Printing - FECA-PT2 - National Association of Letter Carriers

(2) A nurse becomes disabled by pulmonary tuberculosis after a year of continuous
employment on a ward where active tuberculosis patients were housed. If all other factors
were negative, any medical opinion supporting causal relationship would require little or no
rationale, as it would be apparent that the most probable source of the infection was in the
employment.
If, however, investigation had revealed that the employee lived with a spouse in whom an
advanced case of active pulmonary tuberculosis had been discovered 60 days before, two
probable sources of the infection exist: the hospital where the employee was exposed for
40 hours per week in an atmosphere where the hazard was known and appropriate
precautions were taken; and the home, where the hazard was unknown and no precautions
were taken and where the contact was much more intimate and far exceeded 40 hours per
week.
Under these circumstances, it would be more difficult to find that the employment was a
proximate cause of the disease and any medical opinion in support of causal relationship
would require a full description of the medical reasons justifying such an opinion.
Another variation involves the supposition of massive exposure at work and no exposure in
private life, but with a positive skin test for tuberculosis prior to Federal employment. The
major question then would be whether the current illness is a new disease process or a
reactivation of an old one. This issue would require careful consideration, and any opinion
which did not discuss all relevant factors and contain detailed rationale would not be
sufficient to serve as the basis for a decision.
2-0805-5 Obtaining Additional Medical Opinion
5. Obtaining Additional Medical Opinion. When the medical report is prima facie sufficient but the
opinion provided is unrationalized or speculative, the CE may find that causal relationship cannot be
properly determined on the basis of the medical evidence of record. When this happens, the CE must
obtain additional medical evidence. Following is a description of the format such requests should take and
the sources from which additional opinions may be requested.
a. Statement of Accepted Facts (SOAF). The CE should prepare an SOAF as a frame of
reference (see FECA PM 2-809) and should also state on a separate sheet of paper the specific
questions for which medical opinion is desired. These questions should be as precise as possible,
and they should be tailored to the particular circumstances of the case and the particular issue at
hand.
The CE should avoid asking general questions, those which can be interpreted in more than one
way, and those which suggest a certain answer. For instance, the question, "If there was an
aggravation, was it temporary or permanent?" is preferable to "When did the temporary
aggravation cease?"
b. Avoiding Serial or Piecemeal Handling of Cases. To prevent unnecessary delays in
adjudication, the CE should ensure that all medical issues which need resolution are identified
before requesting additional opinion. For example, if acceptance of causal relationship will entail a
further decision about the extent of disability, the claimant's fitness for duty, or the
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