Document ID: chunk:federal_register_of_legislation:F2023C00151:reg:54:p3
Version: federal_register_of_legislation:F2023C00151
Segment Type: reg
Provision Reference: reg 54 (pt 3/36)
Character Range: 76310–80375

(i) impairment as measured by effort tolerance, and (ii) impairment as measured by spirometry;
    if both cardiac and respiratory conditions co-exist, the cardiorespiratory functional impairment rating is the greater of (i) the impairment rating as measured by effort tolerance, and (ii) the impairment rating  as measured by spirometry.

In applying these rules, both accepted and non-accepted cardiac and respiratory conditions are to be taken into account.

Only one rating for effort tolerance is to be given irrespective of the number of conditions that contribute to the relevant impairment.

Only one rating is to be given for physiological measurements of lung function irrespective of the number of conditions that contribute to the relevant impairment.

This single "total cardiorespiratory functional impairment" is due to the combined effect of all cardiorespiratory conditions whether accepted or not.

FIGURE 1c ‑ LOSS OF REPIRATORY FUNCTION RESPIRATORY NOMOGRAM

This nomogram is to be used in accordance with the instructions in Step 5 and the procedural Table 1.5.

Results from this nomogram are to be rounded to the nearest five points. 2.5 is to be rounded up to 5 and 7.5 is to be rounded up to 10.

    This nomogram corresponds to the formula:

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
CARDIAC FAILURE
Impairment Ratings                                                                                                                                                                                    Criteria
NIL                                                                                                                                                                                                   No cardiac failure; that is,  neither symptoms nor X-ray evidence of cardiac failure.
TEN                                                                                                                                                                                                      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 allowed 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