Printing - FECA-PT2 - National Association of Letter Carriers

2-0806 Exhibit 20: Sample Questions--Other Conditions
Factual evidence for the following conditions should include the information listed below. Medical
questions are stated in Chapter 4 of "Medical Management of Claims under the FECA".
Dermatitis
Hepatitis
1. The employment-related exposure to the irritant, including identification of the irritant. In
straightforward cases, identification of the plant or the substance is sufficient. In more complex
cases, a description of the chemical content of the substance may be necessary.
2. The chronological onset of symptoms.
3. Exposure to irritants outside the work place.
4. Prior history of dermatitis or other skin disorders, including any known allergies, according
to the claimant.
5. Any protective equipment furnished the employee and whether or not the employee used it.
1. Description of the employment-related source of the contact, and whether it is known to
contain the hepatitis microorganism.
2. Date of contact.
3. Detailed description of any transfusion, surgery, dental surgery, or other medical procedure
which the employee has undergone during the year prior to diagnosis.
4. Description of any possible exposure outside the workplace, including whether any
immediate family members had hepatitis (history of tattoos, use of illegal drugs).
5. Details of any previous liver disease or other serious illness.
Staphylococcus Infections
1. The source of the contact and the extent to which the employee was exposed to the
infected patient.
2. All known exposure to staph infection outside the workplace.
3. Whether the employee suffered any previous staph infections.
Pulmonary Tuberculosis
FECA-PT2 Printed: 06/08/2010 271