CDR Mark Hammett

1
Writing Effective Medical Opinion Letters for
FECA Claim Cases

• CDR Mark Hammett
• Navy and Marine Corps Public Health Center,
  Portsmouth VA

2
Workers Compensation and the U.S. Navy

• Total compensation and medical bills paid for all
  injured DoD employees in 2006 (two year lag in
  chargeback)
• Total Dept. of Defense 616,689,207
• Navy 244,318,064
• Army 180,248,334
• Air Force 126,663,190
• Other DoD 65,459,619

3
FECA Case Management

• Case management and workers compensation cost
  avoidance strategies are sporadic, intermittently
  successful, and personality driven
• Rely on relations with HR to employ Occupational
  Medicine in the process
• DODINST 1400.25-M Sub-chapter 810
• SC 810.3.5 Activity Medical Service
• SC 810.3.5.1 Medical Officers.
  Medical officers review all reported cases of
  occupational illness and take or recommend
  action. Upon the ICPA's request, they
• SC 810.3.5.1.1 Provide medical
  information to be sent to OWCP to support or to
  controvert a claim for an occupational illness or
  work-related injury

4
The BUMED/CNIC Initiative

• Placing medical opinion letters into the FECA
  case file for OWCP to review
• History
• CAPT Neal Naito and the EAST Coast FECA Office
  started the process
• Picked up by CDR Fran Litow while at USUHS
• CNIC N1 representative and CAPT Naito agree to
  continue the process
• Case tracking mechanism put into place

5
The BUMED/CNIC Initiative

• Medical opinions for the recordWhy bother?
• Provides ICPAs with one more tool to help them
  manage troublesome claims
• Gives the Agencys position to counter the
  medical opinion of the Claimants advocate when
  there appears to be a weak causal link
• OWCP rules dont allow anyone other than a
  physician to interpret medical information
• Because there is evidence that the opinions have
  an effect
• OWCP claims examiners and ECAB judges read the
  reports and note the influence on the case

6
The BUMED/CNIC Initiative

• Current Status (February 2008)
• 120 case opinions filed
• 7 different physicians filing opinions
• 81 cases adjudicated
• 9.04 million in avoided cost on denied claims
• There is still no formal support agreement to
  provide this service to anyone in the workers
  compensation program

7
Medical Reports for the Record

• What cases can we affect?
• Carpal tunnel syndrome
• Asbestos associated diseases
• Cancer
• Hearing loss
• Rotator cuff tears
• Lumbar stenosis
• Osteoarthritis (cervical, lumbar, and knee)
• Plantar fasciitis
• Multiple chemical sensitivity
• and more

8
Medical Reports for the Record

• OWCP criteria for weighing medical reports
• Physician qualifications Specialists in the area
  are better than non-specialist
• Medical rational Opinion supported by a medical
  explanation
• Accuracy and completeness Nothing left out of
  the analysis, and facts stated agree with written
  records
• Comprehensiveness Reflects that all testing and
  analysis
• Consistency Physical findings must substantiate
  the medical opinion
• Decisiveness No equivocatingyes or no, NOT MAYBE

9
Example Case Cancer

• Case Facts
• 60 year old welding shop supervisor trips and
  falls over cables on the shop floor, breaking two
  vertebrae in his back
• His doctor takes the workmans comp case and is
  going to operate on him to stabilize the
  fractures, but his pre-op blood work is abnormal
  for several blood chemistries
• The man subsequently is diagnosed with multiple
  myeloma

10
Example Case Cancer

• The shop supervisor has been followed for years
  by the Occupational Medicine department for
  workplace exposure to
• Cadmium
• Lead
• Noise
• His cadmium level was high oncehe claims that
  his multiple myeloma was caused by the cadmium
  poisoning
• Is there anything about this case that makes it
  workmans comp?
• Is his cancer compensable under FECA?

11
Cadmium

• Acute effects
• Fever, cough, chest pain, throat irritation,
  chills, muscle aches, shortness of breath,
  nausea, vomiting, diarrhea, muscle weaknessdeath
• Chronic effects
• Kidney Renal damage and renal failure
• Prostate Cancer
• Lungs Emphysema, chronic bronchitis, cancer
• Bones Osteoporosis (leading to fractures)

12
Example Case Cancer

• Is his cancer compensable under FECA?
• Multiple myeloma has never been linked to cadmium
  exposure (has been linked to prostate and lung
  cancer)
• Multiple myeloma has been linked to benzene,
  creosote, (and perhaps formaldehyde)
• His multiple myeloma was most likely not caused
  by exposure to cadmium

13
Substitute MOC Credit Question

• Cadmium has been linked to what types of cancer
  with some reasonable level of confidence?
• Prostate and lung cancer
• Questions?