TN 2 (06-15)
Listing 4.00 provides for use of the ETT as primary evidence in cases involving ischemic
heart disease. However, the listing also provides for use of other types of evidence
as the basis for decisions when available evidence does not include acceptable ETT
Obviously, the evidence-to-evidence comparisons needed under the MIRS become more
difficult when evidence from one point (but not both) includes 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
If the file:
contains acceptable ETT results from either the time of the comparison point decision
(CPD) or the current time, but
does not show that an ETT was attempted at the other point, then
the file does not provide a basis for comparing prior and current ETT results.
Find no medical improvement (MI), unless changes in other findings show MI.
does not include acceptable ETT results from the CPD, but
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
contains current acceptable ETT results, then
changes in symptoms connected with the ETTs may provide a basis for finding MI.
Consider such changes in the context of other findings in deciding whether MI occurred.
DI 33535.010 lists ETTs as a possible basis for applying the “new or improved” exception to MI.
Consider that exception where appropriate.
DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement
DI 28020.250 New or Improved Diagnostic or Evaluative Techniques – General
DI 33535.010 Cardiovascular
DI 34001.016 Cardiovascular System