Listing 4.02
Chronic heart failure
This listing covers chronic heart failure — when the heart cannot pump enough blood to the body — while you are following your prescribed treatment.
Read the full plain-language explanation
SSA looks for two things together: (1) imaging proof that the heart is enlarged or not pumping well (Part A), and (2) proof that this seriously limits you, shown by symptoms, repeated hospital-level episodes, or a failed exercise test (Part B). You must satisfy one item from Part A AND one item from Part B.
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What Listing 4.02 asks for
What SSA looks for — see the 5 items
We will check your records against each of these. Every item comes straight from SSA's own listing.
- Part A, option 1 (you need A1 or A2, not both): imaging shows systolic failure — the heart's main pumping chamber is stretched larger than 6.0 cm, or it pumps out 30% or less of its blood with each beat (ejection fraction).
- The measurement must be taken while you are stable, not during a heart failure flare-up.
Read the original wording
Part A, option 1 (you need A1 or A2, not both): imaging shows systolic failure — the heart's main pumping chamber is stretched larger than 6.0 cm, or it pumps out 30% or less of its blood with each beat (ejection fraction). The measurement must be taken while you are stable, not during a heart failure flare-up.
(Listing 4.02, criterion A1)
- Part A, option 2 (you need A1 or A2, not both): imaging shows diastolic failure — the heart muscle is thickened (back wall plus dividing wall totaling 2.5 cm or more), the left atrium is enlarged to 4.5 cm or more, and the ejection fraction is normal or high.
- Again, this must be measured while you are stable.
Read the original wording
Part A, option 2 (you need A1 or A2, not both): imaging shows diastolic failure — the heart muscle is thickened (back wall plus dividing wall totaling 2.5 cm or more), the left atrium is enlarged to 4.5 cm or more, and the ejection fraction is normal or high. Again, this must be measured while you are stable.
(Listing 4.02, criterion A2)
Part B, option 1 (you need only one of B1, B2, or B3): your heart failure symptoms are ongoing and very seriously limit your daily activities, AND a Social Security medical consultant has decided an exercise test would be too risky for you.
(Listing 4.02, criterion B1)
Part B, option 2: within one 12-month span, you had three or more separate flare-ups of acute heart failure with fluid buildup, each needing hospital or ER care lasting 12 hours or more, with at least 2 weeks of stability between episodes.
(Listing 4.02, criterion B2)
- Part B, option 3: on a supervised exercise test, you could not go past a light workload (5 METs or less) because of one of these: (a) shortness of breath, fatigue, palpitations, or chest discomfort
- Certain dangerous irregular heartbeats
- Your blood pressure dropped 10 points or more even as the exercise got harder
- Signs your brain wasn't getting enough blood, like a stumbling walk or confusion.
Read the original wording
Part B, option 3: on a supervised exercise test, you could not go past a light workload (5 METs or less) because of one of these: (a) shortness of breath, fatigue, palpitations, or chest discomfort; (b) certain dangerous irregular heartbeats; (c) your blood pressure dropped 10 points or more even as the exercise got harder; or (d) signs your brain wasn't getting enough blood, like a stumbling walk or confusion.
(Listing 4.02, criterion B3)
How long it must last:
- The impairment must have lasted or be expected to last at least 12 continuous months. 'Persistent' means the required findings have been present, with few exceptions, for at least 12 months, and recurrent episodes must occur within a consecutive 12-month period.
- A longitudinal record of at least 3 months of observation and treatment is usually needed.
Read the original wording
The impairment must have lasted or be expected to last at least 12 continuous months. 'Persistent' means the required findings have been present, with few exceptions, for at least 12 months, and recurrent episodes must occur within a consecutive 12-month period. A longitudinal record of at least 3 months of observation and treatment is usually needed.