Listing code
4.02
Adult (Part A)
Body system
4.00
Cardiovascular system
Subsections
2
Lettered criteria paths
Step in evaluation
3 of 5
Listing match approves the claim
SSA listing text and criteria
Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2 . The required level of severity for this impairment is met when the requirements in both A and B are satisfied.
Subsection A
Medically documented presence of one of the following: 1. Systolic failure (see 4.00D1a(i) ), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or 2. Diastolic failure (see 4.00D1a(ii) ), with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure); AND
- Systolic failure (see 4.00D1a(i) ), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or
- Diastolic failure (see 4.00D1a(ii) ), with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure); AND
Subsection B
Resulting in one of the following: 1. Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or 2. Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e ), with evidence of fluid retention (see 4.00D2b(ii) ) from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization (see 4.00D4c ); or 3. Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to: a. Dyspnea, fatigue, palpitations, or chest discomfort; or b. Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or c. Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise (see 4.00D4d ) due to left ventricular dysfunction, despite an increase in workload; or d. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion. Back to Top
- Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or
- Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e ), with evidence of fluid retention (see 4.00D2b(ii) ) from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization (see 4.00D4c ); or
- Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
Source: SSA Blue Book listing 4.02. Last synced 2026-05-04.
Where claims under 4.02 usually fail
A common miss is using measurements taken during an acute heart failure episode instead of during a period of stability, because subsection A requires the ejection fraction or size measurements during stability. Another miss is meeting only the heart measurement portion in A but not the functional/severity portion in B, such as having low ejection fraction but no documented episodes or exercise-test failure described in B. A third failure mode is confusing diastolic and systolic criteria, since diastolic has specific thickness and left atrium size requirements plus normal or elevated ejection fraction. A fourth miss is describing "heart failure symptoms" generally without tying them to the specific B thresholds, like very serious limits on independently initiating, sustaining, or completing activities of daily living, or the specific exercise-test/workload and physiologic reasons listed under B3.
Medical evidence that strengthens this claim
Medical documentation should include (1) objective heart findings during a period of stability, not during acute heart failure: systolic failure with left ventricular end diastolic dimensions over 6.0 cm or ejection fraction 30 percent or less, or diastolic failure with left ventricular posterior wall plus septal thickness totaling 2.5 cm or more and left atrium at least 4.5 cm, plus normal or elevated ejection fraction. Documentation should also include prescribed treatment status, because the listing is framed as chronic heart failure while on a regimen of prescribed treatment. For subsection B, the record needs one of the B routes: persistent symptoms very seriously limiting activities of daily living with an MC concluding exercise testing would present a significant risk; or three or more separate acute congestive heart failure episodes within a consecutive 12-month period with evidence of fluid retention from clinical and imaging assessments and acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more; or an exercise-tolerate
What happens if your records do not meet this listing
Step 4 and 5 work like a two-stage fit test. First, the medical evidence has to satisfy the listing's required structure, meaning both A (the specific systolic or diastolic measurements during stability) and B (one of the extreme severity outcomes) must be present. If the exact listing criteria are not met, the disability decision can still be based on the overall residual functional capacity from all impairments, plus how that affects work abilities. The functional impact described for B3, such as inability to reach a workload equivalent to 5 METs or less due to the specific listed reasons, can still be important in the broader functional assessment even when the listing's exact thresholds are not fully met.
Work activity and the SGA gate for this condition
For an SSDI claim, the start of the claim process evaluates whether work activity counts as substantial gainful activity (SGA). If the person is working at an SGA level, the claim generally does not proceed based on disability, even if heart failure is present. If approved, trial work period and later extended period of eligibility apply, but the exact eligibility timing depends on the standard SSDI rules. Medical improvement is expected to be assessed against the chronic heart failure severity concepts that appear in subsection A (systolic or diastolic findings during stability) and subsection B (very serious daily-life limits, repeated acute congestive episodes, or failure to achieve 5 METs or less for specific reasons).
Listing 4.02 FAQ
Questions that come up repeatedly for chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00d2 disability claims.