Printing - FECA-PT2 - National Association of Letter Carriers

4. Evaluating Medical Opinions.
a. Determining Causal Relationship. This process may be fairly simple or very difficult. The
degree of difficulty depends mainly on:
(1) The precise employment factors or the nature of the injury which is implicated;
(2) The nature of the disability or the cause of death for which compensation is claimed;
(3) The time which elapsed between the injury and the onset of the condition causing
disability or death; and
(4) The employee's medical history.
b. The influence of these factors on the question of causal relationship is shown by the
following examples:
(1) An employee is hit by a truck and is immediately taken to a hospital, where a
fracture of the right femur is found. It is clear that the fracture was caused by the truck
accident, and the report from the attending physician supporting causal relationship would
need no medical rationale.
Ninety days after the injury, symptoms of thrombophlebitis appear in the right leg and
compensation is claimed for this condition. The passage of this amount of time between the
injury and the development of the thrombophlebitis would create doubt about causal
relationship. The report from the attending physician would need to include medical
rationale to justify an opinion in support of causal relationship.
Six months later, the employee suffers a stroke while sitting quietly in an easy chair at
home. The employee claims additional benefits for the stroke, alleging it was caused by the
original injury. Two reasons now exist for serious doubt concerning causal relationship: (a)
nine months elapsed between the injury and the stroke, and (b) the original injury involved
the leg, whereas the stroke resulted from a lesion in the brain, and no apparent
physiological connection exists between the two. Any medical opinion in support of causal
relationship would have to be well fortified by medical rationale. Otherwise, the claimant's
burden of proof would likely not be met.
FECA-PT2 Printed: 06/08/2010 218