Why this listing matters
Adults with complex congenital heart disease (CHD) often appear “stable” after childhood repair, yet residual shunts, valvular lesions, or cyanosis silently erode functional capacity. Listing 4.06 converts hard cardiology numbers—oxygen saturation, hematocrit, RV pressures—into an automatic allowance. If you marshal the right imaging, catheterization data, and blood-gas studies, clients avoid Step 4/5 disputes about hypothetical sedentary jobs.
Full regulatory text
“4.06 Symptomatic congenital heart disease, with one of the following, despite prescribed treatment and occurring during a period of medical stability (not during an acute event):
A. Cyanotic heart disease, demonstrated by resting arterial O₂ saturation ≤ 90 percent or hematocrit ≥ 55 percent, or
B. Ventricular dysfunction with right-to-left shunt, or pulmonary vascular obstructive disease, demonstrated by mean pulmonary artery pressure ≥ 40 mm Hg as measured by cardiac catheterization, or
C. Residual impairments following surgical treatment, with one of the following:
1. Right ventricular diastolic pressure ≥ 12 mm Hg, or
2. Mean right atrial pressure ≥ 10 mm Hg, or
3. Pulmonary vascular resistance > 3 Wood units, or
4. Resting arterial O₂ saturation ≤ 90 percent, or
5. Marked limitation in the ability to independently initiate, sustain, or complete activities of daily living, documented by clinical findings and corroborated by imaging or catheterization evidence.”*
(Introductory § 4.00E10 defines acceptable test protocols and emphasizes that measurements must be obtained during a period of medical stability.)
Element-by-element checklist
| Path | Key metric | Acceptable proof |
|---|---|---|
| A. Cyanotic disease | Resting SpO₂ ≤ 90 % or Hct ≥ 55 % | ABG, pulse-ox reading in clinic, CBC |
| B. Pulmonary vascular disease / right-to-left shunt | Mean PA pressure ≥ 40 mm Hg | Right-heart-cath report |
| C-1. RV diastolic ≥ 12 mm Hg | Cath hemodynamics | |
| C-2. RA mean ≥ 10 mm Hg | Same | |
| C-3. PVR > 3 Wood units | Cath calculations (Wood = mm Hg/L/min) | |
| C-4. Resting O₂ sat ≤ 90 % | Clinic pulse ox or ABG | |
| C-5. Marked ADL limitation + imaging | Cardiologist narrative plus echo/MRI/cath evidence |
Practice blueprint for a winning 4.06 file
- Lock down resting oxygen saturation
Have the cardiologist document three seated readings on room air; average ≤ 90 % closes Path A or C-4 in one line. - Order a contemporary right-heart catheterization
Many adults with repaired CHD go years without cath; updated pressures (PA mean, RV diastolic, PVR) satisfy Path B or C-1/2/3. - Collect full surgical history
Operative reports (Fontan, Mustard, Rastelli) prove congenital origin and explain residual shunts or conduit failure. - Document hematocrit
Polycythemia (Hct ≥ 55 %) not only meets Path A but underscores chronic hypoxia—attach trending CBCs. - Functional corroboration for C-5
Occupational-therapy or cardiac-rehab notes showing exhaustion after basic ADLs; include NYHA class III/IV assessment. - Differentiate acute vs. stable readings
SSA rejects cath or pulse-ox taken during decompensation; include physician statement that numbers represent baseline stability. - RFC back-stop
If metrics barely miss listing, treating cardiologist can still impose < 2 MET exercise limit and “no work near unprotected heights,” leading to Step 5 grid-override for anyone 50 +.
Professional bottom line
Listing 4.06 unlocks benefits for adults with complex or residual congenital heart disease through objective hemodynamic or oxygenation thresholds. Provide resting O₂ saturation, right-heart-cath pressures, and any polycythemia data obtained during medical stability, and the claim should be allowed at Step 3—before vocational evidence enters the picture.
Under Listing 4.06, a Social Security Disability Lawyer can help compile oxygen saturation readings, hematocrit levels, and right-heart catheterization data to demonstrate the objective severity required by SSA. For congenital heart disease cases, properly documenting hemodynamic pressures, residual structural abnormalities, and functional limitations during medically stable periods is critical to establishing disability at Step 3 and avoiding vocational analysis.