make the cardiovascular listings more inclusive; more up to date regarding the latest knowledge, science, and technology; and more user-friendly, that is, as objective as possible and requiring the minimum number of criteria to be fulfilled to meet a listing.

The committee kept these criteria in mind throughout its discussions, while recognizing the inherent trade-offs among them. The recommendations incorporate the latest knowledge and technology based on current clinical guidelines and scientific literature, but they would only require tests and other procedures that are widely available in medical settings throughout the country. If a claimant has had more sophisticated, cutting-edge diagnostic tests that are only available in leading medical centers, the results should be used, but are not required. In addition, some techniques required by clinical guidelines for a definitive diagnosis (e.g., right heart catheterization to establish pulmonary hypertension) are considered to be too risky for SSA to require claimants to have the procedure if they have not already had it.

Objective criteria may be easier to use and lead to more consistent decisions, but they do not necessarily lead to more correct decisions. The generally limited ability of objective clinical tests to predict functional capacity or work disability is discussed below.

The committee did not try to consider the changing nature of work, other than to be aware of the long-term trend away from physically demanding jobs to less strenuous, but more cognitively demanding, jobs. The committee also could not determine whether the current cardiovascular listings or proposed revisions are correct in terms of validity, that is, the extent to which they allow all claimants who are truly unable to engage in any gainful employment—and only those claimants. This would require further research.

The general approach taken by the committee to revising the cardiovascular listings is shown in an algorithm outlined in Box 4-1. The algorithm was designed to arrive at the listings-level criteria that were the most objective and easiest to administer while maintaining a reasonable degree of accuracy.

Diagnosis Alone

Few diagnoses are sufficient by themselves to meet the Listings. Examples in other body systems include amyotrophic lateral sclerosis and amputation of both hands. Most of the compassionate allowance conditions are based on diagnosis, such as aggressive, incurable cancers and certain rare diseases that are invariably fatal; none of them is a cardiovascular condition.

The committee is not recommending any diagnoses as sufficient to meet a cardiovascular listing, except the current listing for heart transplantation.

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