We have two parties involved, the Claims Examiner, (CE) and a "Reconsideration Specialist". Now, I would love nothing more than to name these two by name, but in the interest of keeping this blog online and protecting the Claimant's identity, let's call the CE Ms. Cheaterson and the reconsideration specialist, Ms. Liesalot.
It starts with Ms. Cheaterson the CE, as most OWCP tales do. Ms. Cheaterson denied the Claimant consequential injuries. Ms. Cheaterson's decision said she relied on the "comprehensive medical report" of the OWCP'S District Medical Advisor, (DMA). Seems reasonable, until you actually use the facts.
So let's first look at the DMA and the comprehensiveness of not one, but two medical reports. The two reports together, yes, I said combined, constitute three paragraphs. My first question to you is, what is wrong with this? The answer is; a "Comprehensive Medical Report" will absolutely contain more than three paragraphs even if it's your first day in OWCPland. So we can be pretty sure something's amiss based on the DMA's economy of words.
Next, we're looking for what the three anorexic paragraphs boil down to. What is the medical opinion? Here, it is this one sentence:
"At this time I do NOT feel that OWCP should expand the accepted conditions in this case."Ms. Cheaterson then assigned weight of medical evidence to the DMA's reports and denied the consequential injuries. Yes folks, when the report is on the side of OWCP, weight of medical evidence can be placed on three paragraphs that boil down to their physician's 'feeling'. Show of hands; how many of you out there think this would fly if it was the Claimant's physician's 'feeling'?? Anyone?
But wait, there's more. The DMA stated in both reports that the Claimant had established that bulging discs were in fact work related. Now wouldn't you know, bulging discs were one of the consequential injuries the Claimant was asking for. Wow, what a coincidence. Break it down and the DMA says bulging discs are established yet he doesn't 'feel' any conditions should be accepted. So which is it? Are they consequential or not? Are they established or not? We don't know because the DMA didn't tell us...which they are required to do.
So, what should a Claimant do if this is also their situation? Well, let me ask you this, is a feeling now considered a medical opinion? No, it is not. First, what kind of feeling is it? The doctor doesn't provide any explanation of why he has this feeling or what feeling it was. How do we know he isn't just hungry? Maybe it's gas. We don't know because he didn't explain why he was feeling whatever it was he was feeling and what caused the feeling he was having.
Also, there is no medical rationale connected to this sort of statement. When a physician declares that medical conditions are not consequential, they must explain how the injuries could NOT be related to the original injuries. The doctor has to state what intervened to break the chain of causation. No physician can make a statement about a Claimant's medical conditions without explaining in detail how they arrived at that specific medical opinion and what evidence they based the opinion on.
Then of course there's the contradictions....the Claimant and her physicians indicate the Claimant has bulging discs related to her original accepted conditions. OWCP then sent the Claimant to a second opinion. OWCP's second opinion physician agreed that all of the Claimant's claimed conditions were not only consequential but indicated that each of the conditions was permanent. OWCP then added three of the consequential injuries, but ignored the rest. OWCP cannot use a medical report to accept some of the conditions and not all the conditions. They can't just cherry-pick what they want, especially when it's THEIR doctor saying it. Once they use a report to accept one condition if that report indicates other conditions are work-related, OWCP has to accept those conditions as well.
On the Claimant's side we've got the treating physician, one of OWCP's own secops and diagnostic tests. On OWCP's side we've got a physician with a feeling who states the Claimant established bulging discs but then goes on to say no conditions should be accepted. Ms. Cheaterson then assigns weight of medical evidence to the DMA, the single opinion that denies the consequential injuries...sound familar? Well, I'm getting sick of it. It does nothing but waste everyone's time and taxpayer money. They know they're wrong, but they just can't bring themselves to admit it.
If you read an OWCP medical report and can ask yourself; which is it? the medical opinion is contradictory. If you're thinking; hey, make up your mind...it's contradictory and an OWCP medical report cannot be contradictory. Your doctor can't do it and either can OWCP's doctors. What applies to you applies to them, even if they haven't figured that out yet.
A three paragraph report does not even cover the history of most claims. So if your OWCP medical report is short, that's an indication it's not proper. They can't say I reviewed the file. They have to say what they reviewed. They can't just review OWCP's doctor reports, they have to consider ALL the evidence, including any evidence they receive on the date of the decision.
As our saga continues, Ms. Cheaterson then issued the formal decision denying the consequential injuries. Shocking. Of course, the Claimant appealed the decision.
Enter Ms. Liesalot, the so called "Reconsideration Specialist". All I can say is, after reading Ms. Liesalot's decision, I can say for sure and for certain there is nothing special about her and she should relinquish her 'specialist' title. Her decision is a blatant violation of FECA policy.
First Ms. Liesalot says that bulging discs have been accepted by the Office. Then goes on to explain that bulging discs aren't going to be accepted. I know, right? Where do they get this stuff?
She then discounts the Claimant's argument against the DMA by suddenly promoting him to the District Medical Director. These are two very different jobs. She also declared the DMA's reports, "Qualified Medical Opinions" Of course, these errors are easily proven, but that requires another appeal which means another delay to the Claimant, which I'm pretty sure is the point.
Ms. Liesalot then states that the consequential injuries that are being requested are already accepted. Again, an easily proven error since there would have been no appeal if the consequential injuries had previously been accepted. Duh.
Ms. Liesalot's decision was so utterly pathetic, that of the four arguments made by the Claimant, she didn't actually address any of them. Really, if you could read it, it's just a bunch of stuff made up, without even one ECAB citing to back her up. If they can't cite an ECAB case to back them up, that's an indication your arguments are sound. If it wasn't so pathetic, it might be comical.
Sometimes, you get a really bad decision and there's not one thing you can do about that except appeal. Obviously, this Claimant isn't going to get anywhere in her District. The decisions speak for themselves in the lack of knowledge of the FECA Manuals, ECAB precedent and Larson's on Workers' Compensation Law. The Claimant now has an appeal on its way to the ECAB and I expect it will be kicked back in the Claimant's favor.
The behavior just disgusts me. It's all a game with people's lives hanging in the balance. It's not enough that your mental status has changed because your physical status has changed. No, they have to add the stress of bogus decisions that they know are wrong. Is it so awful for them to just adhere to the rules and regulations governing the system? Some appeals are not so cut and dry and sometimes you have to make a couple of runs at it before you get everything you need. But other times it's obvious there were errors, it's obvious the Claimant has proved their case beyond a shadow of a doubt. When that happens, they should at LEAST have to cowboy up and approve the Claimant's claim.
Sure, everyone is concerned with their own OWCP case, but think about how many of these decisions are being written every day, five days a week in 12 Districts. How many Claimant's are out there struggling with this system. All Claimant's are asking for is what they're entitled to by the written rules, but OWCP refuses to play fair. This is why no matter how beaten you feel, you must fight back and remember that there are others out there just like you. Feeling the same way you are. You can't let them get away with it, because that's exactly what they want.
Can anyone reading this explain how this system is still being called non-adversarial? It does make me wonder though...is the waste of time, effort and money to both Claimant's and the taxpayers due to ignorance or just plain obstinate? And when is someone going to pay attention to this behavior?