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Paragraph and Subject
2-0805 CAUSAL RELATIONSHIP
TABLE OF CONTENTS
Date Trans. No.
Table of Contents 07/00 00-08
1. Purpose 06/95 95-23
2. Types of Causal Relationship 06/95 95-23
3. Evidence Needed 07/00 00-08
06/95 95-23
4. Evaluating Medical Opinions 06/95 95-23
5. Obtaining Additional Medical Opinion 06/95 95-23
6. Consequential & Intervening Injuries 06/95 95-23
7. Psychological Factors Affecting
Medical Condition 10/95 96-05
8. High-Risk Employment 10/95 96-05
2-0805-1 Purpose and Scope
1. Purpose and Scope. This chapter contains guidelines for determining the question of causal
relationship as it relates to both traumatic injury and occupational illness. (Further information concerning
specific diseases is contained in FECA PM 2-806 and MEDGUIDE, while evaluation of medical evidence is
discussed in FECA PM 2-810.)
2-0805-2 Types of Causal Relationship
2. Types of Causal Relationship. An injury or disease may be related to employment factors in any of
four ways, as follows:
a. Direct Causation. This type of relationship is shown when the injury or factors of
employment, through a natural and unbroken sequence, result in the condition claimed. A
fractured arm sustained in a fall would be considered a direct result of the fall, and a sensorineural
hearing loss might likewise be caused directly by occupational noise exposure over a period of
time.
In occupational disease claims, however, the medical evidence needed to support the relationship
will likely require greater rationale than in traumatic injury claims. The phrase "proximately
caused" is used also to designate this kind of relationship.
b. Aggravation. This kind of relationship occurs if a pre-existing condition is worsened, either
temporarily or permanently, by an injury arising in the course of employment. For instance, a
traumatic back injury may aggravate a claimant's pre-existing degenerative disc disease, and
FECA-PT2 Printed: 06/08/2010 212