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Disability Benefits With Heart Failure: 5 Essential Tips

Medically reviewed by Angelica Balingit, M.D.
Written by Ted Samson
Posted on August 23, 2023

For many people living with heart disease like chronic heart failure, symptoms such as dizziness, shortness of breath, and chest pain can make working full time extremely difficult. Unfortunately, trying to manage heart disease without a source of income can be stressful — a problem many MyHeartDiseaseTeam members experience.

“Tried to go back to work today but almost blacked out just standing and being a cashier,” a MyHeartDiseaseTeam member shared. “What do you do when your doctor says there are other options, but they cost hundreds of thousands of dollars and you don’t have it? Am I just supposed to stand still and die because I can’t afford to live on 40 hours a week at $11 per hour?”

Fortunately, financial assistance is available through the U.S. Social Security Administration (SSA) in the form of disability benefits, including Social Security Disability Income (SSDI) and Supplemental Security Income (SSI). Though applying for benefits can be a time-consuming and confusing process, being approved can bring much-needed peace of mind and income.

Following are some tips to help you navigate the process of applying for Social Security benefits for disability.

1. Understand the Difference Between SSI and SSDI

There are two federal disability programs in the United States, Social Security Disability Income and Supplemental Security Income. It’s possible to get both SSDI and SSI if you have very limited funds and a work history.

Social Security Disability Income provides benefits to people living with a medical condition that meets the SSA’s strict definition of disability. The money comes from payroll taxes, and eligibility hinges on having worked in one or more jobs covered by Social Security and having earned enough work credits.

If you’re approved, you can receive benefits six months after you become disabled. If you’ve been disabled for at least a year, you may be able to get back payments of disability benefits for one year. You’re eligible for Medicare (federal health insurance) 24 months after you start receiving SSDI.

Supplemental Security Income provides benefits to those who haven’t worked the required time period and have a low income. If you’re approved, you can receive benefits in the next month. You may also be eligible for back payments of SSI if you became disabled before your approval. Most states grant Medicaid eligibility to people who are eligible for SSI.

Almost every state offers an SSI supplement, but eligibility rules vary by state. There’s an asset cap for receiving Supplemental Security Income. If an individual has more than $2,000 of assets (or a couple has more than $3,000 of assets), they lose eligibility.

2. Determine Whether You Meet SSA’s Criteria for Disability

To determine whether your health condition counts as an eligible disability, the Social Security Administration will evaluate several factors.

One of the most important qualifying criteria is that you must have a recognized disability. The Social Security Administration provides a Listing of Impairments (also known as the Blue Book), which includes a section titled Cardiovascular System — Adult.

The specific circulatory and heart conditions listed include:

  • Chronic heart failure
  • Ischemic heart disease
  • Recurrent arrhythmias
  • Symptomatic congenital heart disease
  • Heart transplant
  • Aneurysm of aorta or major branches

Each listed condition has its own set of criteria you need to meet — such as having specific symptoms, signs, and diagnostic test results — and they all must be medically documented.

The following qualifying criteria also will be examined when you apply for SSDI benefits:

  • You must be unable to engage in “substantial gainful activity.” You are considered capable of substantial gainful activity if you earn over a certain amount — for 2023, $1,470 or more a month ($2,460 if you’re blind) — although if you do earn more, you may be eligible for reduced benefits.
  • You must be incapable of performing basic tasks required for most jobs, including standing for extended periods, walking, lifting, sitting, and remembering.
  • You must be unable to do any work you did previously.

If you’re applying for SSI, the SSA will determine whether you meet the following criteria:

  • You are 65 years or older, have a disability (as described above), or are blind.
  • Your monthly income falls below a certain limit — typically below $1,913 for individuals or $2,827 for couples if it’s from earnings or, if your income is from a pension, below $934 for individuals or $1,391 a month for couples.
  • You live in a U.S. state or territory or are a student temporarily abroad due to studying or being the child of military parents.

The amount of disability benefits you may qualify for depends on your previous earnings, the state you live in, and how long you’ve been unemployed. See the Social Security Administration publications on SSDI benefits and SSI benefits for more specific information about qualifications.

3. Involve Your Health Care Team Early On

Medical evidence is typically the most important component of a disability claim. Make sure your cardiologist or other health care providers are aware that you’re applying for disability so they can document your condition accordingly. Documentation is especially important if you’re required to have a disability evaluation.

Types of information and documentation you’ll need to submit include:

  • The name and contact information of members of your health care team who can discuss your condition
  • Copies or photocopies of medical records, doctors’ reports, and recent test results
  • A complete list of medications, both past and present
  • A description of how your symptoms affect your ability to perform daily activities

Other types of information and documentation you’ll need to include in your application include:

  • Personal information, including your full name as well as those of past or present spouses and your children
  • Earnings and employment history going back as far as 15 years
  • Documents, including your birth certificate, Social Security card, W-2 and other tax forms, and proof of any worker’s compensation

The SSA website can help walk you through the process of applying for SSDI and SSI. You have the option to apply online, by mail, or in person at your local Social Security office. At any point in the process, you can call 800-772-1213 weekdays from 8 a.m. to 7 p.m. local time to apply by phone or inquire about your application.

4. Prepare for a Long Wait After Applying

Once you submit your application, the SSA will review it to see if you meet their basic requirements. They’ll review your current employment activities and send the application to a state agency or field office. The agency will determine whether you have an eligible disability and make the final decision.

Generally, it takes three to six months for the agency to provide an initial decision, which will come in the mail and online. Filing an incomplete application can slow down the process, so double-check your work.

If you disagree with the state agency’s decision, you have the right to request an appeal within 60 days. At this stage, depending on your reasons for an appeal, your application could be reconsidered, heard by a judge, reviewed by a council, or reviewed by federal court.

Once you are awarded benefits, you will be assigned a disability case worker and will have to regularly check in to make sure your situation hasn’t changed. If you return to work at any point, keep in mind that your disability benefits will likely diminish or disappear.

Ways To Speed Up the Process

There are some ways to potentially speed up the process. For one, you may qualify for the Social Security’s Compassionate Allowances (CAL) program, through which people with certain serious health conditions may have their claims processed faster. Heart-related conditions listed for CAL eligibility include heart transplant graft failure, cardiac amyloidosis — AL type, and heart valve atresias (pulmonary, mitral, aortic, and tricuspid atresia).

The SSA also has a terminal illness (TERI) program. Qualifying conditions and circumstances for TERI include waiting for a heart or lung transplant and having chronic pulmonary failure or heart failure that requires home oxygen.

Your claim may also be processed more quickly if it meets the criteria of a dire need case. This means you don’t have resources for food, medical care, or housing — or that you’re on the brink of losing your home to eviction or foreclosure.

5. Ask for Help

You may be able to complete your application yourself with help from your health care team, the Social Security website, and SSA employees. But given how complex and time-consuming the application process can be, you might consider looking for additional support.

Trusted Friend or Family Member

One potential source of support is a trusted friend or family member. Though they may not have a high level of knowledge and expertise about applying for disability, their support can still be invaluable. They can help you gather necessary documentation, put together your application, make calls on your behalf, and attend any in-person meetings.

The SSA website has a useful section for people who are helping others apply for benefits.

Social Security Disability Attorney

Hiring a disability lawyer or advocate may boost your chances of getting your claim approved in a short time. A qualified lawyer will know what medical evidence you need to submit, how to work with health care providers, and how to navigate the process from application to, if necessary, appeal.

Social Security attorneys work on a contingency basis, which means that you pay them only if you successfully get on SSDI or SSI. If your claim is approved, a portion of the money will go to your attorney. According to the legal guidance website Nolo, “The attorney and the client can agree on any fee, as long as it does not exceed $7,200 or 25 percent of your backpay, whichever is less. That limit on fees is a part of Social Security law, and in most cases, an attorney can’t charge more than that.”

Other Sources

Your local Social Security office can point you to a nonprofit, such as legal aid services or a local bar association, for help. You can find a local office through the SSA website.

Find Your Team

On MyHeartDiseaseTeam, the social network for people with heart disease and their loved ones, more than 57,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you applied for disability benefits? Were you successful? What tips can you offer others? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Disability Benefits — Social Security Administration
  2. Supplemental Security Income (SSI) — Social Security Administration
  3. SSI vs. SSDI: The Differences, Benefits, and How To Apply — National Council on Aging
  4. Disability Benefits | How You Quality — Social Security Administration
  5. Program Operations Manual System (POMS) — Social Security Administration
  6. Who Is Eligible for SSI? — AARP
  7. Spotlight on Resources — 2023 Edition — Social Security Administration
  8. What Is the Social Security Blue Book? — AARP
  9. Disability Evaluation Under Social Security — Social Security
  10. Disability Evaluation Under Social Security (Blue Book — October 2008): 4.00 Cardiovascular System — Adult — Social Security Administration
  11. Disability Benefits — Social Security Administration
  12. Supplemental Security Income (SSI) — Social Security Administration
  13. Medical Evidence — Social Security Administration
  14. Apply for Benefits — Social Security Administration
  15. Social Security Office Locator — Social Security Administration
  16. Compassionate Allowances — Social Security Administration
  17. Compassionate Allowances Conditions — Social Security Administration
  18. Expedited Disability Decisions for Terminal Illness Claims — Nolo
  19. Are There Ways To Speed Up a Disability Claim? — AARP
  20. HALLEX: I-2-1-40. Critical Cases — Social Security Administration
  21. Information for People Helping Others — Social Security Administration
  22. Should You Hire a Disability Lawyer? What Do They Do? — AllLaw
  23. How Much Does a Social Security Disability Lawyer Cost? — Nolo
  24. Looking for a Local Office? — Social Security Administration

Posted on August 23, 2023
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Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
Ted Samson is a copy editor at MyHealthTeam. Learn more about him here.

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