Get Social Security Disability & SSI: Coronary Artery Disease

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Social Security Disability & Coronary Artery Disease - An Evaluation

Overview

Claimants nationwide regularly file for Social Security and SSI disability benefits with coronary artery disease (also called ischemic heart disease, atherosclerosis, or cardiovascular disease) which is either damage to or disease of the heart itself or the arteries that supply blood to it. The main coronary arteries (those mostly commonly affected) are the right main coronary artery, left main coronary artery, left circumflex artery, and the left anterior descending artery. The most common cause of the disease is atherosceloris (cholesterol or plaque) that narrows or blocks (stenosis) arteries and reduces blood and oxygen flow (oxygen is carried in the blood). If a blockage is severe enough, coronary artery disease can lead to a Heart Attack (myocardial infarction).

Diagnosis

Social Security will need to see objective testing of your coronary artery disease disability. Coronary artery disease is diagnosed with five main tests from least to most effective:

1. Electrocardiogram (EKG) where electric signals sent through your heart to determine heart functioning;
2. Echocardiogram where ultrasound waves create a picture of your heart to determine heart functioning;
3. Stress test where you undergo an EKG and your heart is stressed with exercise or drugs to determine heart functioning;
4. Angiogram, or heart/catheterization where dye is injected into your heart and coronary arteries, and a x-ray is taken to view whether there is stenosis; and
5. Heart scan or heart CT where a dye is injected into your heart, and a CT is done to look for stenosis.

Symptoms

When adjudicating a disability case, Social Security acknowledges that coronary artery disease involves the following symptoms:

1. Significant tiredness,
2. Loss of strength,
3. Difficulty breathing, and
4. Angina (pain in and around the chest).

Treatment

If you are not getting ongoing medical treatment, Social Security will conclude your coronary artery disease is not severe enough to require it, and Social Security will usually deny your case. Treatment is fairly standard. Lifestyle choices will always be recommended. Plague in the cardiovascular system is caused primarily by eating cholesterol, so dietary changes are needed. Your doctor will also recommend exercise, smoking cessation, weight loss, and stress reduction.

Medications, no doubt, will be prescribed. The most common medications include -

1. Statins to reduce cholesterol,
2. ACE inhibitors to lower blood pressure,
3. Beta-blockers to lower your heart rate and blood pressure, and
4. Nitroglycerin or ranolazine for angina.

Surgeries. If you have 40% to 50% stenosis or more, three surgeries are generally done.

1. Angioplasty where your artery is widened with a drug or a stent.
2. Atherectomy where plague is vacuumed from the artery.
3. Artery grafting (heart bypass) where the narrowed or blocked artery is so damaged that neither an angioplasty or an athrectomy can remove the plague, and the artery must instead be cut out and replaced. If you had a "double bypass," you had two arteries replaced. If you had a "triple bypass," you had three arteries replaced. And so on.

The Social Security & SSI Coronary Artery Disease Listings

Three listings may apply.

Coronary Artery Disease

The Adult Listing 4.04C requires all three of the following:

1. You have chest pain, difficulty breathing, and angina (chest pain radiating in and around the chest).
2. You are getting regular medical care (you can still equal a listing if you are not getting regular care if you have another impairment).
3. You have with one of the following three -
1. You undergo a heart exercise test showing 5 METs or less,
2. You have three ischemic occurrences (TIAs, mini-strokes, or strokes) occurring in a 12-month timeframe, each either -
   • Needing restoration of blood to the body part that has suffered ischemia (usually by bypass and angioplasty), or
   • Restoration is not possible; and
3. You undergo coronary artery disease with testing (unless a doctor deems the testing unsafe) showing 50 to 70 percent or more narrowing of a coronary artery or a graft vessel that causes significant difficulties in your performance of normal life responsibilities.

Heart Aneurysm

If your coronary artery disease causes an aneurysm (an abnormal bulge in the artery), you may meet Adult Listing 4.10 which requires all three of the following:

1. You have an aneurysm,
2. The aneurysm dissects (the inner lining of the artery begins to separate from the arterial wall), and
3. You have chest pain, an increase in the size of the aneurysm, or compression of at least one branch of the aorta.

Heart Transplant

If you have coronary artery disease that results in a heart transplant, you will satisfy Adult Listing 4.09. Social Security will find you disabled for one year, and then evaluate your heart impairment to decide if you continue to be disabled.

A Coronary Artery Story - Arguing A Listing But Needing A Grid Rule

Mr. Williams was diagnosed with coronary artery disease, high blood pressure, hyperlipidemia (high cholesterol), diabetes, and depression. He was 58 years old and had worked as a long haul truck driver for the past 20 years. His case was denied at the initial and reconsideration levels. He filed his own Request for Hearing. Originally, he intended to handle his hearing on his own. As his hearing drew near, and after many discussions with his wife and family members, he decided to hire counsel. He filed for Social Security disability (SSDI) and SSI benefits.

The first order of business was to review Mr. Williams's Socal Security disability file which is electronic at the hearing level (it is available for review on Social Security's server).

The second order of business was updating his medical records. At the hearing level, Social Security commonly does not update medical records very well. Mr. William's medical records showed that he had undergone an angiogram which showed he had 60 to 80% stenosis in three main coronary arteries. He suffered the classic symptoms of coronary artery disease: severe fatigue, lethargy, weakness, shortness of breath, and chest pain. He underwent an angioplasty and had three stents placed - a triple bypass. He was thereafter prescribed statin and beta-blocker medications.

The third order of business was addressing the main problem in his case: his cardiologist and his primary provider both regularly reported that he was "stable," and that he reported he was doing "fine." Clinical evaluations by both doctors were simply boilerplate language, and they did not indicate significant abnormalities. He also underwent physical therapy, and the therapist found when he completed physical therapy that he met all physical therapy goals.

Counsel intended to argue at the hearing that Mr. Williams met Social Security Listing 4.04C. The listing requires two main criteria: 1) one has 50 to 70% or more narrowing of a coronary artery or a graft vessel (he met this part), and 2) one has significant difficulties in their activities of daily living. This second part the more difficult criteria to prove.

Mr. Williams complained to counsel of severe symptoms both before and even after the surgery. He reported he never felt the same again and lacked the stamina to perform his past full-time work. Because of his age and his past work history, we only needed to show he could not do that type of work.

Counsel contacted his cardiologist, primary doctor, and physical therapist to determine the true nature of Mr. Williams's symptoms. The primary doctor provided a statement that Mr. Williams's symptoms were as severe as reported and that his medical records did not document this fact primarily due to vagueness and boilerplate language. The other providers declined to help. Counsel also obtained statements from three family members about Mr. Williams's problems in carrying out daily tasks. As well, counsel obtained and submitted the sale receipts of Mr. Williams's beloved and regularly used RV, fishing boat, and truck he could longer use due to his heart condition.

At his hearing, Mr. Williams was a believable witness, and so was his wife. Although she provided a written statement prior to the hearing, the judge asked to speak to her. Of special importance was the statement of Mr. Williams's primary doctor which the judge referenced on a couple separate occasions. A decision was not made at the hearing. About 90 days after the hearing, the ALJ issued a fully favorable decision. The ALJ did not find Mr. Williams met Listing 4.04C, but he did find he was unable to perform his past work or other work - he met Social Security Grid Rule 201.06.

TERI: Terminal Disease Case

Social Security may consider a coronary artery disease disability case a TERI case as it is a terminal medical impairment (it cannot be treated and expected to result in your death). Social Security will expedite a TERI case so that a decision can be made sooner - Expedited Cases.