Printing - FECA-PT2 - National Association of Letter Carriers

. Qualifications of the Specialist. The ECAB has indicated that the physician's qualifications
may have a bearing on the probative value of his or her opinion. Thus the opinion of a specialist in
the appropriate field of medicine often will carry more weight than the opinion of a nonspecialist or
a specialist in an unrelated field.
Various medical specialty boards exist. Each such board conducts a certification program in an
effort to ensure quality of medical services by adherence to standards of medical training and
practice in the specialty. Although any licensed physician may limit his or her practice to a certain
specialty, a Board-certified specialist has met the minimum standards of training and competency
in the field, as set by the Board. Some medical boards also award certifications in subspecialties.
For instance, a physician certified by the American Board of Internal Medicine may also be certified
in a subspecialty such as cardiology.
Board-certified specialists may also be known as Diplomates. For example, a Diplomate of the
American Board of Orthopedic Surgery, also known as a Board-certified orthopedic surgeon, is
acknowledged to have competency in evaluating and treating medical conditions in that specialty.
(Board certification should not, however, be confused with board eligibility, which simply means
that a physician has completed the educational requirements for taking certification examinations
but confers no special status.)
The opinion of a Board-certified specialist in the appropriate field usually will carry more weight
than that of a specialist who is not Board-certified or who is certified in an unrelated field. The
opinion of a Board-certified specialist of professorial rank in a medical school or teaching hospital,
or of a specialist who is an acknowledged expert or author on the specific medical problem, will
carry added weight.
c. Rationale. The term "reasoned" or "rationalized" medical opinion means that the
statements of the physician are supported by a medical explanation. In some situations no
explanation is required. For example, where a twisted knee is incurred during performance of duty
and the claimant obtains prompt medical care, a simple affirmative answer by the physician as to
causal relationship will suffice.
In most cases, however, rationale will be required. An occupational disease case or a traumatic
injury case with preexisting or subsequent injury to the same part of the body will require, in
addition to the physician's affirmative opinion, an explanation of the causes of the condition
claimed and a discussion of these factors in relation to the claimant's condition. This explanation
and discussion are what constitute medical "reasoning" or "rationale." Sufficient objective data
(findings on examination, test results) must be present so that a reviewer can see on what the
medical conclusions were based.
d. Factual Basis. When based on an accurate and complete medical and factual background, a
reasoned medical opinion has probative value or weight. By the same token, a reasoned or
rationalized medical opinion based on an inaccurate or incomplete medical and factual background
has little or no probative value or weight.
For example, a physician may indicate that a torn cartilage is due to a work-related fall in a
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