EEIOICPA Procedure Manual Changes – Part 3 Symptoms v. Diagnosis

The Department of Labor’s Division of Energy Employees Occupational Illness Compensation (DEEOIC) revised its Procedure Manual on November 21, 2019.  Cold War Patriots has reviewed the changes and will provide a summary and how they may affect your claim. This is Part 3 of a 5 part series explains procedure a claims examiner (CE) can distinguish between a diagnosed illness and symptoms of an illness.

Chapter 16.5a (1) is a new section to distinguish the difference between diagnosed illnesses and symptoms.  Under this section

1. A physician needs to interpret available clinical and diagnostic evidence to identify a disease.
2. A physician may use his judgment to form a medical diagnosis based on abnormal signs and symptoms.
3. The claimant claiming that the medical evidence establishes a finding, sign or symptom does not necessarily mean this is a diagnosed illness.
4. When the Claims Examiner cannot tell whether the claimed illness is a medical diagnosis or not the CE is to seek clarification from the worker’s physician or a contract medical consultant (CMC).

This one seems mixed.  Requiring the CE to go to the worker’s doctor or a CMC may be helpful to sick workers.  However, requiring the worker’s physician to write yet another document interpreting medical records may well scare off doctors who already feel they have provided DOL with enough documentation.

If you have any questions or concerns about this policy change our Help Center is here for you, 888-903-8989.