Get Social Security & SSI Disability: Peripheral Artery Disease

Winning Your PAD Case

What Social Security Wants To See With Peripheral Artery Disease

Social Security will award you benefits if your peripheral artery disease symptoms disable you. Peripheral artery disease, also known as PAD, is a condition in which atherosclerosis (cholesterol or plaque) blocks or reduces blood flow in the arteries that carry blood to the legs and arms and sometimes the stomach and head. Peripheral artery disease most commonly affects the legs.

Social Security's examination of your medical file begins with the diagnosis of your peripheral artery disease which is done by ultrasound, angiogram, ankle-brachial index, or MRI. If you have not had one of these tests performed, ask your doctor to perform one. The test will establish an objective diagnosis as well as your disease severity

In examining your medical file, Social Security will also learn about the symptoms you report to your doctor which typically include -

1. Swelling,
2. Inflammation,
3. Numbness,
4. Leg fatigue, and
5. Pain.

Social Security will also examine your ongoing medical treatment which usually includes cholesterol-lowering drugs, high blood pressure medications, blood thinners, and sometimes compression stockings. Surgeries such as angioplasty (catheter in the vessel to clear a blockage) or a bypass (removing a blocked artery section) are performed in severe cases.

Peripheral artery disease is most common in Social Security and SSI disability when the claimant is over age 50 (a critical age in Social Security's disability evaluation process). The risk of getting the disease increases with age. Factors such as high blood pressure, high cholesterol, smoking, and diabetes all increase your chance of getting the disease, and all factors generally get worse with age.

Peripheral Artery Disease Social Security & SSI Listing

With a full reading of the Adult Listing 4.12, you'll see it is technical in its medical descriptions. In summation, the listing requires you to establish intermittent claudication (reduced blood flow) and at least one of the following:

1. Reduced resting ankle/brachial systolic blood pressure ratio,
2. Reduced systolic blood pressure,
3. Reduced resting toe systolic pressure, or
4. A reduced resting toe/brachial systolic blood pressure ratio.

A Success Story - Partially Favorable Decision & The Importance of Credibility

Mr. Martens was a veteran from Oakland, CA. When he stopped work, his alleged onset date (AOD) of disability, he was 56. Social Security considers him "advanced age." His past work was as a retail store cashier, sorter, and a machinist. The primary physical function of his past work was being on his feet - standing and walking.

To be found disabled, he was required to show he could not perform his 1) past work or 2) "other work." At his age, if he could show he was limited to sedentary physical exertion (sitting and lifting no more than ten pounds), we would win his case because he would be unable to perform his 1) past work or 2) other work that could be performed with his work skills and required little to no vocational adjustment. Hence, to win his case, we needed to show he could not stand and walk throughout a normal work day. Even if he could sit throughout the day, he could still be found disabled.

Mr. Martens suffered peripheral artery disease of his bilateral lower extremities. He had undergone two ankle-brachial indexes. The first test showed an ABI Value (ankle/brachial systolic blood pressure ratio) of .4 - severe arterial disease. The second showed an ABI Value of 0.7 - moderate arterial disease. He did not meet the Peripheral Artery Disease Listing because of this second test. Though the second test indicated an improvement of his condition, his symptoms had actually worsened. This was a problem at the hearing as Social Security primarily relies on the objective medical testing and medical evidence to establish the severity of an impairment. It did not help that Mr. Martens's clinical evaluations by his doctor were general - lazy doctoring frankly. Social Security secondarily relies on the claimant's subjective complaints of symptoms.

And his symptoms were significant. He did not have the ability to stand and walk throughout an eight-hour day. He was even required to elevate his legs about two to three hours a day to alleviate the swelling of his feet and calves. He used both a cane and a shower chair and rarely ran his own errands since he had difficulting navigating the stores.

At the hearing, counsel asked him about his activities of daily living that required standing and walking or using his lower extremities:

1. Housework,
2. Laundry,
3. Showering,
4. Shopping,
5. Driving,
6. Caring for his grandkids,
7. Making meals/cooking, and
8. Home physical therapy.

Mr. Martens's credibility was critical since the objective testing was mixed. At the hearing counsel and Mr. Martens's stressed several points that highlighted his credibility:

1. He had a good and consistent work record,
2. He used compression stockings,
3. He quit smoking three months after his initial peripheral artery disease diagnosis,
4. His attempts at home physical therapy,
5. He sold his motorcyle because he was unable to ride it anymore,
6. He attempted to return to work as a part-time delivery driver but was fired because he could not effectively perform his work duties, and
7. A surgery (a bypass) had been recommended (though it could not be done as he lost his health insurance).

Mr. Martens's peripheral artery disease Social Security disabiltiy case was allowed; he won. However, the ALJ awarded benefits six months after Mr. Martens's AOD - a partially favorable decision (Mr. Martens got part of what he wanted). An appeal would be made to the Social Security Appeals Council (AC); it would take about two years, and the liklihood of success was about 10%. Success at the AC nearly always means a new hearing (not a finding that Mr. Martens was disabled at an earlier time) with the same ALJ who at the new hearing could 1) make a totally new decision including the possibility that the Mr. Martens was never disabled; 2) that Mr. Martens became disabled after the date originally determined at the first hearing; or 3) at the time of the new hearing, Mr. Martens was no longer disabled. Mr. Martens determined that losing six months of back pay was not worth the time and risk of appeal.

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