QUESTION: I have 2 questions that focus on how to apportion a preexisting impairment that is not listed in the musculoskeletal diagnosis-based impairment grids. The preexisting impairment is metastatic disease.
The patient is a 64-year-old male with metastatic squamous cell carcinoma (primary head and neck), stage IV, who had metastasis to the left proximal femur, which was refractory to radiation therapy (33 treatments). The metastatic disease to the left femur was present symptomatically 7 months prior to his work-related injury, with biopsy confirmation of metastatic disease 3 months preinjury and radiation therapy completed 1 month prior to his injury. He tripped over a cord and fell on his left hip. He had a pathologic fracture through the left femur in the intertrochanteric region; there was a large lytic osseous metastasis at that location. The osseous metastatic lesion measured...
