Under the regulations followed by the Social Security Administration, there are a two ways that an individual suffering from congenital heart disease may be approved for disability benefits.
The Social Security Administration will grant disability benefits to individuals suffering from an impairment that meets or equals a “Listing” in the regulations that the Administration must follow. There are listings for numerous conditions that encompass all body systems as well as mental disorders. Meeting a listing generally requires more than a mere diagnosis, though. In order to meet or equal a given listing, there are usually numerous diagnostic criteria that must be established through the claimant’s medical records.
With respect to listing 4.06, which pertains to “Symptomatic Congenital Heart Disease”, the following criteria must be established in order to meet the listing:
A. Cyanosis at rest, and:
- Hematocrit of 55 percent or greater; or
- Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less.
B. Intermittent right-to-left shunting resulting in cyanosis on exertion (e.g., Eisenmenger’s physiology) and with arterial PO2 of 60 Torr or less at a workload equivalent to 5 METs or less.
C. Secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial systolic pressure.
However, the listing criteria is not the exclusive route to being found disabled due to your congenital heart disease. You may also qualify for disability benefits based on your “residual functional capacity”. Your residual functional capacity is the most that you are able to do in spite of your impairments. The judge will look to your testimony at the hearing as well as the medical evidence in your case to conclude what you would be capable of doing both physically and mentally. If the judge concludes that your residual functional capacity would not allow for you to be able to perform any of the full time work you have performed in the last 15 years, in many instances you will succeed in your claim. However, if you are under 50 years of age and do not meet a listing, you will need to prove that your symptoms not only prevent you from begin able to perform your past work , but from performing any and all work, at least on a full-time basis and without accommodations.