Printing - FECA-PT2 - National Association of Letter Carriers

needed by the CE.
c. District Medical Adviser (DMA). Furnishes opinions, guidance and advice based upon review
of the case file and familiarity with FECA requirements.
d. Second Opinion Specialist. At the request of the Office, provides examination, indicated
diagnostic testing, and rationalized medical opinion when a detailed, comprehensive report and
opinion is needed from a specialist in the appropriate field.
e. Referee Specialist. Examines claimant, arranges diagnostic tests and furnishes rationalized
medical opinion to resolve conflicts between a claimant's physician and a physician of the United
States where the weight of medical evidence is equally balanced.
2-0810-6 Content of a Medical Report
6. Content of a Medical Report. The purpose of this paragraph is to describe the elements which a
medical report should ordinarily contain.
a. History.
(1) A medical opinion is only as good as the "frame of reference" on which it is based.
In other words, the record must show whether the history obtained by the doctor is
substantially in accord with the facts of the accident or accepted employment conditions.
(2) Sound judgment and common sense must be applied. If Form CA-1 shows
concurrence of the employer with a report of fractured ankle due to falling off a ladder, and
this history is repeated in the emergency room report of treatment soon after the time of
injury, there is no need to question a subsequent attending physician's report which fails to
record a history.
(3) It is also essential that the history given a hospital or physician agree with the
substantive facts. For example, the attending orthopedist records a history of lifting a 100
pound sack at work, with positive medical findings to support a low back strain, and
concludes that the disability resulted from the lifting incident. The opinion is of diminished
value if the factual evidence shows that the sack weighed 25 pounds. In this case, the
history given the physician was not accurate, and it is quite possible that the claimant
injured his back in some other activity, not necessarily in Federal civil employment.
b. Findings. The value of a medical report is no greater than the scope of the examination,
which is revealed by the findings in the report. The scope of findings reported will vary with the
type of medical problem and the existence of any diagnostic problem. Adjudicatory needs
requiring a detailed report of findings also will vary. Only minimal findings need to be reported for
a traumatic amputation of a finger, but the doctor should be required to set forth a detailed
account of the findings where the nature of injury, causal relationship to employment and extent of
disability is not so apparent, as in many low back or occupational disease claims. The three
general classes of findings are:
(1) Physical findings, which are noted by the doctor's visual inspection, palpation and
FECA-PT2 Printed: 06/08/2010 328