Document ID: chunk:federal_register_of_legislation:F2023C00151:front:0:p13
Version: federal_register_of_legislation:F2023C00151
Segment Type: other
Provision Reference: 
Character Range: 32188–35251

Step 8  Determine whether any ratings from the relevant Other Impairment tables apply (Tables 1.7, 1.8, 1.9, 1.10).             Page 25

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 assessment.

An examination of the history will indicate whether any Other Impairment ratings (from Tables 1.7, 1.8, 1.9, 1.10) are applicable. For example, in the case of ischaemic heart disease, the history will reveal whether the veteran has had any myocardial infarctions, whether coronary bypass surgery has been performed and the outcome of any such surgery. In other cases, for example when respiratory disease is present, the current treatment will reveal whether any Other Impairment rating for cardiorespiratory conditions is applicable.

In long-standing respiratory conditions, there will often be a disease complex present that is more extensive than that implied by the original diagnostic label. For example, asthma may lead to chronic obstructive respiratory disease and chronic bronchitis may lead to small airways disease. Such extensions of the disease process are to be assessed as part and parcel of the original condition unless there is clear reason why they should not be — for example, they have been determined to be non-accepted conditions.

Effort tolerance

Effort tolerance information should