Opinion ID: 500088
Heading Depth: 3
Heading Rank: 1

Heading: 50 percent or more narrowing of the left main coronary artery; or

Text: 20 b. 70 percent or more narrowing of a proximal coronary artery (see 4.00H3) (excluding the left main coronary artery); or 21 c. 50 percent or more narrowing involving a long (greater than 1 cm.) segment of a proximal coronary artery or multiple proximal coronary arteries.... 22 Section 4.00 H, referred to above, identifies the proximal coronary arteries as the right coronary artery proximal to the acute marginal branch, the left anterior descending coronary artery (LAD) proximal to the first septal perforator, and the left circumflex coronary artery proximal to the first obtuse marginal branch. 23 In the instant case, a catheterization performed on July 10, 1984, indicated a fifteen to twenty percent obstruction in the first one-third of the first diagonal branch of the LAD. However, the LAD itself was normal. Additionally, this catheterization showed a subtotal occlusion in one of the branches of the posterior descending system of the right coronary artery. The fifteen to twenty percent stenosis of the first one-third of the first diagonal branch of the LAD does not meet or equal the obstruction required in the LAD itself. Similarly, the subtotal occlusion of an unspecified percent in one of the branches of the right coronary artery is too vague to meet or equal the listing. In July, 1984, a coronary arteriography indicated a long proximal fifty percent stenosis in the first diagonal branch of the LAD. The arteriography also showed an eighty percent stenosis of the distal portion of the right coronary artery. However, the angioplasty reduced this eighty percent narrowing to twenty to thirty percent. The fifty percent stenosis was not located in the left anterior descending artery itself as required by section 4.04 B 7 c, but was located in one of its diagonal branches. In fact, the arteriography report specified that the LAD was normal except for long proximal fifty percent stenosis in the first diagonal branch. Moreover, even if this stenosis had been found in the LAD itself, the record contains no evidence that this long stenosis was greater than 1 cm. as section 4.04 B 7 c requires. Finally, the eighty percent stenosis of the distal portion of the right coronary artery which was successfully reduced to twenty to thirty percent does not meet the listing because it was located in the distal portion, rather than the proximal portion, of the right coronary artery. Moreover, even if this stenosis had been found in the proximal portion of the right coronary, its successful reduction to twenty to thirty percent would prevent the claimant from meeting section 4.04 B 7 c. 24 Section 4.04 B 8 requires:Akinetic or hypokinetic myocardial wall or septal motion with left centricular ejection fraction of 30 percent of (sic) less measured by contrast or radio-isotopic ventriculographic methods. 25 In the instant case, the only ejection fraction reported in the medical record was thirty-eight percent. Thus, claimant's condition does not meet or equal the requirements for this listing. Since claimant's cardiac condition does not meet or equal any of the alternative subsections proposed, there is no error in the Secretary's failure to find a listed impairment.