Adding Medical Conditions – Consequential Conditions

Once a worker has their “White Card” a common question is, “How do I add related medical conditions?”

Under EEOICPA, any medical condition which was caused by an “approved condition”, or caused through treatment for the approved condition, is potentially a consequential (secondary) condition. A worker may file a claim to formally add/approve such secondary condition(s).  Treatment includes necessary surgery, therapy (chemo or radiation therapy) or prescribed medicines.  There must be a clear cause-and-effect linkage that the approved condition (or it’s treatment) caused, significantly contributed to, or aggravated the secondary condition.  Pre-existing medical conditions that are made worse by the care and treatment of an “approved” condition are also candidates to consider. 

For many primary conditions under EEOICPA, there are common secondary conditions which are easily winnable.  You just need the pieces of the puzzle.  So, what are those puzzle pieces and how do you determine if there is a linkage?  It starts by asking your Nurse, PCP, Oncologist or Pulmonologist if it’s possible that one medical condition is related to another.  If their response is affirmative, then you have a great starting point, a corner piece of the puzzle.

Next, you’ll need a formal diagnosis of the secondary condition (Office Visit/Patient Progress Notes, Specific tests) in which the physician identifies and references the secondary condition.  Then, you’ll need records/evidence of surgery, therapy, or prescribed medicines related to the originally approved condition.  And, finally, a written statement/narrative from your physician that outlines in a few paragraphs the history of your condition, course of treatment, and how this led to the secondary condition.  This statement must be signed by an MD or DO.

Keep in mind that for consequential (secondary) conditions, EEOICPA does not require a physician to state with 100% certainty that one condition (or treatment) led to the other condition. EEOICPA merely requires a well organized statement as to the facts and the physician’s opinion that it is most likely that one led to the other.

If you have questions about possible consequential conditions, please contact me directly.  AtomicWorkers will be happy to respond via phone or email.  Thanks for reading!

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