Combining Heart Ratings (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.

Combining Heart Ratings (California)

Postby kandslaw on Fri Oct 01, 2010 3:03 pm

Police officer case. AME rates for atrial fibrillation (30%WPI), hypertensive cardiovascular disease (30% WPI) and valvular disease (5% WPI). AME says to combine these using CV chart to get overall WPI of 53%.

Is this correct manner to rate overall cardiac impairment or is each WPI adjusted and then combined?
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Re: Combining Heart Ratings (California)

Postby zacko1 on Fri Oct 01, 2010 3:54 pm

In my opinion, per page 1-11 of the 2005 Rating Schedule, you would adjust out each one and then do the CVC, since the general rule is to adjust all WPI numbers separately and then combine, subject to the exceptions to that rule also stated on page 1-11.
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Re: Combining Heart Ratings (California)

Postby denyse on Wed Oct 06, 2010 10:29 am

I concur with the last post. Plus, you have 2 different systems (chapters) involved with 3 & 4. Query: Is there any duplication. This is an issue that has been slow to evolve with the 2005 PDRS.

"Impairment percentages developed by medical specialists are consensus derived estimates that reflect the severity of the medical condition and degree to which the impairment decreases an individual’s ability to perform common ADL, excluding work. Impairment ratings were designed to reflect functional limitations and not disability” - page 4.

Does the IW really have 3 completely different sets of impairments (ADL impact) that stand alone, or do some overlap. Is this guy RTW? Either way (RTW or QIW), I'd check with a DA and see if you have a duplication argument (see page 1-5) to advance (depo MD) or an AG2 argument (depo MD). AG2 works both ways, although I personally like the 1-5 argument. How about both? Sure would lower the floor in negotiations.
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