Cardiovascular disease is a large family of diseases involving the heart and vascular systems, and is in the top 3 causes of disability in the United States. Heart disease causes almost one in every four deaths in the United States. This is the first of 5 posts discussing the major cardiovascular disorders and how they are treated in the social security disability system.
The Greek-origin word “ischemia” mean reduced blood supply. Ischemic Heart Disease, then, is reduced blood supply to the heart muscle. Coronary Artery Disease is the leading cause of Ischemic Heart Disease, and is the most common type of heart disease.
Persons with Ischemic Heart Disease often qualify for social security disability when the severity of this heart condition meets the conditions set out in the “Listing” found at 4.04. It is important to know, however, that just because a claimant’s heart disease does NOT meet Listing 4.04 does NOT mean that the person cannot qualify for social security disability benefits. Rather, more analysis of the medical evidence must be done by social security.
The Ischemic Heart Disease Listing requires the presence of chest pain, referred to as angina, despite following “prescribed treatment” (i.e, you still have chest pain even though you are doing what your cardiologist tells you to do). To meet the Ischemic Heart Disease listing, you also have to have one of the following:
- Three “ischemic episodes” with subsequent “revascularization” in a consecutive 12‑month period. Revascularization would be both angioplasty (stents) and coronary bypass (CABG, referred to as a “cabbage” by doctors).
- Specific findings of ischemia on exercise stress test.
- Specific findings of coronary occlusion (blockage) on angiography testing such as an Echocardiogram.
When a social security disability applicant’s ischemic heart disease does not meet the listing found at 4.04, the social security adjudicator must consider whether the symptoms of heart disease preclude a return to past relevant work, or whether other work could be performed by the claimant. The latter inquiry – whether a claimant could be “other work” – is an age and education-sensitive inquiry. In general the older and less educated you are, the more difficult it will be for social security to say you are not disabled because you can do “other work”.
As you can see by the above items, the exercise stress test is Social Security’s preferred diagnostic test in assessing the extent of disability from ischemic heart disease. Unfortunately there is some evidence that exercise stress test findings correlate only weakly with the ability to perform more routine tasks of daily living and less strenuous work-related activities, the typical limitations that provide the basis for disability. The CABG is the most common and wide-spread treatment for coronary artery disease, yet a recent review of the literature found that 90 percent of patients experience improvement in symptoms following CABG, but only about 50 percent return to work. This suggests that CABG improves symptoms but does not always return the paitient to former functioning.
The primary disabling symptoms of coronary artery disease, whether before or after by-pass and/or stenting, remain fatigue levels and angina. Many post by-pass patients also report significant symptoms of depression and anxiety as well.
An experienced, local social security disability attorney can help develop and present the claim involving ischemic heart disease to achieve a winning result.