Document ID: chunk:federal_register_of_legislation:F2016L01332:reg:25:p1
Version: federal_register_of_legislation:F2016L01332
Segment Type: reg
Provision Reference: reg 25 (pt 1/4)
Character Range: 38990–41869

25

After both substeps have been completed, a single rating will have been obtained. This rating is known as the impairment rating for effort tolerance.

    If symptoms do not occur, a rating for the condition may be found in Table 1.6 (Cardiac Failure) if applicable, or in the relevant Other Impairment table.

    Substep 3A: Determine the symptomatic activity level.

    The symptomatic activity level is the exercise level (measured in METs) at which symptoms occur. One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen per kilogram of body weight per minute. Table 1.1 lists various activities grouped according to their energy expenditure in METs.

    The symptomatic activity level is the level at which the activities from within any one METs category consistently give rise to symptoms of the accepted cardiorespiratory condition, such as angina, dyspnoea, palpitations, or fatigue. The symptomatic activity level may be determined by reference to a report specifically provided for the purpose as well as by reference to clinical notes and by comparison of the information with the activities listed in Table 1.1. (The symptomatic activity level may be determined by reference to activities other than those contained in Table 1.1 if the energy expenditure (in METs) of those activities is available in the medical or scientific literature.)

In determining the symptomatic activity level, greater reliance is to be placed on activities that involve steady, as opposed to sporadic, expenditure of energy. Such activities are more reliable as indicators of exercise tolerance. Less reliance is to be placed on activities that can be completed in less than a few minutes, as symptoms may take longer than this to occur.

 Responses of the type 'I cannot do such and such' or 'I do not do so and so' are not useful in assessing the symptomatic activity level. What must be established is that level of exercise that the veteran is able to do but which results in angina, breathlessness, or some other cardiorespiratory symptom.

 Symptoms that occur while an activity is performed are not necessarily a result of the energy expenditure occasioned by the activity. Many specific activities can be performed in a way which would mean that they were no longer examples of the METs level in which they are placed in Table 1.1. For example, while driving a car sedately is an example of 2-3 METs, driving a car in a Grand Prix is not.

 Estimations of exercise tolerance above the 6-7 METs level should only be made using exercise tests. The following activities are listed for information only.

    7-8 METs                                        + Chopping hardwood.
+ Very heavy exercise                    + Callisthenics.
+ Jogging (8 km/h).                        + Squash (non
+ Horseback riding (galloping).           -