Printing - FECA-PT2 - National Association of Letter Carriers

each opinion. The value of the evidence cannot be established by making a "checklist" or counting
the "pros" and "cons" for each criterion. No individual factor standing alone necessarily determines
the weight of medical evidence.
c. Once all opinions are evaluated, they must be compared. For example, two reports are
submitted: both reports are from Board-certified surgeons; both reports are based on an accurate
medical and factual background; and both are rationalized. However, they offer differing opinions
as to causal relationship: one physician physically examined the claimant while the other did not.
Based on the overall comparison of the reports, the weight of the opinions is equal, and there is a
conflict of opinion requiring resolution by referral to an impartial specialist.
The fact that one physician examined the claimant while the other did not is insufficient to tip the
scale either way. However, had the opinion of the physician who examined the claimant not been
rationalized, the opinion of the physician who had not examined the claimant would have
represented the weight of the medical evidence since it was rationalized. In a particular case, the
fact that the physician had not examined the claimant may be mitigated by the fact that the issue
of causal relationship is frequently not one that requires physical examination.
2-0810-5 Sources of Medical Evidence
5. Sources of Medical Evidence. The purpose of this paragraph is to describe the sources of medical
reports likely to be found in the case file. While this list is not exhaustive, most medical reports will fall
into one of the following categories. Regardless of the source of the report, the CE must consider all
medical reports in file when weighing the medical evidence.
a. Hospital or Emergency Facility. Hospital in-patient reports, such as the admission history
and physician examination, the doctors' progress notes and the discharge summary, along with
emergency and out-patient reports, are frequently valuable in documenting the time of injury and
associated factual circumstances bearing on job-relatedness (from the date and time of admission
and the history recorded), the nature and extent of injury, and the duration of disability
anticipated. However, it is usually not possible to obtain opinions if needed to clarify whatever
reports and physicians' and nurses' notes are submitted.
b. Claimant's Physician. The attending physician is the primary source of medical evidence in
most cases. That physician usually sees the claimant soon after the injury or the onset of
symptoms. He or she may also be familiar with the claimant's medical history and therefore may
know of any preexisting condition which may be responsible for the symptoms, or which may have
been temporarily aggravated by the incident or employment factor claimed. The CE should
carefully study reports for discrepancies in the history given by the claimant to the physician and
reported on Form CA-1 or CA-2.
The quality of attending physicians' reports will vary greatly. Sometimes reports are lacking in
detail because the physician is unaware of the type of information required to meet our needs in a
given case. If reports from the claimant's physician lack needed details and opinion, the CE should
always write back to the doctor, clearly state what is needed, and request a supplemental report.
A copy of the CE's request to the physician should be sent to the claimant (and to any
representative) for informational purposes. Alternatively, if an RN is involved in the case, the CE
may ask the RN to make the contact with the claimant's physician and request the information
FECA-PT2 Printed: 06/08/2010 327