Federal · SSA final rule, Listing 4.00/104.00
Social Security updates how it evaluates heart and blood vessel conditions for disability benefits
Final rule July 2, 2026 ยท Effective Oct. 30, 2026
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The short version
- Social Security's "Listing of Impairments" describes medical conditions severe enough that an adult who meets the criteria is presumed disabled. This final rule revises the heart and blood vessel (cardiovascular) listings for adults and children, the first full revision since 2006.
- Changes include updated terms and criteria for chronic heart failure (including different heart-size cutoffs for men and women), a new measure for ischemic heart disease, functional criteria for cardiomyopathy, and updated peripheral artery disease tests.
- The rule applies starting October 30, 2026, to new applications, pending claims and continuing disability reviews.
- SSA's actuaries estimate net increases of $446 million in Social Security disability-related (OASDI) benefits and $94 million in SSI payments over fiscal years 2026-2035.
- Status
- Final rule published July 2, 2026; effective Oct. 30, 2026.
- Official source
- Federal Register, 91 FR 40804 (July 2, 2026), FR Doc. 2026-13420, "Revised Medical Criteria for Evaluating Cardiovascular Disorders"
What it does
The listings “describe medical conditions that are so severe that we presume any adult who has a medical condition(s) that satisfies the criteria of a listing is unable to perform any gainful activity.” SSA says it does not deny a claim just because a condition doesn’t meet a listing. (Final rule, Background) This rule finalizes a June 29, 2022 proposal, informed by an Institute of Medicine report. (Final rule) Changes from the proposal include:
- Chronic heart failure (listing 4.02): updated terminology and imaging evidence, and a changed left-ventricular end-diastolic dimension threshold with “different cutoffs for males and females.”
- Ischemic heart disease (4.04): a new listing, 4.04D2, using instantaneous wave-free ratio (iFR) as “another measure of listing-level IHD,” plus added language on non-obstructive coronary artery disease.
- Cardiomyopathy (4.08A): added functional criteria.
- Peripheral artery disease (4.12): updated terms and ankle-brachial and toe-brachial measurement standards.
- Congenital heart disease: added pulmonary atresia examples. The rule also adds language on genetic connective tissue disorders such as Marfan syndrome.
(Final rule, summary of major changes from the NPRM)
Who it affects
Adults and children applying for, or receiving, Social Security Disability Insurance or Supplemental Security Income based on heart or blood vessel conditions. (Final rule, Summary)
What it means for you
SSA says: “We will begin to apply this final rule to new applications, pending claims, and continuing disability reviews (CDR), as applicable, as of the effective date.” If your claim is pending on October 30, 2026, the new criteria apply to decisions made on or after that date. For questions, SSA lists 1-800-772-1213 (TTY 1-800-325-0778). (Final rule, “How will we implement this final rule?” and contact information)
Cost
SSA’s Actuarial Services estimate “net increases of $446 million in scheduled Old-Age, Survivors, and Disability Insurance (OASDI) benefit payments and $94 million in Federal Supplemental Security Income (SSI) payments for the 10-year period covering fiscal years (FYs) 2026-2035.” (Final rule, Anticipated Costs to Our Programs)
Current status
Published July 2, 2026; effective October 30, 2026. (Final rule, “Dates”)
Sources
- Federal Register: “Revised Medical Criteria for Evaluating Cardiovascular Disorders,” final rule, FR Doc. 2026-13420 (July 2, 2026)
- SSA Blue Book: 4.00 Cardiovascular System (Adult)
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Every statement above is drawn from the official source text linked here; section references are shown in grey. This is a plain-English summary, not legal advice. Spot an error? Tell us.