January 2026
Can a Treating Doctor’s Causation Opinion Be Wrong and Hurt Your Case?
This Month’s Case: When Early Input From a Physician Consultant Changes the Trajectory
We were recently asked to consult on a case that highlights a crucial question for attorneys handling injury claims:
What happens when the treating physician gets the causation wrong?
The Story:
A 49-year-old woman working retail had multiple boxes fall off a shelf, striking both legs—worse on the left. She was able to walk afterward and didn’t seek immediate care. Over the next three weeks, however, her left calf developed persistent aching, then mild swelling, and finally became painfully swollen, prompting an ER visit.
Diagnosis: acute deep vein thrombosis (DVT) in the left popliteal vein (behind the knee).
Treatment: standard anti-coagulation and follow-up care.
This is where the medical narrative diverged.
The patient had also been under the care of a gynecologist for large uterine fibroids, and during a routine visit (coincidentally the same week she was diagnosed with DVT), the gynecologist suggested her clot was caused by pelvic vein compression from the fibroids. The hematologist agreed referencing the gynecologist’s note and ruling out inherited clotting disorders.
The work injury was not mentioned.
When she applied for workers’ compensation, she pointed to the obvious timeline: trauma ➝ lingering pain ➝ swelling ➝ clot.
But now, the medical record contained two alternate opinions, neither of which accounted for the workplace trauma. That could have jeopardized the claim.
The Analysis: Medical Literature Tells a Different Story
As physician consultants, our role is not to override treating doctors but to ground causation in anatomy, mechanism, and evidence-based reasoning. Here’s what we found:
1. Anatomic Inconsistency
Fibroids may cause DVT but only when very large, and usually in the pelvic or proximal femoral veins.
A popliteal vein DVT (behind the knee) is anatomically inconsistent with fibroid-related compression.
Conclusion: The proposed mechanism doesn’t align with known patterns of fibroid-related DVT.
2. Trauma Is a Well-Established Risk
Blunt leg trauma is a strong transient risk factor for DVT, particularly when deep tissue is involved.
Injury causes vascular endothelial damage, triggering clot formation.
Conclusion: The trauma mechanism fits the known pathophysiology of post-traumatic DVT.
3. Timeline Consistency
Trauma-related DVTs typically develop within 2–3 weeks, precisely what occurred here.
The progression from calf ache ➝ swelling ➝ clot is classic.
Conclusion: The temporal pattern supports a trauma-related DVT.
4. Fibroid-Associated DVT Is Exceptionally Rare
These cases are so uncommon they’re often published as case reports.
Increased incidence appears only when uterine weight exceeds 1,000g—which was not the case here.
Conclusion: Fibroid-related DVT was statistically and clinically unlikely.
The Timeline Told a Different Story
The client, however, recognized a clear sequence, leg trauma followed by persistent pain, swelling, and eventual clot formation and believed her DVT was work-related. She filed a Workers’ Compensation claim, asserting that the clot stemmed from her on-the-job injury.
Why This Matters for Attorneys
This case underscores a critical point:
Treating physicians may mean well but their causation opinions can be wrong, and that can hurt your case.
In this situation:
The anatomic location (popliteal vein)
The injury mechanism (blunt leg trauma)
The timeline (3 weeks to thrombosis)
…all point toward a work-related trauma as the cause not uterine fibroids.
Our detailed medical review, complete with literature citations gave the attorney the evidence needed to challenge the treating physician narrative and support the client’s claim.
Whether you’re navigating delayed symptoms, chronic pain, or pre-existing conditions, we bring early medical clarity, so you can build stronger cases with less cost, fewer delays, and greater confidence.
Let’s Talk About Your Case
Whether you need:
✅ A quick medical read
✅ A focused opinion letter
✅ Or full case strategy support
I’m happy to talk through how we can help.
— Dr. Darshika Goswami, MD
Pacific Northwest MD Legal Consulting
📧 info@pnwmdlegal.com
📞 (503)‑308‑9186