Disability for Heart Failure. Ejection fraction, exercise tolerance, and hospital stays.

How Social Security evaluates chronic heart failure

The usual route under the heart failure listing has two parts. The first is imaging during a stable period: for example, an ejection fraction of 30 percent or less, or findings of an enlarged or thickened heart that meet stated measurements. The second is functional: an inability to complete an exercise test at a workload of 5 METs or less, or a doctor’s conclusion that exercise testing would be too risky together with very serious limits in daily activities, or three hospitalizations within a 12-month period, at least 30 days apart, each lasting at least 48 hours for heart failure.

The listing can also be met by an ejection fraction of 20 percent or less on two evaluations at least 90 days apart within 12 months, or by an implanted mechanical circulatory support device or 30 days of continuous intravenous inotropic therapy.

When no listing is met

Most claims are decided on residual functional capacity: what you can still do in a work setting despite your symptoms. Social Security then asks whether any jobs fit those limits. For heart failure, the limits are fatigue, shortness of breath with exertion, swelling that requires elevating the legs, and how far you can walk or carry.

Evidence that matters

• Echocardiogram reports with ejection fraction and chamber measurements.
• Exercise or stress test results, including the workload reached.
• Hospital records for heart failure admissions.
• Cardiology notes on symptoms, weight changes, and swelling.
• Medication list, defibrillator or pacemaker records.

Ask your doctor to complete the physical impairments form in our free doctor forms. It records your limits in the terms Social Security uses.

Why these claims are denied

• Imaging taken during an acute episode instead of a stable period.
• An improved ejection fraction after treatment, with ongoing symptoms left undocumented.
• No exercise testing and no doctor’s statement about why.
• Daily limits not described in the chart.

Leg elevation and rest

If your cardiologist has told you to elevate your legs or rest during the day, ask that it be written down with how often and how long. A need to elevate the legs at waist height or above for part of the workday rules out most jobs.

If you are 50 or older

Under Social Security’s grid rules, a person limited to sedentary work at 50, or light work at 55, may be found disabled depending on education and past work.

Next steps

If you have been denied, you have 60 days to appeal. See what to do after a denial in Arizona, SSDI in Arizona, and SSI in Arizona. There is no fee unless benefits are awarded.

J Disability Law Firm, PLLC · Joseph J. Duerst, Attorney · 18444 N. 25th Ave, Suite 420, Phoenix, AZ 85023 · (602) 607-0000. This page is general information, not legal advice. Reading it does not create an attorney-client relationship. Every case is different. Past results do not predict the outcome of your case.