Congenital Heart Disease and Social Security Disability Benefits

December 6, 2018
Dayes Law Firm

When a child has congenital heart defects, it can be terrifying for the parents. There is a lot of uncertainty and fear about the child’s future. There are also concerns about how to pay for the medical treatment the child will need. Parents may need to take significant time off of work to take care of the child and take him or her to and from doctor’s appointments.

Fortunately, the child may qualify for Social Security Disability (SSD) benefits. For assistance applying for disability benefits for your child with congenital heart disease, our Phoenix Social Security Disability attorneys are here to help. Request a free, no obligation consultation today.

How Does the SSA Define Congenital Heart Defects?

The Social Security Administration’s (SSA) Blue Book defines congenital heart disease as being documented either by catheterization of the heart or medically accepted imaging, along with one of the following:

  • Cyanotic heart disease that causes persistent and chronic hypoxemia. There are four ways to prove your child is suffering from this condition, such as the inability to tolerate exercise and an increase in hypoxemia when the child starts to exert himself or herself and symptoms that cause the child to be incapacitated because of cyanotic heart disease.
  • Secondary pulmonary vascular obstructive disease. This must be accompanied by pulmonary arterial systolic pressure that rises to a minimum of 70 percent of systemic arterial systolic pressure.
  • Symptomatic acyanotic heart disease along with ventricular dysfunction that causes serious interference with the child’s ability to independently start, sustain or finish activities.
  • A life-threatening congenital heart impairment that will need or already has needed surgical treatment within a child’s first year of life, and the impairment must be anticipated to be disabling due to continued impairment after surgery, recovery time or both until the child reaches at least one year old.

What if My Child’s Condition Does Not Meet the Criteria?

If your child does not meet the requirements to obtain disability benefits under the Blue Book definitions for congenital heart disease, he or she could still be approved. The SSA must determine that one of your child’s symptoms caused by his or her congenital heart disease is severe enough to make the child functionally equal to the listing definitions.

To be considered functionally equal, your child’s congenital heart disease symptoms must cause a marked limitation in two functional areas or an extreme limitation in one area of functioning.

Areas of functioning are:

  • Moving and manipulating objects – This refers to the child’s ability to move from one location to another and handle different objects. For example, children need to be able to crawl, stand, sit and hold things. Limitations with this area of functioning could include trouble holding onto small objects or bad coordination of the hands and eyes.
  • Learning and using information – Children who have limitations in this area may struggle to remember things from the day before, explain what they are trying to say, or solving math problems.
  • Caring for personal needs – Children are supposed to become more independent as they grow older. This includes making decisions and learning the difference between right and wrong. Extreme or marked limitations may include putting things that are not food in their mouths or struggling to sleep.

The SSA will evaluate the child’s medical records, school records, reports from therapists and other documentation. From this information, evaluators will determine if your child suffers from marked or extreme limitations in these areas of functioning.

Before applying for disability benefits for your child, gather the following medical evidence that demonstrates your child meets the Blue Book criteria:

  • Diagnosis reports
  • Lab reports
  • Imaging results
  • Complete medical records
  • Clinical history
  • Surgical history
  • Treatment records
  • Statements from physicians who have treated your child

You should be prepared to file an appeal, as many Social Security Disability claims are denied. Sometimes this has nothing to do with the strength of your claim – the SSA is trying to avoid fraudulent claims.

Contact Our Disability Attorneys for Assistance

If your child was diagnosed with congenital heart disease, he or she may qualify for disability benefits. Request a free, no obligation consultation with our disability lawyers today and learn what legal options may be available.

Determining eligibility for benefits is complicated and confusing and our attorneys are fully prepared to guide you through every step of the process. Handling such a complex and important task on your own is way too much to ask. You need as much time as possible to focus on taking care of your child.

We charge no upfront fees and payment is only owed if we recover compensation for you.

Call 1-800-503-2000 or complete our Free Case Review form now.