Why Was My Heart Failure Disability Application Denied?

Every year, around 550,000 new cases of congestive heart failure (CHF) are diagnosed in the United States. CHF has the capacity to drastically affect one’s health and lifestyle, leading many patients to seek disability benefits for help.

However, in many cases (around 60-65%), disability applicants find that their initial claim attempt is denied. If this is true for you, do not worry — continue below to see how you can continue your disability case moving forward. Some heart defects, such as congestive heart failure, coronary artery disease, and heart transplants, can automatically qualify you for disability benefits through the "Blue Book" List of Conditions.

Difficulties When Applying with Heart Failure

When the Social Security Administration (SSA) evaluates a claim, they compare an applicant’s disorder to its corresponding entry in the “Blue Book.” Compared to most entries, heart failure has a rather long and complex set of requirements in order to qualify, meaning there are many ways a claim may qualify (or be disqualified). Potential reasons for disqualification may include:

Your heart failure was not found to be chronic. In the Blue Book, CHF stands for chronic heart failure, not congestive heart failure. This means that, in order to qualify, the SSA must see evidence of repeated episodes of pulmonary or systemic congestion that drastically impact your quality of life. This can be shown with hospitalization records, medical imaging, unsuccessful treatment history, and physical exam history.

Qualifying for Social Security with heart failure

Your heart failure was not accompanied by official physician assessments stating your inability to work safely. To qualify with heart failure, your disorder must show evidence of either systolic or diastolic failure, as well as one of the following:

  • persistent symptoms of heart failure that, as stated by a physician or cardiac specialist, make an exercise test too risky to perform,
  • three or more episodes of acute congestive heart failure within a year, with each hospital visit lasting 48 hours or more, or
  • an inability to pass an exercise tolerance test due to heart complications assessed during the test.

Regardless of your symptoms, it is best to consult the Blue Book with your physician to determine why your specific case may have been denied.

Your Next Step: Scheduling an ALJ Hearing

Aside from reviewing your initial application, the next step you should take after receiving your decision is scheduling an ALJ hearing. These hearings allow you to retry your case in front of an administrative law judge (ALJ) to try and get your claim decision reversed. These hearings can be scheduled at your nearest Office of Disability Adjudication and Review (ODAR), and should be made as soon as possible. Even if you aren't ready for your hearing when you schedule, wait lists tend to be long enough that you will have plenty of time to prepare.

As a general rule of thumb, you should always prepare more than less when getting ready for a hearing. Any additional information you can provide that wasn’t on your initial application is most helpful. This may include a variety of documents such as new heart tests, retaken previous tests, medication lists, hospitalization records, physician notes, therapy session notes, financial statements, or testimonies from those who can attest to the severity of your condition.

Considering a Disability Attorney

While it may seem daunting, disability attorneys are the best possible resource when it comes to preparing for an ALJ hearing. Their legal expertise and case-building knowledge is specifically made to increasing your chances of getting benefits. And, thanks to federal regulation, disability attorneys cannot take payment unless their efforts win you your case. If you’re curious as to how a disability attorney may be able to help, consider a free consultation with an attorney in your area.

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