The Ejection Fraction (EF) is a measurement that gauges the heart’s efficiency and serves as a primary marker for determining eligibility for Social Security disability benefits related to heart failure. The Social Security Administration (SSA) uses specific, objective medical criteria to evaluate claims, and the EF value is a direct way to assess the severity of a cardiac impairment. This article details the numerical thresholds and functional requirements used by the SSA to determine if a heart condition qualifies for disability benefits.
Understanding Ejection Fraction
Ejection Fraction is the percentage of blood the heart pumps out of the left ventricle with each contraction. This measurement is obtained through various imaging tests, most commonly an echocardiogram. A healthy heart typically ejects between 55% and 70% of the blood volume from the left ventricle.
A lower EF indicates that the heart muscle is weakened and cannot pump blood effectively, a condition often referred to as heart failure with reduced ejection fraction (HFrEF). Values below 50% are considered indicative of cardiovascular decline. While a low EF is significant evidence, it does not automatically guarantee disability approval and must be considered alongside other medical and functional information.
Specific Numerical Requirements for Disability Qualification
The Social Security Administration’s Listing of Impairments, often called the Blue Book, details the medical criteria for automatic disability approval. For chronic heart failure (systolic failure), the most direct numerical path is found under section 4.02. The SSA specifies that an applicant must have an Ejection Fraction of 30% or less.
This specific EF measurement must be documented during a “period of stability,” meaning the heart failure is not in an acute, unstable episode. The measurement must be established by a recent echocardiogram or other appropriate imaging technique. Meeting this numerical threshold is only part of the requirement for chronic heart failure.
To automatically qualify, the applicant must also satisfy additional functional criteria. The SSA requires evidence that the condition is persistent despite receiving prescribed medical treatment. If the EF is slightly above the 30% threshold, the claim shifts to a comprehensive evaluation of functional limitations rather than meeting the listing based on the number alone.
Qualifying Based on Functional Limitations
Many applicants with heart failure do not meet the strict 30% EF cutoff but still have a debilitating inability to work. In these cases, the SSA evaluates the claim based on the severity of symptoms and documented functional limitations. This process assesses the applicant’s Residual Functional Capacity (RFC), which determines the maximum amount of work they can perform despite their impairment.
One objective way to prove severe functional limitation is through an Exercise Tolerance Test (ETT). The SSA’s listing criteria are met if the applicant is unable to perform on an ETT at a workload equivalent to 5 METs (Metabolic Equivalents) or less. The 5 METs level corresponds to light activities, where a MET represents the oxygen consumed while sitting at rest.
The ETT must be a sign- or symptom-limited test, meaning exercise is stopped due to cardiac symptoms like chest pain or shortness of breath. If an ETT cannot be safely performed, the SSA relies on persistent symptoms of heart failure that severely limit daily activities. Alternatively, evidence of three or more documented episodes of acute congestive heart failure requiring hospitalization within a 12-month period can satisfy the functional requirement.
This functional evaluation is important in cases of diastolic heart failure, where the heart does not relax properly, and the EF may remain normal or near-normal. Even with a preserved EF, the applicant can qualify if the medical evidence shows severe functional limitations that prevent them from sustaining full-time work.
Preparing the Medical Evidence for Your Claim
A successful disability claim relies entirely on objective medical evidence submitted to the SSA. The most important document is the recent report from an appropriate imaging test, such as an echocardiogram, clearly stating the Ejection Fraction measurement. This finding must be supported by longitudinal medical records covering at least three months of treatment.
These records must include detailed clinical notes from a treating cardiologist, documenting specific symptoms and the effectiveness of prescribed medications. Any reports of an Exercise Tolerance Test must be submitted, detailing the workload achieved in METs and the reason the test was stopped. All hospital admission and discharge summaries related to acute heart failure episodes should also be included to prove the frequency and severity of the condition.
The documentation must demonstrate that the heart condition is chronic and severe enough to prevent substantial gainful activity. Consistency in the medical records, showing continuous care and treatment for the heart failure, supports the SSA’s evaluation.