Listing code
104.06
Children (Part B)
Body system
104.00
Cardiovascular system (children)
Subsections
4
Lettered criteria paths
Step in evaluation
3 of 5
Listing match approves the claim
SSA listing text and criteria
Congenital heart disease, documented by appropriate medically acceptable imaging (see 104.00A3d ) or cardiac catheterization, with one of the following:
Subsection 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
- Hematocrit of 55 percent or greater on two evaluations 3 months or more apart within a consecutive 12-month period (see 104.00A3e ); or
- Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less; or
- Hypercyanotic spells, syncope, characteristic squatting, or other incapacitating symptoms directly related to documented cyanotic heart disease; or
- Exercise intolerance with increased hypoxemia on exertion. OR
Subsection B
Secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial systolic pressure. OR
Subsection C
Symptomatic acyanotic heart disease, with ventricular dysfunction interfering very seriously with the ability to independently initiate, sustain, or complete activities. OR
Subsection 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. Back to Top
Source: SSA Blue Book listing 104.06. Last synced 2026-05-04.
Where claims under 104.06 usually fail
One frequent failure mode is stopping at diagnosis without the documentation requirement (appropriate medically acceptable imaging or cardiac catheterization) that confirms congenital heart disease. Another is confusing cyanotic and acyanotic tracks, because the criteria use different severity measures: cyanotic disease focuses on chronic hypoxemia, specific oxygen values, and hypercyanotic spells or syncope, while acyanotic disease focuses on ventricular dysfunction interfering very seriously with independent activities. A third pitfall is treating oxygen numbers or pressure relationships as optional details, even though the criteria use specific thresholds like arterial O2 saturation below 90 percent or resting arterial PO2 of 60 Torr or less, and pulmonary arterial systolic pressure at least 70 percent of systemic arterial systolic pressure. A fourth pitfall is missing the infant-special rule for infants under 12 months who need life-threatening surgical treatment in the first year of life, then applying the adult-like lettered criteria without considering the time-limited under-1
Medical evidence that strengthens this claim
Documentation needs two parts. First, the congenital heart disease must be documented by appropriate medically acceptable imaging (referenced as 104.00A3d) or by cardiac catheterization. Second, the record needs objective measurements or clearly tied clinical findings matching one of the lettered criteria, such as hematocrit of 55 percent or greater on two evaluations at least 3 months apart within a consecutive 12-month period, arterial O2 saturation below 90 percent in room air or resting arterial PO2 of 60 Torr or less, and/or hypercyanotic spells, syncope, characteristic squatting, or other incapacitating symptoms directly related to documented cyanotic heart disease, or exercise intolerance with increased hypoxemia on exertion. For the secondary pulmonary vascular obstructive disease track, the record needs pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial systolic pressure. For the symptomatic acyanotic track, the record needs symptomatic acyanotic heart disease with ventricular dysfunction interfering very seriously with the ability,
What happens if your records do not meet this listing
If the required lettered severity findings are not met, SSA does not stop at that single listing. The process can move to evaluate the child under other steps that look at how the impairment limits functioning, including whether the overall medical picture still shows disabling severity. Even when a specific number-based threshold is missed, the next steps often focus on the child's residual functional limits and the practical impact on basic functioning, including whether impairments interfere with very serious independent activities for the acyanotic track or whether symptoms and physiologic measures remain at a level comparable to the listed criteria. For infants under 12 months at filing, the under-disability rule applies only when the impairment is life-threatening congenital heart impairment that requires or already has required surgical treatment in the first year of life, and that expected disabling period runs until at least age 1.
Work activity and the SGA gate for this condition
At the start of an SSDI claim for a child, work activity can be a gate that affects eligibility before medical review, and this listing is one way to show disabling congenital heart disease when its specific findings are documented. If approved under this listing, the child continues to be evaluated for ongoing eligibility after the approval period using SSA's usual continuing review process rules, rather than re-estimating the specific lettered criteria from scratch each day. The medical criteria here are anchored to objective thresholds like hematocrit of 55 percent or greater on two evaluations 3 months apart within a consecutive 12-month period, arterial O2 saturation below 90 percent in room air, resting arterial PO2 60 Torr or less, hypercyanotic spells/syncope/incapacitating symptoms related to cyanotic heart disease, pulmonary arterial systolic pressure at least 70 percent of the
Listing 104.06 FAQ
Questions that come up repeatedly for congenital heart disease, disability claims.