Listing code
4.05
Adult (Part A)
Body system
4.00
Cardiovascular system
Subsections
0
No lettered criteria
Step in evaluation
3 of 5
Listing match approves the claim
SSA listing text and criteria
Recurrent arrhythmias , not related to reversible causes, such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic drug toxicity, resulting in uncontrolled (see 4.00A3f ), recurrent (see 4.00A3c ) episodes of cardiac syncope or near syncope (see 4.00F3b ), despite prescribed treatment(see 4.00B3 if there is no prescribed treatment), and documented by resting or ambulatory (Holter) electrocardiography, or by other appropriate medically acceptable testing, coincident with the occurrence of syncope or near syncope (see 4.00F3c ). Back to Top
This listing has no lettered subsections. The diagnosis itself, supported by the medical evidence described in the body-system overview, is what SSA evaluates.
Source: SSA Blue Book listing 4.05. Last synced 2026-05-04.
Where claims under 4.05 usually fail
A frequent failure is treating a reversible cause as part of the case, even though 4.05 requires the arrhythmias to be 'not related to reversible causes' such as electrolyte abnormalities or toxicity from digitalis glycosides or antiarrhythmic drugs. Another pitfall is missing the 'despite prescribed treatment' requirement, when treatment exists and the record does not show ongoing uncontrolled syncope or near syncope. A third issue is documentation that does not line up with the fainting events, such as an ECG report that does not show the abnormal rhythm coincident with syncope or near syncope. A fourth pitfall is lack of the required type of objective recording, such as no resting or ambulatory (Holter) ECG (or no other appropriate medically acceptable testing) used to document the episodes.
Medical evidence that strengthens this claim
Objective timing documentation matters. The record should include resting or ambulatory (Holter) electrocardiography, or other appropriate medically acceptable testing, with the abnormal rhythm documented coincident with cardiac syncope or near syncope. The case file should also reflect why the arrhythmias are not due to reversible causes, such as electrolyte abnormalities or toxicity from digitalis glycosides or antiarrhythmic drugs, and should include evidence about whether prescribed treatment was being used and that episodes continued in an uncontrolled way.
What happens if your records do not meet this listing
If the strict 4.05 requirements are not met, a claim can still succeed later in the process based on the overall functional limits from the cardiovascular impairment. Step 4 and Step 5 focus on what work activity the person can still do despite symptoms and medical findings, using the functional impact described in the medical record rather than only the presence of a diagnosis. If the record supports that the person cannot sustain work-related functioning, approval can still occur even when the exact 4.05 pattern (uncontrolled syncope/near syncope despite treatment, with coincident ECG documentation, and not due to reversible causes) is not satisfied.
Work activity and the SGA gate for this condition
Work activity is still a gate at the start of an SSDI claim, but this listing concerns whether recurrent arrhythmias are uncontrolled and produce recurrent cardiac syncope or near syncope documented coincident with resting or ambulatory ECG (Holter). If the condition meets the listing criteria, the functional limitations tied to uncontrolled syncope or near syncope would generally support that sustained work may not be realistic. For people who are approved, SSDI includes a trial work period and an extended period of eligibility after approval; those rules determine how earnings and ability to work interact over time. (No specific SGA dollar amounts apply here because 4.05 is about medical criteria for disability, not a specific dollar threshold.)
Listing 4.05 FAQ
Questions that come up repeatedly for recurrent arrhythmias , not related to reversible causes, such as electrolyte abnormalities or digitalis glycoside or antiarrhythmic drug toxicity, resulting in uncontrolled disability claims.