Cardiovascular cases tend to be either very clear or very contested. Either your ejection fraction is at listing level and the case is straightforward, or it isn’t — and we work the medical-vocational angle around ischemia, arrhythmia frequency, or functional capacity.
What 4.00 covers
- 4.02 — Chronic heart failure
- 4.04 — Ischemic heart disease
- 4.05 — Recurrent arrhythmias
- 4.06 — Symptomatic congenital heart disease
- 4.09 — Heart transplant (12-month presumptive)
- 4.10 — Aneurysm of aorta or major branches
- 4.11 — Chronic venous insufficiency
- 4.12 — Peripheral arterial disease
Listing 4.02 — Chronic heart failure
The most common cardiovascular argument. Two pathways to meet:
Pathway A: Documented systolic failure with ejection fraction ≤30% during a period of stability (not during decompensation), AND one of: inability to perform an exercise tolerance test at 5 METs OR documented inability of medical reasons.
Pathway B: Three or more separate episodes of acute congestive heart failure within a 12-month period, each requiring extended physician intervention or hospitalization for at least 12 hours, AND functional limitations between episodes.
For an SSDI case to clearly meet 4.02, you typically need a recent echocardiogram showing EF ≤30%, ideally repeated over time to show this is your baseline (not a transient post-MI finding).
Listing 4.04 — Ischemic heart disease
This one is more complex because the criteria require documented ischemia plus functional limitation. Most claimants meeting 4.04 have one or more of:
- Exercise tolerance test showing ischemia at 5 METs or less
- Three separate ischemic episodes requiring revascularization (or unsuccessful revascularization attempts) in 12 months
- Coronary artery disease documented by imaging plus inability to perform exercise tolerance testing at meaningful workload
Listing 4.05 — Recurrent arrhythmias
Documented recurrent arrhythmias (not controlled by medication) causing uncontrolled, recurrent episodes of cardiac syncope or near-syncope, despite prescribed treatment, AND documented arrhythmia related to the syncope by Holter or other ambulatory monitoring.
ICD (implantable cardioverter-defibrillator) placement is significant evidence here — documented appropriate shocks support an arrhythmia argument.
What evidence wins cardiovascular cases
Cardiology records spanning 12+ months. Recent echocardiogram with EF measurement, ideally repeated over time. Exercise tolerance test (treadmill or pharmacologic) results. Cardiac catheterization reports if relevant. ICD or pacemaker placement documentation. Hospital admission records for any acute events.
For ischemic disease: stress test results and angiogram findings. For arrhythmia: Holter or event monitor data correlated with symptomatic episodes.
Where cardiovascular cases fall apart
Outdated cardiac imaging — an echo from 2023 won’t carry a 2026 case if your status may have changed. Get a current echo if it’s been over a year.
For EF arguments: SSA wants the measurement taken during a period of stability, not during decompensation. If your most recent echo was during an acute episode, request a follow-up after you’ve stabilized.
Missing exercise tolerance documentation — many cardiologists don’t routinely order stress tests on patients who are clearly too symptomatic for them. The medical reason for not testing should be documented if a test wasn’t done.
Compassionate Allowances
Several cardiac conditions are fast-tracked: pulmonary atresia, hypoplastic left heart syndrome, transposition of the great vessels, advanced heart transplant complications.
Free consultation
If you have heart failure, ischemic heart disease, arrhythmias, or recent cardiac surgery, a free 30-minute call clarifies whether your case fits 4.00 — and what evidence you’d need to develop.
Official SSA reference: View Section 4.00 on ssa.gov →