Printing - FECA-PT2 - National Association of Letter Carriers

2-0810-4 Practical Considerations in Weighing Medical Evidence
4. Practical Considerations in Weighing Medical Evidence. The purpose of this paragraph is to
describe the steps a CE should take to weigh medical evidence.
a. In weighing medical reports, the CE should ask the following questions with respect to each
report:
(1) Is the physician a specialist in the appropriate field? The opinions of physicians who
have training and experience in a specialized medical field have greater probative value
concerning medical questions pertaining to that field than the opinions of other physicians.
An extension of this criterion would be whether the physician is Board-certified, an
acknowledged author or expert in the field, or a faculty member of a medical school.
(2) Is the physician's opinion based upon a complete and accurate medical and factual
history? An incomplete or inaccurate history reduces the probative value of medical
opinions based on that history. The lack of any history in a report also diminishes the value
of the report. However, in such cases it is appropriate to ask the physician to state the
history upon which the opinion is based.
(3) What are the nature and extent of findings on examination? Generally, greater
probative value is given to a medical opinion based on an actual examination. The value of
this criterion may change with the issue being addressed. For example, actual examination
would be of greater importance in determining permanent impairment than in rendering an
opinion on causal relationship.
Other things being equal, the probative value of an opinion increases when the physician
reports specific detailed findings, based on a full and careful physical examination, X-ray
studies, appropriate laboratory and clinical tests, and use of consultants. Opinions not
supported by medical findings, or otherwise indicative of cursory examinations, carry little
weight compared to opinions based on detailed examinations and findings. Further, the
opinions and conclusions reached by the physician should be consistent with the
examination and test results.
(4) Is the physician's opinion rationalized? A rationalized opinion is of greater probative
value than an opinion which is not rationalized. The physician should generally explain the
basis for the opinion. This is of particular importance where the question involves a difficult
medical problem, or where there is conflicting opinion.
(5) Is the opinion speculative or equivocal? Such opinions are frequently couched in
terms such as "might be," "could be," or "may be." Medical opinions which are speculative
or equivocal in character have little probative value. Terms such as "probably" or "most
likely" need not constitute a speculative opinion, depending upon the context of usage.
Such words may mean that the physician believes that the medical condition is related to
employment with reasonable certainty, as opposed to absolute certainty. If the physician's
meaning is in question, he or she should be asked to explain the basis for any doubt, and to
state with reasonable certainty whether or not the disability is related to employment.
b. In weighing medical evidence, the CE must determine to his or her satisfaction the merit of
FECA-PT2 Printed: 06/08/2010 326