In several of my blog posts I have examined what symptomatology the Social Security Administration (SSA) looks for when reviewing medical records for the purposes of awarding disability benefits. In today’s blog post I’m going to talk about another common ailment that I see a lot of in my disability practice, Chronic Heart Failure (CHF), and how the SSA determines the severity of their impact on a claimant’s ability to perform their past or any other work.
Chronic Heart Failure and Similar Ailments
The CHF listing can be found tucked away in the SSA’s 4.00 Cardiovascular System – Adult listings section, specifically 4.02 Chronic heart failure. To put it broadly, CHF is basically when your heart begins to weaken and can no longer pump blood effectively. This ailment can be brought on by a number of heart-related conditions, including but not limited to heart attack residuals, hypertension, coronary artery disease, infections located in the muscle itself and alcohol abuse.
Other than CHF, common examples of this group of ailments include Ischemic Heart Disease, Recurrent Arrhythmias, Symptomatic Congenital Heart Disease, Heart Transplants, Aneurisms of the Aorta or other Major Branches, Chronic Venous Insufficiency and Peripheral Arterial Disease.
Symptoms and Severity
When an individual suffers from CHF its associated symptoms can be severe. Often my clients experience a profound loss of stamina and wind, which in and of itself may lead to regular coughing fits. This greatly impedes individual recovery, as often doctors will prescribe physical therapy that the claimants just cannot complete.
Attempting to perform common tasks or chores will often overwhelm them. They may experience pronounced swelling and fluid retention. And most frightening may be regular chest pains, leading the claimant to believe a(nother) heart attack may be on the way. Moreover, beyond these physical symptoms, CHF can also foster psychological ailments such as depression and anxiety just to complicate matters further.
Letter of Support
One way we try to nail down the severity of the condition is to request the client’s heart doctor to produce a letter of support that encompasses the American Heart Association’s Classes of Heart Failure, which in turn is based on the old New York Heart Association Functional Classifications.
It consists of both observations of a patient’s symptoms and a review of the available objective medical evidence, e.g. various diagnostic results, etc. There are four classes in the symptoms category:
- Class One is where there is “[n]o limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
- Class Two is where the claimant exhibits “[s]light limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
- Class Three is when the individual exhibits a “[m]arked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.”
- Class Four is when the sufferer is “[u]nable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.”
If we can get the treating heart physician to produce a letter of support identifying their patient as being in either a Class Three or Class Four stage, they are typically found to be disabled. I won’t list the objective category items as again they are related to test results.
Chronic Heart Failure Listing According to SSD
Below is the complete CHF listing for those interested in the details:
4.02 Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2. The required level of severity for this impairment is met when the requirements in both A and B are satisfied.
- Medically documented presence of one of the following:
- Systolic failure (see 4.00D1a(i)), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or
- Diastolic failure (see 4.00D1a(ii)), with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure);
- Resulting in one of the following:
- Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or
- Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e), with evidence of fluid retention (see 4.00D2b(ii)) from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization (see 4.00D4c); or
- Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
- Dyspnea, fatigue, palpitations, or chest discomfort; or
- Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
- Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise (see 4.00D4d) due to left ventricular dysfunction, despite an increase in workload; or
- Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.
If you or your child have been denied SSA disability benefits or suffer from a severe impairment that is expected to last for more than twelve months and that prevents you from doing any of your past or other work or is causing developmental delay in your child, please contact our office nearest to you to set up a free consultation appointment to discuss your situation.