Vascular Disease Strategy

The primary issue in every Social Security disability case has to do with your capacity to work. If your medical condition produces symptoms that would prevent you from functioning in a competitive work environment you are “disabled” per the Social Security law. SSA’s definition of “disability” asks whether your long term medical condition or conditions leaves you unable to engage in “substantial” activity.

In a vascular disease case the vocational issues involve both physical activities and pain. Mental health limitations can arise from stress and anxiety that many vascular disease patients experience because of the possibility of traveling blood clots.

Deep vein thrombosis (DVT) and peripheral artery disease (PAD) are the most common vascular diseases seen by Social Security disability judges. There are, of course, other vascular diseases, such as intestinal ischemic syndrome, aneurysms, lower extremity ulcers, and other diseases of the blood vessels.

Most Social Security judges have some idea regarding the implicaitons of DVT or PAD – if you suffer from another type of vascular disease it may be worthwhile to provide your judge with background educational information prior to your hearing.

Assuming that the grid rules do not apply, there are two arguments that you can use to win a vascular disease case:

Argument 1 is called “meeting a listing,” and Argument 2 is called “proving that your functional capacity is less than sedentary.” You may use one or both of these arguments in a single case.

Argument 1 – Meeting a Listing

The listings for vascular diseases may be found at Listing 4.00 – Cardiovascular System. Not surprisingly they describe DVT (Listing 4.11) and PAD (Listing 4.12).

Like other listings in the Cardiovascular System section, the vascular disease listings look for very specific diagnostic test results. Either you meet the listing or you do not.

Listing 12.02 (organic mental disorders) may also apply – this listing would be applicable in the case of a stroke or brain aneurysm.

Frequently I meet with claimants who most likely meet the listing but who cannot afford necessary diagnostic testing or who otherwise do not have the appropriate test results in their record. For these individuals, the alternative is to argue for disability based on….

Argument 2 – Proving Functional Capacity is Less than Sedentary

Successful functional capacity arguments arise from clearly identifying specific work limitations that arise from your medical condition. In a vascular disease case, work limitations that reasonable occur include:

  • inability to walk for more than x minutes
  • inability to stand for more than x minutes
  • inability to sit in one place comfortably enough to perform work for more than x minutes
  • medical necessity to elevate one or both legs to heart level or above every x hours, for x hours
  • pain that rises to a level that significantly interferes with attention and concentration (ex. pain at level 8 that lasts 45 to 90 minutes five times a week)
  • stress, depression and anxiety that interferes with attention, concentration, focus and pace of work because of omnipresent threat of traveling blood clot or sudden death
  • swelling of legs and feet that causes high level of pain and discomfort

In my practice, I will modify a standard functional capacity form to include the limitations that over the years I find naturally flow from vascular disease cases. If I can get a treating doctor to fill out this form (sometimes with help from me) my chances of winning my client’s case go way up.

Other factors that always help my client’s cause include:

  • a long and consistent work history
  • my client’s stated desire to return to work and avoid being labeled as “disabled”
  • consistent medical treatment
  • support from treating physicians

Here are some case studies from recent cases I have tried that involve vascular diseases

Vascular Disease Case Study #1: 40 year old man who developed DVT after minimally successful spine surgery. His case was also complicated by diabetes and a significant anxiety and depression history. This case resulted in a favorable decision.

DVT Case Study #2:  46 year old male with recurrent DVT flare-ups and non-healing stasis ulcer likely caused by lupus and antiphospholipid antibody syndrome.  This case resulted in a fully favorable bench decision.

Vascular Disease Case Study #3: 61 year old male with diabetes and decreased heart function.  He experiences dangerous leg swelling unless he keeps his legs elevated at least half of the day.  This case resulted in a favorable decision.