What Functional Class Qualifies a PAH Patient as Disabled?

PAH and PH patients often find their daily activities limited by their condition. When these limitations are severe enough, patients may be considered disabled under Social Security criteria. While determining eligibility depends on the specifics of your case, there are some general guidelines to keep in mind.

Does the Social Security Administration make disability determinations based on functional class?

The Functional Classification of Pulmonary Hypertension in adults is based on the New York Heart Association classification and was published in 1998 as a consensus document of the World Health Organization Symposium held in Evian in that year. The WHO matches patients with similar symptoms and degrees of limitation into four separate classes. The classifications start at Class I and represent individuals with little impairment and progress through Class IV which represents the most seriously impaired individuals. These classifications, however, are not recognized by the Social Security Administration for establishing disability. Although the WHO classification is not determinative of who is and who is not disabled, generally there will be fewer people who qualify for disability in Class I and the number of qualifying individuals will increase as you move into Class IV limitations.

When evaluating an individual’s application for disability the SSA looks at the objective medical evidence to determine how severe an individual’s condition is and then draws its own conclusions as to how limiting the condition would be, and whether that would likely prevent the person from working. It is important to remember that disability is a legal term rather than a medical term, so while the medical diagnosis is important, it is the impact the underlying medical condition has on an individual’s ability to engage in work-like activities, rather than the medical condition itself, that is important.

How does the Social Security Administration view PAH?

The SSA has guidelines that will recognize when an individual’s condition is so severe that they are presumed to be disabled because of the severity of their illness. These guidelines are known as the listing of impairments and if an individual’s medical condition matches or equals the listing then Social Security will consider that person disabled.

The listing that most directly applies to pulmonary hypertension is listing 3.09. The listing itself does not focus on pulmonary hypertension per se, but rather the disease to the right side of the heart that is secondary to chronic pulmonary vascular hypertension which is called cor pulmonale.

To prove impairment from irreversible cor pulmonale caused by chronic pulmonary hypertension requires documentation by clinical signs and laboratory findings of right ventricular overload or failure. Examples of this include an early diastolic right-sided gallop on auscultation, neck vein distension, hepatomegaly, peripheral edema, right ventricular outflow tract enlargement on x-ray or other appropriate imaging techniques, right ventricular hypertrophy on ECG, and increased pulmonary artery pressure measured by right heart catheterization by your doctor, or other acceptable medical proof documenting the condition.

Once the chronic cor pulmonale is established the disability is determined by meeting the criterion in either A or B below.

A. Mean pulmonary artery pressure greater than 40 mm Hg.

or

B. Arterial hypoxemia from chronic impairment of gas exchange due to clinically documented pulmonary disease with one of the following:

  • Arterial blood gas values of PO2 and simultaneously determined PCO2 measured while at rest (breathing room air, awake and sitting or standing) in a clinically stable condition on at least two occasions, three or more weeks apart within a 6-month period, equal to or, less then the values specified in the applicable table III-A or III-B or III-C:

Listing 3.09 is just one listing an individual with PAH or PH might meet. It is important to look at all affected body systems in an individual and compare each system to the ones set out in the listings. If a person’s PAH or PH causes chronic disease in other areas of the body, and the effect meets or equals the requirements in the listing, the individual should be declared disabled by SSA.

What if I don’t meet the Social Security Administration’s “listings” criteria?

It is important to remember that even if an individual does not meet the very strict requirements described in the “listings” an individual with chronic pulmonary hypertension that causes functional limitations may still meet the requirements for disability under the alternate analysis used by the SSA. Most people who apply for Social Security disability are not sick enough to meet the requirements in the listings. These individuals are then evaluated based on the impairments they have as a result of their medical conditions and whether the impairments prevent them from performing any of the work they performed for the 15 years leading up to the date of their disability or any other work they might be qualified to perform based on their age, education, prior work experience and functional limitations.

With the complexities of PAH/PH and the medial limitations they produce, it is important to consult with a doctor to get as much detail about your condition as possible. A consultation with an experienced disability attorney can clarify what your status might be according to the SSA.

We would like to thank our guest writer Charles M. Wilmer for sharing his expertise about PAH and disability.

About Charles M. Wilmer

Charlie WilmerA third generation Arizonan, Charles’ community ties are deep and he has been helping the injured and disabled in Arizona for more than 20 years. He earned a B.A. in economics from the University of Arizona and a J.D. from University of the Pacific’s McGeorge School of Law. In his free time Charles likes to cheer for his hometown Cardinals and spend time with his wife and two children. To contact him and visit his web site click here.

 

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