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2-0803-5 Development of Medical Evidence 5. Development of Medical Evidence. A medical report must appear in file before fact of injury can be affirmatively determined. If it does not appear, the CE should request it. As noted in paragraph 3d above, the report must contain a diagnosis in connection with the claimed incident. a. If such a diagnosis is present, the CE may continue developing the claim with respect to whether the injury occurred within performance of duty, and whether the condition stated by the physician is causally related to the injury or illness claimed. Causal relationship is a separate issue from fact of injury, even though medical evidence is needed to establish both aspects of the claim. A case with a diagnosis present should never be denied on the basis that fact of injury is not established. b. If such a diagnosis is not present, the claim should be denied on the basis that fact of injury is not established. It is not necessary to develop the claim further, and causal relationship should not be stated as a basis for the denial. c. An example of the distinction to be made is as follows: The claimant alleged that he sustained a herniated disc while bending over to tie his shoe at work, and the supervisor confirmed that the incident occurred as described. The medical report from the attending physician contained a history of the injury and a diagnosis. This evidence is sufficient to establish fact of injury. If no diagnosis was present, the case could be denied without further development on the basis that fact of injury had not been established. FECA-PT2 Printed: 06/08/2010 166
2-0804 PERFORMANCE OF DUTY TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 07/97 97-19 1. Purpose and Scope 08/92 92-32 2. Adjudication 08/92 92-32 3. Terminology and Sources of Evidence 09/95 95-34 4. Industrial Premises 08/92 92-32 5. Off-Premises 08/92 92-32 6. To and From Work 08/92 92-32 7. Diversions from Duty 08/92 92-32 8. Recreation 08/92 92-32 9. Idiopathic Falls 08/92 92-32 10. Assault Cases 08/92 92-32 11. Horseplay 08/92 92-32 03/94 94-16 12. Coworker Harassment or Teasing 03/94 94-16 01/97 97-07 13. Prohibited Activities 03/94 94-16 14. Statutory Exclusions 03/94 94-16 09/95 95-34 15. Suicide 03/94 94-16 09/95 95-34 16. Representational Functions 03/94 94-16 17. Work-Connected Events Which Are Not 07/97 97-19 Factors of Employment 03/94 94-16 18. Employing Agency Physical Fitness Programs 19. Deleterious Effects of Medical Services 01/97 97-07 07/97 97-19 03/94 94-16 Furnished by the Employing Establishment 03/94 94-16 FECA-PT2 Printed: 06/08/2010 167
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LIST OF CHAPTERS PART 2 - CLAIMS (I
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which may be useful to the CE. b. C
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d. Continuation of Pay. An employee
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o. Review of OWCP Decisions. Under
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2-0300 COMMUNICATIONS TABLE OF CONT
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2-0300-4 Regular Correspondence 4.R
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(b) Formal Decision. If a formal de
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If the information requested cannot
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eferred to the NOO for adjudication
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2-0400-6 Requesting Files 6. Reques
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the file. This process should mainl
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2-0400-10 Case Transfers and Loans
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2-0401 AUTOMATED SYSTEM SUPPORT FOR
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names and addresses is optional. By
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PW: Entitled to payment on periodic
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AM/C1: Condition accepted. Up to $1
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full appeal rights, and the adjudic
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B Both A Aggravation 2-0402 SECURIT
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a. Signatures. The CE must review c
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(a) The particular issues about whi
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c. Review by DD. Upon receipt of th
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disposition, a report, enclosing th
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2-0500 CONFERENCING TABLE OF CONTEN
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necessary to identify the official(
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2-0500-6 Senior CE Actions 6. Senio
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2-0500-9 Due Process 9. Due Process
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This chapter outlines the major ste
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(d) Been notified that OWCP will pr
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2-0600-4 Initial Actions 4. Initial
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2-0600-5 Nurse Services 5. Nurse Se
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assess the claimant's environment a
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(4) Timely responses to telephone c
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for guidance in composing such ques
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(4) Only if the CE has taken these
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(1) RS Actions. If the claimant agr
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(3) Absent such a recovery, the OWC
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(c) After any training or other pre
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under way and the CE determines tha
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2-0600 Exhibit 1: Sample Letter to
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2-0600 Exhibit 3: Example of Letter
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2-0600 Exhibit 5: Planning Chart fo
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period, and each new recurrence. a.
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a. QCM Screen. When the QCM screen
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(c) Confirmation of Data. After ent
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(1) NFN*--Referred to Field Nurse.
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2-0601-6 Effect of RTW on QCM Statu
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2-0601 Exhibit 1: Disability Tracki
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SRE Referred to SrCE for Conference
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21. FECA Death Gratuity 4/10 10-06
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. Claimant. The claimant is respons
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2-0700-6 Adjudication 6. Adjudicati
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(3) If the parties lived apart for
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(3) If the child does not begin pos
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Compensation was terminated effecti
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. Dependency Criteria. The test of
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(3) Proof of physical or mental inc
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The CE should prepare a memorandum
Page 115 and 116: . Employee Status. The $200 payment
Page 117 and 118: (b) Form CA-1617 should be released
Page 119 and 120: 2-0700-20 Gratuity 20. Gratuity fro
Page 121 and 122: 2-0700 Exhibit 1: Percentages of En
Page 123 and 124: 2-0800-2 Definitions 2. Definitions
Page 125 and 126: . Employing Agency. The FECA requir
Page 127 and 128: claimant, the CE should send a copy
Page 129 and 130: (3) The case must be coded as withd
Page 131 and 132: entire group of cases must be adjud
Page 133 and 134: 2-0800-10 Investigation 10. Investi
Page 135 and 136: 2-0800-13 Affirmative Defense 13. A
Page 137 and 138: 2-0801 TIME TABLE OF CONTENTS Parag
Page 139 and 140: 5 U.S.C. 8122 on the ground that no
Page 141 and 142: (4) If a claim is not received by O
Page 143 and 144: (1) Disappearance During a Period o
Page 145 and 146: 2-0802 CIVIL EMPLOYEE TABLE OF CONT
Page 147 and 148: 2-0802-1 Purpose and Scope 1. Purpo
Page 149 and 150: (1) The precise time when the worke
Page 151 and 152: 2-0802-8 Contract Job Cleaners Used
Page 153 and 154: 2-0802-13 Volunteer Workers with th
Page 155 and 156: (1) Whether, prior to the transfer
Page 157 and 158: . The pay rate for compensation pur
Page 159 and 160: 2-0802-24 U.S. Park Police and Secr
Page 161 and 162: a participant or crew leader servin
Page 163 and 164: 2-0803 FACT OF INJURY TABLE OF CONT
Page 165: 2-0803-4 Development of Factual Evi
Page 169 and 170: time before or after the end of the
Page 171 and 172: (a) A diagram showing the boundarie
Page 173 and 174: d. Workers in a Travel Status. (1)
Page 175 and 176: 2-0804-6 To and From Work 6. To and
Page 177 and 178: (a) The reason the employee was req
Page 179 and 180: (1) At the time of the injury, the
Page 181 and 182: (1) Martha G. List, 26 ECAB 200. Em
Page 183 and 184: duty, the CE may approve the case.
Page 185 and 186: action taken; and (4) Statements fr
Page 187 and 188: 2-0804-14 Statutory Exclusions 14.
Page 189 and 190: would justify such disobedience. (c
Page 191 and 192: (2) The official superior should al
Page 193 and 194: c. Development. (1) It is the CE's
Page 195 and 196: such as soliciting new members or c
Page 197 and 198: c. Performance Ratings. The Board r
Page 199 and 200: Where an employee asserts that emot
Page 201 and 202: The Board noted that Cannon was unl
Page 203 and 204: Since both cases involve procedures
Page 205 and 206: Ashberry's disability was not compe
Page 207 and 208: no longer be considered so in light
Page 209 and 210: 2-0804-18 Employing Agency Physical
Page 211 and 212: f. This matter was initially addres
Page 213 and 214: compensation would be payable for t
Page 215 and 216: limited to the period of work-relat
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(6) Certain other kinds of cases re
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(2) A nurse becomes disabled by pul
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the body originally injured is term
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2-0806 OCCUPATIONAL ILLNESS TABLE O
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2-0806-1 Purpose and Scope 1. Purpo
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the following steps, depending on w
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(4) Exposure to and Identification
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While records of past medical treat
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the medical connection between lift
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(b) The medical evidence presented
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2-080 Exhibit 2: Sample Letter to C
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TITLE _____________________________
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eason, you should call or write to
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9. [FREE FLOW IF DESIRED] We may wr
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If you do not understand any part o
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stressful situations in your person
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TITLE FECA-PT2 Printed: 06/08/2010
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I am writing in reference to your c
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We may write directly to a physicia
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2-0806 Exhibit 20: Sample Questions
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TA Amputation TB Back strain TC Con
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(D )Other Disability, Occupational
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a. Traumatic Injury. If an air traf
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2-0807-6 Period of Entitlement 6. P
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d. Return to Duty. The injured empl
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f. The injury was not reported on a
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W = Total number weeks worked P/W =
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COP is paid for the entire period o
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(c) When the physician's report ind
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(a) Assign or detail the employee t
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. Monitoring the Claim. (1) If Form
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(4) If conflicting information appe
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a. Permanent Total Disability (PTD)
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(1) Prior to December 7, 1940. No p
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(2) Impairment due to amputation is
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. Claims for Increased Schedule Awa
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compensation for temporary total di
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Medical. 2-0809-2 Introduction 2. I
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CE is ready to evaluate the evidenc
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the physician with a complete pictu
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(3) Personal habits such as smoking
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games or operating a construction b
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Jane Doe, date of birth 04/06/1965,
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elated to the employee’s duties;
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16. Physical Therapy 04/01 01-06 03
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evaluating the merits of medical re
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situation where ten days earlier th
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each opinion. The value of the evid
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manipulation of the body. They incl
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. The DMA's performance of these fu
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evidence from physicians who have n
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e. In cases involving a preexisting
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(1) The consultant should be asked
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value). Based on the results of thi
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However, if the impartial specialis
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2-0810-13 Exclusion of Medical Evid
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Leanna Garlington, 37 ECAB 849). Re
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(d) A suggested supplier, if any. (
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need for further treatment as detai
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2-0810-18 Transfer of Medical Care
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2-0810 Exhibit 1: Information from
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Dear CLAIMANT NAME: We need the fol
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2-0810 Exhibit 3: General Guideline
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2-0810 Exhibit 5: Sample Paragraph
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2-0810 Exhibit 7: Letter of Warning
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In addition, a primary goal of case
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(3) Release Form CA-1008 and Pamphl
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a. Where disability is present, the
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f. If the evidence obtained as a re
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eligible for disability benefits. A
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f. Physician's estimate of the date
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2-0812 PERIODIC REVIEW OF DISABILIT
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2-0812-1 Purpose and Scope 1. Purpo
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determine the status of dependents
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whether disability is related to th
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earnings or activity is in question
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eferred to the Office of Inspector
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. Suspension of Compensation. OWCP
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certification clauses on the CA-103
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SI Payment/Entitlement Suspension i
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with the return to work effort. CFF
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should be placed in a PN status. OP
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force. 10. If the business has had
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I am writing in follow up to the Fo
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2-0812 Exhibit 6 - Periodic Entitle
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Service. On 03/14/2003, the claiman
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Authorized Medical Care for Substan
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a. OPM's regulations on retention r
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d. To identify cases for early inte
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2-0813-7 Communication Among the CE
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d. Cooperative Agreement. The title
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ehabilitation process. 2-0813-11 Fa
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(2) To reduce compensation in this
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The specificity of the reasons offe
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in conjunction with graded conditio
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(1) Where the claimant cannot perfo
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2-0813 Exhibit 2: Non-Cooperation W
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2-0814 REEMPLOYMENT: DETERMINING WA
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Exhibits 1. Sample Letter to Claima
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. Preliminary Assessment of Positio
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(b) If the attending physician cont
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(3) The employing agency will be as
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e. Payment/Reimbursement of Relocat
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have no appeal rights attached. c.
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were not reported to OWCP or were o
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(3) If the employee can work only p
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this instance the CE will need to e
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d. Unacceptable Reasons for Abandon
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closure of an installation, cessati
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Code, and returns to duty under ret
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If you receive an increase in pay o
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2-0814 Exhibit 3: Sample Letter To
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RATE DATE FOR SCHEDULE AWARDS 01/10
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(1) Kinds of Appointments. The Post
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year, in the teaching profession, w
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(b) Census enumerators; (c) Casual
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The CE should consider these factor
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The greatest of these pay rates wil
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the Department of Veterans Affairs
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degree of expense, hardship, and in
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(2) Basic bi-weekly pay x premium p
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2-0900-9 Computing Daily Pay Rate 9
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2-0900-11 Computing Monthly Pay Rat
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The salary for these employees may
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2-0901 COMPUTING COMPENSATION TABLE
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2-0901-2 Related Topics 2. Related
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(4) A GS-12 CE or designated CE may
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2-0901-4 Factors in Computing Compe
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(3) For schedule award payments, th
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(4) Compensation payable for less t
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2-0901-9 Special Determinations 9.
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2-0901-11 Maximum Compensation 11.
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payment. a. Beginning Date. Schedul
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(3) ( ) (a) is capable of earning (
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automatic pay increases. For exampl
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claimant to a higher pay rate under
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(a) the beneficiary's maintenance,
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Letter CA-1208 to the claimant, wit
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01/01/76 4.4 10/10/76 18.96-28.44 9
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01/02/2000 44.98-67.47 224.91-337.3
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10/07/79 144.56 722.78 - (2,891.12)
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*Calendar Days 01/01/2001 3.3 365 1
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PERCENTAGE TABLE OF SCHEDULE AWARDS
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2-0901 Exhibit 6: Activity Codes AC
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12. Tennessee Valley Authority 02/9
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. Death Benefits. When compensation
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(3) Certification. The CE should ha
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elected, refer the case to the inac
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(b) If there is accrued compensatio
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Centers, and DVA Hospitals. If the
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(b) The claimant may be entitled to
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d. Obtaining Elections--Educational
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(3) The CE must advise the claimant
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c. Injuries On and After September
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Based on information contained in t
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2-1000-16 Benefits for Judicial Off
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(a) Calculate the number of weeks w
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I. Claimants must elect between Fed
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2-1000 Exhibit 2: OPM Contact List
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When a third party is or may be leg
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(6) Ltr. CA-1109, Authorization to
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7. Administration of Third Party Ca
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(3) If not accurate or complete, th
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the DCE, is urgent should be sent i
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(3) Provide the claimant or attorne
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for a course of action. All formal
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In any other case, where a judgment
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(b) 5 percent of the total to be al
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To determine the amount to be liste
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(6) Section 8133(a) of the FECA pro
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(2) The initial demand letter in an
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of the employee. The USPS cannot re
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not be referred to the FEEWC until
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FECA-PT2 Printed: 06/08/2010 581
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a. Under 5 U.S.C. § 8127(b) and in
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. Should an application be submitte
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and the requested fee is reduced du
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2-1200 Exhibit 1: Sample Formal Dec
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2-1300 LUMP SUM PAYMENTS TABLE OF C
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2-1300-3 Requests for Lump-Sum Paym
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2-1300-4 Calculating Lump-Sum Sched
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2-1300 Exhibit 2: Sample Appealable
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3. REVIEW BY THE EMPLOYEES' COMPENS
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SIGNATURE _________________________
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We have received your request for a
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2-1400 DISALLOWANCES TABLE OF CONTE
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2-1400-1 Purpose and Scope Purpose
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a. Initial Disallowances. Such disa
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(1) Failure to Appear for Medical A
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(1) The name and location of the em
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injury caused no disability for wor
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(3) A specific service which the cl
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2-1400-7 How to Issue Pre-Terminati
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(a) The case is being referred beca
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(a) Compensation is being terminate
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. Source of Advice. District office
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usual rate, i.e., 75 percent of the
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objective findings to support your
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2-1400 Exhibit 3: Sample Notice of
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2-1400 Exhibit 4: Sample Letter Con
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2-1400 Exhibit 6: Sample Notice of
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2-1400 Exhibit 8: Sample Letter Con
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2-1400 Exhibit 10: Sample Letter De
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2-1500 RECURRENCES TABLE OF CONTENT
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(d) Closure of a base or other faci
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(1) The medical evidence needed to
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c. Case Management. The CE should c
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emains the same regardless of wheth
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2-1600 REVIEW PROCESS TABLE OF CONT
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c. Formal Decision. Chapter 2-1400
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the request. H&R will acknowledge r
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spouse or child prevents his or her
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OWCP shall pay fees requested by wi
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2-1601-9 Cases Returned from H&R 9.
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2-1601 Exhibit 2: Sample Letters Ac
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Exhibit 3, page 1 of 3: Hearing Not
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Exhibit 3, page 3 of 3: Hearing Ins
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2-1601 Exhibit 5: Request for Comme
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2-1602 RECONSIDERATIONS TABLE OF CO
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2-1602-2 Policy 2. Policy. The foll
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d. Decision. An untimely applicatio
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percentage of the award under the S
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(2) The cover letter to the agency
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2-1602 Exhibit 1: Sample Letter Ret
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Dear CLAIMANT NAME: We have reviewe
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2-1602 Exhibit 5: Sample Compensati
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2-1603 APPEALS TABLE OF CONTENTS Pa
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d. Timeliness of Filing. A person r
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2-1603-6 Cases Returned to District
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2-1700 SPECIAL ACT CASES TABLE OF C
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2-1700-4 Peace Corps 4. Peace Corps
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(2) Staff Spouses. (a) The spouses
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Compensation for loss of wages may
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(3) Return from Service Abroad. d.
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Section 5 U.S.C. 8101(4), which pro
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(1)While at a Job Corps Center, an
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(1)Enrollees are required to report
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coverage under 5 U.S.C. 8101. b. Co
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2-1800-2 Authority 2. Authority. Ho
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determined by the type of vehicle,
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greatest current fair market value
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Such certification from an architec
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over $10,000, and that amount must
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2-1800-7 Housing Modifications for
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send an approval letter along with
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By signing this agreement, all part
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By signing this agreement, all part
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Memorandum of Agreement - Modificat
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Memorandum of Agreement - Housing M
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