The listings in the Cardiovascular System (4.00) provide for use of the ETT as primary evidence in cases involving chronic heart failure and ischemic heart disease (listing 4.04A). However, the listings also provide for use of other types of evidence as the basis for decisions when available evidence does not include acceptable ETT results.

In the above situations, consider ETT results along with other evidence, but do not use them as the sole basis for establishing either decreased severity or increased function.

If the file:

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  contains acceptable ETT results from either the time of the comparison point decision (CPD) or the current time, but

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  does not show that an ETT was attempted at the other point, then

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  the file does not provide a basis for comparing prior and current ETT results.

Find no medical improvement (MI), unless changes in other signs, symptoms, and laboratory findings show MI.

If the file:

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  does not include acceptable ETT results from the CPD, but

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  shows that a source of medical evidence attempted an ETT but did not obtain acceptable results (e.g., discontinued the test due to the individual's complaints of fatigue or chest pain), and

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  contains current acceptable ETT results, then

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  the ability to perform an acceptable ETT without it being discontinued due to the individual's complaints may constitute changes in symptoms, which may provide a basis for finding MI.

Consider such changes in the context of other signs, symptoms and laboratory findings in deciding whether MI occurred.