SSA Listing 4.02-Chronic Heart Failure

Chronic heart failure (CHF) is a serious medical condition that affects millions of individuals worldwide. In the United States, the Social Security Administration (SSA) provides disability benefits to individuals who are unable to work due to severe impairments, including chronic heart failure. To determine eligibility for benefits, the SSA has specific criteria outlined in the Listing of Impairments. In this blog post, we will explore how the SSA evaluates chronic heart failure based on the provided information in the Listing of Impairments.

Meeting the Criteria:

To meet the SSA's requirements for chronic heart failure, an individual must satisfy the criteria in both Section A and Section B of the Listing of Impairments. Let's examine each section in detail.

Section A: Medically Documented Presence

This section focuses on the presence of specific indicators of chronic heart failure, as follows:

1. Systolic Failure: The left ventricular end diastolic dimensions must be greater than 6.0 cm or the ejection fraction should be 30 percent or less during a period of stability (not during an episode of acute heart failure).

OR

2. Diastolic Failure: The left ventricular posterior wall plus septal thickness must total 2.5 cm or greater on imaging. Additionally, an enlarged left atrium greater than or equal to 4.5 cm should be present, with a normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure).

Section B: Resulting Impairments

This section focuses on the impact of chronic heart failure on an individual's daily life and functioning. To meet the requirements, one of the following conditions must be met:

1. Persistent Symptoms: The individual must have persistent symptoms of heart failure that significantly limit their ability to independently initiate, sustain, or complete activities of daily living. A medical consultant (MC) with expertise in cardiovascular disease must conclude that an exercise test would pose a significant risk to the individual.

OR

2. Episodes of Acute Congestive Heart Failure: The individual must experience three or more separate episodes of acute congestive heart failure within a consecutive 12-month period. These episodes must be accompanied by evidence of fluid retention from clinical and imaging assessments at the time of the episodes. The episodes should require extended physician intervention, such as hospitalization or emergency room treatment for 12 hours or more, and be separated by periods of stabilization.

OR

3. Inability to Perform on an Exercise Tolerance Test: The individual must be unable to perform an exercise tolerance test at a workload equivalent to 5 METs (metabolic equivalents) or less due to various factors such as dyspnea, fatigue, palpitations, chest discomfort, ventricular contractions, decreased systolic pressure, or signs of inadequate cerebral perfusion.

The evaluation of chronic heart failure by the Social Security Administration involves assessing the presence of specific medical indicators and the impact of the condition on an individual's ability to function. Meeting the criteria outlined in the Listing of Impairments is crucial to establish eligibility for disability benefits. If you or someone you know has chronic heart failure and is considering applying for disability benefits, it is advisable to consult with a knowledgeable professional or seek legal assistance to navigate the application process effectively. Remember, this blog post is a general overview, and individual circumstances may vary.