Document ID: chunk:federal_register_of_legislation:F2016L01332:front:0:p11
Version: federal_register_of_legislation:F2016L01332
Segment Type: other
Provision Reference: 
Character Range: 31453–34807

on exercise, cannot always be given an appropriate impairment rating for reduced exercise tolerance. However, the need to apply Chapter 19 (Partially Contributing Impairment) should always be considered before disregarding exercise tolerance figures.

  Calculation of the impairment rating for accepted cardiorespiratory conditions

 Follow the steps below to determine the impairment rating for cardiorespiratory conditions:

 (Each step is elaborated in the following pages.)

 STEP           Establish what cardiorespiratory   conditions are            Page
   1 present. 19

 STEP           Assess the information that is available and decide         Page
   2 whether it is reliable and sufficient. 19

 STEP           Determine the impairment rating based on effort           Page
   3 tolerance. 21

 STEP           (Omit this step if no respiratory disease is present.)            Page
   4 Determine the impairment rating based on measure- 25
          ments of lung function.

 STEP           Determine the total accepted cardiorespiratory        Page
   5 functional impairment rating. 32

 STEP           Consider the effects of cardiac failure (if any).                    Page
  6 36

 STEP           Moderate the total cardiorespiratory functional          Page
   7 impairment rating to allow for effects of any non- 37
          accepted conditions.

 STEP           Determine whether any ratings from the relevant Other          Page
  8 Impairment tables apply (Tables 1.7, 1.8, 1.9, 1.10). 37

Step 1: Establish what cardiorespiratory conditions are present.

    For the purpose of assessing cardiorespiratory impairment, both the accepted and the non-accepted conditions are be taken into account. Both will affect the way in which cardiorespiratory functional impairment is calculated. (Their combined effect is taken into account in the application of Table 1.5 in Step 5.)

    Any non-accepted conditions are to be subsequently allowed for by applying
Chapter 19 (Partially Contributing Impairment)   see Step 7.

    When considering the question: 'What cardiorespiratory conditions are present in this veteran?', it is not appropriate to rely simply on a list of accepted conditions. Both previously claimed but rejected cardiorespiratory conditions and unclaimed cardiorespiratory conditions may also be present.

    Step 2: Assess the information that is available and decide whether it is reliable and sufficient.

    To make a reliable cardiorespiratory assessment, there should be an adequate medical history of the veteran's cardiorespiratory conditions. In addition, there should be information relating to the veteran's effort tolerance and, if any respiratory disease is present, there should also be one or more sets of spirometry or other physiological measurements of respiratory function. The criteria by which the evaluation of the information is to be made are set out below.

    Medical history

    An adequate history of the veteran's illness and a description of the current symptoms and details of the current treatment should be available.

    The history should be reviewed at the start of the cardiorespiratory assessment procedure to establish whether any major cardiorespiratory event (for example a myocardial infarction or bypass surgery) has occurred within the period of