By Chris Sharry on July 17th, 2024 in Disability Children
Tetralogy of Fallot is a rare heart condition that is present at birth. That means it’s a congenital heart defect. A baby born with the condition has four different heart problems. Tetralogy of Fallot is usually diagnosed during pregnancy or soon after a baby is born, but if the symptoms are mild, tetralogy of Fallot may not be noticed or diagnosed until adulthood. Typically, applications filed due to this condition are filed for children seeking SSI benefits.
What it is Tetralogy of Fallot?
Tetralogy of Fallot is made up of the following four defects of the heart and its blood vessels:
1. A hole in the wall between the two lower chambers, or ventricles, of the heart. This condition also is called a ventricular septal defect (VSD).
2. A narrowing of the pulmonary valve and main pulmonary artery. This condition also is called pulmonary stenosis.
3. The aortic valve, which leads to the aorta, is enlarged and receives blood from both ventricles. In a normal heart, it only receives blood from the left ventricle. In this defect, the aortic valve sits directly on top of the VSD.
4. The muscular wall of the lower right chamber of the heart (right ventricle) is thicker than normal. This also is called ventricular hypertrophy.
How does Tetralogy of Fallot affect the heart?
Normally the left side of the heart only pumps blood to the body, and the heart’s right side only pumps blood to the lungs. In a child with tetralogy of Fallot, blood can travel across the hole (VSD) from the right pumping chamber (right ventricle) to the left pumping chamber (left ventricle) and out into the body artery (aorta). Obstruction in the pulmonary valve leading from the right ventricle to the lung artery prevents the normal amount of blood from being pumped to the lungs. Sometimes the pulmonary valve is completely obstructed (pulmonary atresia).
What are the symptoms of Tetralogy of Fallot?
Tetralogy of Fallot symptoms depend on how much blood flow is blocked from leaving the heart to go to the lungs. Symptoms may include:
- Blue or gray skin color.
- Shortness of breath and rapid breathing, especially during feeding or exercise.
- Trouble gaining weight.
- Getting tired easily during play or exercise.
- Irritability.
- Crying for long periods of time.
- Fainting.
Social Security will evaluate the claim to determine if the claimant meets a “listing”. A listing is a set of criteria that the examiner will analyze to determine if you qualify for disability benefits. The SSA listing for congenital heart disease for children is listing 104.06.
104.06 Congenital heart disease, documented by appropriate medically acceptable imaging (see 104.00A3d) or cardiac catheterization, with one of the following:
A. Cyanotic heart disease, with persistent, chronic hypoxemia as manifested by:
1. Hematocrit of 55 percent or greater on two evaluations 3 months or more apart within a consecutive 12-month period (see 104.00A3e); or
2. Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less; or
3. Hypercyanotic spells, syncope, characteristic squatting, or other incapacitating symptoms directly related to documented cyanotic heart disease; or
4. Exercise intolerance with increased hypoxemia on exertion.
OR
B. Secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial systolic pressure.
OR
C. Symptomatic acyanotic heart disease, with ventricular dysfunction interfering very seriously with the ability to independently initiate, sustain, or complete activities.
OR
D. For infants under 12 months of age at the time of filing, with life-threatening congenital heart impairment that will require or already has required surgical treatment in the first year of life, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both) until the attainment of at least 1 year of age, consider the infant to be under disability until the attainment of at least age 1; thereafter, evaluate impairment severity with reference to the appropriate listing.
What if my child does not meet the “listing”?
In children’s disability cases, if the child’s impairment is not severe enough to meet a Social Security “listing”, meaning an approval for disability benefits, then an assessment must be done to determine if the impairment functionally equals a listing. For functional equivalence, the child must have one “extreme” or two “marked” limitations in the six domains of functioning.
The six domains of functioning are:
- Acquiring and using information
- Attending and completing tasks
- Interacting and relating with others
- Moving about and manipulating objects
- Caring for oneself, and
- Health and physical well-being.
The evaluation of how functioning is affected will be done during all of the child’s activities; meaning activities done at home, at school, and in the community. First, Social Security will identify which of the child’s activities are limited, and which domains are involved in those activities. They will then determine whether the child’s impairment(s) could affect those domains and account for the limitations. Second, Social Security will then rate the severity of the limitations in each affected domain(s). If SSA finds one extreme limitation, or two marked limitations, the child will be approved for disability benefits.
If you have any questions about this medical condition, or your disability claim, please call our office at (508) 421-4610
