Printing - FECA-PT2 - National Association of Letter Carriers

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limitations due to his or her work-related injury or illness is withdrawn (except when such withdrawal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