Written by:
Linda Cosme – Vice President of Disability Policy & Strategy, Citizens Disability
Can You Get Disability for Congestive Heart Failure?
Congestive heart failure comes with some highly uncomfortable symptoms, including chest pain, shortness of breath, and extreme fatigue. Your symptoms may be difficult to manage and prevent you from working. If so, it’s possible to qualify for disability for congestive heart failure, provided you meet the eligibility requirements for Social Security Disability Insurance, or SSDI.
What Is Congestive Heart Failure (CHF)?
Congestive heart failure is a chronic condition that prevents the heart from pumping blood effectively. It’s an impairment that results from the inability of the heart to pump enough oxygenated blood to body tissues. An accumulation of fluid in various parts of the body results from the inability of the heart to maintain adequate circulation. In most cases, CHF is irreversible depending on the extent of the damage, although medications and treatments can help manage its symptoms.
The two main types of congestive heart failure include systolic and diastolic failure. Both involve the left side of the heart. They are defined as follows:
- Systolic failure occurs when the heart’s left ventricle stops contracting normally, reducing blood circulation. To be diagnosed with this type, a patient must have a reduced ejection fraction, or EF, of 40 percent or less.
- Diastolic failure happens when the heart’s left ventricle can’t relax or fill with blood. Heart failure with preserved ejection fraction, or HFpE, rates are equal to or greater than 50 percent.
Congestive heart failure involving the right-sided ventricles may follow a systolic or diastolic failure. It occurs when there’s too much fluid pressure on the right ventricle, and the heart transfers blood back through the lungs, causing a blood buildup in the body’s veins.
Contributing causes of congestive heart failure include high blood pressure, coronary artery disease, diabetes, and lifestyle habits such as drinking alcohol and smoking. Genetic heart conditions like cardiomyopathy can also cause chronic heart failure.
Living with congestive heart failure isn’t easy. Symptoms like fluid buildup, chest pain, and breathlessness can limit your ability to manage daily activities or job tasks.
Does Congestive Heart Failure Qualify for Disability Benefits?
It’s possible to qualify for SSDI benefits with congestive heart failure. However, you must demonstrate a pattern of continual symptoms unresponsive to treatment. Simply having a diagnosis won’t be enough to meet the requirements of the Social Security Administration.
The SSA considers a combination of objective test results and subjective symptoms, such as fatigue or an inability to walk short distances, during the SSDI screening process.
Since congestive heart failure is irreversible, it will likely meet the threshold requirement of a condition expected to last at least 12 months.
What Documentation Do You Need?
SSA needs sufficiently detailed reports of history, physical examinations, laboratory studies, and any prescribed treatment and response to allow them to assess the severity and duration of the cardiovascular or heart impairment. A longitudinal clinical record covering a period of not less than 3 months of observations and treatment is usually necessary, unless SSA can make a determination or decision based on the current evidence. It’s important that you keep all your follow-up visits or appointments.
Chronic or congestive heart failure are evaluated by a variety of diagnostic tests. The most commonly seen tests are chest x-ray, electrocardiogram (ECG), echocardiogram, thallium exercise test, resting Doppler/exercise Doppler, catheterizations, angiography, ventriculography, Holter monitor, exercise tolerance test (ETT), treadmill, bicycle or arm ergometer, multigated acquisition (MUGA).
SSA's Criteria for Congestive Heart Failure – Listing 4.02
The SSA evaluates chronic heart failure using the Listings of Impairments, Listing 4.02. To meet the SSDI eligibility requirements, an applicant must submit medical documentation establishing either of the following:
- Systolic failure: Left ventricular diastolic dimensions above 6.0 or an EF rating of 30 percent or less.
- Diastolic failure: Left ventricular posterior wall plus septal thickness of 2.5 centimeters or more in an image test and an enlarged left atrium of at least 4.5 centimeters.
In addition to the medical tests, the SSA requires an applicants to show one of the following:
- Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period with evidence of fluid retention from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization; or
- Inability to perform on an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to:
As you can see, the technical requirements for Listing 4.02 are very specific. If you meet or equal these requirements, you may receive an award notice.
- Dyspnea, fatigue, palpitations, or chest discomfort; or
- Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
- Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload; or
- Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.
As you can see, the technical requirements for Listing 4.02 are very specific. If you meet or equal these requirements, you may receive an award notice.
How To Qualify for SSDI Without Meeting or Equaling Listing 4.02 Criteria
If you don’t meet all of the SSA’s Listings criteria for benefits with congestive heart failure, don’t let that hold you back from applying. Many applicants still qualify for benefits even if they do not meet or equal Listing 4.02 requirements.
If the SSA determines that you don’t meet or equal the listing’s requirements, it may still find you eligible for benefits based on your Residual Functional Capacity, or RFC. Your RFC describes the level of work you can do despite your functional limitations. The SSA will review your entire medical record, including stress tests, echocardiogram results, and notes from your cardiologist. The RFC may also consider the medications you take and the side effects they cause you.
An RFC assessment will determine your physical limitations caused by chronic heart failure. Under this part of the evaluation, the SSA may consider your ability to walk short distances, sit or stand, and complete tasks without exhaustion. The SSA will decide whether your symptoms and doctor-imposed restrictions result in physical limitations preventing you from performing any level of full-time work. If so, it will grant you a medical-vocational allowance.
If the SSA determines the results of an RFC assessment meet its disability eligibility requirements, you may receive SSDI.
Common Reasons Disability Claims Are Denied
The SSA denies between 60 and 70 percent of disability benefit claims annually. Among the most typical reasons for a denial are:
Missing or Inadequate Treatment Records
The Social Security Administration requires thorough documentation of the claimed disabling condition. If your application lacks substantive evidence of disabling chronic heart failure, the SSA will deny your claim. To avoid this scenario, include all the names of all the medical providers to include hospitals or clinics where you received treatment or care. The Disability Determination Services (DDS) disability examiner will request those records at no cost to you. Stress tests, doctor’s notes, medical evaluations, and your prescription history provide comprehensive documentation for the agency to review.
Inconsistent Test Results
It’s not unusual for test results to change over time. If any of your medical tests demonstrate an improvement in your condition, explain why. For instance, your ejection fraction on an echocardiogram may change with medications or reduction in your work activity. Your physician can explain any improvements especially if the improvement was related to a decrease in your work activity.
Lack of Detail From Treating Cardiologists
Doctors are busy people who don’t always include precise notes in medical records. Take the time to review all documents from your cardiologist and other treating physicians before submitting your application. If you find any areas that could benefit from further detail, ask your doctor to provide it.
Gaps in Work History or Unclear Job Descriptions
The SSA considers your work history when applying for benefits. If you haven’t worked for years, officials may wonder why you’re now seeking SSDI. Address any work history gaps in your application and outline specific duties for each position you held.
You must show that your condition prevents you from working. Thus, clearly document your previous work and how your condition affects your ability to perform the required tasks.
How Disability Advice Can Help With Your Heart Failure Claim
Disability Advice helps people understand their options when they can’t work due to a medical condition. We can connect you with a qualified disability attorney who can help you apply for or appeal a request for SSDI benefits related to congestive heart failure.
Your attorney or disability representative will assist you in preparing an SSDI benefits application, including gathering test results, treatment history, and cardiology documentation. If your disability claim has already been denied, we can assist with an appeal to ensure that your appeal has all the relevant information and help you identify tests and other areas that need more attention. All consultations are free, and our services have no upfront costs.
Contact us today, and we’ll connect you with an experienced and knowledgeable advocate.
FAQs About Congestive Heart Failure and SSDI
Is heart failure a permanent disability?
Yes, heart failure is a permanently disabling condition. While medications, lifestyle changes, and treatment can slow its progress, chronic heart failure is a long-term condition. If you have a heart failure diagnosis and suffer severe symptoms despite taking medication, you may be eligible for SSDI benefits from the SSA.
What if I've had a heart transplant—can I still apply?
The SSA automatically considers applicants who undergo heart transplants to be disabled. If you meet the other qualifications for SSDI, you may receive benefits for one year following the surgery. The SSA may extend benefits during its continuing disability review. However, the SSA notes that most people who require a heart transplant begin receiving benefits well before the surgery, provided they meet the agency’s disability requirements.
How long does it take to get approved for chronic heart failure?
As of May 2025, the average processing time for all SSDI benefits applications was 232 days. However, processing times vary substantially across regions and states. To improve your chances of a quick approval, thoroughly complete your application and include all evidence documenting your chronic heart failure diagnosis and its effects on your life.
If I can work part-time, will I be denied?
If your monthly earnings from part-time work average more than $1,620—or $2,700 if you’re blind—you cannot receive disability benefits. The SSA will deny your application for SSDI.
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Written by:
Linda Cosme – Vice President of Disability Policy & Strategy, Citizens Disability
- What Is Congestive Heart Failure (CHF)?
- Does Congestive Heart Failure Qualify for Disability Benefits?
- What Documentation Do You Need?
- How To Qualify for SSDI Without Meeting or Equaling Listing 4.02 Criteria
- Common Reasons Disability Claims Are Denied
- How Disability Advice Can Help With Your Heart Failure Claim
- FAQs About Congestive Heart Failure and SSDI
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“Professionalism at its best. From intake to getting my claim started, they are the ones you need. 100% recommend to everyone.”
Pablo P.
“Having never gone through this process before, it was very easy and straightforward. VERY professional and polite.”
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