Below are the head notes for the FAB decisions and orders relating to the topic heading, Medical Benefits. The head notes are grouped under the following subheadings: Date of commencement, Entitlement to, Home health care, Supporting medical evidence, and Termination of. To view a particular decision or order in its entirety, click on the hyperlink for that decision or order at the end of the head note.

Date of commencement

Entitlement to

Home health care

  • In support of a request for home health care, the employee submitted a letter of medical necessity from his treating physician, but DEEOIC determined that the treating physician did not provide a sufficient explanation of how the employee’s hearing loss hampered his activities of daily living to the point of requiring assistance in the home. Despite being provided multiple opportunities to submit the missing explanation, the employee did not submit additional medical evidence explaining why his hearing loss rendered him unable to maintain a consistent physical environment as suggested by the treating physician, or why assistance in the home was necessary. Therefore, his request was denied. EEOICPA Fin. Dec. No. 20170427-21187-4 (Dep’t of Labor, July 11, 2017).

Supporting medical evidence

  • DEEOIC previously accepted the employee’s cataracts in both eyes as a covered illness, and the employee was awarded medical benefits for the treatment of cataracts under Part E of EEOICPA. Because the employee failed to provide a well-rationalized, written opinion from a treating physician which established that hydrotherapy at a health club facility is likely to cure, give relief or reduce the degree or period of the covered illness of cataracts, FAB determined that the employee did not meet his burden of proof and denied the employee’s request for a health club membership as hydrotherapy treatment. EEOICPA Fin. Dec. No. 20170907-65303-7 (Dep’t of Labor, November 16, 2017).

Termination of

  • FAB issued a final decision on October 29, 2002, awarding beneficiary medical benefits and periodic monitoring for his beryllium sensitivity. On June 4, 2003, he joined a tort suit against a beryllium vendor alleging both occupational and non-occupational exposures resulting in beryllium sensitivity. Section 7385d(c) explicitly bars further receipt of benefits under Part B by any beneficiary who files a tort suit covered under § 7385d(d) after April 30, 2003, if that date is more than 30 months after the diagnosis of a covered beryllium disease. In this case it was, since beneficiary was first diagnosed with beryllium sensitivity on March 6, 1998, and 30 months after that date was September 6, 2000. Accordingly, he was no longer entitled to any benefits effective June 4, 2003, the date he joined the covered tort suit. EEOICPA Fin. Dec. No. 5781-2002 (Dep’t of Labor, September 12, 2006).