, 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, SSA will determine you are not disabled. If you cannot do other work, 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 in the evaluation of your case.
A heart transplant gives you another chance at life, but it does not guarantee that you’ll be healthy enough again to support yourself and your family. If you are hindered from earning after your surgery, you may want some form of assistance – and with the help of a good lawyer, you may be able to receive the assistance you deserve.
Contact Gillette Law Group
We at the Gillette Law Group have years of experience helping disability applicants pursue an effective claim. Our lawyers’ services allow you the best chance at getting approved by the SSA. Consult with us for free. Call (855) 806-4269 today.