Document ID: chunk:federal_register_of_legislation:F2023C00151:front:0:p14
Version: federal_register_of_legislation:F2023C00151
Segment Type: other
Provision Reference: 
Character Range: 34999–37912

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 relevant time in the assessment period to which the information is to be applied.

The nature of the spirometry should be appropriate: the nature of the spirometric readings should be consistent with the known conditions affecting the veteran and should also be consistent with such other information (eg, old spirometry) as is available or can reasonably be obtained. There should be no unexplained inconsistencies between the various reports.

If the nature of the spirometry cannot be reconciled with other relevant information, the spirometry may need to be repeated or the veteran referred to a respiratory physician for clarification of the situation.

If a veteran has emphysema, as evidenced by diminished carbon monoxide diffusing capacity, and diagnosed by a specialist respiratory physician, assessment can be made on the basis of 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