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(2) The CE must evaluate the medical evidence in terms of any intervening injuries or newly acquired medical conditions as described on Form CA-2a. If the information provided with Form CA-2a is not sufficient to obtain a clear picture of the employee's activities and health during the period since release from medical care, the CE should request clarification or additional information as indicated. (3) As with recurrences of medical conditions within 90 days of release from care, additional medical support for the claim will be needed if an adjudicatory action has negated the original finding of causal relationship, or the original acceptance involved a temporary aggravation of a pre-existing condition. c. Recurrence Claims for Injuries in which a Destructive Surgery or Permanent Damage has been accepted. Destructive surgeries are normally not authorized except in cases of severe debilitating injury or disease, after all other medical and therapeutic options for relief have been exhausted. Permanent damage usually follows such procedures. If a recurrence be claimed following a destructive surgery that was approved or where permanent damage has been accepted, the claim can be adjudicated without significant development, regardless of the time that has elapsed since the return to work. 2-1500-6 Recurrent Disability for Work Within 90 Days of Return to Duty 6. Recurrent Disability for Work Within 90 Days of Return to Duty. The purpose of this paragraph is to describe the evidence needed to adjudicate claims for recurrence of disability for work filed shortly after return to light or full duty. Recurrences claimed due to withdrawal of light duty are addressed in paragraph 7a below. a. Burden of Proof. The claimant is not required to produce the same evidence as for a recurrence claimed long after apparent recovery and return to work. Therefore, in cases where recurring disability for work is claimed within 90 days or less from the first return to duty, the focus is on disability rather than causal relationship. b. Disability for Work. Assuming that requirements described in paragraph 5 above concerning causal relationship are met, the CE should ask the employee to submit a Form OWCP-5 and/or a narrative statement from the attending physician which describes the duties which the employee cannot perform and the demonstrated objective medical findings that form the basis for renewed disability for work. The CE should obtain a copy of the employee's current position description if it is not already in file and consider assignment of a Field Nurse to the case. FECA-PT2 Printed: 06/08/2010 646
c. Case Management. The CE should consider a second opinion referral when a recurrence of disability is accepted if the claimant is not under the care of a specialist, or if the claimant had previously been released from treatment and disability for work was not expected to recur, or if a previous history of non-work-related disabling medical condition exists and the injury was a relatively minor one. In such cases, the CE should ask the second opinion specialist to address the questions of continuing causal relationship and whether any residuals exist which prevent return to light or full duty. 2-1500-7 Recurrent Disability for Work After 90 Days from Return to Duty 7. Recurrent Disability for Work After 90 Days from Return to Duty. The purpose of this paragraph is to address the evidence needed to adjudicate a claim for recurrence of disability for work for periods after 90 days from return to duty. This evidence differs according to whether the claimant returned to light or full duty. It does not matter whether the case is open or closed. Recurrence of disability means an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness. This term also means an inability to work that takes place when a light-duty assignment made specifically to accommodate an employee's physical limitations due to his or her work-related injury or illness is withdrawn (except when such withdrawal occurs for reasons of misconduct, non-performance of job duties or a reduction-in-force), or when the physical requirements of such an assignment are altered so that they exceed his or her established physical limitations. See 20 C.F.R. 10.5(x). a. Claimants Performing Light Duty. The reason for claiming the recurrence may be medical, or it may stem from withdrawal of a light duty assignment or other issue affecting the suitability of the work performed. The claimant's work limitations may be well established and stable, or they may be changing in the recovery process. (1) Burden of Proof. Claimants who are performing light duty are not considered fully recovered from their work-related injuries. This is true whether or not they have been rated for LWEC; however, see part 5 in this section where an LWEC rating is in place. Therefore, the claimant's burden of proof is mainly to establish that any increase in disability for work is due to the accepted injury, rather than another cause (Terry L. Hedman, 38 ECAB 222). In Hedman, ECAB found that when an employee, who is disabled from the job he held when injured on account of employment-related residuals, returns to a light-duty position or the medical evidence of record establishes that he can perform the light-duty position, the employee has the burden of establishing by the weight of the reliable, probative and substantial evidence a recurrence of total disability and to show that he cannot perform such light duty. As part of his burden, the employee must show a change in the nature and extent of the injury-related condition or a change in the nature and extent of the light-duty job requirements. However, an increase in pain does not constitute objective evidence of disability. See Sally S. Weinacht, Docket No. 91-1035, issued November 12, 1991. (2) Medical Issues. The CE should obtain a Form OWCP-5 and a narrative statement from the attending physician which describes the duties which the employee cannot perform and the demonstrated objective medical findings that form the basis of renewed disability for work. This information should be evaluated in light of any intervening injuries or subsequently acquired medical conditions reported on Form CA-2a. The CE should obtain a copy of the employee's current position description if it is not already in file. FECA-PT2 Printed: 06/08/2010 647
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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
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Where an employee asserts that emot
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The Board noted that Cannon was unl
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Since both cases involve procedures
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Ashberry's disability was not compe
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no longer be considered so in light
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2-0804-18 Employing Agency Physical
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f. This matter was initially addres
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compensation would be payable for t
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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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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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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
Page 595 and 596: 2-1300-4 Calculating Lump-Sum Sched
Page 597 and 598: 2-1300 Exhibit 2: Sample Appealable
Page 599 and 600: 3. REVIEW BY THE EMPLOYEES' COMPENS
Page 601 and 602: SIGNATURE _________________________
Page 603 and 604: We have received your request for a
Page 605 and 606: 2-1400 DISALLOWANCES TABLE OF CONTE
Page 607 and 608: 2-1400-1 Purpose and Scope Purpose
Page 609 and 610: a. Initial Disallowances. Such disa
Page 611 and 612: (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
Page 621 and 622: (a) The case is being referred beca
Page 623 and 624: (a) Compensation is being terminate
Page 625 and 626: . Source of Advice. District office
Page 627 and 628: usual rate, i.e., 75 percent of the
Page 629 and 630: objective findings to support your
Page 631 and 632: 2-1400 Exhibit 3: Sample Notice of
Page 633 and 634: 2-1400 Exhibit 4: Sample Letter Con
Page 635 and 636: 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
Page 643 and 644: (d) Closure of a base or other faci
Page 645: (1) The medical evidence needed to
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: FECA-PT2 Printed: 06/08/2010 655
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.
Page 665 and 666: 2-1601 Exhibit 2: Sample Letters Ac
Page 667 and 668: Exhibit 3, page 1 of 3: Hearing Not
Page 669 and 670: Exhibit 3, page 3 of 3: Hearing Ins
Page 671 and 672: 2-1601 Exhibit 5: Request for Comme
Page 673 and 674: 2-1602 RECONSIDERATIONS TABLE OF CO
Page 675 and 676: 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
Page 681 and 682: (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
Page 689 and 690: 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
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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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FECA-PT2 Printed: 06/08/2010 713
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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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