The two most common cardiovascular ailments evaluated for disability by Social Security judges are ischemic heart disease and chronic heart failure. The most objective measure that judges rely on in assessing the severity of the cardiac impairment is the Exercise Tolerance (or “Stress”) Test (“ETT”). ETTs measure the claimant’s aerobic abilities: their ability to walk on a grade, to ride a bicycle, or to move one’s arms in an environmentally-controlled setting. These tests can be inconclusive, however, because they do not measure an individual’s ability to perform typical work-related tasks such as lifting and carrying loads or engaging in frequent bending and stooping.
Another measure of cardiac impairments is the electrocardiograph or electrocardiogram (“ECG”). To perform an ECG, a technician will place small nodes on the patient’s arms, legs, and chest. These nodes are then connected to a machine that records electrical impulses of the patient’s heart movements. An ECG may be done while the patient is resting, or in conjunction with an exercise test as described above. ECG tracing may indicate that the heart is not getting as much oxygen as it requires (“ischemia”), that the heart rhythm is abnormal in some way (“arrhythmia”), or other disorders.
For Social Security purposes, a diagnosis of chronic heart failure should rely on descriptions of characteristic signs and symptoms of this disease. Such symptoms include fatigue, weakness, shortness of breath, coughing, and chest pain. Some individuals with chronic heart failure will also experience a shortness of breath that awakens them from sleep, or they may experience palpitations, lightheadedness, or fainting.
Similarly, for allegations of ischemic heart disease, such as coronary artery disease, patients will experience chest discomfort. The discomfort is usually described as pressing, crushing, squeezing, burning, aching, or sharp. If any of these sensations occur with specific activities or emotions, the details should be described and documented.
Although Social Security has various ways of measuring the severity of cardiac impairments using the results of ETTs and ECGs, any evaluation of disability due to cardiac impairments will consider how the cardiac impairment limits daily activities, the ability to stand or walk for extended periods, difficulty in lifting and carrying objects over a certain weight, and the side effects of any medication prescribed for the management of the cardiac condition.