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Heart Disease and Social Security Disability Benefits


  • Published: 2010-05-18 (Revised/Updated 2013-06-08) : Author: Jonathan Ginsberg
  • Synopsis: Social Security sets forth specific criteria when qualifying heart disease applicants for SSDI disability benefits.

Social Security sets forth specific criteria when qualifying heart disease applicants for SSDI disability benefits.

Heart disease is a broad term used to describe a range of diseases that affect your heart, and in some cases, your blood vessels. The term "heart disease" is often used interchangeably with "cardiovascular disease" - a term that generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina), or stroke. Other heart conditions, such as infections and conditions that affect your heart's muscle, valves, or beating rhythm also are considered forms of heart disease.

Heart disease is the No. 1 worldwide killer of men and women, including in the United States. Responsible for 40 percent of all the deaths in the United States, more than all forms of cancer combined (!), heart disease is a legitimate fear. Here, we will discuss the specifics regarding heart disease and how someone with heart disease may qualify for Social Security Disability benefits (or SSDI).

About Heart Disease

The causes of heart disease vary by type of heart disease. While cardiovascular disease can refer to many different types of heart or blood vessel problems, the term is often used to mean damage caused to your heart or blood vessels by atherosclerosis, a buildup of fatty plaques in your arteries, blood vessels that carry oxygen and nutrients from your heart to the rest of your body.

Healthy arteries are flexible and strong. Over time, however, too much pressure in your arteries can create excessive wear and make the walls thick and stiff, therefore restricting blood flow to your organs and tissues. This process is called arteriosclerosis, or hardening of the arteries. Atherosclerosis is the most common form of this disorder. Atherosclerosis is also the most common cause of cardiovascular disease, and it is caused by a variety of factors, including an unhealthy diet, lack of exercise, being overweight and smoking. All of these are major risk factors for developing atherosclerosis and, in turn, cardiovascular disease.

Cardiovascular disease may continue to be undiagnosed until the condition worsens to the point of a heart attack, chest pain (angina), stroke, heart failure, or sudden cardiac death. It's important to watch for cardiovascular symptoms and discuss any concerns with your doctor.

Some of these symptoms include the following:

Chest pain (angina)

Shortness of breath

Pain, numbness, weakness or coldness in your legs or arms, if the blood vessels in those parts of your body are narrowed

Cardiovascular disease can sometimes be found early with regular doctor visits.

Heart disease treatments vary.

Most treatments of cardiovascular disease focus on opening narrowed arteries that cause the symptoms. Depending on how severe the blockages, treatments may include lifestyle changes, medications, and/or surgery.

Applying for Social Security Disability Benefits

Social Security Disability Insurance (SSDI) is a federal program designed to pay monetary benefits to qualified applicants who have worked long enough and paid their social security taxes. Based on medical evidence, work history, and education history, the Social Security Administration determines whether or not applicants qualify for benefits and how much each applicant can receive.

The Social Security Administration (SSA) sets forth specific criteria when qualifying applicants for benefits. With regard to heart disease specifically, the medical evidence must be consistent with SSA's classification within the following criteria: Coronary artery disease, demonstrated by angiography (obtained independent of Social Security disability evaluation) or other appropriate medically acceptable imaging, and in the absence of a timely exercise tolerance test or a timely normal drug-induced stress test, an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that performance of exercise tolerance testing would present a significant risk to the individual, with both 1 and 2:

1. Angiographic evidence showing:

a. 50 percent or more narrowing of a non-bypassed left main coronary artery;

b. 70 percent or more narrowing of another non-bypassed coronary artery;

c. 50 percent or more narrowing involving a long (greater than 1 cm) segment of a non-bypassed coronary artery;

d. 50 percent or more narrowing of at least two non-bypassed coronary arteries;

e. 70 percent or more narrowing of a bypass graft vessel; and

2. Resulting in very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living.

These criteria are addressed in much more detail by the Social Security Administration (SSA). However, keep in mind that the heart disease symptoms which meet the criteria for receipt of benefits may develop as a result of the disease process and/or the medications prescribed and used, or the residual effects of surgical procedures used to treat the disease.

The medical evidence supporting one's argument that he or she may meet these criteria, and therefore qualify for disability benefits, is crucial to obtaining a favorable finding. Physicians are considered experts in their field of practice, and their diagnosis, treatment and prognosis concerning a person's condition are key to determining if someone who suffers with heart disease qualifies for Social Security Disability benefits.

Jonathan Ginsberg has been practicing Social Security Disability law in the Atlanta, Georgia area for over 20 years. His website can be found at www.atlantasocialsecuritydisabilityattorney.net

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