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(2) Evidence from District Medical Advisers (DMAs) whose evaluation is limited to a
review of the case record.
(3) Evidence from "second opinion" physicians, who examine both the claimant and the
case record at the request of the OWCP.
(4) Referee medical evaluations.
Any or all of these four types of medical evidence may be found in a particular case. The CE is
responsible for obtaining the appropriate types of medical evidence, evaluating it, and weighing it
to resolve inconsistencies and conflicts in medical opinions. This chapter defines and discusses the
terms and procedures involved in the weighing process, and provides examples of common
situations in accepted disability cases where medical development and weighing are needed.
b. It is the claimant's responsibility to submit initial medical evidence in support of the claim.
However, if the claimant submits a clear supporting medical opinion, it becomes the CE's
responsibility to assist the claimant in developing additional evidence, or to develop further
evidence by obtaining a consultation as second opinion. It is frequently necessary, especially in
occupational disease cases or cases of traumatic injury involving minimal objective findings, to
seek verification and/or additional details which may be lacking in the reports originally submitted.
Such additional reports and opinions, including input from the District Medical Advisor (DMA), must
first be obtained and then evaluated and compared, or weighed.
c. An important principle in developing and weighing medical evidence in an accepted disability
case is that:
Once the Office accepts a claim, it has the burden of justifying termination or modification
of compensation. After the Office has determined that an employee has disability causally
related to his employment, the Office may not terminate compensation without establishing
that the disability has ceased or is no longer related to the employment.
(Robert R. Henderson, 30 ECAB 549).
d. A second principle is that resolving the issue of whether disability has lessened or ceased or
is no longer causally related to the employment rests primarily within the realm of the medical
expert (Eloise L. Berry, 25 ECAB 61). This is why development and weighing of medical evidence
are both so important in accepted disability cases. A thorough understanding of how to weigh
medical evidence will assist the CE in determining when and how further medical development
should be undertaken and in assigning weight to the medical evidence received.
2-0810-3 General Criteria for Weighing Medical Evidence
3. General Criteria for Weighing Medical Evidence. The purpose of this paragraph is to define the
factors involved in weighing medical evidence, which is the process of evaluating one or more items of
medical information. When medical evidence is present from more than one source, as in most cases, this
process consists of determining the relative value, or merit, of each piece of medical evidence.
a. General Considerations. The Employees' Compensation Appeals Board (ECAB), in
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