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Cardiovascular Illness or Injury

How Do I Get Social Security Disability Benefits for Cardiovascular Illness or Injury?Cardiovascular Illness or Injury and Disability

Cardiovascular illness includes disease of the coronary arteries, heart muscle, nerves of the heart, the heart valves, or congenital heart disease. The Social Security Administration uses the documentation you provide that includes physical signs, symptoms, and lab tests to make their determination for benefits. For those suffering from Cardiovascular Illness, the Social Security Administration requires these medical records to be over a period of at least three months. In some cases, the Social Security Administration will need six months of documentation to make an accurate decision.

If you suffer from a Cardiovascular Illness, cannot work, and have been denied Social Security Disability benefits, call the experienced Anaheim Hills Social Security Disability Attorneys at Howard Law and let us fight to get you the benefits you deserve.

Chronic Heart Failure

The most common causes of Chronic Heart Failure that the Social Security Administration sees are coronary artery disease and alcoholic cardiomyopathy. Most cases of Chronic Heart Failure can be improved with medical treatment, but the underlying disease may still be present.

To qualify for Social Security Disability benefits due to Chronic Heart Failure you must currently suffer from chronic heart failure with medically documented presence of one of the following;

(1) systolic failure with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability or (2) diastolic failure 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.

Additionally, either 1 or 2 above must result in one of the following;

(1) 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 a medical consultant has concluded that the performance of an exercise test would present a significant risk to the individual, or

(2) three or more separate episodes of acute congestive heart failure within a consecutive 12 month period, with evidence of fluid retention 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, or

(3) inability to perform on an exercise tolerance test at a workload equivalent to 5 MET’s or less due to,

(a) dyspnea, fatigue, palpitations, or chest discomfort; or
(b) three or more consecutive premature ventricular contractions, or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
(c) decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload; or
(d) signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.

Ischemic Heart Disease

Ischemic Heart Disease refers to a disease of the heart that deprives the heart muscle of blood flow and oxygen. Most ischemic heart disease is caused by coronary artery disease (a hardening of the arteries) but may also be caused by narrowed heart valves.

To qualify for Social Security Disability benefits due to Ischemic Heart Disease, you must have ischemic heart disease with symptoms due to myocardial ischemia, while on a regimen of prescribed treatment, with one of the following:

  1. Sign-or-symptom limited exercise test demonstrating at least one of the following manifestations at a workload equivalent to 5 METs or less:
    1. Horizontal or down-sloping depression, in the absence of digitalis glycoside treatment or hypokalemia, of the ST segment of at least -0.10 millivolts (-1.0 mm) in at least 3 consecutive complexes that are on a level baseline in any lead other than aVR, and depression of at least -0.10 millivolts lasting for at least 1 minute of recovery; or
    2. At least 0.1 millivolt (1 mm) ST elevation above resting baseline in non-infarct leads during both exercise and 1 or more minutes of recovery; or
    3. Decrease of 10 mm Hg or more in systolic pressure below the baseline blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload; or
    4. Documented ischemia at an exercise level equivalent to 5 METs or less on appropriate medically acceptable imaging, such as radionuclide perfusion scans or stress echocardiography.
  2. Or

  3. Three separate ischemic episodes, each requiring revascularization or not amenable to revascularization, within a consecutive 12-month period.
  4. Or

  5. 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 revealing:
      1. 50 percent or more narrowing of a non-bypassed left main coronary artery; or
      2. 70 percent or more narrowing of another non-bypassed coronary artery; or
      3. 50 percent or more narrowing involving a long (greater than 1 cm) segment of a non-bypassed coronary artery; or
      4. 50 percent or more narrowing of at least 2 non-bypassed coronary arteries; or
      5. 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.

Recurrent Arrhythmias

Arrhythmias are disturbances of the heart’s rate or rhythm. They can cause the heart to beat to fast, too slow or irregularly.

To qualify for Social Security Disability Benefits due to recurrent arrhythmias, you must suffer from recurrent arrhythmias, not related to reversible causes (such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic drug toxicity) resulting in uncontrolled, recurrent episodes of cardiac syncope or near syncope, despite prescribed treatment and documented by resting or ambulatory (Holter) electrocardiography, or by other appropriate medically acceptable testing, coincident with the occurrence of syncope or near.

Heart Transplant

The Social Security Administration will consider you considered disabled for 1 year following surgery. Thereafter, reevaluate residual impairment under the appropriate listing.

Aneurysm of Aorta or Major Branches

An aneurysm is an abnormal widening or ballooning of a portion of an artery. Aneurysms can rupture and result in internal bleeding. This disability refers to aortic aneurysms as well as aneurysms of large arteries that branch from the aorta.

To qualify for Social Security Disability benefits based on an aneurysm of aorta or major branches, you must have had an aneurysm of aorta or major branches, due to any cause (e.g., atherosclerosis, cystic medial necrosis, Marfan syndrome, trauma), demonstrated by an appropriate imaging technique, with dissection not controlled by prescribed medical or surgical treatment.

Chronic Venous Insufficiency of a Lower Extremity

Chronic Venous Insufficiency is a condition where your leg veins cannot pump enough oxygen back to your heart. It can be caused by inflammation, trauma, and your hereditary predisposition.

To qualify for Social Security Disability benefits claiming chronic venous insufficiency, you must have chronic venous insufficiency of a lower extremity with incompetency or obstruction of the deep venous system and one of the following;

  1. Extensive brawny edema involving at least two-thirds of the leg between the ankle and knee or the distal one-third of the lower extremity between the ankle and hip;
  2. Or

  3. Superficial varicosities, stasis dermatitis, and recurrent or persistent ulceration which has not healed following at least 3 months of prescribed treatment

Peripheral Arterial Disease

Peripheral Arterial Disease is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque buildup in the arteries can harden and narrow the arteries. This limits the flow of oxygen rich blood to your organs and other parts of your body.

To qualify for Social Security Disability due to Periperal Arterial Disease, you must have diagnosed Peripheral Arterial Disease as determined by appropriate medically acceptable imaging, causing intermittent claudication and one of the following:

  1. Resting ankle/brachial systolic blood pressure ratio of less than 0.50.
  2. Or

  3. Decrease in systolic blood pressure at the ankle on exercise of 50 percent or more of pre-exercise level and requiring 10 minutes or more to return to pre-exercise level.
  4. Or

  5. Resting toe systolic pressure of less than 30 mm Hg.
  6. Or

  7. Resting toe/brachial systolic blood pressure ratio of less than 0.40.

If you suffer from a cardiovascular disease, cannot work and have been denied Social Security Disability benefits, call the experienced Laguna Hills Social Security Disability attorneys at Howard Law and let us help you get the benefits you deserve.

For more information on Cardiovascular Disease and the Social Security Administration Guidelines, visit the Social Security Administration.

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Listing vs. Residual Functional Capacity (RFC): How Does the Social Security Administration Determine Whether I Qualify for Disability Benefits for Cardiovascular Illness or Injury?

Social Security disability benefits may be available for people who suffer from a Cardiovascular Illness. The Social Security Administration must first determine whether your Cardiovascular Illness is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. The Social Security Administration will conclude that you are disabled and eligible for disability benefits if it determines that you meet or equal a listing because of your Cardiovascular Illness.

If the Social Security Administration decides that your Cardiovascular Illness is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

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How Can I Meet a Listing and Win Social Security Disability Benefits for Cardiovascular Illness or Injury?

The Social Security Administration will determine whether you are disabled at Step 3 of the Sequential Evaluation Process by evaluating whether your Cardiovascular Illness is severe enough to equal a listing.

The term “listing” refers to a compiled list of common impairments. The Social Security Administration created a set of guidelines called the Listing of Impairments that contains the most common impairments. For each listing of a particular impairment, there is an explanation regarding the degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.

The Social Security Administration will consider you disabled if your Cardiovascular Illness is severe enough to meet or equal a listing.

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What is Your Residual Functional Capacity Assessment for a Cardiovascular Illness or Injury?

If the Social Security Administration decides that your Cardiovascular Illness is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

The Social Security Administration expresses an RFC for physical impairments in terms of whether the Social Security Administration believes you are able to do hstrong>heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

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Can Your Doctor’s Medical Opinion Help You Qualify for Social Security Disability Benefits for Cardiovascular Illness or Injury?

The role of the Social Security Administration is to conclusively establish whether you are disabled based on your education, work experience, medical evidence, and your age.

The role of your doctor is to provide the Social Security Administration with information concerning the degree of your medical impairment by providing the Social Security Administration medical source statement that describes your capacity for work which is part of your residual functional capacity assessment. Your residual functional capacity is what you can still do despite your limitations.

The Social Security Administration must consider your treating physician’s opinion because the Social Security Administration considers it to be controlling when making its decision.

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What is the 5 Step Sequential Evaluation Process?

The Social Security Administration has created a five (5) step sequential process to determine whether an adult claimant is entitled to receive disability benefits. Children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

The Social Security Administration presumes that if you are working and that you make a certain amount of money that you are engaging in what it determines to be a substantial gainful activity (SGA). The Social Security Administration considers a person to be engaged in a SGA if that person is earning more than a certain amount of money each month (i.e. net of impairment – related work related expenses).

In 2013, the Social Security Administration has determined that a statutorily blind individual is engaged in a SGA if they earn more than $1740.00 per month while a non-blind individual must earn more than $1040.00 per month. Changes in the national average wage index usually affect the aforementioned SGA amounts.

Step 2: Severe Impairment

The Social Security Administration has determined that each claimant must either have a severe impairment or a combination of impairments. The impairment or combination of impairments must drastically limit the claimant’s physical or mental ability to do basic work activities without regard to age, work history, or education. For many claimants, the level of proof at this level is minimal; therefore, they usually satisfy the Step 2 requirements and proceed to Step 3.

Step 3: Listing of Impairments

The Listing of Impairments details specific impairments that the Social Security Administration considers severe enough to prevent an adult claimant from engaging in a substantial gainful activity and in the case of a minor, the impairment has to be severe enough to cause functional limitations. There is also a durational requirement. The Social Security Administration has determined that the impairment must last for 12 months or long or result in the death of the claimant. If the claimant fails Step 3 because they do not meet or equal a listing then the case will proceed to Step 4.

Step 4: Past Relevant Work

At Step 4, if your condition is severe enough to meet the requirements of Step 2 (Severe Impairment); however, your severe impairment does not meet or equal a listed impairment that is the subject of Step 3 (Listing of Impairments), then the Social Security Administration must decide whether your severe impairment interferes with your ability to do any of the work you previously performed. The Social Security Administration likes to look at the work you performed over the past 15 years prior to the onset of your disability. If the Social Security Administration determines that your impairment does not interfere with work you previously did then you must proceed to Step 5.

Step 5: Ability to Perform Other Work

A majority of disability claims are decided at this level. If you cannot perform work you did in your past, then a determination must be made as to whether you can adjust to different types of work. The determination at this level takes into consideration your education, age, and prior work and is better known as your residual functional capacity.

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