Printing - FECA-PT2 - National Association of Letter Carriers

While records of past medical treatment are helpful, their absence may not prohibit further
development of the claim or a decision on causal relationship. If such a decision cannot be
made without the missing records, the claim should be denied on the basis that the
claimant failed to establish causal relationship, and the decision should explain why causal
relationship cannot be accepted without the missing medical records.
2-0806-5 Developing Medical Evidence
5. Developing Medical Evidence. The purpose of this paragraph is to address the nature of the
medical evidence needed to adjudicate OD cases, and how to obtain it.
a. Review Evidence in File. For the OWCP to undertake development of the medical evidence,
the claimant should submit some medical evidence which states a diagnosis and supports causal
relationship. However, the opinion need not be rationalized.
(1) For most conditions, the attending physician's opinion may be considered conclusive
for adjudicating the claim if he or she: is a specialist in the indicated field of medicine; has
a complete and accurate history of the employment factors; and provides sufficiently
detailed information, including the medical reasoning required to determine diagnosis and
causal relationship.
(2) For cardiac and psychiatric conditions, the CE must prepare a detailed SOAF and
questions for a physician. If the medical evidence submitted by the claimant addresses
these questions and meets the requirements stated above, the CE should prepare a memo
to file stating where in the medical reports of record the questions have been answered.
After completing the memo, the CE may adjudicate the claim.
(3) For hearing loss and asbestosis claims, the OWCP should refer the claimant for
examination by a qualified specialist if the report submitted by the claimant does not meet
all of the OWCP's requirements for adjudication (see FECA PM 3-0600).
b. Identify Sources of Information. The CE should use the telephone to find out the best party
to contact if this information not readily apparent. For instance, if the attending physician is not
identified in the file, call the claimant and inquire.
(1) Comprehensive Medical Report. The CE should ask the claimant to submit such a
report from the attending physician, except in cases for asbestos and hearing loss, where a
report which contains the information noted in paragraph a directly above will suffice.
(2) Medical Records. These may be requested from the employing agency, which
maintains the Employee Medical Folder (EMF). For a claimant who is now retired, or who
was employed at a now-defunct facility, the CE may request the EMF from the Federal
Records Center.
Medical records may also be requested directly from the claimant or physician. If
necessary, the CE should send the claimant an authorization for release of records (Form
CA-57) to sign and return.
FECA-PT2 Printed: 06/08/2010 231