Document ID: chunk:federal_register_of_legislation:F2023C00151:reg:0:p4
Version: federal_register_of_legislation:F2023C00151
Segment Type: reg
Provision Reference: reg 0 (pt 4/12)
Character Range: 415918–418813

 "transfers" means moving from one seat to another, changing position from sitting to standing, and transferring to and from the toilet and bed;
    "locomotion" means walking on the level, on gentle slopes and down stairs;
    "dressing" means putting on socks, stockings, and shoes, as well as clothing the upper and lower trunk;
    "personal hygiene" means grooming, and washing of face, trunk, extremities and perineum;
    "feeding" means eating and drinking, but not the preparation of food.

"Effects on ADLs" is to be used to assess conditions for which criteria do not exist in the system specific tables of Chapters 1 to 12, or are inadequate, or for which the application of the tables in Chapter 14 (Malignant Conditions) or Chapter 15 (Intermittent Impairment) is inappropriate.

Table 16.3 (Other Impairment) covers such non-specific indicators of disease as pain, lethargy and prognosis.

This chapter is to be applied in the assessment of conditions that result in the veteran being bedfast, chairfast, housebound or nearly housebound. Such conditions include the effects of severe strokes, severe Parkinson's disease, severe heart failure, severe respiratory disease, severe liver failure, severe kidney failure and some dementias.

ADLs may be used to rate a single condition if its effects are well-differentiated, or may be used to rate all conditions together if their effects are difficult to differentiate.

When ADLs are used to rate a single condition, an impairment rating or ratings from other chapters may be combined with a rating derived from Chapter 16 provided that the ratings relate to different conditions.

When ADLs are used to rate all conditions together, no ratings from other chapters are to be combined with the rating from Chapter 16.

Calculation of the impairment rating for an accepted condition using ADLs

Follow the steps below to calculate the impairment rating due to an accepted condition using the ADLs.

(Each step is elaborated in the following pages.)

STEP 1  For each of the six ADLs obtain a grading code for that activity.                                   Page 181
STEP 2  Add up the grading codes for each of the six ADLs.                                                  Page 181
STEP 3  Using the sum obtained in Step 2, determine a functional impairment rating by applying Table 16.2.  Page 182
STEP 4  Determine an Other Impairment rating for the condition by applying Table 16.3.                      Page 183
STEP 5  Compare the ratings obtained in Steps 3 and 4. Take the higher rating.                              Page 183

Step 1: For each of the 6 ADLs, obtain a grading code for that activity using Table 16.1.

From Table 16.1 obtain a separate grading code for:
    movement in bed;
    transfers;
    locomotion;
    dressing;
    personal hygiene; and
    feeding.

Table 16.1
ACTIVITIES OF