Document ID: chunk:federal_register_of_legislation:F2016L01332:reg:2:p1
Version: federal_register_of_legislation:F2016L01332
Segment Type: reg
Provision Reference: reg 2 (pt 1/5)
Character Range: 65088–68233

2

  Step 6: Consider the effects of cardiac failure (if any).

 For the purposes of assessment under this Guide, cardiac failure is considered to be a surrogate measure of cardiorespiratory impairment. When cardiac failure is present, the impairment rating calculated using effort tolerance will usually exceed any possible impairment rating from Table 1.6. Table 1.6 is of particular importance in assessing a veteran who is unable to be rated using effort tolerance because of significant conditions such as hemiplegia.

Functional Loss
Table 1.6

       Impairment

CARDIAC FAILURE
Ratings                                      Criteria

       NIL                No cardiac failure; that is, neither symptoms nor
                X-ray evidence of cardiac failure.

                    * No symptoms, but X-ray evidence of early cardiac failure.
                    * Evidence of right ventricular failure.

                FIFTEEN  Left or biventricular cardiac failure demonstrated by ejection fraction of between 40% and 60% and persisting despite therapy.

                TWENTY     Left or biventricular cardiac failure demonstrated on X-ray or by ejection fraction of less than or equal to 40% and persisting despite therapy.

       Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

No age adjustment permitted for this table

A rating from Table 1.6 is to be compared with the total cardiorespiratory functional impairment rating (obtained in Step 5) and the higher of the two is to be chosen.

Step 7: Moderate the total cardiorespiratory functional impairment rating to allow for effects of any non-accepted conditions.

    Partially contributing impairment

    If non-accepted conditions contribute to the impairment, Chapter 19 (Partially Contributing Impairment) is to be applied to determine impairment from the accepted conditions.

    If cardiac conditions exist in the absence of respiratory disease: if there is more than one cardiac condition present (for example ischaemic heart disease and a valvular heart disease) and some are accepted and some are not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition.

    If a respiratory condition exists in the absence of cardiac disease, the symptomatic activity level will generally be the exercise level (in METs) at which dyspnoea occurs. If there is more than one respiratory condition present and at least one is accepted and at least one is not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition or conditions.

    If cardiac and respiratory conditions co-exist, and at least one is accepted and at least one is not accepted, it is necessary to determine the total cardiorespiratory functional  impairment  rating (as set out in the previous steps), and then