AMA Rating for a radical mastecomy (California)

Ask your AMA Guide questions to Dr. Chris Brigham. Christopher R. Brigham, MD is recognized as the nation's leading expert, author, and trainer on the Guides (www.impairment.com). We have expanded this category to include other rating questions under both new and old schedules.

AMA Rating for a radical mastecomy (California)

Postby simplygwents on Mon Jan 28, 2013 11:15 am

Hello,
Any help you could provide in how to rate (or, better yet, what questions to ask the AME regarding establishment of a WPI) for a firefighter with breast cancer who had a radical mastecomy and was treated with chemotherapy "in a cyclic fashion". With tissue cut away, pain and some restriction of ROM...where do I go? Thanks in advance for any assistance.
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Re: AMA Rating for a radical mastecomy (California)

Postby theAxe on Mon Jan 28, 2013 1:41 pm

Not that it is of much help, but "Mammary Glands" are discussed on page 239 of the AMA Guides fifth edition.

Good luck...
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Re: AMA Rating for a radical mastecomy (California)

Postby simplygwents on Mon Jan 28, 2013 2:56 pm

Actually, that was quite helpful AXE! I couldn't find anything like it at all...looked under breasts and mastecomy...but didn't think to look up "mammary glands"! Arguably under this section, with no psyche component, he would have up to 5% WPI. Thanks...great place to start before hitting consideration of Almaraz/Guzman.
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Re: AMA Rating for a radical mastecomy (California)

Postby denyse on Tue Jan 29, 2013 9:18 am

What about skin disorders (scarring) under table 8-2? All depends on ADL impact and functional loss. Class 1 goes to 9% WPI. Mild GAF 65 psyche is 8% WPI (11% after FEC adjustment). Nice combo for a sympathetic witness. File may close sooner than later.

I'd stick with the strict if you can, and especially if she is still employed. AG2 can add months if not years to the life of a file, and you are the rebutting party to a presumed correct. Plus, some of these analogies or functional loss assessments can put your job at risk if you have a heavy occupation.

Although this is a terrible situation, I am not sure the Guides (and/or AG2) acknowledge much functional loss. That is why the combo is recommended. Psyche in particular is outside the box and less apt to be challenged (under ADL impact). Skin disorder is obvious and keeps this under the radar.
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