TN 2 (06-15)

DI 28010.130 Role of Exercise Tolerance Tests (ETTs) in Medical Improvement Review Standard (MIRS) Comparisons

A. Introduction to ETTs

1. Listing 4.00

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 results.

2. Interaction with MIRS

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.

B. Reviewing ETTs

1. ETT and comparison

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.

2. No basis for comparison

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.

3. Possible basis for comparison

If the file:

  • 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.

C. ETTs and Group I exceptions

DI 33535.010 lists ETTs as a possible basis for applying the “new or improved” exception to MI. Consider that exception where appropriate.

D. References

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