What does SSA mean by 'intermittent claudication' for peripheral arterial disease?

The listing requires peripheral arterial disease determined by appropriate medically acceptable imaging, and it also requires intermittent claudication. The qualifying criteria then depend on specific blood-pressure or pressure-ratio measurements (A through D) rather than only on a general diagnosis of PAD.

Do ankle-brachial index results qualify if the number is close but not under the cutoff?

For 4.12A, the resting ankle/brachial systolic blood pressure ratio must be less than 0.50. For 4.12D, the resting toe/brachial systolic blood pressure ratio must be less than 0.40. If the documented measurements do not cross the required 'less than' thresholds, the criteria in A or D are not met.

If exercise makes my leg pain worse, do I automatically qualify under the exercise criteria?

Not automatically. Under 4.12B, the ankle systolic pressure must drop by 50 percent or more from the pre-exercise level, and it must take 10 minutes or more to return to the pre-exercise level. The exercise response has to be documented with those measurements and timing, not just described as worsening symptoms.

Is toe pressure testing required, or can ankle results be enough?

Either can be enough, depending on which lettered criterion matches. 4.12A uses a resting ankle/brachial systolic ratio, 4.12B uses an exercise ankle systolic response with return-to-baseline timing, and 4.12C uses a resting toe systolic pressure of less than 30 mm Hg. 4.12D uses a resting toe/brachial systolic ratio below 0.40.

Does having a peripheral arterial disease diagnosis on imaging automatically meet listing 4.12?

Imaging is part of the requirement, but it does not end the test. The listing also requires intermittent claudication and then one of the specific objective pressure criteria A through D. Without matching one of those criteria, the listing is not met.

Can work still be approved if the listing criteria do not match exactly?

Yes. If the A through D criteria are not met, the decision can still turn on the residual functional capacity (RFC) at later steps. That RFC describes what work-related activities can still be done despite the impairment, and then the medical-vocational framework is used to decide whether jobs are possible.

Is peripheral arterial disease a disability? SSA Blue Book listing 4.12

SSA listing text and criteria

Peripheral arterial disease , as determined by appropriate medically acceptable imaging (see 4.00A3d , 4.00G2 , 4.00G5 , and 4.00G6 ), causing intermittent claudication (see 4.00G1 ) and one of the following:

Subsection A

Resting ankle/brachial systolic blood pressure ratio of less than 0.50. OR

Subsection B

Decrease in systolic blood pressure at the ankle on exercise (see 4.00G7a and 4.00C16 - 4.00C17 ) of 50 percent or more of pre-exercise level and requiring 10 minutes or more to return to pre-exercise level. OR

Subsection C

Resting toe systolic pressure of less than 30 mm Hg (see 4.00G7c and 4.00G8 ). OR

Subsection D

Resting toe/brachial systolic blood pressure ratio of less than 0.40 (see 4.00G7c ). Back to Top Support Contact us Find an office Forms Publications Report fraud Languages Español Other languages Plain language Services for Employers & businesses Government agencies Other groups Representatives About Careers Chief actuary data Communications Financial reports Initiatives Research & policy Social Security Administration <path fill-rule="evenodd" d="M0 15C0 6.716 6.716 0 15 0a15 15 0 0 1 15 15c0 8.284-6.716 15-15 15-8.284 0-15-6.716-15-15Zm19.035 9A4.98 4.98 0 0 0 24 19.035v-8.07A4.98 4.98 0 0 0 19.035 6h-8.07A4.98 4.98 0 0 0 6 10.965v8.07A4.98 4.98 0 0 0 10.965 24h8.07ZM15 12a3 3 0 1 0 0 6 3 3 0 0 0 0-6Zm4.035-4.41a3.375 3.375 0 0 1 3.375 3.375v8.07a3.375 3.375 0 0 1-3.375 3.375h-8.07a3.375 3.375 0 0 1-3.375-3.375v-8.07a3.375 3.375 0 0 1 3.375-3.375h8.07ZM10.365 15a4.635 4.635 0 1 0 9.27 0 4.635 4.635 0 0 0-9.27 0Zm10.29-3.99c-.22.218-.515.342-.825.345a1.245 1.245 0 0 1-.825-.345 1.17 1.17 0 0 1 0-1.665A1.23 1.23 0 0 1 19.83 9a1.17 1.17 0 0 1

Source: SSA Blue Book listing 4.12. Last synced 2026-05-04.

Where claims under 4.12 usually fail

One failure mode is having imaging that shows PAD, but not showing intermittent claudication along with the imaging and then matching A through D. Another is having resting ankle-brachial information but using values that do not meet the exact cutoffs, like missing the 'less than 0.50' threshold in A or the 'less than 0.40' threshold in D. A third pitfall is treating the exercise response as a general symptom without the specific exercise criteria in B, including needing a 50 percent or more drop at the ankle and 10 minutes or more to return to pre-exercise level. A fourth is mixing up ankle measurements with toe measurements, since C requires a resting toe systolic pressure of less than 30 mm Hg.

Medical evidence that strengthens this claim

The key evidence is objective blood-pressure testing tied to PAD with intermittent claudication, along with appropriate medically acceptable imaging. For the lettered criteria, the record needs the exact resting ankle/brachial systolic blood pressure ratio for A, the exercise ankle systolic response plus the timing back to pre-exercise level for B, the resting toe systolic pressure for C, or the resting toe/brachial systolic blood pressure ratio for D. PAD must be determined by appropriate imaging, and the measurements should be documented in a way that clearly indicates they are resting versus exercise, and ankle versus toe values.

What happens if your records do not meet this listing

If the A through D measurements do not match, approval can still be possible through steps 4 and 5, which evaluate what can still be done despite the impairment. The key question becomes the residual functional capacity (RFC), meaning the most an individual can do in work activities on a sustained basis. Even when a listing is not met or equaled, RFC limits are then combined with the medical-vocational framework at later steps to decide whether work is possible.

Work activity and the SGA gate for this condition

At the start of an SSDI claim, substantial gainful activity (SGA) is used as a work-activity gate. If sustained work at SGA level is done, the claim can be denied at that stage, even if imaging and the intermittent claudication with a qualifying A, B, C, or D measurement are present. For people who do not have SGA, the listing establishes whether the impairment meets the criteria based on the objective PAD measurements, including one of the specific thresholds like a resting ankle/brachial ratio below 0.50 (4.12A) or a resting toe systolic pressure below 30 mm Hg (4.12C). After approval, work is evaluated under the usual trial-work-period and extended period of eligibility rules described for SSDI; the ability to do work may change over time.

Other listings under 4.00

Within the cardiovascular listings, 4.12 focuses specifically on peripheral arterial disease with intermittent claudication proven by medically acceptable imaging and tied to the lettered ankle or toe pressure criteria A through D. Other nearby listings (4.02, 4.04, 4.05, 4.06, 4.09, 4.10, 4.11) cover different cardiovascular impairment patterns rather than the specific PAD imaging plus claudication and pressure-threshold structure used here.

4.02

Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2

4.04

Ischemic heart disease , with symptoms due to myocardial ischemia,

4.05

Recurrent arrhythmias , not related to reversible causes, such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic drug toxicity, resulting in uncontrolled

4.06

Symptomatic congenital heart disease (cyanotic or acyanotic),

4.09

Heart transplant

4.10

Aneurysm of aorta or major branches , due to any cause (e.g., atherosclerosis, cystic medial necrosis, Marfan syndrome, trauma), demonstrated by appropriate medically acceptable imaging, with dissection not controlled by prescribed treatment

4.11

Chronic venous insufficiency of a lower extremity with incompetency or obstruction of the deep venous system and one of the following

Listing 4.12 FAQ

Questions that come up repeatedly for peripheral arterial disease , as determined by appropriate medically acceptable imaging disability claims.

Social Security disability for peripheral arterial disease: Blue Book listing 4.12

SSA listing text and criteria

Where claims under 4.12 usually fail

Medical evidence that strengthens this claim

What happens if your records do not meet this listing

Work activity and the SGA gate for this condition

Listing 4.12 FAQ

More Social Security disability reference

Disability reference

Annual program amounts

Other benefits