Printing - FECA-PT2 - National Association of Letter Carriers

The CE must advise the claimant of the deficiencies of a claim before adjudicating it. Only one
such notification is required, although the CE should attempt to clarify any discrepancies which
arise from information already in file or received in response to the first request. If the time
allowed for response expires and no reply has been received, the CE may adjudicate the case on
the evidence of record.
A Senior Claims Examiner (SrCE) may be assigned to develop and adjudicate a complex OD claim.
Such assignment may be desirable where the agency disputes the facts in the case; where
conferencing will likely be the most effective means of developing the factual evidence; or where
factual discrepancies remain after several attempts to resolve them.
2-0806-3 Kinds of OD Claims
3. Kinds of OD Claims. The purpose of this paragraph is to discuss the level of development required
by various kinds of occupational disease claims. The level of development usually corresponds to the
nature of injury. Most cases will require limited or no development, while a smaller number will require
full-scale, extensive development.
a. Standard Development. Most claims for skin, orthopedic, virological, infectious, and
parasitic diseases can be adjudicated with an initial request for information and perhaps a follow-up
query for clarification. (Some will clearly address all five basic requirements and may be
adjudicated on their face if all necessary evidence is in file). These cases are considered basic OD
claims.
(1) Examples. The following situations illustrate the kinds of cases which may be
considered basic OD:
(a) A claim for poison ivy where the claimant's employment involves exposure to
the plant, and the medical evidence confirms the diagnosis.
(b) A claim for a stress fracture of the foot from a letter carrier who walks a
route, where the medical evidence confirms the diagnosis and relates it to extensive
walking.
(c) A claim for carpal tunnel syndrome from a postal letter-sorting machine (LSM)
operator where medical tests establish the diagnosis.
(d) A claim for brucellosis filed by a meat inspector where medical evidence
shows that Brucella was cultured from the employee's blood.
(2) Adjudication. The CE may accept a basic OD case if the file contains a statement
describing the employment-related exposure and a medical report which both defines the
medical condition and relates it to the claimed exposure. An affirmative opinion on causal
relationship, without rationale, will be sufficient to accept most cases. In questionable
cases, the CE must determine whether further medical development, such as a letter to the
attending physician or a second opinion examination, is needed before adjudication.
(3) Disability. If the medical evidence of record establishes disability, the CE should take
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