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Qualifying for Disability Benefits With a Congenital Heart Defect

Each year, approximately 1 in 100 babies are born with a defective heart, making this the most common type of birth defect. Thanks to advances in pediatric cardiology, more of these babies than ever are surviving to adulthood. According to the most recent statistics, over one million adults currently living have a congenital heart defect.

Congenital Heart Defects

The overall health and wellbeing of these adults largely depends upon the type of defect with which they were born. Cardiologists have identified at least 18 different types of heart defects.

 

Less severe defects might include a problem with one of the valves or a hole in the heart. Other heart conditions are much more complex, such as single ventricle defects or a combination of numerous symptoms.

Congenital heart defects can also be broken down into two main groups: cyanotic and acyanotic. Cyanotic means the body isn’t able to receive adequate amounts of oxygen and the skin can be a bluish color as a result.

The treatment required depends on the heart defect. For instance, those who have been diagnosed with less complex heart defects may only need routine testing. Those with complex defects may need a combination of open heart surgery and prescription medications.

People born with complex heart defects often struggle with work and completing tasks that require physical exertion. Because of this, some people who have been diagnosed with a congenital heart qualify for Social Security benefits.

Social Security Disability

If you are an adult with a congenital heart defect and want to know if you qualify for Social Security Disability (SSD), you will need to answer some questions regarding your work history and whether the heart defect interferes with your ability to work.

In answering these questions, you will need to prove that you are medically disabled as a result of having a heart defect.  Social Security has a Listing of Impairments.  However, not all impairments are listed there.  For instance, you may not find a Double Outlet Right Ventricle (DORV) on the List. We must then look at your symptoms.

To find out whether your symptoms qualify you for benefits, we go to the subcategory called symptomatic congenital heart disease. If you are cyanotic while resting and a cardiac catheterization shows that your proportion of red blood cells is over 55 percent or your oxygen saturation levels are less than 90 percent, you may qualify for Social Security benefits.

Other underlying conditions or symptoms that may help those with congenital heart defects qualify for Social Security benefits include:

  • Chronic heart failure
  • Recurrent arrhythmias
  • Myocardial ischemia
  • Chronic venous insufficiency

Sometimes, those born with congenital heart defects must undergo a heart transplant. Transplant recipients may qualify for disability for up to a year following the procedure. After the year is up, you will need to be reevaluated to see if you still qualify for disability benefits.

You will need medical documentation to prove that your heart condition is causing any of the above symptoms. If all the criteria are met and it can be proven that a congenital heart condition is indeed a disability affecting your work, you should qualify for benefits.

Unlisted Conditions

What happens if you have a condition that is not listed on the SSA page? While it will be more difficult for you to qualify for disability benefits, doing so may still be possible.

If you can prove that your heart condition is causing too many physical limitations and that you can’t work full time as a result, you can have your doctor provide a special form called a physical Residual Functional Capacity assessment (RFC). This document should list the following types of limitations:

  • How long you’re able to walk, sit, or stand
  • Whether you’re able to push, pull, or carry
  • How often you need to rest or lie down

Ideally, your RFC should be provided by a cardiologist who specializes in adults with congenital heart defects. An attorney who practices in Social Security law can provide this form. 

If you need help going through the process of qualifying for Social Security benefits, contact Glen Cook Social Security Attorney for a free evaluation.