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Heart Disease and Social Security Disability Claims – Part 2

By Pitt Dickey

This column will continue the review of various heart diseases in connection with eligibility for Social Security Disability payments. Last month’s column looked at the mechanics of how the heart works and dealt specifically with Social Security’s criteria for evaluating chronic heart failure. This column will examine the guidelines used by Social Security to determine disability eligibility for Coronary Artery Disease and Recurrent Arrhythmia. Coronary Artery disease refers to diseases of the arteries that supply blood to the heart. Arrhythmia refers to irregular beating of the heart.

Unfortunately coronary artery disease (CAD) is a fairly common condition that effects a large number of Americans. CAD refers to diseases of the arteries that supply the heart with blood. The two large coronary arteries that are attached to the aorta supply the heart with blood and oxygen. The aorta is the largest artery in the body and carries blood with oxygen away from the heart. If these coronary arteries become blocked by some object then the heart does not receive the necessary blood and oxygen for it to function.

Atherosclerosis is a condition which frequently causes CAD. Fat deposits called atherosclerotic plaque collect on the inside of the coronary arteries which cause the inside of the arteries to narrow as the fat deposits build up. Imagine a garden hose, if you poured bacon grease into the hose and let it harden it would partially block the flow of water through the hose. If you poured enough grease into the hose the grease could totally block the hose and no water could go through. The plaque that builds up inside of the coronary arteries effects the heart in the same way. Too much plaque results in decreased blood flow to the heart. If the artery is completed filled with plaque then there is no blood flow to the heart through that artery.

The consequences of atherosclerosis are not good. When the plaque collects inside the artery walls it can cause the blood to form abnormal clumps called clots. These clots can cause a thrombotic occlusion which is a blood clot that blocks the coronary artery. The plaque build up can also cause the coronary artery’s interior to become totally blocked. The consequence of either of these events leads to either reduced blood flow (ischemia) through the artery or if the blood flow is totally blocked then it can cause the death (necrosis) of the part of the heart that would have otherwise have received the blood.

The part of the heart that dies as a result of the lack of blood is called a myocardial infarction. This is commonly referred to as a heart attack. The amount of damage to the heart depends on how big the artery is and the extent of the obstruction in the artery.

People who suffer from angina pectoris are experiencing pain in their chest because their heart is temporarily not receiving enough oxygen. This lack of oxygen can result from a variety of reasons including the blockage of coronary arteries which are supposed to supply blood to the heart. Doctors can treat episodes of angina with nitroglycerin.

The Social Security Administration uses certain rules called ‘Listings’ to determine if a worker’s disability claim should be approved without the need for a hearing before an Administrative Law Judge. The listing for Coronary Artery Disease is met when a person meets the following tests:

Angiography testing: An angiograph is a test in which dye is injected into the heart and x-rays are made of the heart and the large blood vessels in the chest. The angiograph must be obtained from an independent physician, preferably a doctor who has experience in treating patients with cardiac disease. The doctor must conclude that the performance of an exercise test would present a significant risk to the patient. The angiograph must show both of the following conditions with the patients coronary arteries:

1. Angiographic evidence showing:

a. At least 50% narrowing of a non-bypassed left main coronary artery ; or

b. 70% or more narrowing of another non-bypassed coronary artery; or

c. 50 % or more narrowing involving a long (greater than 1 centimeter) segment of a non-bypassed coronary artery; or

d. 50% or more narrowing of at least 2 non-bypassed coronary arteries; or

e. Total obstruction of a bypass graft vessel; and

2. The coronary artery disease results in a marked limitation of physical activity demonstrated by fatigue, palpitation ( irregular heart beat patterns), dyspnea (difficulty in breathing) , or anginal discomfort (chest pain) during ordinary physical activity even though the patient may be comfortable without symptoms when he is at rest.

Arrhythmia is basically an abnormal heart beat rhythm. There are several types of irregular heart beats including fibrillation which is a rapid and random type beating of the heart Flutter is a rapid beating of the heart that does have a pattern. Heart block is when due to a malfunction in the heart’s nervous system that the heart misses a beat periodically. The implantation of a pacemaker into the heart can usually restore the heart to a normal rhythm.

The Listing for Recurrent Arrhythmia require that the abnormal heart beat not be related to reversible causes such as an electrolyte imbalance in the body. The abnormal heart beating must result in uncontrolled repeated episodes of cardiac syncope or near cardiac syncope (cutting off of the blood supply to the heart) and abnormal heart beats despite prescribed medical treatments which is documented by an electrocardiography (a test that records the electricity flowing through the heart) occurring at the time of the syncope or near syncope event.

Pitt Dickey has practiced law handling Social Security Disability claims in Fayetteville since 1978. He has handled SSA disability claims for over eighteen years. He practices with the firm of Smith, Dickey, Dempster, Harris , P.A. at 315 Person Street and can be reached at 910- 484-8195, [email protected] or www.smithdickeydempster.com