4.02: Chronic Heart Failure

What actually decides a claim under 4.02

Documented systolic or diastolic failure while on a regimen of prescribed treatment, together with one of: persistent symptoms that very seriously limit daily activity, three or more separate episodes of acute failure within twelve consecutive months, or an inability to perform an exercise tolerance test at a specified workload. 'While on prescribed treatment' does a lot of work — the failure has to persist despite treatment, not before it.

Conditions evaluated under 4.02

• Congestive Heart FailureHow SSA evaluates it, the evidence that decides it, and why claims are denied

Frequently asked questions

Do you have to meet 4.02 to be approved?

No. Meeting a listing is one route to approval and not the most common one. Most awards are made on residual functional capacity — what SSA concludes you can still do across a full working week, given your age, education and past work. A claim that falls short of 4.02 can still be approved that way, which is why a denial citing this listing is not the end of the matter.

What if my records do not meet 4.02 exactly?

Two things can still happen. SSA can find your condition medically equals the listing — equal in severity and duration without matching every criterion — or it can move on to the functional assessment described above. What sinks these claims is usually a gap in the file rather than a gap in the criteria: a limitation you live with that no doctor wrote down.

Which conditions are evaluated under 4.02?

Congestive Heart Failure. The criteria are the same; what differs is the evidence each condition needs to satisfy them.