Congestive Heart Failure And Long-Term Disability Insurance Claims

Are You Unable to Work Due to Heart Failure or Congestive Heart Failure?

Patients with congestive heart failure may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their congestive heart failure may qualify for long-term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan. Our long-term disability and Social Security disability attorneys can help you evaluate your case and access any benefits you may be entitled to.

What is Congestive Heart Failure?

The term “heart failure” does not mean that your heart has stopped or is about to stop working. However, congestive heart failure (CHF) is a serious (and potentially lethal) medical condition where the heart cannot pump enough blood. CHF should be treated with appropriate medical care. In some cases, the heart cannot fill with enough blood (diastolic heart failure). In other cases, the heart cannot pump blood to the rest of the body with enough force (systolic heart failure). This lack of flow can cause blood to accumulate in the vessels leading to the heart and may cause congestion or accumulation of fluid in various parts of the body.

If the left chambers of the heart fail, blood backs up into the lungs, which causes lung congestion. If the right chambers of the heart fail, blood backs up into the legs and the liver, which causes congestion and swelling. This type of swelling is called edema. Heart failure, which is typically a chronic illness that is expected to worsen over time. It can affect one or both sides of the heart, and a person can have both diastolic heart failure and systolic heart failure at the same time.

Who Is At Risk of Developing Congestive Heart Failure?

While Congestive Heart Failure can occur at any age, patients who are most at risk of developing this condition include those who:

• Have untreated or improperly managed high blood pressure
• Have a family history of heart disease
• Suffer from arrhythmias or other abnormal heartbeats
• Smoke, drink excessively or use drugs such as cocaine or methamphetamines
• Suffer from diseases of the heart valves
• Were born with a congenital heart defect
• Have a thyroid disease
• Have diabetes
• Have untreated sleep apnea or a poor history of sleep

Symptoms and Treatment of Congestive Heart Failure

CHF is typically accompanied by an enlargement in the size of the heart. The condition can range from mild to serve and symptoms can come and go over time. The most common symptoms of heart failure or congestive heart failure include:

• Shortness of breath
• Fluid in the lungs
• Chronic cough or wheezing
• Fluid retention and rapid weight gain due to fluid retention
• Dizziness
• Fatigue
• Weakness
• Rapid heartbeat
• Irregular heartbeat

Accessing the symptoms of congestive heart failure can be tricky, however, as sometimes the symptoms do not correlate with how weak the heart really is. There may be patients who have severe damage to the heart who do not experience any or very minor symptoms, whereas other patients may have minimal damage to the heart and experience severe symptoms as a result of their condition.

Causes of Congestive Heart Failure

Congestive heart failure is generally progressive and typically develops over a period of months or even years. Heart failure is caused by many conditions that damage the heart muscle, including:

• Coronary artery disease (CAD). CAD is a disease of the arteries that supply blood and oxygen to the heart, which causes decreased blood flow to the heart muscle. If the arteries become blocked or are severely narrowed, then the heart becomes starved for oxygen and nutrients;
• Heart attack. A heart attack occurs when a coronary artery is suddenly blocked, which stops the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in an area of the heart that is scarred and does not function properly;
• Cardiomyopathy. Cardiomyopathy is damage to the heart muscle from causes other than artery or blood flow problems. Examples include infections or alcohol or drug abuse; and
• Other conditions that overwork the heart. Other medical conditions such as uncontrolled hypertension / high blood pressure, valve disease (or valvular heart disease), pericarditis (or pericardial heart disease), endocarditis or myocarditis (where the heart muscle, valves, or surface tissue become inflamed), thyroid disease, kidney disease, diabetes, or congenital heart defects present at birth can all cause heart failure.

These types of conditions eventually cause an enlargement of the heart and lead to congestive heart failure.

Treatment Options for Congestive Heart Failure

While heart failure or congestive heart failure can be life-threatening, there are a number of treatment options that can be used to treat this condition and ultimately heal the muscle of the heart.

To start, doctors may prescribe drugs known as ACE Inhibitors or Vasodilators to open up narrowed blood vessels and improve blood flow.  Beta-Blockers can also be used to reduce blood pressure and treat arrhythmias that may be contributing to the development of congestive heart failure.  Diuretics are also commonly used in the treatment of congestive heart failure, as the condition causes patients to retain too much fluid in the body.   

Cardiologists will also recommend lifestyle changes to help the patient heal from congestive heart failure, including the cessation of drinking alcohol and smoking, the discontinuation of stimulants such as caffeine or illegal drugs, tracking one’s daily fluid intake, diet change and weight loss, managing stress, treating any sleep disorders, getting plenty of rest and staying physically active with appropriate exercise.

Finally, surgery may be necessary if medications or lifestyle interventions are not effective.  Surgical procedures used to treat congestive heart failure include angioplasties to open up blocked arteries and heart valve repair surgery.

Qualifying for Long-Term Disability With Chronic Heart Failure

Again, because the symptoms and limitations that one experiences with congestive heart failure can vary from person to person, applying for long-term disability benefits can be challenging and often requires the assistance of an experienced long-term disability attorney in order to get your claim approved.

Some cases of congestive heart failure are considered treatable and even reversible, such as congestive heart failure that is experienced during or after pregnancy. If your condition is expected to improve with medications or lifestyle interventions such as temporary bed rest, you likely will not qualify for long-term disability benefits.

However, when a person’s heart failure is more severe, and the muscle is more extensively damaged, it can permanently alter the activities that a person can engage in, including manual and even sedentary work.

For example, an exercise tolerance test may show that a person with congestive heart failure experiences symptoms with very little exertion, such as walking or lifting more than 5 to 10 pounds. He or she would likely be approved for benefits as it would be very difficult, if not impossible, to find a job that this person could safely perform without aggravating their condition.

Objective Symptoms of Congestive Heart Failure

You should try and provide as much objective medical evidence showing the extent of your CHF as possible. Objective evidence may include evidence of either systolic or diastolic heart failure.

Systolic failure occurs when the heart has weakened pumping strength and can be evidenced by one of the following:

• The heart’s ejection fraction, which is the percentage of blood pumped out of the heart with each heartbeat, is very low (for example, 30% or less) during a period of stability (i.e., not during an episode of acute heart failure), or
• The heart’s left ventricular end-diastolic dimensions are larger than 6.0 cm.

Diastolic failure occurs when the heart is unable to fill properly, and may be shown by all of the following:

• The thickness of the left ventricular wall and interventricular septum 2.5 cm or larger on imaging;
• An enlarged left atrium 4.5 cm or larger, and
• Normal or elevated ejection fraction during a period of stability (i.e., not during an episode of acute heart failure).

Functional Limitations of Congestive Heart Failure

The following symptoms may evidence functional limitations caused by CHF:

• Inability to perform an exercise tolerance test (ETT) at a workload equivalent to 5 METs or less due to certain difficulties;
• If an exercise tolerance test would be too risky, you should still endeavor to present evidence of persistent symptoms of heart failure that very seriously limit your activities of daily living (ADLs), or
• Evidence of episodes of heart failure and fluid retention that required emergency room treatment or hospitalization.

Qualifying for Long-Term Disability Because of Your Functional Limitations

The insurance company will consider the effect of your heart condition on your capacity to work or perform routine daily activities. The adjuster handling your claim will give you a rating of the type of work he or she thinks you can do, called your residual functional capacity (RFC).

Your RFC will rate your ability to do sedentary, light, or medium duty work. For example, if your doctor has limited you to no lifting more than 5 or 10 pounds at a time, your RFC will be for sedentary work. Or, if your exercise tolerance test shows you can only perform very little physical exertion before you experience symptoms (such as shortness of breath, chest discomfort, heart palpitations, or confusion), you will probably be assessed with a light RFC.

Next, the insurance company will determine whether you can work given the limitations of your RFC. For example, if you are unable to sit, stand and walk for at least eight hours a day, then you will be assessed with a “less than sedentary” RFC and disability will be granted.

Appealing an Adverse Decision in a Congestive Heart Failure Claim

Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your congestive heart failure. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.

While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.

The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your congestive heart failure and its impact on your ability to work, call us at (888) 321-8131. We would be happy to evaluate your case and discuss how to help you through the appeal process.