A heart murmur is the sound of turbulent blood flow within the heart, detected during a physical exam with a stethoscope. While the sound itself is not a disease, it indicates a change in how blood moves through the heart’s chambers or valves. The serious underlying heart condition that causes a severe murmur can meet the legal definition of a disability. For a heart condition to potentially qualify, the resulting functional limitation must be severe enough to prevent substantial work activity.
Heart Murmurs: A Spectrum of Severity
Heart murmurs fall into two main categories: innocent and pathological. Innocent murmurs, also called functional or benign, are extremely common and do not result from structural heart disease. They are simply sounds created by rapid but normal blood flow, often occurring during periods like fever, anemia, or pregnancy, and they require no treatment or follow-up.
Pathological murmurs are caused by a structural defect in the heart, making them the type that may indicate a disabling condition. These defects often involve the heart valves, such as narrowing (stenosis) or leakage (regurgitation), or a congenital defect present from birth. The severity of the underlying condition—like valvular heart disease or chronic heart failure—determines if the resulting physical limitations are disabling. A pathological murmur is a sign that prompts a physician to investigate the potential for serious functional impairment.
Legal Criteria for Disabling Heart Conditions
The Social Security Administration (SSA) defines disability as the inability to engage in Substantial Gainful Activity (SGA) due to a medically determinable impairment. This condition must be expected to last for a continuous period of at least twelve months or result in death. SGA is an annually adjusted earnings threshold that represents the maximum monthly income a person can earn and still be considered disabled; for 2026, this amount for a non-blind individual is set at $1,690 per month.
The SSA does not have a listing for “heart murmur” but evaluates the underlying disorder that the murmur signals under Section 4.00 of its Listing of Impairments, referred to as the Blue Book. This section covers cardiovascular conditions such as chronic heart failure, ischemic heart disease, and symptomatic congenital heart disease. An applicant can be approved if their condition “meets” or “equals” the severity requirements of one of these specific listings.
If the condition does not meet the precise criteria of a listing, the SSA will assess the individual’s Residual Functional Capacity (RFC). The RFC determines the maximum amount of work a person can perform despite their limitations, such as performing only sedentary or light work. The SSA then determines if the applicant can perform their past work or any other work existing in the national economy, considering their age, education, and work experience.
Required Medical Proof of Functional Limitation
To meet a listing for a disabling heart condition, the SSA requires objective medical evidence that demonstrates a severe functional limitation. This evidence must come from diagnostic tests like echocardiograms, cardiac catheterizations, and exercise tolerance tests (ETT). For conditions like chronic heart failure, a primary measure of severity is the ejection fraction (EF), which is the percentage of blood pumped out of the heart with each beat.
A condition may meet a listing if diagnostic imaging shows a significantly reduced EF, often below 30%, indicating severe ventricular dysfunction. The ETT measures a person’s work capacity in metabolic equivalents (METs). To satisfy certain listing criteria, the applicant must demonstrate an inability to exercise to a workload equivalent of 5 METs or less due to symptoms such as chest discomfort or shortness of breath.
The medical record must be longitudinal, documenting the condition’s severity and the failure of prescribed treatments over a period of time, typically at least 12 months. For ischemic heart disease, a listing can be met by documenting three separate ischemic episodes requiring revascularization within a consecutive 12-month period. These objective metrics translate the diagnosis of the underlying heart condition into a proven, work-limiting functional impairment.
Navigating the Disability Application Process
The application process begins with an initial claim submitted to the SSA, which is then sent to Disability Determination Services (DDS). DDS examiners review all medical records to determine if the criteria for disability are met. A complete medical history, especially notes from the treating cardiologist, is helpful in this review, as the physician’s assessment of functional limitations carries significant weight.
If the initial application is denied, the applicant must file a timely request for reconsideration, which is a review of the claim by a different examiner. Following a second denial, the next step is to request a hearing before an Administrative Law Judge (ALJ). The entire process emphasizes the importance of adhering to the prescribed treatment plan, as failure to follow a doctor’s orders without a justifiable reason can lead to a denial of benefits.