Printing - FECA-PT2 - National Association of Letter Carriers

. The DMA's performance of these functions does not lessen the CE's responsibility in case
management. The CE must always maintain responsibility for the case and should use the services
of the DMA only for direction. The CE needs a good understanding of how to weigh medical
opinions if the DMA's services are to be properly used. For example:
(1) Where an attending physician certifies continuing disability while there are few
physical findings, the CE may suspect a "problem" situation that needs further medical
evaluation. A DMA at this point may be asked to give his or her reasoned opinion on the
problem.
(2) Where, after an extended period of time, a physician still certifies total disability and
states maximum improvement has not been reached, the CE may suspect that this is not
reasonable and may request guidance on the issue from the DMA.
(3) Two medical reports being compared may be referred to DMA for review and
comment if the CE needs advice on unfamiliar or medically technical issues. For example,
the CE may ask the DMA to discuss whether the tests performed by the physician are
appropriate and complete and whether the test results support the physician's opinion.
The DMA should, however, be used only where the CE truly needs medical guidance to weigh the
reports in file. If the CE can determine on his or her own that a discrepancy exists between
reported disability status and physical findings or between the nature of injury and the degree or
duration of reported disability, other action may be appropriate. Such action may take the form of
writing to the attending physician or arranging for second opinion evaluation.
c. The DMA's function of evaluating and clarifying the reports of other physicians may take
several forms. For example, in a claim for a schedule award the medical evidence of record
indicates maximum medical improvement has been reached and describes the permanent partial
impairment of the affected member in accordance with the current edition of the AMA Guides to
the Evaluation of Permanent Impairment. (If it does not, the CE should obtain this evidence prior
to DMA review, either from the examining physician or, if this were unsuccessful, through
independent evaluation.)
The DMA must review the report to verify correct application of the AMA Guides and confirm the
percentage of permanent impairment and the date maximum improvement was reached. The DMA
should specify his or her reasons for assigning a certain percentage of loss of use to the
measurements or factors provided by the examining physician. Where factors other than actual
measurements are involved, the CE should ask for a detailed explanation of the percentage
assigned.
The evaluative and interpretive functions of the DMA are separate. The CE seeks evaluation from
the DMA in order to proceed with developing and weighing the medical evidence. The CE seeks
interpretation from the DMA only where the medical evidence is complete and sufficient prior to
such review. In either case, the comments or opinions of the DMA should be explained or
rationalized. The unrationalized or unexplained opinions of a DMA are as lacking in probative value
as the unrationalized or unexplained opinions of any other physician.
FECA-PT2 Printed: 06/08/2010 331