The Third Circuit's Take on Cardiac Listings

The Biswas v. Commissioner of Social Security case was decided by the Third Circuit in 2024. It offers critical insights for practitioners with cases involving cardiovascular impairments, particularly under Listing 4.00.

✦ Case Background

Biswas, a former limousine driver, underwent open-heart surgery for an aortic valve replacement in 2001 and applied for Social Security disability benefits for a closed period of disability. The ALJ acknowledged his severe impairments, including status post-aortic valve replacement and peripheral vascular disease, but determined they didn’t meet or equal the severity of a listed impairment under the Social Security regulations. The Third Circuit ultimately upheld the denial of benefits, citing substantial evidence supporting the ALJ’s decision.

✦  The Cardiac Listings Debate

The primary focus was whether Biswas’s condition met or medically equaled the requirements of Listing 4.00, which governs cardiovascular impairments. Here’s what the court addressed:

▷ What the Listing Requires:

To meet the cardiovascular listing, objective medical evidence (e.g., ECGs, stress tests, or imaging) must demonstrate the severity of the impairment. Specific criteria, such as persistent symptoms despite treatment, functional limitations, or certain test thresholds must be satisfied.

✦ The ALJ’s Analysis:

The ALJ reviewed Biswas’s medical records, which included evaluations by Dr. Celia Roque and Dr. Francky Merlin. While Biswas reported symptoms of fatigue, shortness of breath, and chest discomfort, the ALJ highlighted the following:

▷ EKG and Imaging Results: These tests didn’t show findings consistent with listing-level severity.

▷ Examination Findings: Both doctors observed mild cardiomegaly but found no signs of congestive heart failure, murmurs, or severe functional limitations.

▷Residual Capacity: Dr. Roque concluded Biswas could perform basic activities (sitting, standing, walking) with some limitations for exertion-heavy tasks.

✦ Court’s Conclusion:

The Third Circuit found the ALJ explained why Biswas’s medical evidence fell short of listing-level severity. The consistency of medical opinions reinforced the conclusion that his impairments, though severe, did not rise to the threshold necessary for an automatic finding of disability.

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