How to Qualify for Disability with Heart Failure (Updated for 2024)

If your heart is not pumping enough blood for your body, you are suffering from heart failure. Heart failure is a chronic condition that will worsen throughout time. On rare occasions, it can develop more suddenly. Sometimes it is called congestive heart failure. It can impact either one side or both sides of the heart.

When your heart is unable to pump blood out to your body, it is a condition known as systolic heart failure. If your heart’s chambers do not properly fill with blood, it is diastolic heart failure. Regardless of the kind of heart failure from which you are suffering, there is a real danger of blood backing up into other systems of the body and causing congestion to the liver, lungs, gastrointestinal tract, or even the extremities. You can have both systolic and diastolic heart failure at the same time.

Heart failure can impact your ability to function in daily activities as well as impair your ability to work. Congestive heart failure can involve shortness of breath, the build-up of bodily fluids, swelling of the feet and ankles, swollen belly, confusion, increased heart rate, persistent coughing, and other symptoms. It is usually a long-term condition that will worsen over time, so it requires frequent medical treatment and monitoring.

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.

What Are the Costs for Treating Congestive Heart Failure?

Because heart failure is a long-term, chronic illness that can have a variety of symptoms, it can involve frequent visits to doctors, require extensive testing, and involve several prescription medications that can treat a variety of the symptoms. If you are insured, you will have co-pays and deductibles for doctor visits and prescriptions.

The regular treatment over a long period of time will definitely add up. According to the February 22, 2014 issue of Clinical Cardiology, the annual cost of heart failure in the U.S. is $39.2 billion with total direct costs reaching $60.2 billion for those with primary diagnosis and $115.4 billion for those who had the diagnosis as part of another disease.

The average hospital stay for an individual with heart failure was listed at 4.77 days with more than 1 million stays having been recorded, which resulted in professional services costs totaling about $4.46 billion. The disease is very costly to treat, and there are no cures for this condition. As the population ages, it is expected the number of people diagnosed with the problem will increase and the costs will continue to climb.

For the average individual with insurance, the costs are anticipated to be around $1,200 to $5,000 out-of-pocket each year to cover co-pays and coinsurance for medications, testing, and doctor office visits.

Can You Work With Congestive Heart Failure?

Congestive heart failure is not necessarily untreatable. It may be progressive if the causative factors that led to the heart failure continue to aggravate the condition of the heart and its functional components. A management plan may be drawn up with the help of your doctor to control any more deterioration in the condition of your heart. This may be enough if you follow the management plan closely to allow you to continue working, even if that means changing your job or changing what you do in the job you have so it doesn’t involve so much stress on your heart.

Typical management methods include:

Stopping smoking;
Adopting an exercise regime which has been developed to reduce heart failure;
Monitor your heart’s blood pressure to keep it within prescribed limits;
Monitor your salt intake, i.e. control your diet so that high sodium levels are minimized;
Attempt to reduce your weight through a combination of a healthy diet, reduced consumption and exercise;
Ensure you take all medications prescribed;
Make regular visits to your doctor to monitor the condition of your heart;
Seek urgent medical attention if you experience worsening symptoms such as worsening shortness of breath; inability to exercise, irregular heart rate; swelling in your ankles, other extremities or abdomen, unexplained rapid weight gain, bloating, or a lung infection that doesn’t improve.

Note that approval for disability benefits is conditional on evidence that any management plan, treatment or surgery is unable to prevent you from being unable to continue working and that inability is likely to last at least 12 months.

Congestive Heart Failure Work Restrictions

If you have congestive heart failure, you may find that you cannot do the work you used to and will experience some work restrictions. It's likely you may have to adjust what you do for work, especially if you work in a stressful or strenuous environment. Some work restrictions for heart failure you may experience include:

limiting strenuous work
not being able to lift above a certain weight limit
not being able to stand or walk for long periods of time
needing aids for walking, standing up, and doing aspects of your jobs

You may be required to reduce the hours you work, or even stop working entirely. If this happens to you, you may be eligible for disability benefits.

Is Congestive Heart Failure Considered a Disability?

Congestive heart failure occurs when the heart cannot pump enough blood around the body. Blood tends to back up in the body and can cause fluid build-up, lethargy, weakness and other symptoms. Congestive heart failure may be a chronic condition or an acute one. You may be able to obtain a disability benefit from the Social Security Administration (SSA) if your congestive heart failure disability meets the exacting criteria in the SSA’s Blue Book.

The Blue Book is a comprehensive list of all types of disability that may qualify for a benefit. There are many good reasons for obtaining a disability benefit, especially when you can no longer work or earn an income because of the effects of the condition you are suffering from. Each type of disability is listed separately in the Blue Book and the criteria needed to obtain a benefit are described in detail. You need to look carefully at the Blue Book listing for heart failure to determine whether the symptoms you are experiencing match the Blue Book listing.

The SSA will consider your application for a benefit if you can show evidence that your disability is severe enough to prevent you from working for at least 12 months and that they match the Blue Book listing. Evidence concerning your heart’s condition should be obtained from your doctor together with complete medical history and results of all tests and scans. A residual functional capacity (RFC) assessment can be made to show that you are unable to continue working.

Does Heart Failure Qualify For Disability?

Yes, heart failure does qualify for disability. 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.

What Are The SSA's Medical Requirements For Heart Failure?

The SSA has its own disability evaluation book, which is called the Blue Book.

Heart failure is listed under Section 4.00, which deals with the various kinds of heart failure and symptomatic heart disease as well as cardiac transplants. Section 4.02 address 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 these criteria:

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.

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.

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.

How Do I Meet Disability Criteria with an RFC?

If you don’t meet the disability requirements per the Blue Book, you may still be able to qualify using the vocational medical allowance. This process considers your conditions, your symptoms, your age, your educational level, your past work experience, and any transferable skills.

Your doctor will be asked to complete a residual functioning capacity (RFC) form that will completely detail how your ailment has impacted your life. It will indicate if you have to reposition yourself every two hours, if your mental confusion impacts your memory and ability to do repetitive work, if you have severe swelling that causes weeping of the skin that renders you unable to walk or stand, and how any other symptoms come into play in regards to your ability to work or care for yourself.

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. Make sure your physician maintains thorough notes and documents any problems that arise from your condition so they can be used to support your disability claim. Check out other tips on how to apply for heart failure Social Security disability benefits here.

You Could Earn Up to $3,822 Per Month! Get a Free Case Evaluation

A disability claim can be very complicated and time-consuming. You can be denied disability twice and you would have to appeal those rulings. The final step is a hearing before an administrative law judge to make a ruling on your case.

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.

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 tha Can You Work With Congestive Heart Failure? t 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.

If you are interested in applying for SSDI benefits, you should visit the SSA website or call 1-800-772-1213 to start the process over the phone.

Considering applying for Social Security disability benefits but not sure how much you’ll earn per month? Our Social Security Benefits Calculator can help you determine how much you’ll receive from the SSA before you file for disability.

You can also get a free evaluation of your Social Security Disability case by filling out this free evaluation form.

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