The Houston disability benefits lawyers at Marc Whitehead & Associates have helped individuals all across the nation obtain the disability benefits they need after the symptoms of congestive heart failure and other serious health conditions leave them unable to work.
How Congestive Heart Failure Can Lead to Disability
According to the Mayo Clinic, there are almost 200,000 cases of congestive heart failure (CHF) diagnosed each year. CHF occurs when the heart muscle doesn’t pump blood as efficiently as it should. It’s a serious, potentially life-threatening condition that can happen suddenly (acute CHF) or be an ongoing (chronic CHF) condition.
The factors that lead to CHF — such as narrowed arteries in your heart (coronary artery disease) or high blood pressure — can’t always be reversed, but medication and lifestyle habits — exercising, dieting, watching your salt intake, not smoking, and maintaining a healthy weight — can help reduce the chances of future heart failure and improve the quality of life.
Living with the symptoms of CHF can make it difficult to perform many routine daily tasks. Symptoms of CHF can include:
- Chest pain
- Fatigue and weakness
- Rapid or irregular heartbeat
- Shortness of breath (dyspnea) when exerting yourself or while lying down
- Persistent cough or wheezing
- Reduced physical ability
- Swelling in your legs, ankles, and feet
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
Heart valve problems, kidney damage or failure, heart rhythm problems, and liver damages, are a few of the complications that can be caused by CHF.
Disability Benefits for Congestive Heart Failure
For some individuals, the symptoms of CHF can be so severe as to prevent a person from being able to work and earn a living. In that case, they may need to seek short term or long term disability benefits from the Social Security Administration (SSA), Veterans Affairs (VA), or a group disability benefits insurance policy.
Unfortunately, it’s not uncommon for many disability claims to be rejected the first time around. Let’s look at some of the reasons why your application for congestive heart failure disability benefits claim might have been denied.
Social Security Disability Benefits: You Failed to Supply the Necessary Medical Evidence
If you applied for Social Security disability benefits, your application for congestive heart failure disability may have been denied simply because you failed to provide the SSA with the necessary medical evidence to support your claim of disability. The requirements for qualifying for Social Security disability benefits are listed in Section 4.00 Cardiovascular System — Adult of the Social Security Administration’s Blue Book listings of recognized disabilities.
The SSA is very specific about the evidence they require. You must have medically documented evidence of either a systolic failure or diastolic failure that results in:
- Persistent symptoms of heart failure;
- Three or more separate episodes with a consecutive 12 month period; and
- The inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to dyspnea, fatigue, palpitations, or chest discomfort; or three or more consecutive premature ventricular contractions or a decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or signs attributable to inadequate cerebral perfusion.
The SSA will require detailed reports of your medical history, physical examinations, laboratory studies, and any prescribed treatment and response to assess the severity and duration of your cardiovascular impairment. A longitudinal clinical record covering a period of not less than 3 months of observations and treatment is usually necessary to assess the severity and expected duration of your impairment(s).
VA Disability Benefits: You Did Not Demonstrate That Your Condition is Service-Related
If your claim was filed with the VA, it may have been rejected because you failed to show that your medical condition was service-related. To establish that your condition is service-related, you will need a current diagnosis of your heart condition; an in-service event, injury or illness; and a medical nexus letter from your doctor linking your current, diagnosed heart condition to the in-service event.
Group LTD Insurance Policy: Your Claim Was Turned Down as a Delaying Tactic
Even when a policyholder submits the necessary medical evidence to support their claim of CHF disability, it’s not uncommon for insurance companies to delay — or outright deny — a claim when it’s first submitted. In some instances, they consider only parts of your medical record without looking at the full picture of your disability. The goal is to discourage a policyholder from seeking the benefits to which they are entitled.
Most group employer LTD insurance policies are governed by ERISA laws. Among other things, ERISA gives policyholders the right to appeal an insurance company’s decision to deny a claim. The important thing to remember is you have only a limited time in which to submit their appeal.
Marc Whitehead & Associates Can Help Appeal Your Denial of CHF Disability Benefits
Being represented by an experienced disability benefits attorney greatly improves your chances of getting your disability claim approved. They can help you avoid making the kinds of mistakes that can prevent you from getting the benefits you need.
If you have filed a disability claim for congestive heart failure disability only to have it denied, we urge you to call the offices of Marc Whitehead & Associates without delay. We can help you submit an appeals package that contains all the evidence needed to support your claim and if necessary, represent you at an SSA and VA administrative hearing or help you file a lawsuit in federal court. Contact us today to schedule a free consultation to discuss your CHF disability claim.