Document ID: chunk:federal_register_of_legislation:F2023C00151:front:0:p15
Version: federal_register_of_legislation:F2023C00151
Segment Type: other
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Character Range: 37630–40688

effort tolerance alone.

Step 3: Determine the impairment rating based on effort tolerance.

To determine the impairment rating based on effort tolerance follow the substeps below.

(Each step is elaborated in the following pages.)

Substep 3A  Determine the symptomatic activity level by applying Table1.1 — Activity Levels (with energy expenditure in METs).                                                                                                                                                    Page 10
Substep 3B  Convert that symptomatic activity level into an impairment rating. This step involves consulting either Table 1.2 — Loss of Cardiorespiratory Function: Exercise Tolerance (Males); or Table 1.3 — Loss of Cardiorespiratory Function: Exercise Tolerance (Females).  Page 13

After both substeps have been completed, a single rating will have been obtained. This rating is known as the impairment rating for effort tolerance.

If symptoms do not occur, a rating for the condition may be found in Table 1.6 (Cardiac Failure) if applicable, or in the relevant Other Impairment table.

           Substep 3A: Determine the symptomatic activity level.

The symptomatic activity level is the exercise level (measured in METs) at which symptoms occur. One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen per kilogram of body weight per minute. Table 1.1 lists various activities grouped according to their energy expenditure in METs.

The symptomatic activity level is the level at which the activities from within any one METs category consistently give rise to symptoms of the accepted cardiorespiratory condition, such as angina, dyspnoea, palpitations, or fatigue. The symptomatic activity level may be determined by reference to a report specifically provided for the purpose as well as by reference to clinical notes and by comparison of the information with the activities listed in Table 1.1. (The symptomatic activity level may be determined by reference to activities other than those contained in Table 1.1 if the energy expenditure (in METs) of those activities is available in the medical or scientific literature.)

In determining the symptomatic activity level, greater reliance is to be placed on activities that involve steady, as opposed to sporadic, expenditure of energy. Such activities are more reliable as indicators of exercise tolerance. Less reliance is to be placed on activities that can be completed in less than a few minutes, as symptoms may take longer than this to occur.

Responses of the type 'I cannot do such and such' or 'I do not do so and so' are not useful in assessing the symptomatic activity level. What must be established is that level of exercise that the veteran is able to do but which results in angina, breathlessness, or some other cardiorespiratory symptom.

Symptoms that occur while an activity is performed are not necessarily a result of the energy expenditure occasioned by the activity. Many specific activities can be performed in