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2-0806 Exhibit 7: Sample Letter to Agency--Carpal Tunnel Syndrome Dear EMPLOYING AGENCY REPRESENTATIVE: I am writing in reference to the claim for benefits under the Federal Employees' Compensation Act (FECA) filed by the above-named employee for carpal tunnel syndrome. We have reviewed the Form CA-2 and all accompanying information. We need the following additional information from you to determine whether the employee is eligible for benefits under the FECA. 1. Provide comments from a knowledgeable supervisor on the accuracy of all statements provided by the employee relative to this claim. Does the agency concur with the employee's allegations? If there are points of disagreement, please explain fully and provide any supporting evidence. 2. What tasks did the employee perform which involved repetitive hand and wrist movements? What was the frequency and duration of these activities? 3. Describe in detail the specific work area implicated by the claimant in the development of the claimed condition. (A diagram may be submitted for reference). a. Describe desk, type of chair, location/height/alignment of keyboard and VDT, height and location of items for which the employee routinely reached, etc. 4. What precautions were taken to minimize the effects of these activities, e.g., rest breaks, alternate duties? 5. Provide a copy of this employee's position description and physical requirements of the job. If the actual duties varied from the official description, explain how. 6. [FREE FLOW IF DESIRED] Title 20 CFR 10.102(b) provides that, in the absence of a full reply from the agency, we may accept the claimant's allegations as factual. Your assistance in ensuring that all requested information is provided to OWCP within 30 days is appreciated. If clarification of any portion of this request is required, or if you cannot provide any requested information, please contact us immediately. Thank you for your assistance. Sincerely, NAME OF SIGNER TITLE FECA-PT2 Printed: 06/08/2010 250
2-0806 Exhibit 8: Sample Letter to Claimant--General Dear CLAIMANT NAME: I am writing in reference to your claim for benefits under the Federal Employees' Compensation Act (FECA) for [CONDITION OR LOCATION OF ILLNESS]. We have received and reviewed [DESCRIBE WHAT WAS RECEIVED]. This information is not sufficient for us to determine whether you are eligible for benefits because [EXPLAIN WHY EVIDENCE INSUFFICIENT]. Please provide the information requested below to us at the address on the letterhead. Include as much detail as possible. Send a copy of your response to your employer for comments. 1. Describe the work-related exposure or contact which you believe contributed to your condition: a. To what were you exposed? b. How were you exposed? What tasks did you perform which required the claimed exposure or contact? c. How often were you exposed? For how long on each occasion? 2. Describe all exposure outside your Federal employment, i.e. in other work, at home, or with any hobbies, which is similar to the working conditions which you believe led to your illness. 3. Describe the development of the claimed condition. When did you first notice it? Has it come and gone or has it been present continuously? What symptoms have you had? What seems to make the condition worse? Better? What treatment has been effective in controlling or curing it? 4. Describe all previous similar conditions. 5. Provide a comprehensive medical report from your treating physician which describes your symptoms; results of examinations and tests; diagnosis; the treatment provided; the effect of treatment; and the doctor's opinion, with medical reasons, on the cause of your condition. Specifically, if your doctor feels that exposure or incidents in your Federal employment contributed to your condition, an explanation of how such exposure contributed should be provided. 6. Provide the name, address and phone number of your attending physician(s). 7. Sign and return a medical release form for each physician or medical facility who has treated you for the claimed condition. Two forms are enclosed for this purpose. This will allow us to correspond directly with your physician(s) if additional information or clarification is necessary. 8. [FREE FLOW IF DESIRED] We may write directly to a physician or any other party who may be able to provide information which will help us decide your eligibility for benefits. Our efforts are intended to assist you in collecting evidence. Please understand that it is ultimately your responsibility, as the claimant, to provide or ensure the FECA-PT2 Printed: 06/08/2010 251
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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
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. Employee Status. The $200 payment
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(b) Form CA-1617 should be released
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2-0700-20 Gratuity 20. Gratuity fro
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2-0700 Exhibit 1: Percentages of En
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2-0800-2 Definitions 2. Definitions
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. Employing Agency. The FECA requir
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claimant, the CE should send a copy
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(3) The case must be coded as withd
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entire group of cases must be adjud
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2-0800-10 Investigation 10. Investi
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2-0800-13 Affirmative Defense 13. A
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2-0801 TIME TABLE OF CONTENTS Parag
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5 U.S.C. 8122 on the ground that no
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(4) If a claim is not received by O
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(1) Disappearance During a Period o
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2-0802 CIVIL EMPLOYEE TABLE OF CONT
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2-0802-1 Purpose and Scope 1. Purpo
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(1) The precise time when the worke
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2-0802-8 Contract Job Cleaners Used
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2-0802-13 Volunteer Workers with th
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(1) Whether, prior to the transfer
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. The pay rate for compensation pur
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2-0802-24 U.S. Park Police and Secr
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a participant or crew leader servin
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2-0803 FACT OF INJURY TABLE OF CONT
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2-0803-4 Development of Factual Evi
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2-0804 PERFORMANCE OF DUTY TABLE OF
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time before or after the end of the
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(a) A diagram showing the boundarie
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d. Workers in a Travel Status. (1)
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2-0804-6 To and From Work 6. To and
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(a) The reason the employee was req
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(1) At the time of the injury, the
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(1) Martha G. List, 26 ECAB 200. Em
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duty, the CE may approve the case.
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action taken; and (4) Statements fr
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2-0804-14 Statutory Exclusions 14.
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would justify such disobedience. (c
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(2) The official superior should al
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c. Development. (1) It is the CE's
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such as soliciting new members or c
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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
Page 217 and 218: (6) Certain other kinds of cases re
Page 219 and 220: (2) A nurse becomes disabled by pul
Page 221 and 222: the body originally injured is term
Page 223 and 224: 2-0806 OCCUPATIONAL ILLNESS TABLE O
Page 225 and 226: 2-0806-1 Purpose and Scope 1. Purpo
Page 227 and 228: the following steps, depending on w
Page 229 and 230: (4) Exposure to and Identification
Page 231 and 232: While records of past medical treat
Page 233 and 234: the medical connection between lift
Page 235 and 236: (b) The medical evidence presented
Page 237 and 238: 2-080 Exhibit 2: Sample Letter to C
Page 239 and 240: 2-0806 Exhibit 3: Sample Letter to
Page 241 and 242: TITLE _____________________________
Page 245 and 246: eason, you should call or write to
Page 249: 9. [FREE FLOW IF DESIRED] We may wr
Page 255 and 256: If you do not understand any part o
Page 261 and 262: stressful situations in your person
Page 263 and 264: TITLE FECA-PT2 Printed: 06/08/2010
Page 265 and 266: I am writing in reference to your c
Page 269 and 270: We may write directly to a physicia
Page 271 and 272: 2-0806 Exhibit 20: Sample Questions
Page 273 and 274: TA Amputation TB Back strain TC Con
Page 275 and 276: (D )Other Disability, Occupational
Page 277 and 278: a. Traumatic Injury. If an air traf
Page 279 and 280: 2-0807-6 Period of Entitlement 6. P
Page 281 and 282: d. Return to Duty. The injured empl
Page 283 and 284: f. The injury was not reported on a
Page 285 and 286: W = Total number weeks worked P/W =
Page 287 and 288: COP is paid for the entire period o
Page 289 and 290: (c) When the physician's report ind
Page 291 and 292: (a) Assign or detail the employee t
Page 293 and 294: . Monitoring the Claim. (1) If Form
Page 295 and 296: (4) If conflicting information appe
Page 297 and 298: a. Permanent Total Disability (PTD)
Page 299 and 300: (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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2-0813 Exhibit 4: Sample Letter to
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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
Page 457 and 458:
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
Page 471 and 472:
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
Page 505 and 506:
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)
Page 517 and 518:
*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
Page 525 and 526:
. Death Benefits. When compensation
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(3) Certification. The CE should ha
Page 529 and 530:
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
Page 535 and 536:
(b) The claimant may be entitled to
Page 537 and 538:
d. Obtaining Elections--Educational
Page 539 and 540:
(3) The CE must advise the claimant
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c. Injuries On and After September
Page 543 and 544:
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
Page 585 and 586:
. 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
Page 593 and 594:
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
Page 599 and 600:
3. REVIEW BY THE EMPLOYEES' COMPENS
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SIGNATURE _________________________
Page 603 and 604:
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
Page 613 and 614:
(1) The name and location of the em
Page 615 and 616:
injury caused no disability for wor
Page 617 and 618:
(3) A specific service which the cl
Page 619 and 620:
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
Page 631 and 632:
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
Page 637 and 638:
2-1400 Exhibit 8: Sample Letter Con
Page 639 and 640:
2-1400 Exhibit 10: Sample Letter De
Page 641 and 642:
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
Page 649 and 650:
emains the same regardless of wheth
Page 651 and 652:
2-1600 REVIEW PROCESS TABLE OF CONT
Page 653 and 654:
c. Formal Decision. Chapter 2-1400
Page 655 and 656:
Page 657 and 658:
the request. H&R will acknowledge r
Page 659 and 660:
spouse or child prevents his or her
Page 661 and 662:
OWCP shall pay fees requested by wi
Page 663 and 664:
2-1601-9 Cases Returned from H&R 9.
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2-1601 Exhibit 2: Sample Letters Ac
Page 667 and 668:
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
Page 677 and 678:
d. Decision. An untimely applicatio
Page 679 and 680:
percentage of the award under the S
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(2) The cover letter to the agency
Page 683 and 684:
2-1602 Exhibit 1: Sample Letter Ret
Page 685 and 686:
Dear CLAIMANT NAME: We have reviewe
Page 687 and 688:
2-1602 Exhibit 5: Sample Compensati
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2-1603 APPEALS TABLE OF CONTENTS Pa
Page 691 and 692:
d. Timeliness of Filing. A person r
Page 693 and 694:
2-1603-6 Cases Returned to District
Page 695 and 696:
2-1700 SPECIAL ACT CASES TABLE OF C
Page 697 and 698:
2-1700-4 Peace Corps 4. Peace Corps
Page 699 and 700:
(2) Staff Spouses. (a) The spouses
Page 701 and 702:
Compensation for loss of wages may
Page 703 and 704:
(3) Return from Service Abroad. d.
Page 705 and 706:
Section 5 U.S.C. 8101(4), which pro
Page 707 and 708:
(1)While at a Job Corps Center, an
Page 709 and 710:
(1)Enrollees are required to report
Page 711 and 712:
coverage under 5 U.S.C. 8101. b. Co
Page 713 and 714:
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2-1800-2 Authority 2. Authority. Ho
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determined by the type of vehicle,
Page 719 and 720:
greatest current fair market value
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Such certification from an architec
Page 723 and 724:
over $10,000, and that amount must
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2-1800-7 Housing Modifications for
Page 727 and 728:
send an approval letter along with
Page 729 and 730:
By signing this agreement, all part
Page 731 and 732:
By signing this agreement, all part
Page 733 and 734:
Memorandum of Agreement - Modificat
Page 735 and 736:
Memorandum of Agreement - Housing M
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