Printing - FECA-PT2 - National Association of Letter Carriers

e. In cases involving a preexisting or underlying condition, the specialist should be asked to
provide a rationalized opinion as to whether the preexisting or underlying condition was aggravated
by the employment incident or factors and, if so, whether the aggravation was temporary or
permanent. If temporary, the specialist should also state when the aggravation ceased or can be
expected to cease. This information should be requested in addition to that required in paragraph
9c, above.
f. If the case has been accepted and the second opinion referral is undertaken while the RN is
participating, either at the CE's direction or on the RN's initiative, the RN may assist in composing
questions to be addressed by the second opinion specialist and/or schedule the examination.
g. The information described above should give the CE a clear picture of the nature and extent
of the claimant's disability and its relationship to the accepted condition(s). It should also allow
the CE to determine the next logical intervention in the case. Should there be a subsequent need
for an independent specialist's opinion, the CE's questions to the specialist should be specific to the
issue at hand. The same specialist used for the initial examination may be used to obtain
subsequent opinions. The CE should not refer second opinion examination reports to the DMA for
review.
h. The findings or opinions of an independent specialist will often differ from those of the
claimant's attending physician. If of equal weight, the differing opinions would constitute a conflict
requiring referral to a third physician. This is a time-consuming process which is not always
necessary. Frequently a decision can be reached by weighing the medical evidence of record
without referral to a referee specialist. The following are examples of situations in which
differences of opinion can in all probability be resolved without impartial referral.
(1) The attending physician (a general practitioner) and the "second opinion" physician
(a Board-certified specialist in the appropriate specialty) differ with respect to an issue such
as diagnosis or causal relationship. All other factors being equal, the opinion of the
Board-certified specialist would constitute the weight of medical evidence. 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.
(2) The opinions of two Board-certified specialists differ, but the opinion of one of the
physicians is based upon an inaccurate or incomplete history. The opinion based on an
incomplete or inaccurate history would be of lesser probative value than one based upon a
complete and accurate history of injury.
FECA-PT2 Printed: 06/08/2010 335