Case: Obtained Group I, Subgroup B Disability Status for Malignant Brain Astrocytoma: Documented ECOG, Karnofsky Score and the Need for Constant Care

Real case: how Group I, Subgroup B disability status was obtained for 5 years in a brain astrocytoma case within 30 days.

Legal assistance following refusal to issue sick leave and assessment using the ECOG and Karnofsky scales.

The client’s problem: severe cancer, loss of capacity for work and inaction by doctors

A 36-year-old woman from Kyiv diagnosed with astrocytoma, a malignant brain tumour, approached Prikhodko & Partners for assistance. The patient was in a critical condition: progressive cerebral oedema, hemiplegia (impaired limb mobility), deep vein thrombosis and an episode of pulmonary embolism. She had almost completely lost the ability to move independently, perform basic daily activities and work.

Despite the obvious loss of capacity for work, doctors refused to issue and properly extend her electronic sick leave certificate, delayed preparation of the documents and failed to arrange a referral for Expert Team Assessment. The patient was left to deal with the problem on her own, without the ability to formalise constant third-party care and in a state of complete legal uncertainty.

Why referrals for Expert Team Assessment of Daily Functioning may be refused

Under the new reform of medical and social assessment introduced by Resolution of the Cabinet of Ministers of Ukraine No. 1338, Expert Teams assess not so much the diagnosis recorded in the medical file as the degree of loss of independence and the patient’s limitations in daily functioning.

In cancer cases, primary care doctors often refuse to open an electronic case because of:

• formally waiting for a continuous sick leave period exceeding 120 days, even though delays are prohibited where the condition has an unfavourable clinical prognosis;
• the absence of specialised functional assessment scales in the medical records;
• reluctance to assume responsibility for referring palliative patients and formalising the need for third-party care.

The importance of the ECOG scale and Karnofsky Performance Scale in oncology when determining Group I disability

When establishing Group I or Group II disability status in cancer cases, objective international tools for assessing functional status play a key role.

ECOG scale (Eastern Cooperative Oncology Group): a grading system from 0 to 5. Where the condition deteriorates to ECOG 3, meaning the person spends more than 50% of the time in bed or a chair, or ECOG 4, meaning complete loss of independence, being confined to bed and requiring constant care, there are direct indications for establishing Group I disability status.

Karnofsky Performance Scale: a scale from 0% to 100%. Scores of 30–40% or below indicate significant dependence on third-party assistance, severe disability and inability to work.

Without documentary recording of these parameters in reports from specialist oncologists and neurologists, Expert Teams often assign a lower disability group or return the case for lengthy additional preparation.

Step-by-step actions of a medical lawyer: from audit to referral

The medical lawyers implemented a strategy to protect the patient’s rights:

1. Medical and legal audit: detailed analysis of contrast-enhanced brain MRI results, histology reports, vascular ultrasound protocols and changes in the patient’s condition over time.
2. Preparation of the evidentiary basis: arranging follow-up examinations to accurately document functional impairment, including neurological deficit (flaccid hemiplegia), cardiac and thrombotic risks, as well as formal assessment under the ECOG and Karnofsky scales.
3. Protection of the right to continuous sick leave: legal assistance with the proper preparation of medical conclusions on temporary incapacity for work, which ended pressure on the client to return to work. The Expert Team decision extended her temporary incapacity for work.
4. Preparation of the electronic referral for Expert Team Assessment: complete preparation of the electronic documentation package through the electronic healthcare system with appropriate ICF coding, including severe limitations in self-care, serious mobility restrictions and limitations in the ability to work.

Why it is critical to document the need for third-party care at the referral stage

In practice, it is not enough simply to report difficulties with everyday activities during the Expert Team assessment. During the legal review of the medical documentation, we paid particular attention to a mandatory requirement: the need for constant third-party care must be expressly recorded in the primary medical documentation and included in the electronic referral to the Expert Team.

In the referral, the attending physician must specify the particular purpose of the assessment — determining the need for constant third-party care — and clearly describe the severe limitations in self-care and mobility: inability to get out of bed independently, prepare food, manage medication or leave the home.

Because these parameters were properly documented before the case was submitted, the Expert Team reached an objective decision — disability status was established with official confirmation of the need for constant third-party care. This not only provides access to the appropriate social benefits and assistance, but also creates a lawful basis for arranging constant care for the client.

Outcome of the Expert Team assessment: extract from the decision

The entire procedure, from the initial audit to receipt of the final extract, took less than one month: the referral was registered on 31 October 2026 and the assessment was completed on 4 November 2026.

The establishment of disability status for a full 5-year period was recorded on the basis of Resolution of the Cabinet of Ministers of Ukraine No. 1338 for oncological diseases with an unfavourable course. The client obtained the right to the full range of social guarantees, regular state payments and formalisation of official constant care.

Turnkey legal assistance with establishing disability status

Establishing a disability group in cases involving severe medical conditions requires proper medical and legal substantiation. If doctors refuse to provide a referral to an Expert Team, fail to issue sick leave or the Expert Team deliberately understates the degree of functional impairment, do not waste time on bureaucratic disputes.

The company’s medical lawyers provide a complete range of services: professional audit of medical documentation, referral for assessment of ECOG and Karnofsky scores, supervision of the preparation of the electronic referral and in-person or remote legal support during the Expert Team assessment.

If a severe oncological condition has caused you to lose the ability to care for yourself, move independently or work, but doctors are delaying the referral for Expert Team Assessment, the medical lawyers at Prikhodko & Partners can review the documentation, record the functional limitations and provide legal support throughout the disability assessment procedure.