The CE provider will describe and discuss, as appropriate:

a. Dyspnea, orthopnea, fatigue, and exercise intolerance;

b. Chest pain (angina, angina equivalents, or variant angina) and reduced cerebral perfusion (for example, confusion, difficulty walking);

c. The quality, location, radiation, and duration of the chest pain noted, along with factors that exacerbate the chest pain (for example, continued activity, deep breathing, etc.); and factors that relieve the chest pain (for example, rest, nitroglycerin, food, etc.);

d. Any associated symptoms such as shortness of breath, diaphoresis, nausea, dizziness, lightheadedness, near syncope, or syncope;

e. Intermittent claudication, swelling, and skin changes in the lower extremities; and

f. Dates and results of relevant diagnostic procedures, such as electrocardiography, exercise-tolerance stress testing, angiography, echocardiography, Doppler tests, and any other imaging studies.

The CE provider will describe and discuss, as appropriate, any employment history relevant to the alleged condition(s) such as exposure to chemicals or irritants. Include pertinent findings about use of tobacco products, alcohol, and nonprescription drugs.

The CE provider will describe and discuss, as appropriate:

a. Lungs:

1. Whether respiratory rate is labored or unlabored and diaphragmatic motion;

2. Occurrence of cough, audible wheezing, pallor cyanosis, hoarseness, clubbing of fingers, chest wall deformity, any abnormal curvature of the spine; and

3. Breath sounds (air exchange), whether there is prolongation of the exhalatory phase of respiration, and the presence or absence of adventitious sounds (such as rales or rhonchi).

b. Heart and vascular:

1. Presence of any lifts, heaves, or thrills;

2. Heart size;

3. Point of maximal impact of cardiac apex;

4. Presence of any murmurs, rubs, or gallups;

5. Presence and location of any bruits;

6. Distention of neck veins;

7. Presence, type, and extent of any peripheral edema and any associated skin discoloration or ulceration;

8. Quality of peripheral pulses in extremities;

9. Presence and quality of carotid pulses; and

10. Presence of any abdominal pulsation or bruit.

c. Electrocardiogram (ECG), exercise tolerance test (ETT), and Doppler test

Obtain ECG, ETT, and Doppler test only after receiving proper authorization from the DDS.

1. ECG: Perform as specified in section 4.00C of the cardiovascular listings (see DI 34001.016) and provide ECG tracings.

2. ETT: Perform as specified in section 4.00C of the cardiovascular listings (see DI 34001.016).

3. Doppler tests: Perform as specified in section 4.00C of the cardiovascular listings (see DI 34001.016).