Printing - FECA-PT2 - National Association of Letter Carriers

appropriateness of medical care, these issues should be formulated in precise questions to the
physician.
The CE may find it useful to imagine all the possible answers to the initial question and then to
consider what information would be needed to take the next action in accordance with each of the
possibilities. This exercise may suggest further questions which should be posed to the physician.
c. Additional Medical Opinion. The following may be asked to provide further medical
rationale:
(1) Attending Physician. The SOAF and list of questions should be sent to the attending
physician.
(2) Second Opinion Specialist. In cases which cannot be adjudicated on the basis of
opinions provided by the attending physician, an opinion will be requested from a physician
who specializes in the pertinent field of medicine. Form CA-19, Memorandum of Referral to
Specialist, may be used to list the questions for the specialist. (FECA PM 3-500.3 discusses
such referrals.)
(3) Referee Specialist. A conflict of medical opinion may be created when opinions of
approximately equal weight appear in the file. When this occurs, the entire case file is
referred to a board-certified specialist in the pertinent field of medicine. (FECA PM 3-500.4
addresses these referrals.)
2-0805-6 Consequential and Intervening Injuries
6. Consequential and Intervening Injuries. Under certain circumstances an injury occurring outside
performance of duty may affect the compensability of an already-accepted injury.
a. Consequential Injury. This kind of injury occurs because of weakness or impairment caused
by a work-related injury, and it may affect the same part of the body as the original injury or a
different area altogether. For instance, a claimant with an accepted knee injury may fall at home
because the weakened knee has buckled. This incident will constitute a consequential injury
whether the affected part of the body is the knee or some other area, such as the back or arm.
Or, a claimant with an injured eye may compensate for loss of functioning by overuse of the other
eye, which may result in a consequential injury. If such an injury is claimed, the CE should:
(1) Ask the claimant to explain the details of the second injury and give reasons for
believing that it is related to the first;
(2) Ask the claimant to furnish a medical report on the second injury which includes an
opinion concerning the relationship between the two injuries;
(3) Obtain an evaluation from the DMA concerning the causal relationship of the second
injury to the first.
b. Intervening Injury. An injury occurring outside the performance of duty to the same part of
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