Is peripheral artery disease (PAD) with a foot amputation a reason for disability?

From the Guidelines

Peripheral artery disease (PAD) resulting in foot amputation typically qualifies as a disability due to its significant impact on mobility, independence, and ability to perform work-related tasks. This condition involves narrowed arteries reducing blood flow to the limbs, particularly the legs, causing tissue damage severe enough to necessitate amputation in advanced cases 1. The loss of a foot significantly impacts an individual's quality of life, as noted in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease, which highlights the association of PAD with impaired quality of life (QOL), walking performance, and functional status 1.

Key Considerations

• The functional limitations caused by both the underlying PAD and the amputation itself, including walking difficulties, balance problems, pain, and the need for assistive devices or prosthetics, are critical factors in determining disability 1.
• Recovery from amputation requires extensive rehabilitation, including physical therapy and prosthetic training, which may take months, further supporting the consideration of PAD with foot amputation as a disability.
• PAD is often accompanied by other cardiovascular conditions that can further limit functional capacity, as discussed in the context of optimal exercise programs for patients with PAD by the American Heart Association 1.

Application for Disability Benefits

Individuals with PAD and foot amputation should apply for disability benefits through Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), providing comprehensive medical documentation of their condition, treatment history, and functional limitations to support their claim. This documentation should include details on the severity of their PAD, the necessity of the amputation, and the impact of these conditions on their daily life and ability to work. Given the most recent and highest quality evidence from the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1, it is clear that PAD resulting in foot amputation has a profound effect on an individual's morbidity, mortality, and quality of life, thereby qualifying it as a significant reason for disability.

From the Research

Peripheral Artery Disease and Disability

• Peripheral artery disease (PAD) is a common and acute social burden worldwide, and lower-limb amputation is a severe consequence of the disease 2.
• The incidence of lower-limb amputation remains high despite advancements in treatment, and it leads to significant deterioration of the patient's quality of life and has an extremely negative prognosis concerning the frequency of subsequent complications and survival 2.
• Consequences of amputations include not only severe disability but also an unfavorable prognosis of life, thus determining the necessity of adequate prevention of such events 2.

Amputation as a Reason for Disability

• Lower-limb amputation is considered a severe psychological blow for the patient and leads to significant deterioration of his or her quality of life 2.
• The rate of death after major lower extremity amputation in the US is approximately 48% at 1 year and 71% at 3 years, despite this significant morbidity and mortality, the use of diagnostic testing in the year prior to amputation is low and varies based on patient, provider, and regional factors 3.
• Risk factors associated with amputation-free survival for patients with PAD include sociodemographic factors, disease-related characteristics, and comorbidities, and managing modifiable risk factors has the potential to improve outcomes of PAD interventions 4.

Treatment and Management of PAD

• Antiplatelet agents are the hallmark of the treatment of PAD and improve the symptoms as well as the progression of the disease 5.
• Antithrombotic therapy, including antiplatelet and anticoagulant drugs, is critical in the management of PAD and can help improve patient outcomes 6.
• Reconstructive and endovascular operations, as well as amputations, are associated with a significant increase of the probability of the development of major adverse cardiovascular events, the frequency of repeat hospitalizations, and the cost of treatment 2.