Can You Get Disability for Low or Poor Ejection Fraction?

Ejection fraction (EF) is a medical term that describes how well your heart pumps blood. EF is expressed as a percentage that measures the amount of blood ejected through a chamber—usually the left ventricle—per heartbeat. Ejection fraction is an important metric for doctors who use it to determine the severity of cardiovascular conditions such as chronic (congestive) heart failure.

The lower your EF percentage is, the more difficulty your heart has in pumping oxygen-rich blood from its main chamber. According to the American Heart Association, a healthy heart has a normal ejection fraction of about 50-75%. An EF below 50% is called predominant systolic dysfunction and can signal to your doctors that you have an increased risk of heart disease.

What Ejection Fraction Qualifies for Disability?

If you have an ejection fraction of 30% or less during a period of stability (meaning the measurement isn't taken while you're experiencing cardiac arrest), and you have additional medical evidence showing very poor heart function, you might qualify for disability automatically under Social Security's Listing 4.02 for chronic heart failure.

People with a stable EF greater than 30% might not meet (or equal) the requirements of the listed impairment but can still get benefits if they can show that symptoms from their heart condition prevent them from working full-time.

Symptoms and Causes of Poor Ejection Fraction

When your heart isn't pumping blood correctly, you can feel the effects in many different parts of your body. Some of the most common symptoms reported in people with poor EF include:

• confusion
• fatigue
• heart palpitations
• nausea
• shortness of breath (dyspnea)
• water retention in your abdomen or feet, and
• weakness.

The underlying causes of low ejection fraction can vary, but anything that weakens the heart muscle can make it harder to contract and eject the right amount of blood. Cardiomyopathy (problems with your heart muscle) can be present at birth or acquired later. Examples of conditions that might result in acquired cardiomyopathy include high blood pressure, diabetes, thyroid disorders, or viral infections.

Getting Disability With an Ejection Fraction of 30% or Less

As you can see from the above chart, doctors consider an EF of 30% or less (at rest) to be severely abnormal. The Social Security Administration (SSA) uses medical guidelines when crafting the requirements for the "Blue Book" of listed impairments, conditions that the agency considers to be severe enough to award somebody disability benefits without having to prove they can't work.

But meeting the criteria of listing 4.02, chronic heart failure, isn't as easy as having an ejection fraction of 30% or less. You'll need to show that your low EF causes at least one of the following medical or functional limitations:

• you have significant difficulty completing your activities of daily living without help
• repeated (no less than three in twelve months) and prolonged (requiring hospitalization for at least twelve hours) episodes of heart failure with evidence of fluid retention, and
• inability to complete a basic exercise test without experiencing chest pains, an irregular heartbeat, a drop in blood pressure, or uneven gait due to lack of oxygen.

The SSA will need to see objective evidence of your poor ejection fraction in the form of medical imaging. Examples of acceptable medical imaging techniques include:

• chest X-ray, MRI, or CT scan
• echocardiography (M-Mode, 2-dimensional, or Doppler)
• radionuclide studies (MUGA scan)
• cardiac catheterization, and
• ultrasound.

Medical imaging is especially important in disability applications based on heart disease. Unlike most other conditions, Social Security can look at a specific number (the EF) representing how severe your impairment is and make a reasonable conclusion about how limited you are as a result. Even if you have an EF above 30% and can't qualify for benefits under Listing 4.02, medical imaging can still support the extent of your functional limitations.

Getting Disability With an Ejection Fraction That Prevents You From Working

Some disability applicants will have a stable EF that falls within the "moderately abnormal" range—for example, they have an ejection fraction of 35%. Or, they might have an ejection fraction of 25% but they don't meet the other listing criteria. These applicants can still get disability benefits if they have a residual functional capacity (RFC) that rules out all jobs.

What's In Your RFC?

Your RFC is a set of limitations that reflect the most you're capable of doing in a work setting. Because people with low EF get out of breath with physical activity, their RFC will likely contain restrictions on the most time they can walk and the heaviest amount they can carry. (In Social Security lingo, these are called exertional limitations.) Restrictions that aren't about how much weight you can lift and how long you can be on your feet are called non-exertional limitations.

How Does Social Security Use Your RFC?

Social Security compares the restrictions in your RFC with the demands of your past work to see whether you could do those jobs today. For people over the age of 50, being unable to return to their past jobs might be enough for the SSA to find them disabled under the medical-vocational grid rules.

For people under the age of 50 who can't do their past jobs, the SSA will then determine whether they can perform the easiest sit-down jobs despite the restrictions in their RFC. If your RFC says you can't lift even 10 pounds or stand for 2 hours without struggling to breathe, for example, or you need to elevate your legs frequently to decrease swelling caused by water retention in your feet, Social Security will likely find that no jobs exist that you can do.

For more information, see our article on how Social Security decides if you can do past or other work.

Applying for Disability Benefits for Low Ejection Fraction

The disability determination process can be lengthy. You can help streamline the process by addressing important preliminary issues before you begin your application for benefits.

• Are you still working? The SSA needs to see that your low EF (or related heart condition) keeps you from earning substantial gainful activity for at least twelve months. If you don't expect to be out of work for a year, look into short-term disability benefits.

• Which disability program do you qualify for? Social Security Disability Insurance (SSDI) is based on how much you've worked in the past, while Supplemental Security Income (SSI) is available to people with low income and resources.

• Have you been receiving medical treatment? The SSA can't award benefits for conditions that aren't backed up by doctors' visits, so make sure you get treatment that you can reasonably afford.

Once you're ready to apply, Social Security offers several methods for you to file.

• Go online at ssa.gov. If you have reliable internet access, this is a great way to keep track of your application's progress.
• Call 800-772-1213 from 8 a.m. to 7 p.m. Monday through Friday. If you're deaf or hard of hearing, you can call the TTY number at 800-325-0778.

Visit your local Social Security field office. You may want to call and set up an appointment ahead of time to avoid long wait times.