Reviewed By: Pramod Kerkar, MD, FFARCSI

Is Open Heart Surgery A Disability?

Open heart surgery becomes essential for performing CABG i.e. Coronary artery bypass graft and it is essential for patients of coronary heart problems. Coronary heart problems take place because of the plaque formation or fatty deposits within the coronary arteries i.e. atherosclerosis. The formation of plaque results in hardening and narrowing of arteries responsible to supply oxygen and blood to heart muscles. This results in stoppage or slowing of blood flow towards the heart. Thus, depending on severity of various symptoms and open-heart surgery, individuals fail to do their daily activities and qualify for social security disability benefits.

Qualifying for SSA Disability Benefits

SSA officials evaluate coronary heart problem of a patient based on patient's latest objective medical evidence present in the medical record or related evidence. Alternative, the organization orders a consultative examination to assist in the evaluation of impairment. If a person does not remain on a regimen containing a prescribed treatment, you have to fulfill symptoms and test results as per listing 4.04 to get disability benefits.

Necessary Symptoms

According to the listing 4.04, a patient underwent with open heart surgery should possess the following symptoms to qualify for SSA disability-

  • Chest discomfort or angina pectoris caused mainly because of emotion or activities and relieved quickly when person goes at rest
  • Atypical angina refers to the discomfort or pain located in other places than the chest of a patient. These are jaws, necks and inner left arm, upper and back abdominal areas.
  • Anginal equivalent that involves breathing shortness during exertion but without any complain about discomfort or chest pain.
  • Variant angina contains angina episodes when person remains at rest because of spasm of the coronary artery.
  • Silent ischemia means the occurrence of myocardial infarction or myocardial ischemia without any pain or related symptoms.

Excluding the symptoms mentioned here, Listing 4.04 mandates either of the following in patients to qualify for SSA disability benefits. These are ischemic episodes, abnormal stress test or abnormal image results.

Abnormal Stress Test

Abnormal Stress Test refers to a specific exercise tolerance test performed at 5 METs workload and it causes either of the following abnormalities-

Down-slopping or horizontal ST segment depression of about -0.10 milivolt and it lasts for minimum 1 minute within the exact recovery period.

Minimum 1 mm or 0.1 milivolt of elevation in the ST segment during any type of physical exercise that lasts for 1-minute period or more within the recovery period.

Reduction in 10 mmHg of systolic pressure or higher than that below the level of baseline or preceding systolic pressure tracked during the physical exercise. This takes place because of the dysfunction of one’s left ventricle irrespective of the increase in workload.

Ischemia highlighted at 5 METs exercise level an appropriately acceptable medical imaging, like for instance the stress echocardiography.

Ischemic Episodes in Patients

Patients experiencing three separate episodes of ischemic problem within a period of consecutive 12 months or 1 year qualify for SSA disability benefits. Each episode should compulsorily include revascularization i.e. bypass surgery or angioplasty.

Abnormal Image Results

If there is too much risk involved in overall performance of exercise tolerance test, doctors and SSA officials recommend for angiography or any other similar type of medically acceptable imaging procedure to demonstrate the problem of coronary artery problem.

Medical Evidence to Claim for Disability Benefits

SSA will also look for longitudinal clinical evidence associated with your coronary heart problems. For instance, you have to undergo treatment for about 3 months to justify that your present evidence is adequate to make a determination under SSA disability benefits. Basic documentation that you have to provide to SSA should include detailed reports about your physical examinations, history, lab tests and any prescribed treatment, along with response to the respective treatment.

Therefore, based on the necessary criteria under listing 4.04 and the relevant medical evidence, you may quality to get the necessary disability benefits after your open-heart surgery from SSA officials.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: April 19, 2018

This article does not provide medical advice. See disclaimer

Sign Up for Our Newsletter

We'll help you live each day to the healthiest