Can I Get Disability Benefits After a Heart Attack?

Can I Claim Disability After a Heart Attack?

If you're experiencing severe limitations in what you can do because you've suffered a heart attack, you might be able to get Social Security disability benefits—if you're prevented from working for 12 months or more. Social Security has two ways you can qualify for Social Security disability benefits:

• Meet a "listing." Social Security has a disability evaluation handbook (the "Blue Book") that outlines the criteria for disability for various medical conditions. Social Security calls these rules "listings."
• Be unable to work. Even if you don't meet a listing, you may still be eligible for disability benefits if you can prove that you have a severe medical impairment that makes you unable to do much physical activity.

Meeting a Disability Listing for a Heart Attack

After a heart attack, Social Security might evaluate your condition under listing 4.04 for "ischemic heart disease." Listing 4.04 is for people who have coronary artery disease with obstructed blood flow to the heart.

To meet this listing, Social Security normally expects you to have symptoms of "myocardial ischemia" and your symptoms must occur even though you're following your doctor's recommended treatment plan.

The most typical symptom of ischemia is angina (chest pain that's caused by activity or emotion and is relieved by rest or fast-acting medication like Nitroglycerin). You could also have "atypical angina" (pain occurring in places other than the chest, like the left arm, neck, jaw, or back) or the equivalent of angina (shortness of breath without chest pain when you're active).

Some people have angina occurring at rest (especially at night), instead of having pain on activity. In this case, Social Security will want to see an electrocardiograph (ECG) showing "transitory ST-segment elevation."

If you don't have angina at all, you might have "silent ischemia," which Social Security might accept if you have evidence of abnormalities on an ECG, Holter monitor, or medical imaging.

In addition to documentation of these ischemic symptoms, listing 4.04 states you must also have one of the following:

• an abnormal stress test, which is a test that measures the heart's ability to respond to exercise in a controlled environment
• abnormal imaging results, or
• three ischemic episodes requiring bypass surgery or angioplasty within a year.

For the detailed stress test and imaging results that Social Security wants to see to meet this listing, see our article on the disability listing for ischemic heart disease.

As you've probably guessed, the criteria required to meet the cardiac listings are very specific and can be hard to understand if you're not a doctor. You could show your doctor listing 4.04 and ask if you might meet its requirements.

Being Unable to Work After a Heart Attack

Meeting the criteria explained in the listings can be difficult. In fact, most disability claims that are approved for benefits don't meet the criteria of one of the listings contained in Social Security's Blue Book. Instead, Social Security approves the claims when disability applicants' limitations make them unable to perform their previous jobs, and they're unable to transition into other types of work.

To decide if you're unable to work at any job, Social Security will look at your medical records to see whether your heart-related problems limit your ability to do many work-related activities. You aren't expected to do a job that's beyond your capabilities, physically or mentally.

To prove that there are no jobs within your capabilities, first, you must have a diagnosis of CAD and it must be backed up by medical findings, like ECGs, lab tests, or imaging, not just your reports about shortness of breath or chest pain.

Social Security's RFC

If Social Security agrees that your diagnosis is serious and your condition is severe, next a claims examiner will determine your Residual Functional Capacity (RFC). Your RFC is the most intensive work you can still do (medium, light, or sedentary), despite the limitations caused by your medical condition. For example, if you've suffered a heart attack, your doctor might limit you to standing only two hours a day due to fatigue or shortness of breath (sedentary work).

A full RFC for someone who has experienced a serious heart attack might include the following limitations:

• walk and stand no more than two hours of an eight-hour workday
• sit no more than four hours of an eight-hour workday
• lift and carry no more than twenty pounds occasionally (defined as 1/3 of an eight-hour workday) and ten pounds frequently (defined as occurring from 1/3 to 2/3 of an eight-hour workday)
• occasionally stoop, crouch, crawl, kneel, or bend
• never climb ladders, ropes, or scaffolds, and
• occasionally climb ramps or stairs.

Social Security would probably find that someone with these limitations would be unable to complete a full work shift and so would be unable to perform most jobs. Let's look at how the SSA uses your RFC.

How Does Social Security Use Your RFC?

Social Security will look at each job you've done in the last five years to see if you could do any of them now, with your current RFC and cardiac limitations. If you can't be expected to do the work safely, the agency will determine whether any other easier jobs exist that you can do.

Most younger disability applicants need to show that they can't do even the least physically demanding jobs before Social Security will award them benefits. But if you're 50 years of age or older, you might be able to use the medical-vocational grid rules to qualify for benefits if you can physically perform light or sedentary work, but you've never done it before (and can't learn the skills to do it).

What Medical Evidence Will Social Security Need to Decide Your Claim?

Social Security requires a "longitudinal clinical record," meaning that you must have had at least three months of treatment with a cardiologist, unless the agency already has enough evidence for Social Security to make a decision. But Social Security also requires that your cardiovascular problems have been, or are expected to be, disabling for a year or more, so continuing to see your doctor for your condition is very important.

At a minimum, your medical records should include:

• reports of any tests you've had, like ECGs or exercise stress tests
• a summary of any hospitalizations or surgeries you've had
• a description of the ongoing medical care you're receiving
• documentation of medications you've tried and your response to them, and
• doctor's notes reflecting the frequency and severity of your symptoms.