The Social Security Administration (SSA) has special rules for certain impairments. If your condition is severe enough and on SSA’s list of impairments, then it is possible you may be granted benefits. Chronic heart failure is an impairment that is on SSA’s list. It is the inability of the heart to pump enough oxygenated blood to body tissues. This syndrome is characterized by symptoms and signs of pulmonary or systemic congestion (fluid retention) or limited cardiac output. If you have been diagnosed with chronic heart failure, SSA will use listing 4.02 when they decide whether or not it is severe enough to be compensable.
Below is listing 4.02 in its entirety.
4.02 Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2. The required level of severity for this impairment is met when the requirements in both A and B are satisfied. 4.00D2 refers to objective evidence that a claimant can submit including, x-rays, echocardiography, radionuclide studies, or cardiac catheterization.
- Medically documented presence of one of the following:
- Systolic failure (see 4.00D1a(i)), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or
- Diastolic failure (see 4.00D1a(ii)), 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 (not during an episode of acute heart failure);
- Resulting in one of the following:
- 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 an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or
- Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e), with evidence of fluid retention (see 4.00D2b(ii)) 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 (see 4.00D4c); or
- Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
- Dyspnea, fatigue, palpitations, or chest discomfort; or
- Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
- Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise (see 4.00D4d) due to left ventricular dysfunction, despite an increase in workload; or
- Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.