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Disability Benefits for Ebstein's Anomaly

Ebstein's Anomaly

Ebstein's anomaly is one of several congenital disorders of the heart that may be diagnosed at birth. If it is severe, it may require urgent treatment (including heart surgery) at birth or shortly thereafter, or it may not be diagnosed until adulthood when it begins to cause cardiac symptoms such as shortness of breath, chest pain, fatigue, lightheadedness, dizziness, palpitations, and arrhythmias of the heart. It is a rare disorder which affects approximately 1 in 20,000 infants.

In adults, Ebstein's anomaly can worsen over time and result in the development of disabling symptoms.

Patients born with Ebstein's anomaly typically suffer from a defective tricuspid valve, which does not open or close correctly. The tricuspid valve lies between the right atrium and the right ventricle of the heart. It has three valve “leaflets,” which are misshapen at birth, and don't function well. This can result in increased strain on the right side of the heart and lead to heart failure.

Ebstein's anomaly is often associated with an atrial septal defect (ASD), which is a “hole” in the heart at the level of the atria (upper chambers). An ASD permits blood to pass between the right and left sides of the heart, allowing oxygenated and un-oxygenated blood to mix together, thereby causing dysfunctionality of the heart's pumping function.

Rhythm disturbances (“arrhythmia”) are commonly seen in Ebstein's anomaly. They can produce symptoms of premature beats, palpitations, lightheadedness, weakness, fatigue, pre-syncope, and syncope (fainting).

Symptoms vary from patient to patient. They can be mild or extreme, from palpitations, shortness of breath, dizziness, and syncope, to heat failure.

Treatment

When symptoms are mild, they are often successfully treated with medications, such as beta blockers for palpitations and arrhythmias. Heart surgery, to repair a defective tricuspid valve or to close an atrial septal defect, may be required when these abnormalities are hemodynamically significant and impair cardiac function.

Atrial arrhythmias can be treated with “maze surgery,” in which the surgeon creates new electrical pathways in the heart to try to restore normal heart rhythm.

Disability Benefits for Ebstein's Anomaly

Having a diagnosis of Ebstein's anomaly does not “automatically” entitle an applicant to an award of disability benefits under either Social Security (SSDI) and/or a long-term disability (LTD) employer-sponsored plan (ERISA).

To successfully obtain an LTD award under either SSDI or ERISA, it is important that your doctor document in the medical records the specific cardiac symptoms that your Ebstein's anomaly causes, and what job-related functional impairments you have as a result.

For example, if you have Ebstein's anomaly, with palpitations and atrial arrhythmias, your doctor may order a Holter monitor to document how many premature atrial contractions (PAC's) and other arrhythmias you have, and he/she may evaluate the function of your heart with an electrocardiogram (EKG), echocardiogram, stress echocardiogram, treadmill stress test, nuclear heart scan, and other similar studies.

Studies such as these are important in that they are objective, and their findings can be used to support the validity and credibility of the symptoms that you report and the disabling functional impairments that they cause.

Symptoms are, by their very nature, subjective and self-reported. They will be considered credible, reliable, and “disabling,” to the extent that they are consistent with objective findings documented in your medical records, from physical examination, laboratory testing, x-ray or imaging scans, to other diagnostic studies, such as the cardiac studies mentioned above.

Even if you have a desk job (“sedentary work”), if your palpitations, pre-syncopal, or syncopal episodes prevent you from concentrating on your work and staying on task, or if they require you to take frequent breaks from your job, such as having to get up and step away from your work, or require you to lie down, then they may be determined to be disabling.

The medications that you are required to take for your heart condition may affect your ability to work. For example, patients who suffer from cardiac arrhythmias are frequently treated with "beta blockers," such as metoprolol, which may cause considerable fatigue and tiredness in some patients. That should also be documented in the medical records.    

Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.

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