Printing - FECA-PT2 - National Association of Letter Carriers

Medical.
2-0809-2 Introduction
2. Introduction. The SOAF is one of the most important documents a Claims Examiner (CE) prepares.
It is the written summary of the CE's findings of facts. It serves as a factual frame of reference for the
medical specialist, the CE or other case reviewer. When it is used by physicians who base their medical
opinions solely on the information presented in the SOAF, the outcome of a claim may depend on its
completeness and accuracy. Therefore, the SOAF must clearly and accurately address the relevant
information.
a. The SOAF represents what the OWCP in its capacity as fact finder has accepted as factual in
a particular case. In Leopold J. Gunston, 15 ECAB 83 (1963), the ECAB stated:
A statement of accepted facts is not a counterpart of a “stipulation of facts” between
adversarial parties in court procedure. In the determination of facts in a claim for
compensation, the [OWCP] is acting in its adjudicatory function as a trier of the facts.
Given the variation in the factual events which occur in some compensation claims, the number of
issues to be resolved, and the differing courses of medical development, the CE will need to assess
the relevance and validity of factual evidence and how it should be presented in the SOAF. While
some elements will be common to all SOAFs, inclusion of others will depend on the issue to be
resolved and the history of the injury. The SOAFs prepared in psychological/emotional stress
claims are inherently different from all other types.
b. The SOAF provides the physician a framework from which to formulate an opinion regarding
a particular medical issue or question. It allows the physician to place the medical questions posed
in the larger context of the mechanism of injury, the requirements of the claimant's job, or the
conditions which prevailed in the workplace. It may also provide the physician with a chronology
of events after the injury.
c. The SOAF is also the means by which factual findings are separated from medical findings
and opinions. This separation of functions is aimed at seeing that the CE does not inadvertently
make medical decisions. Similarly, properly written SOAFs demonstrate to physicians what OWCP
has accepted as factual; clear factual findings are aimed at preventing physicians from making
erroneous factual assumptions about the case, which could undermine their medical conclusions.
d. In certain circumstances SOAFs are required, and in other situations the CE may elect to
prepare them:
(1) All issues requiring a medical opinion for resolution, except for
those which do not depend on the facts of the claim, should have SOAFs. For example, a
request for surgery for repair of a broken bone where causal relationship is not an issue
would not necessarily require a SOAF. Issues commonly referred for medical opinion where
a SOAF may be required or useful include causal relationship, extent and duration of
disability, percentage of impairment, and appropriateness of care.
(2) To assist an attending physician in formulating a well-founded medical opinion, the
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