WASHINGTON – Social Security has rewritten the medical rules it uses to decide disability claims involving the heart and the blood vessels. They take effect on 30 October 2026.
The new criteria will not wait for new applications. The rule names both groups. Here is the sentence that does it.
“to new applications filed on or after the effective date of the rule, and to claims that are pending on or after the effective date.”
So a claim filed in March and still undecided in November is judged by criteria that did not exist when it was filed.
A footnote widens that. It reaches any case in which the agency makes a decision.
“including new applications, pending claims, and continuing disability reviews (CDRs), as applicable.”
A continuing disability review is the periodic check on whether someone still qualifies. So the new criteria reach people who already have benefits.
The footnote does not stop there, and the rest of it matters to anyone whose case has left the agency.
“We expect that Federal courts will review our final decisions using the rules that were in effect at the time we issued the decisions.”
Read that carefully. It is what the agency expects of the courts, not a rule it can impose on them.
And the test is the date of the decision, not the place the case now sits. A decision the agency issues on or after 30 October is issued under the new criteria, wherever it is later reviewed.
The footnote adds one more step. It covers a court that reverses a decision and sends the case back after 30 October.
In that case the agency says it will apply the new rule to the whole period at issue.
Contents
What these rules actually decide#
The listings are a shortcut, not the whole test.
They describe conditions severe enough that the agency stops asking anything else.
“we presume any adult who has a medical condition(s) that satisfies the criteria of a listing is unable to perform any gainful activity …”
That presumption holds “regardless of their age, education, or work experience.”
Meeting a listing ends the question early. It sits at step three of five.
Failing one ends nothing. The rule says so directly: “We do not deny any claim solely because a person’s medical condition(s) does not satisfy the criteria of a listing.”
That sentence carries more weight than any criterion in the document. A claim that misses the listing carries on to the later steps, where age, education and past work come in.
The rewrite is wider than the heart. It also covers dissecting aneurysm of the aorta, chronic venous insufficiency in a leg, and peripheral artery disease. The childhood listings are rewritten too, under a different standard.
The version in force until 30 October sits on Social Security’s own listings page. The heading there still reads Blue Book, October 2008.
Twenty years, and a report from 2010#
The agency last rewrote these rules on 13 January 2006. The replacement arrives twenty years and nine months later.
The path between the two is on the record. An advance notice came in April 2008. The Institute of Medicine published the report the changes lean on in 2010.
The final rule was proposed on 29 June 2022. The comment period was due to close that August and was extended to 30 September 2022.
Fourteen comments arrived. Three of those letters only asked for the extension.
Then nearly four years passed. The final rule appeared on 2 July 2026, forty-eight pages long.
Commenters raised the age of it at the time. The agency’s answer is in the document.
“Despite the age of the IOM report, it remains relevant because it was drafted within the context of the statutory definition of disability …”
It adds that it also reviewed current research and consulted its own cardiologists.
A written criterion decides a case the way a scoring tool does, and that comparison is ours rather than the agency’s. a scoring tool decides hours raises the same question. Who is allowed to disagree with the result?
The forecast is in dollars#
One commenter put the worry plainly. The changes “may not make the listings more scientifically accurate and may result in some people no longer qualifying for benefits through the listings.”
The agency’s actuaries forecast higher payments, not lower. Here is their estimate.
“net increases of $446 million in scheduled Old-Age, Survivors, and Disability Insurance (OASDI) benefit payments …”
The same estimate adds $94 million in federal Supplemental Security Income payments. Both figures cover the ten years from fiscal 2026 to 2035.
That does not tell you how many people. Higher scheduled payments could mean more allowances. They could equally mean fewer people losing benefits at review. The rule forecasts dollars and names no cause, so this page will not pick one.
The estimate assumes the rule is “effective for all disability determinations made on or after February 1, 2026.” That is not the effective date, and the document explains the practice behind it. Its projection window is fixed to the President’s Budget, so an assumed start later than the window’s first day shortens the years counted.
Administratively the agency expects to save, not spend: “a net administrative savings of less than 15 work years and $2 million annually.”
It is also “not a major rule as defined by the Congressional Review Act.” The document states no consequence of that label, and neither does this page.
What it does not say#
It gives no count of how many people are affected each year. That number is not in the document.
It does not say how many claims move from denied to allowed.
It does not say whether anyone with a claim already waiting will be told the criteria changed underneath it. The rule commits to applying the new criteria to pending claims. It says nothing about a letter.
Nor does it loosen every criterion. Commenters asked the agency to accept a higher ejection fraction for heart failure. It declined.
There is one more document. A correction was published on 16 September 2026. It adds a missing “2.” to one heading. That is the whole of it, and it changes nothing for anyone.
Three things hold for a person with a claim today. The listing is not the only route to an allowance. Filing before 30 October does not lock in the old criteria, because pending claims move. And the rule is public, which means how to check a summary.
Related: when a machine decides.
Source: Social Security Administration final rule 2026-13420, 91 FR 40804, published 2 July 2026, full text read; and the correction C1-2026-13420, 91 FR 58593, published 16 September 2026, full text read.