How to Get Disability Benefits for Heart Failure

Heart failure is considered a disability by the Social Security Administration (SSA). To qualify for disability with heart failure, you must be out of work for at least 12 months. The SSA will use the Blue Book to determine if you medically qualify for disability with heart failure. You will also need to have enough work credits. 

Applying for Disability Benefits with Heart Failure

If you suffer from heart failure and are unable to work, you may be able to qualify for disability benefits. Social Security disability benefits are available for those with heart failure who qualify under the blue book listing. Here are the following steps you need to take to apply for disability benefits for heart failure.

1. Finding a Disability Lawyer 

When applying for disability benefits with heart failure, consulting a disability lawyer can make a significant difference in the outcome of your claim. Heart failure cases can be complex – detailed medical records and a deep understanding of SSA guidelines is needed. 

A disability lawyer with experience in cardiovascular cases can help you with the difficult steps it takes to apply. They can assist in collecting and presenting the most relevant medical evidence, which ensures that your condition is correctly represented in your application. 

Your lawyer will also assist you during the appeals process if your initial claim is denied. A disability lawyer can help you avoid common mistakes during the application process and strengthen your case, increasing the odds of your claim being approved.

2. Criteria for Heart Failure

Heart failure is listed under Section 4.00 of the SSA Blue Book, which deals with the various kinds of heart failure and symptomatic heart disease as well as cardiac transplants. Section 4.02 addresses heart failure that is chronic.

In order to be qualified for SSDI due to chronic heart failure, you must be continuously undergoing prescribed treatment. In addition, you must meet a certain criteria in the Blue Book.

You must have been diagnosed with chronic heart failure, and it should have been evidenced by one of the following:

Systolic failure of the heart with left ventricular having end diastolic dimensions of more than 6.0 cm or have an ejection fraction reaching 30% or less when the heart is stable and not during an acute episode.

AND

The previously mentioned condition results in the persistent symptoms of heart failure that cause serious limitations impairing your ability to independently take care of daily tasks. Also, you cannot perform any exercise tests without having significant health risks.

OR
You have experienced three or more unique congestive heart failure episodes within a year. There must also be fluid retention that can be validated using clinical and imaging assessments at the time of the attack and extended physician intervention was required.

OR
You cannot perform an exercise test with a workload of 5 METS or less because of severe symptoms, three or more episodes of tachycardia, left ventricular dysfunction causing a decrease of 10mm HG or more systolic pressure, or ataxic gait or mental confusion, or one of several other problems.

If you don’t meet the disability requirements per the Blue Book, you may still be able to qualify using the vocational medical allowance. Your doctor will be asked to complete a residual functioning capacity (RFC) form that will completely detail how your ailment has impacted your life. 

Providing as much documentation as possible for your case can help you more easily win your benefits because they have evidence of your condition and how your life is severely impacted. 

It’s important to understand that you can only apply for Social Security benefits if you’ve been unable to work for the past 12 months, or have a condition that will put you out of work for the next 12 months.

You’ll also have to make sure you meet the work and financial requirements. You need to have earned enough work credits for your age group. Work credits are earned by working and paying Social Security taxes. You’re able to earn up to 4 work credits each year.

If you’re applying for SSDI, you need to ensure you’re earning under the substantial gainful activity (SGA) limit, which is $1,550 for non-blind individuals. SSI is more of a needs based program, so the total asset limit is $2,000 for individuals, and $3,000 for couples.

If you have a disability attorney, they will work closely with you and your doctor to go over the medical, work, and financial criteria and understand if you meet it or not.

3. Gathering Medical Evidence for Your Case

Following the criteria stage, you and your lawyer need to get in contact with your doctors to start collecting medical records to support your heart failure claim. This should include detailed records from your cardiologist. 

There are several medical tests used to diagnose heart failure. Those tests include chest X-rays, ECGs, echocardiograms, stress tests, heart catheterization, MRIs, and nuclear heart scans. Your physician may also order creatinine tests, liver functioning panels, complete blood counts, and a urinalysis.

It's also crucial to include records of any hospitalizations, notes on treatments, medications, lifestyle changes, or surgical interventions like a pacemaker or defibrillator implantation. 

Statements from your healthcare providers that describe how heart failure limits your physical capabilities and ability to perform daily activities can be a deciding factor in your case as well. Documenting the progression of your condition and worsening symptoms will help demonstrate the severity of your heart failure to the SSA. 

Your lawyer will know exactly what medical evidence you need to provide to the SSA to present your case in a favorable way, giving you the best chance of approval. The more detailed and specific your medical evidence, the stronger your application will be.

4. Submitting Your Application for Heart Failure

After collecting medical evidence with the help of your doctors and lawyer, it’s time to complete your application and submit it to the SSA. When filling out the application, it’s critical that you’re thorough in detailing how heart failure affects your ability to work and carry out daily activities. 

Make sure to include all relevant medical records that you collected, like test results, treatments, medications, and doctors’ notes. It’s important to describe your symptoms in detail, particularly how they limit your physical capabilities and ability to perform even basic tasks. 

Applications are available online, over the phone, or in person at a SSA office. Your lawyer will make sure to double and triple check everything you’re planning on submitting to ensure it’s filled out completely.

An incomplete application can cause delays or denials, so making sure that everything is in order ensures a smooth application process.

5. Following Up on Your Application 

Once your application is submitted, the waiting game begins. The process typically takes 1-2 months before a decision is made and you’ll want to track your application to see how far along it is in the decision process. 

You can monitor the status of your application online through the SSA’s website or by contacting their offices directly. It’s important to stay updated on your application to be able to promptly respond to additional requests or next steps from the SSA. Failing to do so could result in a denial.

Stay in touch with your lawyer during this process, as they can help you submit additional evidence if needed and understand next steps. By keeping track of your application’s progress, you ensure your claim continues moving forward smoothly.

6. Filing an Appeal if Necessary

In 70% of disability cases, the initial application submitted is denied. The good thing is you’re able to appeal this decision, and if you’re working with a disability attorney, they’ll know the exact steps to take to do this. The appeals process can be tough, but it gives you another opportunity to receive the help you need. 

Your first step will be to request a reconsideration, where your application will be reviewed by a different SSA examiner. If this is unsuccessful, you can then request a hearing before an administrative law judge (ALJ). During an ALJ hearing, you or your lawyer can provide new evidence and clarify any misunderstandings in the initial application. 

Having a disability lawyer who specializes in heart failure cases can be especially beneficial during the appeals process. They can help gather additional medical evidence, prepare you for the hearing, and represent you, increasing your chances of overturning the decision.

Heart failure may qualify you for Social Security disability benefits. Find out if you condition does!

Heart Failure & Comorbid Conditions

Heart failure rarely occurs in isolation. Many individuals with heart failure also suffer from other medical conditions, known as comorbidities, which can complicate the management of their health and significantly impact their ability to work.

Common comorbid conditions associated with heart failure include hypertension, diabetes, chronic kidney disease, and arrhythmias. These comorbidities often worsen the symptoms of heart failure, which can lead to increased fatigue, shortness of breath, and fluid retention. This can further limit physical activity and working ability.

When applying for disability benefits for heart failure, it's important to document all comorbid conditions in addition to heart failure. The SSA considers the combined effect of these conditions when evaluating your claim. 

For example, if you have both heart failure and diabetes, the SSA will assess how both of these conditions affect your overall health and ability to function. 

Detailed medical records from your doctors that explain how each condition worsens the others and limits your daily activities can strengthen your claim. Having comorbid conditions will likely increase your odds of being approved for benefits.

What Evidence Can Strengthen Your Heart Failure Claim?

One of the most important pieces of evidence is the result of an echocardiogram, which measures your heart’s ejection fraction. This test is a key indicator of how well your heart is pumping blood. An ejection fraction of 30% or lower typically indicates severe heart failure and can be a strong basis for your claim.

Stress tests that show a reduced exercise capacity can further show the limitations because of heart failure. If your heart failure has led to many hospitalizations, records of these events are also important. 

Surgical interventions, like pacemakers or defibrillators, are also significant evidence of the severity of your condition. These records should be submitted by your cardiologist or other doctors that explain how heart failure restricts your physical activities, prevents you from maintaining employment, and impacts your daily life.

Documenting the side effects of medications, such as dizziness, fatigue, or fluid retention, can help show challenges you face in treating heart failure. The SSA will see that despite following prescribed treatments, your symptoms are still severe. 

How Much Can You Receive from Heart Failure Benefits?

In 2025, you can earn up to $3,882 per month for heart failure disability benefits. The average is around $1,500 per month, as things like age, education, condition, and many other factors are taken into account to determine what you’ll receive. 

You have a lot to gain from a successful Social Security disability claim. A successful claim wouldn’t just mean consistent financial support for your ailment—it would also grant you the kind of stability that you may have been missing out on for years now. 

Unfortunately, winning a claim isn’t a cakewalk, which is why you should consider consulting a Social Security disability attorney or disability advocate. Your attorney will use his or her knowledge and experience to fight on your behalf and help you get the benefits you need—and you don’t even need to pay your lawyer unless you win. 

A successful Social Security claim could be life-changing, so don’t wait to get an evaluation and talk to a Social Security disability attorney as soon as possible. You can also get a free evaluation of your Social Security Disability case by filling out this free evaluation form.

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