[0:01] If you're applying for disability benefits or help people that are, the path to success
[0:05] has never been more complicated.
[0:07] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview
[0:11] the country's top experts to help you better navigate the disability process.
[0:16] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated.
[0:26] I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, this is Chad Brano, the Disability Expert Podcast.
[0:34] Once again, talking about all things, social security, disability, my disability crime,
[0:41] fighting partner, senior associate, federal court extraordinaire, Aaron Dalton.
[0:48] What's up, Aaron?
[0:49] Hey, glad to be back.
[0:50] You know, it's funny.
[0:51] We have another podcast with Caleb, and I can't say all those things.
[0:55] He's another one of our associates.
[0:57] Anyway, we'll talk about that.
[0:59] We are back again today, and we are working through some conditions, working through issues
[1:06] that real conditions that people are dealing with, not their specific cases.
[1:12] For example, we're not doing that.
[1:13] That's something we ought to do.
[1:14] We have to do some case studies in the future.
[1:15] That might be fun.
[1:16] Just take no client names included, but we will, we'll go through some case studies.
[1:21] That might be fun, but that's not what we're doing today.
[1:23] What we're doing today is going through heart conditions, actually.
[1:27] We've done some episodes on respiratory illness, depression, anxiety, mental health, musculoskeletal
[1:36] back issues, which are very prominent in the disability process.
[1:42] Heart problems are right there.
[1:45] It's funny.
[1:46] We're talking about this episode of what we're going to talk about, and one of the things
[1:49] I think people probably should understand is I think heart cases are way harder to win
[1:57] today than there were 20 years ago.
[2:00] The advances in medicine, it's interesting, you probably know this, Renee.
[2:06] My wife was nurse practitioner, but she actually does a lot of stuff in our office and helps
[2:09] with medical workups and stuff.
[2:12] She did her master's thesis on thrombolytics, and thrombolytics are used in heart attacks
[2:20] to basically stop them.
[2:23] The reality is with the advances in thrombolytics and cardiac care, I mean I remember back
[2:30] in 0405, 20 plus years ago, we were doing these cases, if you came in and you had a heart
[2:35] attack, we were like, yeah, that's a straight take.
[2:39] We're going straight takes like a case that obviously we think we can win, we don't need
[2:42] to ask you more questions.
[2:43] No, follow up.
[2:44] Yeah, we don't need to follow.
[2:45] We all are going to ask them because we're doing our due diligence, but the reality is
[2:48] we didn't need to, because if you had a massive heart attack, you won.
[2:52] Today people have mass heart attack and I go home the next day or two days from now and
[2:56] don't really have that many residual issues.
[2:59] And so I think sort of the big takeaway, if you don't take anything else away from this
[3:05] episode is you cannot assume that because you have a heart attack, you're going to win your
[3:10] case.
[3:11] And that's, it's very common and it's common for clients to call, especially leads and
[3:16] you know, well, why are you thinking about applying for disability or what are you dealing
[3:21] with?
[3:22] And you're like, oh, I had a heart attack, you know, like, okay, no, no, I had a heart
[3:25] attack.
[3:26] And I'm like, okay, like, you understand, like that's not enough.
[3:30] That's not enough at all.
[3:32] Doesn't mean you can't get on disability if you've had a massive heart attack.
[3:35] It doesn't mean you can't get on disability if you don't have heart problems.
[3:38] In fact, that's what we're doing today.
[3:39] We're going to go through how you win cases with heart problems.
[3:42] But the thing I think, you know, maybe most value to people to understand is in the social
[3:48] security disability space, heart disease, especially related to heart attacks or myocardial infarctions
[3:56] or whatever you want to use the technical term, there's no assumption or pre-supposition
[4:04] by a judge that you're disabled because this has happened to you.
[4:07] In fact, with many judges, not just, you know, my favorite judge to Nazimal, but even with
[4:13] sort of run of the, you know, sort of middle of the road judges, there's sort of a presumption
[4:17] that, okay, well, you had a heart attack, all right, you know, well, you know, how are
[4:21] you now?
[4:22] Right.
[4:23] You know, because there's really a, you know, a presumption that if you had the heart attack
[4:26] and you got, you know, you got effective, quick medical treatment, then the reality is it
[4:32] probably wasn't that damaging.
[4:34] Which is wonderful.
[4:35] I'm glad that people that have heart attacks don't, you know, end up in a chair the rest
[4:39] of their life because they don't have enough energy to do anything and that they don't die
[4:42] from them.
[4:44] But you know, we're, we're not in the medical business here.
[4:46] We're in the one in disability case business and the one in disability case business.
[4:51] Heart attacks are, are not near the, they're not near the green light.
[4:56] Hey, we should move ahead that they used to be.
[4:58] So that doesn't change the fact though, that there are people with serious heart conditions
[5:03] coronary arteries, congestive heart failure and these sort of commonings we deal with.
[5:08] So there's two primary routes that these clients can go through to get on disability.
[5:13] Just like in all cases, they can meet the listing or we can establish an RFC, tell us
[5:19] a little bit about the listings.
[5:20] We're not going to talk much about them and there's a good reason for that.
[5:23] But just talk a little bit about the cardiac listings, what the difficulties are and what sort
[5:28] of levels of severity might reach a listing and if you can, I mean, what are you actually
[5:33] going to have to do to win a case with a heart listing?
[5:35] Yeah.
[5:36] So the heart listings are tough.
[5:37] We, you know, we've talked recently about the, the pulmonary listings and how objective
[5:42] they are, cardiac listings are still trying to be objective, but there's some, some caveats
[5:48] there.
[5:49] So for example, in some of the listings, the, the ejection fractions that they're looking
[5:54] for, you have to have an injection fraction that's a certain low percent.
[6:00] But it can't be during an acute cardiac crisis.
[6:03] So it can't be when you're in the ER having the heart attack.
[6:05] It has to be during a period of stabilization.
[6:08] And so the judges can be looking at your file and say, well, you know, that, that one
[6:13] that you thought meets the listing, that was during a crisis event, your, your baseline is
[6:17] much better than that.
[6:18] So you don't meet the listing.
[6:19] And there's other listings for the other cardiac conditions, but just generally, we don't
[6:23] see a ton of people meeting the cardiac listings.
[6:26] Right.
[6:27] And I think, you know, you have, you have some multiple factors there.
[6:31] One is if you do meet a cardiac listing, it's not that, you know, we can't look at your
[6:36] records and say, okay, the requirements for the listing are A, B, C, and D, we see A,
[6:41] we see B, we see C, we see D, we think you meet it.
[6:45] I mean, that's, that's almost unheard of to win that in court.
[6:48] You can point out the listing, but the, but judges by and large, even if the objective evidence
[6:55] on its face appears to meet the listing are really hesitant to approve a case based on
[7:00] a listing without a medical expert.
[7:02] So I think when you have certain levels of severity, because some people have heart attacks
[7:09] and don't recover.
[7:10] Some people don't have insurance and they can't do, you know, the, the cardiac rehab that
[7:14] takes them from that acute state where they would have met the listing to a recovered state
[7:21] where they don't, that cardiac rehab a lot of times is what sort of bridges them from meeting
[7:26] the listing to not meeting the listing.
[7:29] But if you don't have insurance and you can't do that, I mean, they're not going to, I mean,
[7:32] they're not going to probably give you cardiac rehab for free.
[7:34] It's really expensive, right?
[7:36] So, if you do meet the listing, it's almost necessary to have a cardiologist come in and
[7:43] meet the listing, which has its own set of issues.
[7:47] Historically I find cardiologists to be very reluctant to get involved in disability cases.
[7:51] I don't know.
[7:52] That's, I'm not upset with cardiologist.
[7:55] I'm just telling you my experience.
[7:57] And not only that, you have to get them to actually jump through the hoops of the listings
[8:02] which are typically extensive.
[8:03] So, you know, to win a case with a listing with the cardiologist, you're going to have to
[8:07] educate the cardiologist on the listing, not, not what the components mean, but how the
[8:12] components have to be put together.
[8:14] And you're going to have to document it because sometimes there has to be periods of time and
[8:19] they have to look at different periods and different tests and multiple tests.
[8:22] And so, not only do you have to educate the cardiologist, you have to get them to check the box
[8:27] and you have to get them to document the evidence that supports it.
[8:30] You know, sometimes they'll, they'll check the box and we can come behind and say, and
[8:35] they're right about this because of these records that, you know, you wouldn't believe me
[8:39] about it, but you won't believe the cardiologist.
[8:42] So, the point is, is that you're going to need that.
[8:46] And even then, in hearings, it's not uncommon if your cardiologist says you meet the listing,
[8:51] the judge will say, well, that's your cardiologist.
[8:54] Let me bring in the, you know, let me bring in the, the podiatrist over here.
[8:58] Let's get there, you know, whether you meet the listing, right?
[9:01] So, the point is, is that the listings, if you meet them, are often indicative of a, of
[9:07] a real level of severity with the cardiac listings.
[9:10] But the reality is, is that most people don't meet them.
[9:13] If they do meet them, they don't meet them beyond the acute sort of heart event that they had.
[9:20] And even if they do getting a doctor to write the letter to support it and say the things
[9:26] they need to say is not as easy as you would think, which leads to the reality that most
[9:32] cases aren't one with the cardiac listings.
[9:34] And in fact, a lot of the ones that are one, though, are one initially where the, the components
[9:40] of the listing are so clearly documented, you know, honestly, a lot of those cases, you
[9:46] know, people apply on their own and they don't, they don't ever need a lawyer because there's,
[9:49] you know, saying, don't hire a lawyer if you have a cardiac problem.
[9:53] The level of severity that meets a listing sometimes is self-evident and when it's not
[9:58] self-evident, a lot of times it's difficult to get a doctor to maybe jump in and say, well,
[10:02] they really do meet the listing or potentially equal listing.
[10:07] And so it's difficult.
[10:08] So we spend most of our time, once again, you know, in this golden chain of evidential progression,
[10:14] getting our solid diagnosis, looking at what the symptoms are, building our functional
[10:18] limitations and, and building that RFC that's going to be able to help them win.
[10:23] So let's just go through this because this is what we do in every case.
[10:27] So if you're looking for your diagnosis, what are some of the, some of the basic things
[10:32] people need to understand about establishing a heart related or cardiac diagnosis, it's
[10:37] going to get you sort of in the door that now we can go down this, this rabbit hole trying
[10:40] to build your case and hopefully get, hopefully, you know, get a winner.
[10:44] Yeah.
[10:45] So sometimes that diagnosis is obvious.
[10:46] You have the heart attack, you're at the hospital, boom, there we go, diagnosed.
[10:51] Sometimes it takes a little bit longer to get that diagnosis.
[10:54] We start off seeing the records, it says, you know, well, my family has a history of heart
[10:58] disease and I'm having chest pain.
[11:00] If you stop there, we don't have a diagnosis.
[11:03] But if you follow that up, a lot of times that leads to some testing and the providers able
[11:07] say, okay, yes, you do actually have a cardiac issue.
[11:10] Yeah.
[11:11] And then, and so you're looking for coronary artery disease, congestive heart failure.
[11:16] There's a range of cardiac issues that you can have.
[11:18] I mean, we could, we could do full episodes on individual cardiac conditions, but the
[11:22] point is, you usually, what we would prefer to see is once again, with specialists, you
[11:29] need to see a cardiologist if it's all possible.
[11:32] You need to be, and sort of part of the underlying rationale is, if your heart problem is not
[11:40] severe enough that it doesn't need to be managed by a cardiologist, is it really severe enough
[11:44] to preclude employment.
[11:46] So once again, we're back to the family doctor who sort of wants to treat and manage everything.
[11:54] It's not necessarily that they can't prescribe your medications, but, and they can't manage
[12:00] your heart condition, but the reality is is that people who have cardiac problems or heart
[12:06] related issues that are severe enough to place them on disability need to be seen by a cardiologist
[12:10] if at all possible.
[12:12] So the functional limitations will get to, but what are some of the symptoms that people
[12:19] deal with who have cardiac issues and heart related problems that they need to not only vocalize
[12:26] to their lawyer and to their doctor, but ultimately, you know, express to the judge to say,
[12:31] hey, yes, I have congestive heart failure.
[12:35] These are the symptoms that I deal with.
[12:36] So what are some of the big things that we're looking for in those type, in the symptom world
[12:40] with these type cases?
[12:41] With congestive heart failure, a big one is fluid retention.
[12:45] And so having one thing that I'm looking for in the records is, you know, on the exam is,
[12:51] is the doctor actually looking at your ankles, doing that poke test to see, you know, how
[12:57] much swelling are we talking about?
[12:59] You have pitting a demon.
[13:00] Is it plus one?
[13:01] It's plus two or whatever it is, right?
[13:02] Are you on?
[13:03] Are you on diuretics?
[13:04] You're having to go to the bathroom because of the fluid management issues.
[13:10] Our conditions generally shortness of breath, fatigue, difficulty with stairs, steps, heels,
[13:18] things like that.
[13:19] Sometimes they have chest pain.
[13:22] Chest pain.
[13:22] We've got red fox and red Sanford, little, it's the big one's coming.
[13:29] The big one's coming, right?
[13:32] That's the real thing though, people do have chest pain, often it's exertional related,
[13:38] right?
[13:39] Chest pain.
[13:40] So those are some of the symptoms that we see.
[13:41] But I think those are the main ones, we're looking at fatigue, we're looking sometimes with
[13:45] shortness of breath, especially with people I've CHF, we're looking at medication side effects.
[13:51] So even though, per se, it's not a symptom, the medications that they give you often create
[13:58] fatigue, you know, in urinary frequency, sometimes they have issues with, with heat, sometimes
[14:09] they have issues with cold, sometimes you end up with exertional, sorry, environmental limitations
[14:13] with people who have heart issues.
[14:16] But once again, we're back and I know we seem to say the same things every episode at some
[14:20] level.
[14:21] But that's because what it takes to win, like it's not enough for you to say, I have fatigue,
[14:27] like it's not enough to have fatigue, you have to say you have fatigue, you have to tell
[14:31] your doctor, you have fatigue, you have to tell your doctor to put it in the record that
[14:35] you have fatigue.
[14:36] Is the doctor assumed that you have it?
[14:38] Maybe, maybe not, probably, depending on what level of heart disease that you have, but
[14:44] you just can't assume.
[14:47] You can't assume that the doctor knows, you can't assume that the CMA is going to put it
[14:51] in the medical record when they help create the note.
[14:55] And once again, the danger is you assume they knew, you figured everybody knew, and you
[15:00] get to the judge and you're like, I don't see any evidence in here that you've ever complained
[15:04] about fatigue.
[15:05] Where's that in the record, Mr. Dalton?
[15:06] Yeah, where's that in the record?
[15:10] But that's completely within your control.
[15:13] It's not complaining, right, which is a big problem we see with clients who say, I just don't
[15:18] want to complain.
[15:19] Well, okay.
[15:20] Well, don't tell your cousin, Aunt Susie at dinner next week, but tell your doctor, right?
[15:24] Like, if you don't want to complain and you don't want to talk about it with your family
[15:27] or church or the Lines Club or whatever it is you're going to, right, don't, but you're
[15:32] not complaining when you tell your doctor.
[15:34] What you're doing is establishing a basis for the documentation that we need in the medical
[15:39] record to be able to say, look, they say they have fatigue.
[15:43] Like, you can't put someone at medium work who has to walk six hours a day and lift 50 pounds
[15:49] that has fatigue when they're walking to the mailbox that just doesn't jive.
[15:53] And if you have the proper medical diagnosis with it, we're going to be able to say, and
[15:58] it's completely reasonable that they have fatigue.
[16:01] They have congestive heart failure, right?
[16:02] So, we have to get the symptoms out of your mind and into the medical record.
[16:11] And if you do that, okay, we're now we're two-thirds of the way to building a chain that we
[16:16] can build an RFC for, what are we looking for in terms of limitation, documentation, limitation,
[16:23] evidence that ultimately we can say, hey, these are the limitations that my client has.
[16:28] They're reasonable from the symptoms they have.
[16:31] They're reasonably flowed from the diagnosis.
[16:33] What are the types of things we're going to see in heart cases with respect to limitations
[16:36] that, hey, if you have these things, you need to make sure somebody knows about them.
[16:40] With the leg swelling from congestive heart failure, I'm trying to get a limitation to
[16:45] elevating the legs in the RFC, almost all of the vocational experts agree that leaning
[16:51] back with your legs up parallel to the floor is not a work like posture even at the sedentary
[16:56] level.
[16:57] Was it the office, the guy that ran the office?
[16:59] He was always sitting back with his legs up.
[17:01] That is not competitive.
[17:02] It's not competitive employment.
[17:05] With fatigue generally, having to take naps, having to take extra breaks, can go to time-off
[17:10] task, sort of generally being unable to complete that eight-hour work day.
[17:15] I think you're in a frequency and the necessity of being able to have ready bathroom access
[17:21] is a big factor in sort of a sedentary office, semi-skilled, skilled environment, maybe
[17:29] less of a deal, but if you're in a unskilled manufacturing environment, for example, or
[17:37] you're on a work site or you're in any sort of plant or factory, you're not going to be
[17:43] given the ability to go to the bathroom anytime you want to.
[17:47] You can't just wander off.
[17:48] You're not required to where it depends while you work.
[17:51] That's not reasonable.
[17:53] It's important that if you're staying on a diuretic and you're having to go to the bathroom
[17:58] 25 times a day, you have to document it.
[18:01] Even if it means keeping a journal of all things, but you have to document it and importantly,
[18:07] you have to tell your doctor, it's like, well, how is the diuretic working?
[18:12] Well, it's fine.
[18:14] It's doing what it's supposed to do, but doing what it's supposed to do, you need to tell
[18:18] them.
[18:19] It's making you go to the bathroom all the time.
[18:21] If you're taking medications that make you tired, and that's producing limitations in your
[18:26] ability, for example, to climb stairs or carry groceries in, like you have to tell someone.
[18:33] The functional limitations that we're going to see are by and large going to be, you know,
[18:38] exertional.
[18:39] We're going to see often difficulties with walking, difficulties with standing, lifting,
[18:44] carrying, pushing, pulling.
[18:46] Those are going to be clear limitations that people likely have and non-exertional sort
[18:53] of, sometimes people have postural limitations that would come up.
[18:57] Sometimes you have environmental limitations, but nobody knows if you don't tell them.
[19:01] Right?
[19:02] So, these are the type of limitations that we're looking for, but if the first time you tell
[19:08] someone is in the pre-hearing, before we talk to you about your case, odds are it's not
[19:14] in the medical record if you've never told anyone.
[19:18] But if we can get the diagnosis right and we can get the symptomology included in the
[19:23] record, it's not difficult to convince the judge that you have certain limitations.
[19:28] Like, you know, it's not in common, for example, if you can't walk 200 feet and you need a handicap
[19:35] placard, you need to ask your doctor for it because that's statutory evidence that there's
[19:41] limitations and how far you can walk.
[19:44] You know, somewhat touchy subject, a lot of our male clients who have hard issues deal
[19:48] with issues with erectile dysfunction, and so if you're having, you know, sort of those
[19:54] types of issues, yeah, it might be a little embarrassing to talk about, but at the same time,
[19:59] that's also evidence that, hey, there's a level of severity there that may be beyond the
[20:04] person, you know, the other, the other, you know, 100 people a year, whatever the dead
[20:09] judge hears who have sub-level of heart problem, right?
[20:12] So the point is, is that when the limitations are there, and they're going to be there,
[20:18] we've got to get them documented, right?
[20:20] So let's spend a minute, though, talking about what I think is one of the keys to winning
[20:27] heart cases, though, and that's comorbidities, can you talk a little bit about how heart problems
[20:32] rarely exist in isolation?
[20:34] Yes, so there's a lot of different comorbidities that could be at play here, obesity is a big
[20:40] one, especially with congestive heart failure, diabetes, COPD, lots that can go in.
[20:49] And so the judges are not just supposed to look at each condition and isolation, they're
[20:54] supposed to look at everything taken together.
[20:57] So sometimes we can, you know, maybe we can look at the lumbar degenerative disc disease to
[21:02] get you down to light, and then we look at the cardiac issues and that adds in more limitation.
[21:07] So it's not just the one thing.
[21:08] Yeah, and so when you come into the process, it's interesting, you know, because we take
[21:15] leads at all stages.
[21:16] So some people call us and we file their initial application.
[21:19] Some people do their initial application on their own, they come to us when they get their
[21:22] initial denial.
[21:24] Sometimes people do two levels, sometimes people don't call us before they get to the hearing.
[21:28] It never ceases to amaze me, and we've got to do an issue with Tia, Tia's our intake director.
[21:32] We're going to have Tia on at some point and let's you meet Tia, who manages all of our intake.
[21:39] We're talking about a case, and they're like hard, hard, hard, hard, hard, and kind of
[21:45] find out they have severe obstructive sleep apnea, and they're like, well, I didn't think
[21:49] that mattered because what I can see, what I view myself as disabled from is my heart condition.
[21:56] And that's a huge misunderstanding of the process.
[21:59] This is not a personal injury case where we're just talking about your broken leg from the
[22:04] car accident, right?
[22:06] That's not a worker's comp case where we're just focusing on the fact that you injured
[22:09] your hand in the manufacturing accident, right?
[22:12] They're looking at your person as a whole and how all of the different impairments impact
[22:18] you, and once again, they don't know you have obstructive sleep apnea.
[22:24] Now sometimes it pops up in the record, but all you've told them, especially in the early
[22:30] levels at DDS, if all you're told them is hard, it doesn't matter that you have terrible
[22:35] COPD.
[22:36] A lot of times they'll just ignore it and they'll say, well, I'm assuming they don't
[22:39] talk to us really, but when they do talk to us, they'll be like, well, I didn't know
[22:42] they had that.
[22:43] It was in the record.
[22:44] Well, yeah, but we weren't looking for that in the records.
[22:47] We were just looking at the cardiac records, the cardiology records because that's all they
[22:50] told us about, right?
[22:51] So understand that when you have heart disease, it's highly unlikely that you only have heart
[22:58] disease, that you only have coronary artery disease or you only have congestive heart failure,
[23:03] whatever it is.
[23:04] We're going to have a range of other issues and we need to put them together because what
[23:08] we're trying to do is piece all of these together to show that collectively, your residual function
[23:14] capacity from all of the different things you deal with is going to either preclude our
[23:18] work or limit you to a level of work said in terror light that based on your age is not
[23:24] going to require you to work.
[23:25] I think some of the big mistakes people make with these cases are sort of relying on a diagnosis,
[23:32] lying on ejection fraction, failing to understand comorbidities.
[23:37] There's one final thing I want to hit on, though, and that's the issue of drug use because
[23:42] I think this is one of these areas where it's not uncommon to people, especially people
[23:49] who have a significant history of cocaine use or a significant history of methamphetamine
[23:53] use, to have significant heart problems.
[23:59] I've over the years, we historically don't not represent people because they have history
[24:06] of drug use.
[24:08] Generally, we come in our office like, hey, we're not going to hold what happened before
[24:12] against you, but if this persists, we may withdraw.
[24:15] I think it's important for people who have a strong history of drug use and have heart
[24:21] damage from it to not simply think they can't apply for disability.
[24:27] People do really dumb things for a long period of time in their life, and then horrible events
[24:32] happen because of it.
[24:34] They basically blow their heart up with cocaine, but they really are disabled after that.
[24:39] It doesn't, and a lot of times that event leads them to rehab, and they stop using drugs,
[24:45] and they're left, though, with a heart that really can't be repaired.
[24:49] A lot of times, we start the show talking about sort of run-of-the-mill heart attacks that
[24:53] are repaired very quickly.
[24:55] On the other end of that spectrum, though, are sort of traumatic, drug-related events where
[25:00] people have significant heart problems that often can't be rehabilitated.
[25:05] In those cases, I just think it's important if people know one, just the cause of your
[25:10] heart problem doesn't have to be from genes or from whatever it is.
[25:17] It's not heart problems from source X that get on disability.
[25:21] It's like, look at your heart.
[25:22] They look at the function of it and how it impacts you.
[25:25] When you have people who have significant drug use that leads to heart problems, I don't
[25:30] want them to be deterred from coming into the system, but also understand that if you continue
[25:35] to use drugs, I'm going to argue materiality that doesn't matter how much crack they continue
[25:43] smoking.
[25:44] The heart damage is done, but judges are not very receptive to that argument.
[25:51] Heart problems, real deal.
[25:53] They really do impact people, often in conjunction with a lot of other issues.
[25:57] There's a lot more we could go into, but I think if people understand, if you have a really,
[26:02] really severe heart problem, you may meet a listing, but you're going to need your cardiologist
[26:06] involved.
[26:08] Most people who have heart-related issues that are trying to get on disability need to focus
[26:13] on, get to a cardiologist and get the diagnosis.
[26:16] Then, the symptoms and limitations that you have, make sure someone knows about them.
[26:23] Don't just keep them to yourself.
[26:25] Don't be worried about being seen as complaining, get those out, get them in the record, because
[26:30] if you do that, especially when you factor in medication side effects, which can be really
[26:34] detrimental to people's ability to work an eight-hour day, we're going to be able to build
[26:39] a really good heart case.
[26:40] We win a lot of those cases, especially with people over 50 and 55, so that's it.
[26:46] That's all we got for today.
[26:49] Thank you for watching, and if you have a heart problem, hey, listen to the episode, work
[26:53] through these issues, build your case, you can win these things.
[26:56] Anyway, that's all we got.
[26:58] Thanks for watching.
[26:59] Subscribe.
[27:00] Until next time, take care.
[0:05] has never been more complicated.
[0:07] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview
[0:11] the country's top experts to help you better navigate the disability process.
[0:16] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated.
[0:26] I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, this is Chad Brano, the Disability Expert Podcast.
[0:34] Once again, talking about all things, social security, disability, my disability crime,
[0:41] fighting partner, senior associate, federal court extraordinaire, Aaron Dalton.
[0:48] What's up, Aaron?
[0:49] Hey, glad to be back.
[0:50] You know, it's funny.
[0:51] We have another podcast with Caleb, and I can't say all those things.
[0:55] He's another one of our associates.
[0:57] Anyway, we'll talk about that.
[0:59] We are back again today, and we are working through some conditions, working through issues
[1:06] that real conditions that people are dealing with, not their specific cases.
[1:12] For example, we're not doing that.
[1:13] That's something we ought to do.
[1:14] We have to do some case studies in the future.
[1:15] That might be fun.
[1:16] Just take no client names included, but we will, we'll go through some case studies.
[1:21] That might be fun, but that's not what we're doing today.
[1:23] What we're doing today is going through heart conditions, actually.
[1:27] We've done some episodes on respiratory illness, depression, anxiety, mental health, musculoskeletal
[1:36] back issues, which are very prominent in the disability process.
[1:42] Heart problems are right there.
[1:45] It's funny.
[1:46] We're talking about this episode of what we're going to talk about, and one of the things
[1:49] I think people probably should understand is I think heart cases are way harder to win
[1:57] today than there were 20 years ago.
[2:00] The advances in medicine, it's interesting, you probably know this, Renee.
[2:06] My wife was nurse practitioner, but she actually does a lot of stuff in our office and helps
[2:09] with medical workups and stuff.
[2:12] She did her master's thesis on thrombolytics, and thrombolytics are used in heart attacks
[2:20] to basically stop them.
[2:23] The reality is with the advances in thrombolytics and cardiac care, I mean I remember back
[2:30] in 0405, 20 plus years ago, we were doing these cases, if you came in and you had a heart
[2:35] attack, we were like, yeah, that's a straight take.
[2:39] We're going straight takes like a case that obviously we think we can win, we don't need
[2:42] to ask you more questions.
[2:43] No, follow up.
[2:44] Yeah, we don't need to follow.
[2:45] We all are going to ask them because we're doing our due diligence, but the reality is
[2:48] we didn't need to, because if you had a massive heart attack, you won.
[2:52] Today people have mass heart attack and I go home the next day or two days from now and
[2:56] don't really have that many residual issues.
[2:59] And so I think sort of the big takeaway, if you don't take anything else away from this
[3:05] episode is you cannot assume that because you have a heart attack, you're going to win your
[3:10] case.
[3:11] And that's, it's very common and it's common for clients to call, especially leads and
[3:16] you know, well, why are you thinking about applying for disability or what are you dealing
[3:21] with?
[3:22] And you're like, oh, I had a heart attack, you know, like, okay, no, no, I had a heart
[3:25] attack.
[3:26] And I'm like, okay, like, you understand, like that's not enough.
[3:30] That's not enough at all.
[3:32] Doesn't mean you can't get on disability if you've had a massive heart attack.
[3:35] It doesn't mean you can't get on disability if you don't have heart problems.
[3:38] In fact, that's what we're doing today.
[3:39] We're going to go through how you win cases with heart problems.
[3:42] But the thing I think, you know, maybe most value to people to understand is in the social
[3:48] security disability space, heart disease, especially related to heart attacks or myocardial infarctions
[3:56] or whatever you want to use the technical term, there's no assumption or pre-supposition
[4:04] by a judge that you're disabled because this has happened to you.
[4:07] In fact, with many judges, not just, you know, my favorite judge to Nazimal, but even with
[4:13] sort of run of the, you know, sort of middle of the road judges, there's sort of a presumption
[4:17] that, okay, well, you had a heart attack, all right, you know, well, you know, how are
[4:21] you now?
[4:22] Right.
[4:23] You know, because there's really a, you know, a presumption that if you had the heart attack
[4:26] and you got, you know, you got effective, quick medical treatment, then the reality is it
[4:32] probably wasn't that damaging.
[4:34] Which is wonderful.
[4:35] I'm glad that people that have heart attacks don't, you know, end up in a chair the rest
[4:39] of their life because they don't have enough energy to do anything and that they don't die
[4:42] from them.
[4:44] But you know, we're, we're not in the medical business here.
[4:46] We're in the one in disability case business and the one in disability case business.
[4:51] Heart attacks are, are not near the, they're not near the green light.
[4:56] Hey, we should move ahead that they used to be.
[4:58] So that doesn't change the fact though, that there are people with serious heart conditions
[5:03] coronary arteries, congestive heart failure and these sort of commonings we deal with.
[5:08] So there's two primary routes that these clients can go through to get on disability.
[5:13] Just like in all cases, they can meet the listing or we can establish an RFC, tell us
[5:19] a little bit about the listings.
[5:20] We're not going to talk much about them and there's a good reason for that.
[5:23] But just talk a little bit about the cardiac listings, what the difficulties are and what sort
[5:28] of levels of severity might reach a listing and if you can, I mean, what are you actually
[5:33] going to have to do to win a case with a heart listing?
[5:35] Yeah.
[5:36] So the heart listings are tough.
[5:37] We, you know, we've talked recently about the, the pulmonary listings and how objective
[5:42] they are, cardiac listings are still trying to be objective, but there's some, some caveats
[5:48] there.
[5:49] So for example, in some of the listings, the, the ejection fractions that they're looking
[5:54] for, you have to have an injection fraction that's a certain low percent.
[6:00] But it can't be during an acute cardiac crisis.
[6:03] So it can't be when you're in the ER having the heart attack.
[6:05] It has to be during a period of stabilization.
[6:08] And so the judges can be looking at your file and say, well, you know, that, that one
[6:13] that you thought meets the listing, that was during a crisis event, your, your baseline is
[6:17] much better than that.
[6:18] So you don't meet the listing.
[6:19] And there's other listings for the other cardiac conditions, but just generally, we don't
[6:23] see a ton of people meeting the cardiac listings.
[6:26] Right.
[6:27] And I think, you know, you have, you have some multiple factors there.
[6:31] One is if you do meet a cardiac listing, it's not that, you know, we can't look at your
[6:36] records and say, okay, the requirements for the listing are A, B, C, and D, we see A,
[6:41] we see B, we see C, we see D, we think you meet it.
[6:45] I mean, that's, that's almost unheard of to win that in court.
[6:48] You can point out the listing, but the, but judges by and large, even if the objective evidence
[6:55] on its face appears to meet the listing are really hesitant to approve a case based on
[7:00] a listing without a medical expert.
[7:02] So I think when you have certain levels of severity, because some people have heart attacks
[7:09] and don't recover.
[7:10] Some people don't have insurance and they can't do, you know, the, the cardiac rehab that
[7:14] takes them from that acute state where they would have met the listing to a recovered state
[7:21] where they don't, that cardiac rehab a lot of times is what sort of bridges them from meeting
[7:26] the listing to not meeting the listing.
[7:29] But if you don't have insurance and you can't do that, I mean, they're not going to, I mean,
[7:32] they're not going to probably give you cardiac rehab for free.
[7:34] It's really expensive, right?
[7:36] So, if you do meet the listing, it's almost necessary to have a cardiologist come in and
[7:43] meet the listing, which has its own set of issues.
[7:47] Historically I find cardiologists to be very reluctant to get involved in disability cases.
[7:51] I don't know.
[7:52] That's, I'm not upset with cardiologist.
[7:55] I'm just telling you my experience.
[7:57] And not only that, you have to get them to actually jump through the hoops of the listings
[8:02] which are typically extensive.
[8:03] So, you know, to win a case with a listing with the cardiologist, you're going to have to
[8:07] educate the cardiologist on the listing, not, not what the components mean, but how the
[8:12] components have to be put together.
[8:14] And you're going to have to document it because sometimes there has to be periods of time and
[8:19] they have to look at different periods and different tests and multiple tests.
[8:22] And so, not only do you have to educate the cardiologist, you have to get them to check the box
[8:27] and you have to get them to document the evidence that supports it.
[8:30] You know, sometimes they'll, they'll check the box and we can come behind and say, and
[8:35] they're right about this because of these records that, you know, you wouldn't believe me
[8:39] about it, but you won't believe the cardiologist.
[8:42] So, the point is, is that you're going to need that.
[8:46] And even then, in hearings, it's not uncommon if your cardiologist says you meet the listing,
[8:51] the judge will say, well, that's your cardiologist.
[8:54] Let me bring in the, you know, let me bring in the, the podiatrist over here.
[8:58] Let's get there, you know, whether you meet the listing, right?
[9:01] So, the point is, is that the listings, if you meet them, are often indicative of a, of
[9:07] a real level of severity with the cardiac listings.
[9:10] But the reality is, is that most people don't meet them.
[9:13] If they do meet them, they don't meet them beyond the acute sort of heart event that they had.
[9:20] And even if they do getting a doctor to write the letter to support it and say the things
[9:26] they need to say is not as easy as you would think, which leads to the reality that most
[9:32] cases aren't one with the cardiac listings.
[9:34] And in fact, a lot of the ones that are one, though, are one initially where the, the components
[9:40] of the listing are so clearly documented, you know, honestly, a lot of those cases, you
[9:46] know, people apply on their own and they don't, they don't ever need a lawyer because there's,
[9:49] you know, saying, don't hire a lawyer if you have a cardiac problem.
[9:53] The level of severity that meets a listing sometimes is self-evident and when it's not
[9:58] self-evident, a lot of times it's difficult to get a doctor to maybe jump in and say, well,
[10:02] they really do meet the listing or potentially equal listing.
[10:07] And so it's difficult.
[10:08] So we spend most of our time, once again, you know, in this golden chain of evidential progression,
[10:14] getting our solid diagnosis, looking at what the symptoms are, building our functional
[10:18] limitations and, and building that RFC that's going to be able to help them win.
[10:23] So let's just go through this because this is what we do in every case.
[10:27] So if you're looking for your diagnosis, what are some of the, some of the basic things
[10:32] people need to understand about establishing a heart related or cardiac diagnosis, it's
[10:37] going to get you sort of in the door that now we can go down this, this rabbit hole trying
[10:40] to build your case and hopefully get, hopefully, you know, get a winner.
[10:44] Yeah.
[10:45] So sometimes that diagnosis is obvious.
[10:46] You have the heart attack, you're at the hospital, boom, there we go, diagnosed.
[10:51] Sometimes it takes a little bit longer to get that diagnosis.
[10:54] We start off seeing the records, it says, you know, well, my family has a history of heart
[10:58] disease and I'm having chest pain.
[11:00] If you stop there, we don't have a diagnosis.
[11:03] But if you follow that up, a lot of times that leads to some testing and the providers able
[11:07] say, okay, yes, you do actually have a cardiac issue.
[11:10] Yeah.
[11:11] And then, and so you're looking for coronary artery disease, congestive heart failure.
[11:16] There's a range of cardiac issues that you can have.
[11:18] I mean, we could, we could do full episodes on individual cardiac conditions, but the
[11:22] point is, you usually, what we would prefer to see is once again, with specialists, you
[11:29] need to see a cardiologist if it's all possible.
[11:32] You need to be, and sort of part of the underlying rationale is, if your heart problem is not
[11:40] severe enough that it doesn't need to be managed by a cardiologist, is it really severe enough
[11:44] to preclude employment.
[11:46] So once again, we're back to the family doctor who sort of wants to treat and manage everything.
[11:54] It's not necessarily that they can't prescribe your medications, but, and they can't manage
[12:00] your heart condition, but the reality is is that people who have cardiac problems or heart
[12:06] related issues that are severe enough to place them on disability need to be seen by a cardiologist
[12:10] if at all possible.
[12:12] So the functional limitations will get to, but what are some of the symptoms that people
[12:19] deal with who have cardiac issues and heart related problems that they need to not only vocalize
[12:26] to their lawyer and to their doctor, but ultimately, you know, express to the judge to say,
[12:31] hey, yes, I have congestive heart failure.
[12:35] These are the symptoms that I deal with.
[12:36] So what are some of the big things that we're looking for in those type, in the symptom world
[12:40] with these type cases?
[12:41] With congestive heart failure, a big one is fluid retention.
[12:45] And so having one thing that I'm looking for in the records is, you know, on the exam is,
[12:51] is the doctor actually looking at your ankles, doing that poke test to see, you know, how
[12:57] much swelling are we talking about?
[12:59] You have pitting a demon.
[13:00] Is it plus one?
[13:01] It's plus two or whatever it is, right?
[13:02] Are you on?
[13:03] Are you on diuretics?
[13:04] You're having to go to the bathroom because of the fluid management issues.
[13:10] Our conditions generally shortness of breath, fatigue, difficulty with stairs, steps, heels,
[13:18] things like that.
[13:19] Sometimes they have chest pain.
[13:22] Chest pain.
[13:22] We've got red fox and red Sanford, little, it's the big one's coming.
[13:29] The big one's coming, right?
[13:32] That's the real thing though, people do have chest pain, often it's exertional related,
[13:38] right?
[13:39] Chest pain.
[13:40] So those are some of the symptoms that we see.
[13:41] But I think those are the main ones, we're looking at fatigue, we're looking sometimes with
[13:45] shortness of breath, especially with people I've CHF, we're looking at medication side effects.
[13:51] So even though, per se, it's not a symptom, the medications that they give you often create
[13:58] fatigue, you know, in urinary frequency, sometimes they have issues with, with heat, sometimes
[14:09] they have issues with cold, sometimes you end up with exertional, sorry, environmental limitations
[14:13] with people who have heart issues.
[14:16] But once again, we're back and I know we seem to say the same things every episode at some
[14:20] level.
[14:21] But that's because what it takes to win, like it's not enough for you to say, I have fatigue,
[14:27] like it's not enough to have fatigue, you have to say you have fatigue, you have to tell
[14:31] your doctor, you have fatigue, you have to tell your doctor to put it in the record that
[14:35] you have fatigue.
[14:36] Is the doctor assumed that you have it?
[14:38] Maybe, maybe not, probably, depending on what level of heart disease that you have, but
[14:44] you just can't assume.
[14:47] You can't assume that the doctor knows, you can't assume that the CMA is going to put it
[14:51] in the medical record when they help create the note.
[14:55] And once again, the danger is you assume they knew, you figured everybody knew, and you
[15:00] get to the judge and you're like, I don't see any evidence in here that you've ever complained
[15:04] about fatigue.
[15:05] Where's that in the record, Mr. Dalton?
[15:06] Yeah, where's that in the record?
[15:10] But that's completely within your control.
[15:13] It's not complaining, right, which is a big problem we see with clients who say, I just don't
[15:18] want to complain.
[15:19] Well, okay.
[15:20] Well, don't tell your cousin, Aunt Susie at dinner next week, but tell your doctor, right?
[15:24] Like, if you don't want to complain and you don't want to talk about it with your family
[15:27] or church or the Lines Club or whatever it is you're going to, right, don't, but you're
[15:32] not complaining when you tell your doctor.
[15:34] What you're doing is establishing a basis for the documentation that we need in the medical
[15:39] record to be able to say, look, they say they have fatigue.
[15:43] Like, you can't put someone at medium work who has to walk six hours a day and lift 50 pounds
[15:49] that has fatigue when they're walking to the mailbox that just doesn't jive.
[15:53] And if you have the proper medical diagnosis with it, we're going to be able to say, and
[15:58] it's completely reasonable that they have fatigue.
[16:01] They have congestive heart failure, right?
[16:02] So, we have to get the symptoms out of your mind and into the medical record.
[16:11] And if you do that, okay, we're now we're two-thirds of the way to building a chain that we
[16:16] can build an RFC for, what are we looking for in terms of limitation, documentation, limitation,
[16:23] evidence that ultimately we can say, hey, these are the limitations that my client has.
[16:28] They're reasonable from the symptoms they have.
[16:31] They're reasonably flowed from the diagnosis.
[16:33] What are the types of things we're going to see in heart cases with respect to limitations
[16:36] that, hey, if you have these things, you need to make sure somebody knows about them.
[16:40] With the leg swelling from congestive heart failure, I'm trying to get a limitation to
[16:45] elevating the legs in the RFC, almost all of the vocational experts agree that leaning
[16:51] back with your legs up parallel to the floor is not a work like posture even at the sedentary
[16:56] level.
[16:57] Was it the office, the guy that ran the office?
[16:59] He was always sitting back with his legs up.
[17:01] That is not competitive.
[17:02] It's not competitive employment.
[17:05] With fatigue generally, having to take naps, having to take extra breaks, can go to time-off
[17:10] task, sort of generally being unable to complete that eight-hour work day.
[17:15] I think you're in a frequency and the necessity of being able to have ready bathroom access
[17:21] is a big factor in sort of a sedentary office, semi-skilled, skilled environment, maybe
[17:29] less of a deal, but if you're in a unskilled manufacturing environment, for example, or
[17:37] you're on a work site or you're in any sort of plant or factory, you're not going to be
[17:43] given the ability to go to the bathroom anytime you want to.
[17:47] You can't just wander off.
[17:48] You're not required to where it depends while you work.
[17:51] That's not reasonable.
[17:53] It's important that if you're staying on a diuretic and you're having to go to the bathroom
[17:58] 25 times a day, you have to document it.
[18:01] Even if it means keeping a journal of all things, but you have to document it and importantly,
[18:07] you have to tell your doctor, it's like, well, how is the diuretic working?
[18:12] Well, it's fine.
[18:14] It's doing what it's supposed to do, but doing what it's supposed to do, you need to tell
[18:18] them.
[18:19] It's making you go to the bathroom all the time.
[18:21] If you're taking medications that make you tired, and that's producing limitations in your
[18:26] ability, for example, to climb stairs or carry groceries in, like you have to tell someone.
[18:33] The functional limitations that we're going to see are by and large going to be, you know,
[18:38] exertional.
[18:39] We're going to see often difficulties with walking, difficulties with standing, lifting,
[18:44] carrying, pushing, pulling.
[18:46] Those are going to be clear limitations that people likely have and non-exertional sort
[18:53] of, sometimes people have postural limitations that would come up.
[18:57] Sometimes you have environmental limitations, but nobody knows if you don't tell them.
[19:01] Right?
[19:02] So, these are the type of limitations that we're looking for, but if the first time you tell
[19:08] someone is in the pre-hearing, before we talk to you about your case, odds are it's not
[19:14] in the medical record if you've never told anyone.
[19:18] But if we can get the diagnosis right and we can get the symptomology included in the
[19:23] record, it's not difficult to convince the judge that you have certain limitations.
[19:28] Like, you know, it's not in common, for example, if you can't walk 200 feet and you need a handicap
[19:35] placard, you need to ask your doctor for it because that's statutory evidence that there's
[19:41] limitations and how far you can walk.
[19:44] You know, somewhat touchy subject, a lot of our male clients who have hard issues deal
[19:48] with issues with erectile dysfunction, and so if you're having, you know, sort of those
[19:54] types of issues, yeah, it might be a little embarrassing to talk about, but at the same time,
[19:59] that's also evidence that, hey, there's a level of severity there that may be beyond the
[20:04] person, you know, the other, the other, you know, 100 people a year, whatever the dead
[20:09] judge hears who have sub-level of heart problem, right?
[20:12] So the point is, is that when the limitations are there, and they're going to be there,
[20:18] we've got to get them documented, right?
[20:20] So let's spend a minute, though, talking about what I think is one of the keys to winning
[20:27] heart cases, though, and that's comorbidities, can you talk a little bit about how heart problems
[20:32] rarely exist in isolation?
[20:34] Yes, so there's a lot of different comorbidities that could be at play here, obesity is a big
[20:40] one, especially with congestive heart failure, diabetes, COPD, lots that can go in.
[20:49] And so the judges are not just supposed to look at each condition and isolation, they're
[20:54] supposed to look at everything taken together.
[20:57] So sometimes we can, you know, maybe we can look at the lumbar degenerative disc disease to
[21:02] get you down to light, and then we look at the cardiac issues and that adds in more limitation.
[21:07] So it's not just the one thing.
[21:08] Yeah, and so when you come into the process, it's interesting, you know, because we take
[21:15] leads at all stages.
[21:16] So some people call us and we file their initial application.
[21:19] Some people do their initial application on their own, they come to us when they get their
[21:22] initial denial.
[21:24] Sometimes people do two levels, sometimes people don't call us before they get to the hearing.
[21:28] It never ceases to amaze me, and we've got to do an issue with Tia, Tia's our intake director.
[21:32] We're going to have Tia on at some point and let's you meet Tia, who manages all of our intake.
[21:39] We're talking about a case, and they're like hard, hard, hard, hard, hard, and kind of
[21:45] find out they have severe obstructive sleep apnea, and they're like, well, I didn't think
[21:49] that mattered because what I can see, what I view myself as disabled from is my heart condition.
[21:56] And that's a huge misunderstanding of the process.
[21:59] This is not a personal injury case where we're just talking about your broken leg from the
[22:04] car accident, right?
[22:06] That's not a worker's comp case where we're just focusing on the fact that you injured
[22:09] your hand in the manufacturing accident, right?
[22:12] They're looking at your person as a whole and how all of the different impairments impact
[22:18] you, and once again, they don't know you have obstructive sleep apnea.
[22:24] Now sometimes it pops up in the record, but all you've told them, especially in the early
[22:30] levels at DDS, if all you're told them is hard, it doesn't matter that you have terrible
[22:35] COPD.
[22:36] A lot of times they'll just ignore it and they'll say, well, I'm assuming they don't
[22:39] talk to us really, but when they do talk to us, they'll be like, well, I didn't know
[22:42] they had that.
[22:43] It was in the record.
[22:44] Well, yeah, but we weren't looking for that in the records.
[22:47] We were just looking at the cardiac records, the cardiology records because that's all they
[22:50] told us about, right?
[22:51] So understand that when you have heart disease, it's highly unlikely that you only have heart
[22:58] disease, that you only have coronary artery disease or you only have congestive heart failure,
[23:03] whatever it is.
[23:04] We're going to have a range of other issues and we need to put them together because what
[23:08] we're trying to do is piece all of these together to show that collectively, your residual function
[23:14] capacity from all of the different things you deal with is going to either preclude our
[23:18] work or limit you to a level of work said in terror light that based on your age is not
[23:24] going to require you to work.
[23:25] I think some of the big mistakes people make with these cases are sort of relying on a diagnosis,
[23:32] lying on ejection fraction, failing to understand comorbidities.
[23:37] There's one final thing I want to hit on, though, and that's the issue of drug use because
[23:42] I think this is one of these areas where it's not uncommon to people, especially people
[23:49] who have a significant history of cocaine use or a significant history of methamphetamine
[23:53] use, to have significant heart problems.
[23:59] I've over the years, we historically don't not represent people because they have history
[24:06] of drug use.
[24:08] Generally, we come in our office like, hey, we're not going to hold what happened before
[24:12] against you, but if this persists, we may withdraw.
[24:15] I think it's important for people who have a strong history of drug use and have heart
[24:21] damage from it to not simply think they can't apply for disability.
[24:27] People do really dumb things for a long period of time in their life, and then horrible events
[24:32] happen because of it.
[24:34] They basically blow their heart up with cocaine, but they really are disabled after that.
[24:39] It doesn't, and a lot of times that event leads them to rehab, and they stop using drugs,
[24:45] and they're left, though, with a heart that really can't be repaired.
[24:49] A lot of times, we start the show talking about sort of run-of-the-mill heart attacks that
[24:53] are repaired very quickly.
[24:55] On the other end of that spectrum, though, are sort of traumatic, drug-related events where
[25:00] people have significant heart problems that often can't be rehabilitated.
[25:05] In those cases, I just think it's important if people know one, just the cause of your
[25:10] heart problem doesn't have to be from genes or from whatever it is.
[25:17] It's not heart problems from source X that get on disability.
[25:21] It's like, look at your heart.
[25:22] They look at the function of it and how it impacts you.
[25:25] When you have people who have significant drug use that leads to heart problems, I don't
[25:30] want them to be deterred from coming into the system, but also understand that if you continue
[25:35] to use drugs, I'm going to argue materiality that doesn't matter how much crack they continue
[25:43] smoking.
[25:44] The heart damage is done, but judges are not very receptive to that argument.
[25:51] Heart problems, real deal.
[25:53] They really do impact people, often in conjunction with a lot of other issues.
[25:57] There's a lot more we could go into, but I think if people understand, if you have a really,
[26:02] really severe heart problem, you may meet a listing, but you're going to need your cardiologist
[26:06] involved.
[26:08] Most people who have heart-related issues that are trying to get on disability need to focus
[26:13] on, get to a cardiologist and get the diagnosis.
[26:16] Then, the symptoms and limitations that you have, make sure someone knows about them.
[26:23] Don't just keep them to yourself.
[26:25] Don't be worried about being seen as complaining, get those out, get them in the record, because
[26:30] if you do that, especially when you factor in medication side effects, which can be really
[26:34] detrimental to people's ability to work an eight-hour day, we're going to be able to build
[26:39] a really good heart case.
[26:40] We win a lot of those cases, especially with people over 50 and 55, so that's it.
[26:46] That's all we got for today.
[26:49] Thank you for watching, and if you have a heart problem, hey, listen to the episode, work
[26:53] through these issues, build your case, you can win these things.
[26:56] Anyway, that's all we got.
[26:58] Thanks for watching.
[26:59] Subscribe.
[27:00] Until next time, take care.
