Friday, June 04, 2010

Will Coronary Artery Heart Disease qualify you for disability?

This question was recently asked on another site. One of the respondents on the site stated that social security will deny you even if you are at death's door. Is that true? Unfortunately, it sometimes is. As an examiner and in disability representation, I've seen numerous individuals die while their disability claim was still pending. In some instances, the individual had been "dealing with the system" for years.

Here's my answer from the perspective of a former disability claims examiner. Will coronary artery disease qualify you for disability? Well, it may...or it may not. That may not sound to be the most helpful or authoritative answer, but, considering the statistical outcomes of such cases, it is essentially descriptive of how things go at the initial disability application and reconsideration appeal levels.

As a disability examiner, I routinely saw cases in which heart disease, past surgical intervention (bypass grafts, angioplasty) and even recent heart attacks or surgery had figured prominently in the claimant's list of impairments. In some instances, those claimants were denied when it might have seemed to the casual observer that a review of the individual's medical history ought to have warranted an approval.

Why were those disability cases denied? Ok, clearly in many cases, disability determination services--for those who are unaware, this is the state-level agency that makes decisions on SSD and SSI claims--simply put the wrong decision on the claim. If that were not the case, then we wouldn't have a disability benefit system in which so many cases are denied at the first two levels of the system and then later, a couple of years down the road, are approved at a hearing.

However, as often as that happens, denials in such cases occur routinely because of what transpires after the heart attack or surgical intervention. As I've said many times, social security is not so concerned with the claimant's diagnosed condition itself as it is with how it affects the claimant's ability to engage in normal daily activities and work activity. This method of looking at disability applicants and their conditions focuses in on something known as residual functional capacity, which is a measurement of what an individual can, and cannot do, in light of their physical or mental condition.

Residual functional capacity is a factor in all disability cases. It is seen more obviously in cases involving medical and vocational evaluation (for example, if you get approved based on the fact that A) your condition is too limiting to allow you to go back to one of your old jobs and B) your condition is too limiting to allow you to even to switch to a new type of work, this is known as a medical vocational allowance). But even in cases where a claimant is approved on the basis of meeting or equaling a listing (in the social security list of impairments, or blue book), residual functional capacity considerations are built in to the nature of the listings themselves.

This is why the SSA listing for ischemic heart disease states that coronary artery disease must not only meet the objective criteria for certain listing-level occlusions (blockages) in bypassed or non-bypassed arteries, but must also result in "very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living".

Will coronary artery disease qualify you for SSD or SSI? Possibly, based on satisfying the requirements of listing 4.04, Ischemic heart disease, or on the basis of a medical vocational allowance, in which the determination is made that you cannot perform work activity at a substantial and gainful level. However, it all depends on what your medical records indicate your residual functional capacity to be. In the case of this particular listing, the wording ("very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living") is very clear in its intent.

Of course, don't be surprised if you file for disability on the basis of a heart condition and the evaluation of your claim is deferred for 3 months. If you've had an MI (myocardial infarction or heart attack) then the disability examiner will be required to evaluate your residuals, i.e. ascertain how well you've recovered and whether or not you subsequently have the ability to engage in SGA-level work activity. Having said this, though, it goes without saying that many SSD and SSI claims are won chiefly on the basis of heart disease due to the limiting effects it may impose upon one's ability to work. This fact, however, must be validated by medical evidence. And, often, this finding is not reached by a disability examiner at the initial claim or reconsideration level, but by an administrative law judge at a disability hearing, where a claimant is entitled to representation.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Drawing Social Security Disability Benefits for a medical or mental condition
SSI Benefits - How to apply for SSI Disability
Social Security Disability Retroactive
When should you file for Disability Benefits
Social Security Disability SSI Tips Advice Answers to Questions
Social Security Disability Mistakes
How to get Approved for Disability Benefits - Information on disability claims
Social Security Disability Qualifications
Social Security Disability Requirements