Listing code
4.04
Adult (Part A)
Body system
4.00
Cardiovascular system
Subsections
3
Lettered criteria paths
Step in evaluation
3 of 5
Listing match approves the claim
SSA listing text and criteria
Ischemic heart disease , with symptoms due to myocardial ischemia, as described in 4.00E3 - 4.00E7 , while on a regimen of prescribed treatment (see 4.00B3 if there is no regimen of prescribed treatment), with one of the following:
Subsection A
Sign-or symptom-limited exercise tolerance test demonstrating at least one of the following manifestations at a workload equivalent to 5 METs or less: 1. Horizontal or downsloping depression, in the absence of digitalis glycoside treatment or hypokalemia, of the ST segment of at least −0.10 millivolts (−1.0 mm) in at least 3 consecutive complexes that are on a level baseline in any lead other than a VR, and depression of at least −0.10 millivolts lasting for at least 1 minute of recovery; or 2. At least 0.1 millivolt (1 mm) ST elevation above resting baseline in non-infarct leads during both exercise and 1 or more minutes of recovery; or 3. Decrease of 10 mm Hg or more in systolic pressure below the baseline blood pressure or the preceding systolic pressure measured during exercise (see 4.00E9e ) due to left ventricular dysfunction, despite an increase in workload; or 4. Documented ischemia at an exercise level equivalent to 5 METs or less on appropriate medically acceptable imaging, such as radionuclide perfusion scans or stress echocardiography. OR
- Horizontal or downsloping depression, in the absence of digitalis glycoside treatment or hypokalemia, of the ST segment of at least −0.10 millivolts (−1.0 mm) in at least 3 consecutive complexes that are on a level baseline in any lead other than a VR, and depression of at least −0.10 millivolts lasting for at least 1 minute of recovery; or
- At least 0.1 millivolt (1 mm) ST elevation above resting baseline in non-infarct leads during both exercise and 1 or more minutes of recovery; or
- Decrease of 10 mm Hg or more in systolic pressure below the baseline blood pressure or the preceding systolic pressure measured during exercise (see 4.00E9e ) due to left ventricular dysfunction, despite an increase in workload; or
- Documented ischemia at an exercise level equivalent to 5 METs or less on appropriate medically acceptable imaging, such as radionuclide perfusion scans or stress echocardiography. OR
Subsection B
Three separate ischemic episodes, each requiring revascularization or not amenable to revascularization (see 4.00E9f ), within a consecutive 12-month period (see 4.00A3e ). OR
Subsection C
Coronary artery disease, demonstrated by angiography (obtained independent of Social Security disability evaluation) or other appropriate medically acceptable imaging, and in the absence of a timely exercise tolerance test or a timely normal drug-induced stress test, an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that performance of exercise tolerance testing would present a significant risk to the individual, with both 1 and 2: 1. Angiographic evidence showing: a. 50 percent or more narrowing of a nonbypassed left main coronary artery; or b. 70 percent or more narrowing of another nonbypassed coronary artery; or c. 50 percent or more narrowing involving a long (greater than 1 cm) segment of a nonbypassed coronary artery; or d. 50 percent or more narrowing of at least two nonbypassed coronary arteries; or e. 70 percent or more narrowing of a bypass graft vessel; and 2. Resulting in very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living. Back to Top
- Angiographic evidence showing:
- Resulting in very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living. Back to Top
Source: SSA Blue Book listing 4.04. Last synced 2026-05-04.
Where claims under 4.04 usually fail
One frequent failure is missing the treatment condition: the criteria require being on a regimen of prescribed treatment (and if there is no such regimen, the rule points to 4.00B3). Another pitfall is using an exercise tolerance test result without matching the required workload threshold (workload equivalent to 5 METs or less) and without the specific ST segment or recovery findings listed in 4.04A. People also fail by not having the right episode pattern for 4.04B, which requires three separate ischemic episodes within a consecutive 12-month period. For 4.04C, a common miss is not meeting the combination of angiographic narrowing thresholds, the absence of a timely exercise tolerance test or a timely normal drug-induced stress test, and the medical consultant concluding that testing would present a significant risk, plus very serious limitations in independently initiating, sustaining, or completing activities of daily living.
Medical evidence that strengthens this claim
For 4.04A, documentation needs an exercise tolerance test showing at least one specified manifestation at a workload equivalent to 5 METs or less, including ST segment horizontal or downsloping depression of at least -0.10 millivolts (-1.0 mm) for the required pattern of consecutive complexes and a specified duration in recovery, or ST elevation of at least 0.1 millivolt (1 mm) above resting baseline during exercise and 1 or more minutes of recovery, or a specified systolic blood pressure drop (10 mm Hg or more) due to left ventricular dysfunction despite increasing workload. For 4.04A, an alternative path is documented ischemia at 5 METs or less on appropriate medically acceptable imaging such as radionuclide perfusion scans or stress echocardiography. For 4.04B, documentation needs three separate ischemic episodes within a consecutive 12-month period, and each episode must either require revascularization or be not amenable to revascularization. For 4.04C, documentation needs angiographic evidence (obtained independent of the disability evaluation) showing the specific coronary orb
What happens if your records do not meet this listing
If none of the lettered criteria in 4.04A, 4.04B, or 4.04C are met, the claim does not qualify under this specific listing. In that situation, step 4 and step 5 depend on the overall residual functional capacity (RFC) and whether the person can do past relevant work or can adjust to other work. Even when a listing is not met, the medical record can still support functional limits that reduce the ability to work.
Work activity and the SGA gate for this condition
At the start of an SSDI claim, work activity above the substantial gainful activity (SGA) level generally limits eligibility, regardless of whether the person has ischemic heart disease findings. When 4.04A includes an exercise tolerance test demonstrating manifestations at a workload equivalent to 5 METs or less, or when 4.04B requires three separate ischemic episodes within a consecutive 12-month period, or when 4.04C includes very serious limitations in activities of daily living, the medical picture often aligns with inability to sustain substantial work activity, but the exact SGA question turns on the work activity itself, not on the listing label. If approved, SSDI eligibility can continue after the approval decision under the trial work period and extended period of eligibility rules, with the specific rules for continued payments tied to work activity during those periods.
Listing 4.04 FAQ
Questions that come up repeatedly for ischemic heart disease , with symptoms due to myocardial ischemia, disability claims.