Listing code
4.06
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
Symptomatic congenital heart disease (cyanotic or acyanotic), documented by appropriate medically acceptable imaging (see 4.00A3d ) or cardiac catheterization, with one of the following:
Subsection A
Cyanosis at rest, and: 1. Hematocrit of 55 percent or greater; or 2. Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less. OR
- Hematocrit of 55 percent or greater; or
- Arterial O2 saturation of less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less. OR
Subsection B
Intermittent right-to-left shunting resulting in cyanosis on exertion (e.g., Eisenmenger's physiology) and with arterial PO2 of 60 Torr or less at a workload equivalent to 5 METs or less. OR
Subsection C
Secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of the systemic arterial systolic pressure. Back to Top
Source: SSA Blue Book listing 4.06. Last synced 2026-05-04.
Where claims under 4.06 usually fail
One pitfall is having imaging or a catheter report for congenital heart disease but not matching any lettered criteria, such as missing the specific oxygen thresholds (for example, arterial O2 saturation under 90 percent in room air, or arterial PO2 at 60 Torr or less). Another pitfall is treating the oxygen number as optional within Subsection A, even though criteria A requires cyanosis at rest plus one of the listed lab cutoffs (hematocrit 55 percent or greater, or the specified arterial oxygen limits). A third pitfall is assuming exertional symptoms automatically qualify under Subsection B; Subsection B requires intermittent right-to-left shunting causing cyanosis on exertion and arterial PO2 of 60 Torr or less at a workload equivalent to 5 METs or less. A fourth pitfall is missing the precise pulmonary vascular relationship in Subsection C, which requires secondary pulmonary vascular obstructive disease with pulmonary arterial systolic pressure elevated to at least 70 percent of systemic arterial systolic pressure.
Medical evidence that strengthens this claim
To fit 4.06, the record needs documentation of symptomatic congenital heart disease using appropriate medically acceptable imaging (see 4.00A3d) or cardiac catheterization. The most persuasive documents are those that include the specific measures used in the lettered criteria: cyanosis at rest with hematocrit of 55 percent or greater, or arterial O2 saturation less than 90 percent in room air, or resting arterial PO2 of 60 Torr or less (Subsection A). For exertional cyanosis from right-to-left shunting, documents should show intermittent right-to-left shunting consistent with Eisenmenger's physiology, with arterial PO2 of 60 Torr or less at a workload equivalent to 5 METs or less (Subsection B). For pulmonary vascular obstructive disease, documents should provide pulmonary arterial systolic pressure and systemic arterial systolic pressure so the relationship can be judged as at least 70 percent (Subsection C).
What happens if your records do not meet this listing
If criteria under 4.06 are not met, the claim does not end automatically. Step 4 looks at whether the remaining work capacity (often called residual functional capacity) allows past relevant work. Step 5 considers whether other work is possible given the functional limits, and medical-vocational factors such as age, education, and work experience. In practice, many claims that miss the exact listing thresholds are still evaluated based on the broader functional impact reflected in the medical record and treatment response.
Work activity and the SGA gate for this condition
At the start of an SSDI claim, the ability to work at a level that counts as substantial gainful activity (SGA) is considered, separate from whether criteria like those in 4.06 are met. For someone with symptomatic congenital heart disease who meets 4.06 criteria (such as cyanosis at rest with specified arterial oxygen limits in Subsection A, or exertional cyanosis with arterial PO2 limits at 5 METs or less in Subsection B, or the pulmonary arterial pressure relationship in Subsection C), sustained work may be difficult depending on the medical record's description of symptoms and functional limits. If disability is found, benefits can include a trial work period and an extended period of eligibility for those who return to work.
Listing 4.06 FAQ
Questions that come up repeatedly for symptomatic congenital heart disease (cyanotic or acyanotic), disability claims.