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for guidance in composing such questions).
e. Other Medical Developments. From medical reports, the RN, RS, or RC, the CE may learn of
other medical factors affecting the claimant's recovery. These include pregnancy; prescription of a
course of physical therapy or medical rehabilitation; the emergence of a non-work-related
condition; or the need for surgery (work-related or not).
If the situation will materially affect the time needed to recover from the work-related injury, the
CE may advise the RN or RS to modify the intervention or interrupt efforts until the projected
recovery date, if less than six months away. (Interrupted status, rather than an extension, is
appropriate since the claimant would require little or no active involvement by the FN during this
time.)
f. Transfer of Care. If the attending physician is repeatedly unresponsive to requests from the
Office for a treatment plan, the CE may consider transfer of care to another physician (see PM
Chapter 2-810 or 3-300).
g. Recurrences. If the employee claims a recurrence of total disability or a relapse which
returns him or her to light duty status or fewer hours of work per day, the CE will need to follow
the procedures outlined in PM Chapter 2-1500. The CE will need to decide whether the RN or RS
should continue to work with the claimant. This decision should be based on whether return to
work with the Federal employing agency remains feasible, the length of time since the original
injury, and the degree of disability. If nurse or rehabilitation services are under way:
(1) The RN or RS must refer the case to the CE for a decision on the recurrence before
services are interrupted or terminated.
(2) The RS may wish to refer the case, through the CE, to an OWCP RN for assessment
of the claimant's medical situation. The CE may authorize such a referral.
h. Work Limitations. The CE may ask the RN to obtain a description of work limitations from
the attending physician, or the CE may request them directly from the attending physician or a
second opinion specialist. Ordinarily, Form OWCP-5 should be used for this purpose. A description
of these limitations should appear in file before any referral for vocational rehabilitation services is
made.
2-0600-7 Referrals for Vocational Rehabilitation Services
7. Referrals for Vocational Rehabilitation Services. This paragraph addresses the criteria and
procedures for referring cases for vocational rehabilitation services. Further information about vocational
rehabilitation may be found in FECA PM Chapter 2-0813 and OWCP PM Part 3.
a Criteria for Referral. If the claimant has stable, well-defined work limitations which allow
him or her to work eight hours per day, the case should be referred for rehabilitation services. (A
limited referral may be made for placement services with the previous employer when the claimant
can work at least four hours per day and the previous employer may be able to offer a modified
job. The CE should note on Form OWCP-14 that the referral is limited to placement with the
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