SSA Listing 4.12-Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a condition characterized by the narrowing or blockage of arteries in the limbs, usually the legs, leading to reduced blood flow. This can result in symptoms like intermittent claudication (leg pain during physical activity) and various complications. The Social Security Administration (SSA) provides guidelines to evaluate PAD for disability benefits. In this blog post, we will explore how the SSA evaluates peripheral arterial disease for disability purposes based on the criteria outlined in the Listing of Impairments.

Meeting the Criteria:

To be considered for disability benefits, individuals with peripheral arterial disease must meet specific requirements stated in the Listing of Impairments (Section 4.12). Let's examine the criteria in detail:

1. Appropriate Medically Acceptable Imaging:

   • The SSA requires appropriate medically acceptable imaging, such as Doppler ultrasound, angiography, or other relevant tests, to confirm the presence and severity of peripheral arterial disease. These imaging results serve as evidence for evaluation.

2. Intermittent Claudication:

   • To meet the criteria for disability, an individual must have intermittent claudication, which is pain, cramping, or fatigue in the legs during physical activity, such as walking, that resolves with rest. This symptom indicates reduced blood flow to the affected limbs.

AND

One of the following additional requirements:

To qualify for disability benefits, individuals with peripheral arterial disease must also meet one of the following conditions:

1. Resting Ankle/Brachial Systolic Blood Pressure Ratio:

   • The resting ankle/brachial systolic blood pressure ratio must be less than 0.50. This ratio compares the blood pressure in the ankle to the blood pressure in the arm. A lower ratio indicates significant arterial narrowing and compromised blood flow. OR

2. Decrease in Systolic Blood Pressure on Exercise:

   • There should be a decrease in systolic blood pressure at the ankle during exercise of 50 percent or more compared to the pre-exercise level. Additionally, the individual's blood pressure should require 10 minutes or more to return to the pre-exercise level. This criterion indicates the severity of arterial obstruction and impaired blood flow during physical exertion. OR

3. Resting Toe Systolic Pressure:

   • The resting toe systolic pressure should be less than 30 mm Hg. This measurement reflects the blood pressure in the toes and provides further evidence of compromised arterial circulation. OR

4. Resting Toe/Brachial Systolic Blood Pressure Ratio:

   • The resting toe/brachial systolic blood pressure ratio must be less than 0.40. This ratio compares the blood pressure in the toes to the blood pressure in the arm. A lower ratio signifies significant arterial narrowing and compromised blood flow in the lower extremities.

Evaluation of Impairments:

Once an individual meets the criteria mentioned above, the SSA will assess the severity of their impairments resulting from peripheral arterial disease. The evaluation focuses on the impact of the condition on an individual's ability to perform daily activities, work-related tasks, and overall functionality.

Factors considered during evaluation may include:

1. Medical Documentation:

   • The SSA will review the medical records, including imaging results, clinical examinations, and treatment history, to confirm the diagnosis and severity of peripheral arterial disease.

2. Symptoms and Functional Limitations:

   • The SSA will evaluate the frequency, duration, and severity of intermittent claudication, as well as any associated symptoms like pain, cramping, or muscle weakness. The impact of these symptoms on an individual's mobility, endurance, and ability to perform tasks will be assessed.

3. Response to Treatment:

   • The effectiveness of prescribed treatments, such as medications, lifestyle modifications, and surgical interventions, will be considered. The SSA will evaluate whether the treatment has provided relief, improved functionality, or resulted in any complications.

Evaluating peripheral arterial disease for disability purposes requires meeting specific criteria outlined by the SSA. Individuals must provide appropriate medical evidence, including imaging results, to confirm the diagnosis and severity of their condition. Additionally, the presence of intermittent claudication and meeting at least one of the additional criteria is necessary. If you or someone you know is considering applying for disability benefits due to peripheral arterial disease, it is advisable to seek professional assistance or legal guidance to navigate the application process effectively. Remember, this blog post provides a general overview, and individual circumstances may vary.