Cardiovascular Disability Updating the Social Security Listings (2010) / Chapter Skim
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15 Comorbidities
15 Comorbidities
Pages 219-230
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From page 219... ...
, and beneficial for claimants with chronic comorbidities, to recognize claimants whose cardiovascular impairment is not severe enough to meet a listing, but who are unable to work because of the combined effect of their impairments, and to allow them at Step 3. This chapter reviews the current state of knowledge about the extent of cardiovascular comorbidities and their effects on functional capacity.
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From page 220... ...
.1 Depression and Anxiety Depression and anxiety can cause profound functional impairment. Major depressive disorder produces impairment in functioning as severe as other chronic medical illnesses, including cardiovascular disease (Hays et al., 1995; Kessler et al., 2003; Ormel et al., 2008; Papakostas, 2009)
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. Depressed patients with cardiovascular disease have a higher rate of hospitalization, experience more frequent cardiac symptoms, have more physical impairment and functional decline, are less likely to attend cardiac rehabilitation, are slower in returning to work following a myocardial infarction, and are twice as likely to suffer a second heart attack or to die, compared with those without depression symptoms (Beck et al., 2001; Carney and Freedland, 2008; deJonge et al., 2006; Frasure-Smith and Lespérance, 2006, 2008; Ladwig et al., 1994; Lane et al., 2001; McDermott et al., 2003; Ruo et al., 2007; Soderman et al., 2003; Spertus et al., 2000)
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From page 222... ...
generalized anxiety disorder Approximately 24 to 31 percent of patients with CHD exhibit symptoms of anxiety. A recent cohort analysis from the Heart and Soul Study found that patients with stable CHD and generalized anxiety disorder had a 62 percent higher risk of cardiovascular events such as myocardial infarction, stroke, or death than CHD patients without anxiety symptoms, after controlling for factors such as demographics, major depressive disorder, other comorbid conditions, cardiac disease severity, and medication use (Martens et al., 2010)
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2 Lower extremity disease includes peripheral artery disease and peripheral neuropathy. Mobility limitations are defined as the inability to perform activities of daily living or walk one-quarter mile or climb 10 steps without resting.
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One of the leading causes of death among patients with COPD is comorbid heart failure. In a cohort study of 1,927 patients, patients with COPD had a 194 percent increase in the risk of heart failure after adjustment for age and sex, and a 194 percent increase in the risk of death after adjustment for age and sex, compared with patients without COPD (García Rodríguez et al., 2010)
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From page 225... ...
. EVALUATING COMORBIDITIES AT THE LISTINGS STEP Current Policies and Procedures According to current SSA policy, claimants may be allowed at Step 3 of the sequential evaluation process on the basis that their impairment medically equals a listing if they have "a combination of impairments, no one of which meets a listing, but the findings related to these impairments are at least of equal medical significance to those of a listed impairment." SSA also may find medical equivalence in two other ways: • The claimant's impairment is described in a listing, but it does not exhibit one or more of the findings specified in the particular list ing, or it exhibits all of the findings, but one or more of them is not as severe as specified in the listing, and there are other findings 3 The QT interval is the time from the electrocardiogram Q wave to the end of the T wave corresponding to electrical systole.
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From page 226... ...
In 2008, more than one-third of the adult cardiovascular Step 3 allowances were based on medical equivalence rather than meeting a listing.4 Medical equivalency accounted for 30 to 50 percent of the listing-based allowances, with the exception of heart transplant.5 More than 90 percent of heart transplantation Step 3 allowances were based on meeting the heart transplantation listing, probably because it is easy to ascertain objectively that a heart transplant occurred. For children under age 18 who have a severe impairment or impairments that do not meet or medically equal a listing, SSA will determine whether the impairment or impairments functionally equal the Listings.
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From page 227... ...
If, for example, 95 percent or more of claims with a diagnosis of major depression and certain ejection fraction values are allowed at Step 5, SSA could consider creating a listing criterion for major depression in combination with those ejection fraction values. Alternatively, SSA could provide more focused training to adjudicators on how to evaluate equivalency at Step 3 in such cases.
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From page 228... ...
Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul Study. archives of general Psychiatry 67(7)
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2008. Depressive symptoms in peripheral arterial disease: A follow-up study on preva lence, stability, and risk factors.
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