Blood clots, medically known as thrombosis or embolism, can potentially qualify an individual for disability benefits, but only when they lead to severe, long-term complications. The mere occurrence of a blood clot is typically not enough to meet the criteria set by the U.S. Social Security Administration (SSA). The SSA requires that the resulting impairment is prolonged and significantly limits the ability to work. The evaluation focuses not on the initial diagnosis but on the chronic, disabling consequences of the thrombotic event.
Defining Disability for SSA Benefits
The Social Security Administration has a precise definition of disability that applies across all medical conditions. A person is considered disabled if they are unable to engage in Substantial Gainful Activity (SGA) due to a medically determinable physical or mental impairment. SGA refers to a specific monthly earnings threshold set by the SSA, which signifies the ability to perform productive work for pay or profit. If an applicant is earning above this monthly limit, their claim is typically denied immediately.
The medical condition must have lasted, or be expected to last, for a continuous period of at least 12 months, or be expected to result in death. This duration requirement means that a single, successfully treated blood clot that resolves quickly would not qualify. The SSA assesses whether the individual can perform their past work and, if not, whether they can adjust to any other type of work that exists in the national economy. An applicant must demonstrate that their condition prevents them from performing any job, not just their previous one.
Meeting the SSA’s Medical Severity Requirements
The SSA evaluates the severity of chronic complications from blood clots primarily against its official List of Impairments, known as the “Blue Book.” Blood clot complications often fall under the Cardiovascular System listings. Merely having a history of deep vein thrombosis (DVT) is insufficient; the resulting chronic condition must meet specific criteria.
Chronic Venous Insufficiency (CVI), a common long-term complication of DVT, is evaluated under Listing 4.11. To meet this listing, the applicant must document CVI of a lower extremity with obstruction of the deep venous system. This requires extensive brawny edema, which is dense, non-pitting swelling, involving at least two-thirds of the leg between the ankle and knee. Alternatively, the listing can be met by demonstrating recurrent or persistent ulceration that has not healed despite at least three months of prescribed medical treatment.
For a pulmonary embolism (PE), the evaluation shifts to the resulting damage, such as chronic pulmonary hypertension, which is assessed under related cardiovascular listings. Thrombotic events may also be evaluated under Listing 7.08 (Hematological Disorders), which focuses on the frequency of events requiring hospitalization. This requires evidence of three hospitalizations within a 12-month period, each occurring at least 30 days apart and lasting a minimum of 48 hours. These listings represent the most direct path to approval, requiring objective medical evidence of severity.
Qualifying Based on Limited Functional Capacity
Most claims for disability benefits based on blood clot complications are approved through an alternative path, which assesses the claimant’s Residual Functional Capacity (RFC). The RFC is the maximum amount of work an individual can still perform despite their medically determinable limitations. This assessment is used when the severity of the condition does not meet the requirements of the Blue Book listings.
The SSA evaluates how chronic symptoms, such as persistent leg pain, swelling, and fatigue, limit daily function and work-related tasks. A person with CVI may be unable to stand or walk for prolonged periods due to swelling and pain, or they may require frequent leg elevation throughout the workday. Side effects from necessary medications, such as the increased risk of bleeding or lightheadedness from long-term anticoagulant therapy, are also considered in determining functional limitations.
The RFC assessment synthesizes all medical evidence to determine the individual’s ability to lift, carry, stand, sit, push, pull, and concentrate. If the combined effect of the physical limitations and necessary work restrictions—such as the inability to sit for more than one hour or the need to alternate between sitting and standing—precludes all past work and any other available work, the claim may be approved. This approach focuses on the practical, day-to-day impact on the capacity to maintain a full-time work schedule.
Essential Medical Evidence for Your Claim
A disability claim for blood clot complications requires comprehensive medical documentation. The SSA requires objective evidence to substantiate the severity of the chronic impairment, whether the claim is based on meeting a listing or a limited RFC. Diagnostic reports are fundamental, including Doppler ultrasounds and venography or angiography reports that confirm the presence and extent of deep venous obstruction or damage.
Hospital records detailing the initial thrombotic event, including emergency room notes and inpatient stays, must be provided. The SSA needs longitudinal records demonstrating the chronic nature of the impairment, such as ongoing treatment adherence to anticoagulation therapy and repeated medical evaluations. Detailed statements from treating physicians regarding functional limitations are also essential. These statements should specifically outline restrictions on sitting, standing, walking, and lifting, directly supporting the limitations claimed in the RFC assessment.