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Ischemic heart disease and chronic heart failure are the two cardiac impairments I see most often in my Social Security disability cases.
The Social Security Administration depends heavily upon exercise testing in evaluating ischemic heart disease and chronic heart failure. To meet the chronic heart failure Listing or the ischemic heart disease Listing, a state agency doctor must first determine that exercise testing would present a significant risk to the individual.
For ischemic heart disease, three “ischemic episodes” in one year, each requiring revascularization, defined as an angioplasty or bypass surgery, will meet the ischemic heart disease Listing.
The Social Security Administration is looking for an extreme limitation, “that is, an impairment that very seriously limits your ability to independently initiate, sustain, or complete activities of daily living.”
If you have ischemic heart disease, and state agency doctors found that your impairment did not meet the requirements of Social Security Administration’s Listing for ischemic heart disease, it is probably because the Social Security Administration found a negative exercise test result in the medical records they gathered.
Many times such exercise tests can be properly placed in context and are not inconsistent with you being found disabled. Such exercise tolerance tests, abbreviated ETT, have limitations that have been acknowledged by SSA:
4. Do ETTs have limitations? An ETT provides an estimate of aerobic capacity for walking on a grade, bicycling, or moving one’s arms in an environmentally controlled setting. Therefore, ETT results do not correlate with the ability to perform other types of exertional activities, such as lifting and carrying heavy loads, and do not provide an estimate of the ability to perform activities required for work in all possible work environments or throughout a workday. Also, certain medications (such as beta blockers) and conduction disorders (such as left or right bundle branch blocks) can cause false-negative or false-positive results. Therefore, we must consider the results of an ETT together with all the other relevant evidence in your case record.
The Social Security Administration has also acknowledged that a negative test is not necessarily decisive:
11. How do we evaluate ETT results? We evaluate ETT results on the basis of the work level at which the test becomes abnormal, as documented by onset of signs or symptoms and any ECG or imaging abnormalities. The absence of an ischemic response on an ETT alone does not exclude the diagnosis of ischemic heart disease. We must consider the results of an ETT in the context of all of the other evidence in your case record.
And the Social Security Administration says that if your impairment does not meet or equal an impairment found in the Listings, you “may or may not have the residual functional capacity to engage in substantial gainful activity.” Thus, you can be disabled despite a negative exercise tolerance test.
The Social Security Administration also states that the results of an exercise test are timely only for 12 months after the date performed “provided there has been no change in your clinical status that may alter the severity of your cardiovascular impairment.” When the Social Security Administration evaluates a test that is more than 12 months old, it “must consider the results in the context of all the relevant evidence, including why the test was performed and whether there has been an intervening event or improvement or worsening of your impairment.” I always explore the possibility that your condition worsened after the date of a negative exercise tolerance test.
When I take on a cardiac impairment case, I obtain a detailed description of your functional capacity from your treating cardiologist. At the hearing level there is always more room for argument, and more opportunities for a treating cardiologist to explain why in the claimant’s case an exercise tolerance test is not dispositive.
I fully explore all opportunities like this when I take on a Northeast Ohio Social Security disability case, whether it is a cardiac impairment or other health problem.
If you would like us to evaluate your Social Security disability claim, use the contact information below or the evaluation form to your right.
John Paul Oreh
Northeast Ohio Disability Attorney
25550 Chagrin Blvd., Suite 320
Beachwood, OH 44122