Printing - FECA-PT2 - National Association of Letter Carriers

(3) Release Form CA-1008 and Pamphlet CA-1009 to the claimant. Form CA-1336 may
be sent to the attending physician if desired. The information and instructions given in
these letters will provide a framework to the recipients for understanding the basis of future
actions taken in the claim.
e. Where permanent impairment is anticipated, a call-up should be set for the expected date
of maximum medical improvement so the claimant's entitlement to a schedule award can be
explored.
2-0811-5 Medical Matrices
5. Medical Matrices. For use in managing disability claims, OWCP has developed medical matrices
showing the usual periods of disability for a number of commonly accepted conditions. The matrices
appear in MEDGUIDE, which is contained in Folioviews.
a. The matrices may be applied only to the diagnoses indicated. Because the guidelines are
organized by ICD-9 code, CEs should code accepted conditions as precisely as possible, using four
or five digit codes whenever applicable. This practice will maximize the accuracy and usefulness of
the matrices.
b. To allow for factors which may prolong the period of disability such as concurrent
conditions, unusual severity and/or certain complications, an additional period of three months of
disability may be authorized in individual cases, based on the medical information provided by the
treating physician. It is anticipated that the conditions included in the matrices will not require
additional time beyond the three months for resolution, except in very rare instances.
c. The time limits stated in the matrices apply exclusively to the ICD-9-CM diagnosis codes
listed in the guidelines. The matrices are not applicable to cases in which the treating physician
changes the initial diagnosis (for which there is a matrix) to a more complex diagnosis not present
in the matrices (e.g., an initial diagnosis of a simple back strain is changed to herniated
intervertebral disc), nor are they applicable to cases where the initial diagnosis (present in the
matrices) results in a complication best described by another ICD-9-CM diagnosis code.
d. The matrices include length of disability values for surgery associated with several
conditions. In cases involving surgery, the CE should use the date of the procedure as the first day
of disability, regardless of the time elapsed from the date of injury or the period of compensation
already paid.
For example, a claimant suffers ruptured ligaments of the right knee and is being treated
conservatively, so the CE assigns a length of disability of six weeks. Four weeks after the date of
injury, the claimant undergoes surgical repair of the torn ligament. At this point, 12 additional
weeks should be allowed, starting on the day of surgery. If the period of disability from surgery
for a particular condition is not stated in the matrix, the CE should obtain it from the treating
physician.
e. While the length of disability will often be shorter than the intervals stated, individual claims
may fall outside the accepted limits for a number of medical reasons such as unusual severity,
complications, concurrent conditions, and advanced age. The second matrix (also found in FECA
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