Document ID: chunk:federal_register_of_legislation:F2016L01332:front:0:p12
Version: federal_register_of_legislation:F2016L01332
Segment Type: other
Provision Reference: 
Character Range: 34525–37466

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 always be obtained except if the veteran has a condition that renders the collection of reliable effort tolerance information impracticable.

 Examples of conditions that may render the collection of reliable effort tolerance information impracticable include:
 + hemiparesis following a stroke;
+ quadriplegia or hemiplegia;
+ severe arthritis of the lower limbs; and
+ certain mental conditions such as dementia (in which the veteran's ability to co- operate or provide useful information may be restricted).

 The date of the effort tolerance information used must be appropriate to the period of assessment: the effort tolerance information should be not more than six months older than the relevant time in the assessment period to which the information is to be applied.

 Measurements of lung function

 Spirometry should always be obtained if any condition affecting the function of the lungs is present unless it is not practicable or appropriate to perform spirometry because:
 + the veteran is very old or frail and cannot  reasonably  attend a clinic where
   spirometry can be performed; or
+ the veteran lives in a remote locality and cannot reasonably attend a clinic where spirometry can be performed; or
+ the veteran's impairment from other accepted conditions is of such a degree that it would result in a combined impairment rating of at least 68 points.

 The date of the spirometry used must be appropriate to the period of assessment: the spirometry should be not more than six months older than the