Getting Disability Benefits for Cardiomyopathy

Cardiomyopathy (kahr-dee-oh-my-OP-uh-thee) is an umbrella term used by doctors that refers to problems with your heart muscle. Depending on the type of cardiomyopathy you have—ischemic, dilated, hypertrophic, or restrictive—your heart muscle may become thicker, larger, or stiffer than normal. This can cause your heart to struggle to pump enough blood throughout your body.

Conditions that can cause cardiomyopathy include coronary artery disease, congestive heart failure, high blood pressure, late-stage kidney disease, viral infections, alcohol abuse, or systemic lupus erythematosus. Symptoms of cardiomyopathy include chest pain, severe fatigue, swelling in the legs and feet, irregular heartbeats, dizziness, fainting, and shortness of breath.

What Heart Problems Qualify for Disability?

Any heart condition that is serious enough to keep you from working full-time for at least one year can potentially qualify you for disability. The Social Security Administration (SSA) evaluates disability applications for heart conditions under the "Blue Book" section 4.00 for disorders of the cardiovascular system.

The Blue Book is a list of impairments that the agency considers especially severe. You can qualify for disability automatically if your heart condition meets the requirements of a "listing" in section 4.00. People with cardiomyopathy may qualify under the following listings:

• Listing 4.02 for chronic heart failure
• Listing 4.04 for ischemic heart disease
• Listing 4.05 for recurrent arrhythmias
• Listing 4.06 for symptomatic congenital heart disease
• Listing 4.09 for heart transplant
• Listing 4.10 for aortic aneurysm
• Listing 4.11 for chronic venous insufficiency, or
• Listing 4.12 for peripheral arterial disease.

Meeting a listing can be difficult because the SSA needs to see specific test results that your heart is working very poorly. But you can still get disability benefits without meeting a listing if you can show that you have functional limitations that rule out all full-time work.

Is Congestive Heart Failure a Disability?

You can get disability for congestive heart failure under listing 4.02 if you have medical documentation of either systolic or diastolic dysfunction. Systolic dysfunction means that your heart can't contract and expel blood normally, while diastolic dysfunction means that your heart can't relax and fill with blood properly.

The SSA will look for evidence of systolic or diastolic dysfunction in cardiac testing such as your ejection fraction (the percentage of blood pumped out with each heartbeat) and objective imaging of your atria or ventricles (chambers of the heart that can thicken from cardiomyopathy). You'll also need to show that your congestive heart failure causes serious functional limitations, such as multiple hospitalizations within a short time frame, poor performance on an exercise stress test, or limited independence in your daily activities.

Is Coronary Artery Disease a Disability?

If you've had an angiography (a type of X-ray used to visualize blood vessels and heart chambers) that shows significant narrowing of your coronary arteries (the vessels that supply blood to the heart), you could qualify for disability under listing 4.04. As with similar cardiovascular listings, you'll also need to establish very serious functional limitations in your ability to complete your daily routine independently.

Can I Still Qualify for Disability if My Cardiomyopathy or Heart Conditions Don't Meet a Listing?

Few people will have cardiomyopathy severe enough to meet one of the Blue Book listings. But you can still qualify for disability if your heart problems keep you from regularly working at any job. In Social Security terms, this is known as a "medical-vocational allowance."

In order to determine whether you can work, the agency reviews your medical records and doctors' notes for any work-related limitations. Functional limitations that are supported by substantial evidence become part of your residual functional capacity (RFC). Your RFC is a short paragraph outlining what you can and can't do, mentally and physically, in a work environment.

What Does an RFC for Heart Problems Contain?

A typical RFC for somebody with cardiomyopathy, congestive heart failure, or coronary artery disease will likely contain exertional limitations. Exertional limitations are restrictions on basic strength-related physical activities, such as lifting, carrying, walking, standing, and sitting. For example, if you get shortness of breath from walking after just a short time, your RFC might limit you to sedentary (sit-down) work.

Your RFC may contain non-exertional limitations as well. Non-exertional limitations aren't based on how much weight you can carry or how far you can walk, but still have an impact on your ability to work. People with cardiomyopathy may have environmental restrictions against working around dust, fumes, gasses, or hazards which could pose a risk of exacerbating their symptoms. Mental limitations—such as an inability to maintain focus on tasks due to fatigue—could also be included in your RFC, which can rule out skilled or semi-skilled jobs.

How Does Social Security Use the RFC to Determine Disability?

Social Security compares the limitations in your current RFC with the duties of your past jobs to see whether you could still do them today. If you can't return to your past work, then the agency will need to determine if other jobs exist that you can do, despite the restrictions in your RFC.

People 50 years of age and older can have an easier time showing that they can't do other work thanks to a special set of rules called the "medical-vocational grid." Social Security doesn't expect people nearing retirement age to easily switch careers, so the agency will consider whether you've acquired any transferable skills that you can use at a less demanding job. For example, a 52 year old former plumber may win benefits even if they can physically perform sedentary work because they can't use the skills they learned as a plumber to do a desk job.

People younger than 50 will generally need to show that they can't do unskilled, sedentary work in order to get disability benefits. Limitations in your RFC that can rule out even simple, sit-down jobs include needing to take extra breaks throughout the workday, having to recline or lie down to reduce swelling in the legs, or being physically unable to stand for two hours total in an eight hour day.

Medical Records You'll Need to Get Disability for Heart Problems

Your medical records are the cornerstone of your disability claim. The SSA is going to need to see objective evidence that supports your diagnosis of cardiomyopathy, heart failure, or coronary artery disease.

Ideally, you'll have established a regular relationship with a cardiologist (heart doctor) or general practitioner who serves as your primary care provider. When you apply for disability benefits, the SSA will, with your permission, contact your providers to obtain records of your treatment. The agency will be on the lookout for the following information in those records:

• clinical notes from each doctor's visit containing your doctor's observations and your subjective complaints
• physical examinations
• objective tests and medical imaging, such as an electrocardiogram (ECG) stress (treadmill) tests, or Doppler (ultrasound) studies
• blood pressure readings over time
• medication lists, including any side effects you experience, and
• admission and discharge documents from any hospitalizations, particularly surgical records.

You may also wish to submit witness statements from friends, relatives, or former employers who have first-hand experience with the ways that cardiomyopathy has limited your activities.

Applying for Disability Benefits for Cardiomyopathy

When you're ready to begin your application for disability benefits, you have several convenient options to choose from. Many people prefer to file online at Social Security's website, but if you prefer, you can speak with a representative at 800-772-1213 (TTY 800-325-0778 if you're deaf or hard of hearing) from 8 a.m. to 7 p.m., Monday through Friday. You can also schedule an in-person appointment at your local Social Security field office.

If you'd like help starting your application, appealing a denial, or if you're simply not sure whether you have a good case, consider contacting an experienced disability attorney. Most disability lawyers offer free consultations, so you can test the waters a bit before making a decision to hire a representative. And because they work on contingency, you're likely to have few, if any, upfront out-of-pocket costs.

_{Updated April 26, 2024}