Is Advanced Congestive Heart Failure a Disabling Condition or Not?

by Editorial Board on November 11, 2010 · 0 comments

in Heart & Circulation

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The Social Security Administration (SSA) has a strict definition of disability; in order to qualify for Social Security benefits a condition must meet this definition plus the SSA criteria for the specific condition or be able to show they cannot sustain employment. The SSA usually requires three months of detailed medical records to evaluate disability claims for congestive heart failure.

About Congestive Heart Failure

Congestive heart failure (CHF), also called chronic heart failure or heart failure, occurs when the heart fails and is not able to pump enough blood to the rest of the body. As a result, blood collects in the vessels leading to the heart and fluids accumulate in various organs. The locations of fluid accumulation depend on which chambers of the heart fail.

Symptoms of CHF include shortness of breath, fatigue, waking up during the night with a feeling of suffocation, chest pain, heart palpitations, dizziness, lightheartedness, and fainting. Medication may control some symptoms.

CHF is a progressive and potentially fatal condition that usually develops over months or years. Treatment typically involves rest, moderate activity, dietary restrictions, and prescription medications.

CHF and Disability Benefits

The SSA often looks at CHF conditions over time (typically three months) to see if functioning stays the same, gets worse, or improves with treatment.  To do this SSA requires medical records that include hospital and medical visit information, date of CHF diagnosis, cause of CHF, medications prescribed and their effectiveness, the patients compliance with treatment, and a statement of the patients residual functional ability.

To qualify for SSA disability benefits under the CHG listing, medical records must show clinical heart failure plus significant limitations in the ability to perform activities of daily living. The New York Heart Association (NYHA) Functional Classification for CHF is one way to evaluate such limitations. A higher classification indicates more serious limitations; a patient in a higher class is more likely to qualify for Social Security disability benefits.

NYHA classifications:

Class I: Patient has symptoms with more than ordinary activity.

Class II: Patient has symptoms with ordinary activity.

Class III: Patient has symptoms with minimal activity.

Class IV: Patient has symptoms when resting.

A CHF patient can support his or her disability claims with a letter from the treating physician and or cardiologist. In the letter the doctor should summarize the diagnosis, testing, and treatment. The letter should give a NYHA classification and describe the patient’s ability to function in terms of lifting, carrying, sitting, walking, etc. It would be helpful, although it is not always necessary, if the physician includes a statement that the patient cannot work on a regular basis due to the limitations of CHF, or that the patient could only work part time.

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