Holcombe Medical Consulting

03/02/2026

Most employers offer mental health benefits.

Most employees don’t use them.

That gap matters.

Across healthcare, aviation, manufacturing, and corporate environments, organizations are investing heavily in workforce wellbeing. Yet Employee Assistance Programs (EAPs) often see utilization rates in the single digits.

If support exists but isn’t accessed, risk isn’t truly reduced.

That’s why more employers are beginning to explore corporate chaplaincy — not as a religious program, and not as therapy — but as a voluntary, confidential, relational support presence in the workplace.

When structured properly, corporate chaplaincy:
- Is non-proselytizing and inclusive
- Does not diagnose or provide therapy
- Does not replace mental health professionals
- Serves as a bridge to appropriate care
- Reduces stigma barriers to early engagement

From an occupational medicine perspective, this connects directly to:
- Safety culture
- Burnout prevention
- Retention strategy
- Crisis preparedness
- Total Worker Health principles

Workforce wellbeing is no longer just an HR initiative — it is a risk management issue.

If your organization is evaluating how to better support employees while protecting operational stability, this is a conversation worth having.
—
Thomas Holcombe, MD
Holcombe Medical Consulting, PLLC
Occupational Medicine & Total Worker Health Advisory



Link in the comments.

02/28/2026

I’m excited to share something new I’ve been building.

Through Holcombe Medical Consulting, I’m officially launching Occupational Medicine Consulting services.

Most people think about workplace injuries after something happens — a claim, a restriction, an OSHA issue, or a dispute.

But occupational health isn’t just about treatment.
It’s about prevention, compliance, safety, and protecting both employees and organizations.

Occupational and Environmental Medicine is a board-certified specialty focused on the relationship between work and health. It involves:

• Fitness-for-duty evaluations
• Return-to-work strategy
• OSHA medical surveillance compliance
• Independent medical evaluations
• Work-relatedness and causation analysis

The goal is simple: help organizations manage workforce health risk proactively — not reactively.

This service line is designed to support employers, safety professionals, HR teams, and attorneys who want clear, objective, evidence-based medical guidance in complex workplace situations.

If you or someone you know works in workforce safety, HR leadership, risk management, or employment law, I’d be glad to connect.

Link in the comments. More to come soon.

— Thomas Holcombe, MD, MPH

02/27/2026

Recently in my Medical Review Officer practice, I reviewed a positive amphetamine drug test for a commercial truck driver.

At first glance, it seemed straightforward.

The lab confirmed the result.
The driver had a valid prescription.
The pharmacy verified it.

But during the interview, the driver explained the prescription wasn’t for ADHD.

It was for narcolepsy.

That changes the analysis.

Under federal DOT regulations, my role is to determine whether a legitimate medical explanation exists for a positive result. A valid prescription may satisfy that requirement.

But in safety-sensitive occupations like commercial driving, we also have to consider the underlying medical condition.

Narcolepsy is a neurologic disorder that affects wakefulness. Even when treated, some individuals may continue to experience excessive daytime sleepiness. In transportation work, that matters.

The key distinction:

Verifying a prescription is not the same as determining fitness for duty.

Medication presence does not automatically equal safety clearance.

These cases are rarely dramatic — but they are often nuanced. And when safety-sensitive work is involved, nuance matters.

If your organization encounters complex DOT drug testing or fitness-for-duty questions, structured, evidence-based review is essential.

Link in the comments.

02/24/2026

Most VA disability claim denials aren’t because the condition isn’t real.

They’re often denied because the medical documentation isn’t structured well enough.

A nexus letter by itself usually isn’t enough.

What matters most is the quality of the medical record behind it:

✔ Consistent documentation over time
✔ Objective findings (range of motion measured in degrees, imaging, validated scales)
✔ Clear diagnostic language
✔ Documentation of how the condition affects function
✔ Medical reasoning — not just conclusions

When a physician has documented a condition across multiple visits, with objective findings and consistent terminology, the resulting medical opinion carries far more evidentiary weight.

VA claims are decided on evidence — not assertion.

The benefit-of-the-doubt standard applies when evidence is balanced. But there has to be credible medical evidence to weigh in the first place.

Documentation drives outcomes.

Clinical integrity is non-negotiable.

Holcombe Medical Consulting, PLLC provides objective, regulatory-aligned medical evaluations and causation analysis.

Link in the comments.

02/19/2026

What does a VA disability rating actually measure?

It’s not a pain score.
It’s not based solely on MRI findings.
And it’s not about how serious a diagnosis sounds.

Under federal regulation, VA disability ratings are designed to reflect average impairment in earning capacity in civilian occupations.

In other words:
The VA is asking how a service-connected condition affects your ability to function and work — not just whether it exists.

In my latest article, I explain:
• Why two veterans with the same diagnosis can receive different ratings
• How the VA combined ratings formula really works
• What the new 2026 medication rule means
• When TDIU may apply

If you’re navigating a VA claim — or helping someone who is — understanding this framework changes everything.

Read the full article here: https://holcombemedicalconsulting.com/resources/va-disability-ratings-explained

02/16/2026

What makes a medical opinion defensible?

In occupational medicine, many of the opinions we provide affect employment, disability determinations, workers’ compensation claims, and regulatory compliance.

In those settings, it’s not enough to “feel right” about a decision.

A defensible opinion must be:
• Grounded in published standards
• Consistent with regulatory requirements
• Transparently reasoned
• Clearly documented

For example, when evaluating a commercial driver after a heart attack, the decision isn’t based on sympathy or personal comfort. It’s based on FMCSA cardiovascular standards and risk assessment.

Objectivity isn’t cold detachment — it’s disciplined methodology.

I shared more thoughts on the distinctions between morality, ethics, virtues, and values in occupational and medical-legal work. If you’re in safety-sensitive industries, legal practice, or occupational health, I’d welcome thoughtful discussion.

https://holcombemedicalconsulting.com/resources/professional-ethics-independent-medical-evaluation

02/13/2026

Workplace drug positivity is rising — and most employers don’t realize this:

A confirmed positive lab result is not the same as a verified positive.

That’s where the Medical Review Officer (MRO) comes in.

The MRO is a physician responsible for reviewing results, verifying legitimate prescriptions, ensuring DOT compliance, and protecting both employer liability and employee rights.

In fact, research shows that a significant percentage of positive drug tests are medically explained after proper physician review.

Drug testing programs are only as strong as the oversight behind them.

If your organization relies on workplace drug testing — especially under DOT regulations — it’s worth asking:

Is your MRO process truly defensible?

Link in the comments.

02/13/2026

VA Nexus Letters Explained: How an Independent Medical Opinion Can Strengthen Your Disability Claim

A strong VA disability claim requires more than a diagnosis — it requires a clear medical nexus. Learn when an independent medical opinion can strengthen your claim and why the right language matters.

https://holcombemedicalconsulting.com/resources/va-nexus-letters-explained

02/11/2026

Musculoskeletal Disorders in Truck Drivers: A Hidden Driver of Turnover and Cost

Nearly 62% of truck drivers report musculoskeletal pain — and it’s affecting far more than just the lower back. These preventable injuries impact retention, reliability, and claim costs, making early ergonomic and medical intervention a smart workforce strategy.

https://holcombemedicalconsulting.com/resources/musculoskeletal-disorders-truck-drivers

10/16/2025

Thanks to Abel George, we now have our scheduling link up and running. Schedule your FAA medical with the link below!

Welcome to my scheduling page. Please follow the instructions to add an event to my calendar.

10/14/2025

A history of breast cancer doesn't need to slow down your FAA medical certificate if you meet the requirements. Link in the comments.

09/27/2025

Chronic sinusitis can represent a significant risk to aviation safety. If you have this diagnosis, are you prepared for your FAA medical certification exam? Link in the comments.