FECA Transmittals

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation (DFELHWC) with this issuance announces a revision to its procedures regarding simple traumatic injury cases that are closed upon receipt.

In the FECA program, certain cases which are considered very simple/minor traumatic injuries, and are not expected to involve large medical expenses, may be administratively closed without formal adjudication by claims staff.

These cases are automatically reopened if the medical bills exceed $1500, a wage loss or recurrence claim is received, the "controverted indicator" in the case record is changed to "Y" due to receipt of a late agency controversion, or the continuation of pay (COP) nurse has closed the case without a return to full time employment by the claimant.

This revision emphasizes that a claimant may also request formal adjudication of their case for any other reason at any time. If such request is received, the CE should proceed with development, as necessary, and issue a formal decision.

For consistency across procedure, these cases will now be called "Administrative Authorization of Limited Benefits" cases. Previously, they have been identified as a "Short Form Closure" cases or "Administrative Review" cases.

The following paragraph of the noted chapter has been updated:

Chapter 1-0400, Paragraph 4, has been updated to change the name of these claims to "Administrative Authorization of Limited Benefits" cases. Also added was the indication that a claimant may also request formal adjudication of their case for any other reason at any time and when such request is received, the CE should proceed with development, as necessary, and issue a formal decision.

Renaming changes consistent with the above were also made to Chapter 1-0400, Exhibit 1, Chapter 2-0401, Paragraph 8, Chapter 2-0600, Paragraph 4, Chapter 2-0800, Paragraphs 2, 4, 5, and 11.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation (DFELHWC), with this issuance, announces a revision to Procedure Manual Chapter 2-0803 pertaining to fact of injury, element three of the five basic requirements, with respect to the adjudication of initial traumatic and occupational injury claims. Claims Examiners are responsible for the adjudication of claims filed under the FECA and ensuring that the five basic elements are met prior to accepting a claim. Various issues arise when determining whether an employee was injured as claimed and whether the medical evidence established a diagnosis in connection with the claimed injury. The scope of these issues varies and may require different levels of review depending on the complexity of the claim.

To that end, due to the complexity and detail of these issues, Chapter 2-0803 has been updated. Paragraph 3: Fact of Injury (FOI)-Factual has been separated into five paragraphs: the general criteria for the factual component of FOI, FOI-Factual in Traumatic Injury claims, FOI-Factual in Basic Occupational Disease claims, FOI-Factual in Extended Occupational Disease claims, and FOI-Factual in Stress Claims.

Because of the additional paragraphs defining FOI-Factual, paragraphs 4: FOI-Medical and 5: Denial Reason have been moved to paragraphs 8 and 9 respectively. Further detail was added to paragraph 8: FOI-Medical to define the types of medical evidence that is and is not appropriate to establish the claim. New guidance was added for instances when the claim would otherwise be acceptable had the medical report been signed by a qualified physician. In these instances, the CEs are guided to seek the opinion of the DMA.

References to Employees' Compensation Appeal Board (ECAB) decisions that discuss aspects of what is considered established as factual have been updated as appropriate.

The specific changes are outlined below.

ECAB citations have been updated throughout PM 2-0803, Fact of Injury, to provide more recent references. And multiple examples have been added throughout to help put the guidance into practice. The following paragraphs from PM 2-0803, Fact of Injury have been updated as follows:

Paragraph 2, PM 2-0803, Components of Fact of Injury, has been updated to include an ECAB from 2015 that explains FOI-Factual and FOI-Medical. Paragraph 2b, FOI-Medical, removed the reference for no medical required for visual injury.

Paragraph 3, PM 2-0803, Fact of Injury – Factual, has been updated to focus on the general concept of the factual component of this element and the documentation submitted with a claim that is considered in determining whether FOI-Factual has been met. Paragraph 3a was re-formatted and fit into the main paragraph to be more concise. Paragraphs 3b and 3c were removed as the concepts it contained have been modified and incorporated in later paragraphs with more precise guidance.

Paragraph 4, PM 2-0803, Fact of Injury – Factual in TI Claims, has been added to provide clarity on the requirements in establishing the factual basis of a TI claim, to include the types of evidence that is considered (i.e., statements from the claimant, employing agency, and/or witnesses), examples, inconsistent statements and the development actions to the claimant and/or employing agency that the CE may undertake to obtain the evidence necessary to establish that the injury occurred as claimed. Emphasis is provided to stress the importance of accepting the claimant's allegations in the absence of contrary evidence.

Paragraph 4a(2) provides guidance that a positive statement from the employing agency is not required and that a negative statement should be weighed against the claimant's statement to determine if any challenge is valid. Emphasis is provided to support that an injury does not need to be witnessed in order to be supported to have occurred. Delays in notification or seeking medical treatment have been removed as an example of an inconsistency within the factual evidence. The guidance contained in paragraph 4c(1) was adjusted from its prior version at paragraph 3c(1) where the requirements for a claimant's statement has been made to be more concise and unnecessary details that do not directly relate to the claimant's work injury are no longer part of the development process.

Paragraph 5, PM 2-0803, Fact of Injury – Factual in Basic OD Claims, has been added to distinguish between the factual evidence required in TI claims and the factual evidence required in Basic ODs to establish the factual component of FOI. Examples and evidence required to establish the factual basis of Basic OD claims were added. Emphasis has been placed to confirm that the strength of the claimant's statement holds probative value in the absence of any strong or persuasive evidence to the contrary. 803-5b(1)(b) furthers the discussion on assessing a claimant's position to determine the amount of detail needed to establish the factual element of the claim. Paragraph 5d(2) makes adjustments to the requirements for a claimant's statement similar to the changes found in paragraph 4c(1).

Paragraph 6, PM 2-0803, Fact of Injury – Factual in Extended OD Claims, has been added to distinguish between the factual evidence required for Basic OD claims and Extended OD claims. The sources of evidence and the evidence required to establish the factual basis of an Extended OD claim were added. The paragraph also includes a discussion of the development required when inconsistencies are identified in the evidence. Given the nature of injury claimed, often more evidence is required to establish the injury occurred as claimed. Separate guidance is provided to establish the specific information required to support claims for hearing loss, infectious diseases and other extended OD claims including cardiovascular conditions. Greater emphasis is placed on obtaining information from the employing agency to support a claimant's allegations; however, the lack of corroborative evidence from the employer is not fatal to the case. The complexity of the cases is stressed as is the need to weigh inconsistencies and the potential for multiple levels of development.

Paragraph 7, PM 2-0803, Fact of Injury - Factual in Stress Claims, has been added to expand on the factual evidence required to establish a claimed allegation and to explain that corroborating evidence is required to establish an allegation. This paragraph also includes the sources of information and the development actions required to establish an allegation when there are inconsistencies in the evidence of record. Pertinent examples were included to illustrate the instances where a claimed allegation is established. It is noted that perceptions alone are not sufficient to support an allegation.

It is emphasized that it is the claimant's burden to establish the factual element of their claim and may corroborate their allegations with witness statements, findings from EEO complaints or grievances, or sufficient detail that could establish the specifics of each allegation. However, it is also noted that such detailed specifics may not be necessary if the general accusation raised by the claimant is supported by the employing agency.

Paragraph 8, PM 2-0803, Fact of Injury – Medical, has been moved from paragraph 4, after the procedural discussion of the factual component of Fact of Injury. This paragraph expands on the type of medical evidence that may be used to establish the medical component of Fact of Injury, including the requirement for a wet or electronic signature of a qualified physician and/or a countersignature of a qualified physician if a non-qualifying physician provided the report. Guidance is also given for serious and catastrophic cases and accepting the claim as soon as possible for the established minor condition(s).

Guidance was added to note that, in traumatic injury cases when all five basics would have been satisfied, but the only medical reports supporting Fact of Injury – Medical and Causal Relationship were provided by a physician's assistant or a nurse, the CE should seek the opinion of the DMA regarding the medical aspect of the claim. The case can be accepted if the DMA concurs, and should be denied for Fact of Injury – Medical if the DMA disagrees.

A further discussion on the types of medical evidence that may be present in the file and what can and cannot be used to satisfy Fact of Injury – Medical has been added to clarify the evidentiary requirement.

ECAB citation L.N., Docket No. 10-1695 (issued May 3, 2011) was removed in lieu of adding two examples to expand on the discussion of the difference between FOI: Medical and Causal Relationship with emphasis on the presence of a firm diagnosis from a physician as the criteria for establishing FOI: Medical.

A further discussion on diagnoses of pain, symptoms and discomfort has been added for clarity in addressing these references in medical reports.

Paragraph 9, PM 2-0803, Denial Reason, formerly Paragraph 5, has been revised to explain the guidance, following the due process period, when a claim fails to establish the factual and/or medical component of the Fact of Injury requirement. A discussion of the absence of a claimant's response to the questions posed by the office in the development letter being the sole reason for a factual denial is insufficient and how the claims examiner should review the totality of the evidence in determining whether Fact of Injury is established. The CE must weigh all of the evidence present at the time of rendering the decision and identify how the totality of the factual evidence fails to establish the factual element of the claim.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapter 1-0200 pertaining to jurisdiction of new extended occupational disease claims.

With this revision, extended occupational disease claims for emotional conditions will no longer be processed within FECA non-specialized offices. Instead, they will be processed within the Special Claims Unit of DFELHWC until adjudication. Once adjudicated, claims may be reassigned to a claims examiner in a non-specialized office. The following paragraph of the noted chapter has been updated:

Paragraph 3, Special Jurisdiction, c. Processed in the Special Claims Unit until Adjudication

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a full revision to Procedure Manual Chapter 2-1601, Hearings and Reviews of the Written Record. This chapter describes the processing of requests for hearings, to include review of the case file, arrangements for the hearing, conduct of the hearing, and issuance of the decision. Additionally, procedures are described for handling requests for review of the written record. These functions, along with pre-recoupment hearings in overpayment cases (see FECA PM Part 6), are the responsibility of the Branch of Hearings and Review (H&R) within DFELHWC's National Office.

The specific changes are outlined below.

Paragraph 2, Policy, was updated to cite current ECAB case precedent regarding OWCP’s discretionary authority to grant a claimant’s request for a hearing regardless of the date of injury or death.

Paragraph 3, Applications, was updated to reflect the utilization of ECOMP to submit requests and reference to the Central Mail Room. A new section was added detailing that the Branch will assign multiple pending appeals on the same case to the same Hearing Representative.

Paragraph 4, Initial Review of the Case, was revised to reference ECOMP, and to provide current ECAB case precedent regarding simultaneous appeals. A section was added that outlined the handling of case records that contain a reasonable accommodation with a documented need for communication assistance. Another section was added to include reference to reversals during the initial review process.

New sections were also added that outline the issuance of reversals and remands before a hearing and the hearing representative’s ability to contact the claimant or authorized representative via telephonic communication to obtain evidence needed, including appropriate examples.

Paragraph 5, Review of the Written Record, was modified to include new sections outlining the formal review, remand, and reverse processes, including issuance of reversals and remands before formal review, as well as the representative’s ability to contact the claimant or authorized representative for additional evidence needed, similar to what is described in paragraph 4.

Paragraph 6, Arranging for Hearings, was modified to omit obsolete language involving magnetic tape recording. A requirement was added that the formal denial of a subpoena request must explain the other available means which are reasonably likely to allow discovery of the information or why the information requested is not necessary for the adjudication of the claim.

Paragraph 7, Conduct of Hearings, was modified to provide updated guidance to ensure any reasonable accommodations are adhered to during the hearing.

A new section was added that detailed the processing of summary decisions in cases that warrant a remand or reversal of the Office’s decision, including appropriate examples. The new section also outlined that summary decisions are issued contemporaneous to a hearing, allowing the injured worker to receive a remand or reversal decision faster. Emphasis was added that under no circumstances may a summary decision be used to issue an affirmation.

Paragraph 8, Reaching a Determination, was updated to state that ECAB citations used should be current if possible, and relevant to the specific issue.

Paragraph 9, Claims Office Actions, was updated to show that action is to be taken promptly after the return of the case. The current contacts for reporting a remand decision believed to contain a serious error or fact of law were also updated.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC), with this issuance, announces a brief revision to Procedure Manual Chapter 2-0812 pertaining to periodic reviews of disability claims. In all periodic roll cases, it remains the responsibility of the Claims Examiner (CE) to ensure that evidence remains current in the case, that all necessary medical care is provided, and that appropriate use is made of nursing and rehabilitation services.

All cases on the periodic roll require completion of Form EN-1032 on a yearly basis. Form CA-1032 is the cover letter for the EN-1032. DFELHWC generates and mails Form CA-1032 (with EN-1032 attachment) to claimants.

This procedural update clarifies the timeframes in which the CE should review and respond to the claimant’s completed EN-1032. Specifically, within 180 days of the PER create date, the CE should either close the PER, or, if a follow up action is needed, the CE should take the necessary action and take subsequent actions at least every 120 days thereafter until all issues are resolved and the PER can be closed.

The specific change is outlined below.

Paragraph 5, PM 2-0812, Monitoring Claims on the Periodic Roll, has been updated to reflect the above-referenced timeframes.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation (DFELHWC) with this issuance announces de minimis revisions to the above-referenced Procedure Manual (PM) Chapter.

Specifically, FECA Procedure Manual Chapter 6-0500 has been updated to clarify (1) wording concerning the formula to determine whether compromising of the debt to limit the repayment period is required and (2) that referrals to the Treasury Offset Program (TOP) are discretionary.

The updates are outlined below.

Paragraph 6, Compromise to Limit the Repayment Period, (c) a Specific Mathematical Formula, (2) To Determine Whether the Compromise is Required has been updated to clarify that you divide rather than multiply the principal balance plus any accrued charges by the monthly payment.

Paragraph 12, Referral to the Department of the Treasury has been updated to indicate that a referral "may" be made rather than "should" be made. A similar update was made in Paragraph 15, Recovery of an Existing Debt from a Deceased Debtor's Estate, subparagraph (e).

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation (DFELHWC) with this issuance announces revisions to the above-referenced Procedure Manual (PM) Chapter. Procedures concerning requests for an appeal to the Employees Compensation Board (ECAB), and the handling of the case files have been updated.

Specifically, FECA Procedure Manual Chapter 2-1603 has been updated to address procedures when a request for an appeal is received by OWCP rather than ECAB. The revisions also address timeliness of filing appeals, electronic filing of requests, responsibility of claims office in cases where appeal is at ECAB, actions taken with the preliminary review of the request for appeal, and reinstatement of benefits after an appeal.

The updates are outlined below.

Paragraph 2, Function of the ECAB, (b) Evidence, has been updated to clarify that ECAB may choose to hear oral argument, and (d) Timeliness of Filing, that the claimant must file the request for appeal to the Board within 180 days.

Paragraph 3, Requests for Appeal and Information about Board Procedures, language was added advising that requests for appeals must either be in writing and sent directly to the Board, or that they may be filed electronically through ECAB's Electronic Filing System. Language was updated to state that when a claimant sends a request for an appeal to OWCP rather than ECAB, that instead of OWCP sending the request to ECAB, the Claims Examiner will send a letter informing the claimant their request is being returned, and that the request and all correspondence must be sent directly to the Board.

Language was added to note that when the appeal is transmitted to the Board, that the office no longer has jurisdiction over the issue on appeal, even though they still have electronic access to the case record, and can issue decisions on matters that do not relate to the issue on appeal.

Paragraph 4, Transfer of Paper Case Files, the paragraph was removed.

Paragraph 5, Processing of Cases on Appeal, was renumbered to be Paragraph 4. Language was added concerning (a) Preliminary Review of cases, stating that a pleading from SOL is not required, and that the failure to submit a pleading doesn't prejudice the rights of the claimant or Director. Language was also added to state that ECAB will notify OWCP via nightly transmission that the case has been docketed, and that the claimant and their representative will receive written notification, which will be bronzed into the claims file. Language was removed from (b) Case Maintenance concerning the case remaining in the office while ECAB has the contents, (c) Inspection of the case record, was removed, and (d) Return of Case Record following ECAB's decision, was changed to (c).

Paragraph 6, Cases Returned to the Office, was renumbered to be Paragraph 5. Language for (a) Timeliness of Action, was changed from 30 days, to prescribed timeframes. In (b) Reinstatement of Benefits, CA-8 was changed to CA-1032, and language was changed to indicate that the Office should reinstate benefits following necessary development.

Paragraph 7, Representative's Fees, was renumbered to be Paragraph 6.

Exhibit 1, a sample letter advising that a request for an appeal was being forwarded to ECAB, has been removed.

NANCY GRISWOLD
Acting Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapters 2-800 and 2-0805 pertaining to the requirements necessary to adjudicate a claim for a minor, visible injury without medical evidence.

Specifically, a visible, minor injury can be accepted without a medical report when both of the following criteria have been met:

a. The condition reported is a minor one which can be identified on visual inspection by a lay person (e.g., burn, laceration, insect sting or animal bite); and

b. The injury was witnessed or reported promptly, and no dispute exists as to the occurrence of an injury.

The requirement that the claimant not lose time from work in order to be considered for acceptance without a medical report has been eliminated. The issue of disability is separate and distinct from initial claim adjudication; medical evidence remains required within 10 calendar days of filing for payment of continuation of pay. See 20 CFR 10.210. Further, for wage loss benefits, the claimant must also submit medical evidence showing that the condition claimed is disabling. See 20 CFR 10.115(f).

The list of requirements in both PM 2-800-6 and PM 2-805-3c has been amended accordingly to remove “c. No time was lost due to disability” and “(3) No time was lost due to disability”, respectively.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC), with this issuance, announces revisions to the above-referenced Procedure Manual Chapters. These updates comply with the Fiscal Year 2023 National Defense Authorization Act’s (NDAA) requirement to change the number of days to submit evidence in support of an initial claim for injury or disease.

On December 23, 2022, President Biden signed the Fiscal Year 2023 NDAA into law. Section 5305(c) of the NDAA provided for an increase in the time period for Federal Employees’ Compensation Act (FECA) claimants to supply supporting documentation to the Office of Workers’ Compensation Programs (OWCP). Specifically, the legislation directed the Secretary of Labor to (1) amend the FECA regulations at 20 CFR 20.121 to increase the minimum time to submit supporting documentation on an initial claim from 30 to 60 days and (2) modify the FECA procedure manual to do the same.

With these updates, the FECA Program now provides that prior to an initial claim being denied, claimants will be allowed at least 60 days to submit evidence in all initial development letters issued effective the date of this transmittal.

In addition, procedure now indicates that approximately halfway through the 60-day development period, if the evidence remains insufficient to accept the case, the CE should conduct a second review of the evidence and explain to the claimant why such evidence does not meet their burden of proof, reminding them that a final decision will be issued at the end of the 60-day period. This interim review will occur in traumatic injury claims, short form closures (administrative review claims) and basic occupational disease claims. See FECA PM 1-0400 Exhibit 1, FECA PM 2-0800.2.

The above procedures are being implemented prospectively for all claims developed on or after the date of this transmittal. This supersedes FECA Bulletin 23-03, issued January 9, 2023.

The following paragraphs of the noted chapters were updated to reflect 60 days instead of 30 days and to include the requisite secondary review.

Chapter 2-0600:

Paragraph 4, Case Adjudication.

Chapter 2-0800:

Paragraph 4, Responsibilities, c, OWCP, (2) Requesting Evidence

Paragraph 5, General Development, d, Lack of Response

Paragraph 8, Development of Medical Evidence, b, Initial Review and Development of Medical Evidence, (2) If after initial review

Paragraph 8, Development of Medical Evidence, b, Initial Review and Development of Medical Evidence, (3) Following the issuance of the initial development letter.

Chapter 2-0804:

Paragraph 16, Representational Functions, e, Case Development.

Chapter 2-1401:

Paragraph 2, Statutory and Regulatory Requirements, c, 20 C.F.R. §10.121 outlines that if the claimant

Paragraph 3, Burden of Proof, b, Timely Decisions

Paragraph 5, Writing the Initial Denial, b, Elements of the Denial, (1) Complete Background.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapter 2-0800, Initial Development of Claims, further clarifying the requirements to establish a claim where no development is needed due to a visible injury.

Established procedure provides that when the following criteria are satisfied, a case may be accepted without a medical report and no development of the case need be undertaken:

a. The condition reported is a minor one which can be identified on visual inspection by a lay person (e.g., burn, laceration, insect sting or animal bite); and

b. The injury was witnessed or reported promptly, and no dispute exists as to the occurrence of an injury.

This revision clarifies that corroborating evidence that the injury was actually identified on visual inspection by a lay person is not needed to establish a visible injury. Employing agency challenges on the basis that an agency representative did not visually identify the condition hold limited probative value.

PM 2-0800.6 has been modified accordingly to memorialize this guidance and provide examples of certain situations whereby a condition may still qualify as a visible injury despite not being readily apparent to an agency reviewer.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapter 2-0805, Causal Relationship, pertaining to the requirements for a medical specialist needed to establish an emotional condition.

Specifically, now only extended occupational disease claims for emotional conditions require a medical report from a psychiatrist or clinical psychologist in order to support a causal relationship between the reported work factors and the development of the emotional condition. This effectively removes that restriction from other claims, enabling physicians with other specialties to submit medical reports to establish initial claims. These are typically traumatic injuries where the event or events are very specific, unambiguous and are generally clearer to physicians outside the psychiatric specialty as incidents that may naturally result in an extreme emotional reaction.

The only paragraph in PM 2-805-3d(3)(c) has been amended. Instead of applying to “A claim for an emotional condition […],” the requirements of PM 2-805-3d(3)(c) now specifically only apply to “An extended occupational disease claim for an emotional condition [...]”.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Longshore and Harbor Workers' Compensation, with this issuance, announces revisions to the above-referenced Procedure Manual (PM) Chapter. With these revisions, self-certifications of certain payments will now be permissible to a GS-12 Claims Examiners or a higher-level authorities.

PM Chapter 2-0901, Compensation Claims. This chapter discusses the development of compensation claims, explains how to calculate compensation payments, and provides formulas for calculating basic compensation entitlements. In addition, this chapter also covers the payment certification authorization levels.

Paragraph 3, Certification; section b, Types of Payment; number (4), Self-Certification, has been updated to reflect that a GS-12 Claims Examiner or higher-level authority may be authorized to self-certify ongoing payments for temporary total disability unless there is a change in the official pay rate. In addition, a Supervisory Claims Examiner or higher-level authority may also individually grant self-certification permission to a GS-11 Claims Examiner.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapter 2-1701 pertaining to claims filed by the Peace Corps.

The Sam Farr and Nick Castle Peace Corps Reform Act of 2018 (Farr-Castle) modified various aspects of the Peace Corps’ operations, including changes to the initial provision of health care to volunteers following termination of service. Under an amendment to section 8142, the Farr-Castle Act directs the Secretary of the Department of Labor to authorize the Director of the Peace Corps to furnish medical benefits to a volunteer, who is injured during the volunteer’s period of service, for a period of 120 days following the termination of such service if the Director certifies that the volunteer’s injury probably meets the requirements set forth in 5 U.S.C. 8142(c)(3).

DFELHWC and the Peace Corps have collaborated to create a new form, the CA-15, Peace Corps Volunteer Authorization for Examination and/or Treatment, which will authorize medical treatment for recently terminated Peace Corps volunteers who require medical treatment for injuries/exposure sustained in the performance of their volunteer service.

This revision provides a detailed explanation of the procedures to be followed in using Form CA-15 to authorize medical treatment. It also eliminates the discretionary authority of the Peace Corps to pay for medical costs directly where the treatment of certain, specified medical conditions was under $1500, as such conditions will now be handled through the CA 15 process.

Additionally, the revisions to this chapter now allow Peace Corps volunteers to file claims while still in service abroad. Previously, volunteers filed at the time of separation of service. However, the Peace Corps continues to provide any medical care needed while abroad for the duration of the volunteer’s service.

Paragraph 1, Introduction, was modified to provide an introductory summary about the Sam Farr and Nick Castle Peace Corps Reform Act of 2018.

Paragraph 2, Statutory Provisions of the FECA, was modified to include the specific statutory amendments to the FECA per the Sam Farr and Nick Castle Peace Corps Reform Act.

Paragraph 5, Jurisdiction, was modified to change jurisdictional policy. Peace Corps claims will no longer be adjudicated in the Special Claims Unit. Instead, they will be assigned to a claims examiner in any FECA office by rotation.

Paragraph 8, Conditions of Coverage While Serving Abroad, was modified to emphasize that where certain conditions occur within 120 days of separation from service, a CA-15 may be issued. It was also modified to note that OWCP may only pay for abortions if rape, incest or the health of the mother is involved.

Paragraph 10, Initial Authorization for Medical Care, was modified in its entirety to fully explain that Form CA-15, Peace Corps Volunteer Authorization for Examination and/or Treatment, may be used to authorize medical treatment for recently terminated Peace Corps volunteers who require medical treatment for injuries/exposure sustained in the performance of their volunteer service. This section outlines the applicability, covered conditions, covered services, choice of provider and period of authorization.

Eliminated from Paragraph 10 is the discretionary authority of the Peace Corps to pay for medical costs directly where the treatment of certain, specified medical conditions was under $1500. Such conditions will now be handled through the CA-15 process.

Previous paragraph 11 was eliminated and consolidated with Paragraph 10 as the CA-15 will be the vehicle for initial authorization of medical care.

Previous paragraph 12 (now paragraph 11), Reporting Injuries and Deaths, was modified to provide for the ability of a Peace Corps Volunteer to file a claim while abroad through the use of the Employees’ Compensation Operations and Management Portal (ECOMP) or other designated electronic system. The Peace Corps provides for any medical care needed while abroad for the duration of the volunteer’s service, and will document the volunteer's medical treatment upon receipt of the CA-1 including indicating the name of the physician that first provided medical care as well as the date of such care.

Exhibit 1, Annual Pay Rates for Computing Compensation for Peace Corps Volunteers, was updated to include applicable pay rates through and including 2020.

Also, with this update, duplicative procedure on Peace Corps cases in section 2-1700.4 of the Procedure Manual has been removed.

A corresponding update has also been made in FECA PM Part 1, Chapter 1-0200, Jurisdiction to indicate the removal of Peace Corps cases from the jurisdiction of the special claims unit.

An update has been made in FECA PM Part 1, Chapter 1-0400, Creation of Cases, to allow for traumatic injury claims from the Peace Corps to short-form close on receipt.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC), with this issuance, announces a revision to Procedure Manual Chapter 1-0200 pertaining to jurisdiction. Specifically, paragraph 3, part b, Adjudicated and Managed in the FECA Special Claims Unit, was amended to incorporate claims filed by federal Firefighters (case designation FIR), effective December 14, 2021.

Exhibit 1 was updated to include COVID-19 cases covered under the American Rescue Plan Act (ARPA) of 2021, with a case number prefixed using 19.

Additionally, Exhibit 2 was updated with four new case designations, as outlined below.

C19 – This case designation will be used to identify cases containing reports of injuries related to COVID-19 claims covered under the American Rescue Plan Act (ARPA) of 2021.

COV – This case designation will be used to identify cases containing reports of injuries related to COVID-19 vaccines.

AHI – This case designation will be used to identify cases containing reports of injuries related to Anomalous Health Incidents (i.e. Havana Syndrome cases).

FIR – This case designation will be used to identify cases containing reports of injuries sustained by federal Firefighters created after December 14, 2021.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601, Disability Management Tracking, was revised and updated in its entirety in October 2011, with subsequent updates in November 2012, November 2013, and October 2017. An additional update to the chapter, as outlined below, is being made at this time.

One of the primary objectives of disability management is to return the claimant to work as soon as medically possible, but particularly within one year of the onset of disability. This one-year deadline is significant because section 8151(b) of the FECA requires the employing agency to offer the claimant his or her former position, or its equivalent, if the injury or disability has been fully overcome within one year.

In the past, claims staff were responsible for issuing such reminder letters no later than ten (10) months post the Disability Management (DM) application’s Track Date. After issuing the Ten Month Letter, the code TML was entered into the DM Tracking record. However, at this time, the process has been updated to allow for an automated batch process issuance of the Ten Month Letter. The batch process will run monthly and identify cases in an active QCM status where ten (10) months will have elapsed from the DM Track Date during that month. For those identified cases, the Ten Month Letter will automatically be issued to the claimant, the employing agency, and any authorized representative.

As a result of this automated batch process, the TML code is no longer necessary and has been deactivated from the DM Tracking application. Therefore, Paragraph 7, CE Intervention Codes, which outlines mandatory claims examiner codes, was updated to remove the TML (Ten Month Letter Issued) code.

Chapter 2-0600, Paragraph 11, Claimant Intervention, has been revised to delete the instruction that it is the claims examiner’s responsibility to issue the Ten Month Letter.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

Under the Federal Employees’ Compensation Act, (FECA), if an employee refuses to submit to or obstructs an examination, his or her right to compensation under this subchapter is suspended until the refusal or obstruction stops. Compensation is not payable while a refusal or obstruction continues, and the period of the refusal or obstruction is deducted from the period for which compensation is payable to the employee. See 5 U.S.C. §8123(d).

With this update, the FECA program provides additional clarification with respect to the obstruction component of the statute. If an injured worker does appear for a directed medical examination appointment (second opinion or referee), but obstructs the examination, a sanction may be appropriate.

Revised procedures categorize obstruction of a medical examination into three general categories:

(1) Engaging in hostile or threatening behavior before, during, or after an examination

(2) Refusing to complete, or fraudulently completing, any necessary paperwork required by the examining physician

(3) Refusing to cooperate with the examining physician who is attempting to complete a clinical history and/or physician examination.

These are just examples, and any behavior that obstructs the ability of the physician to conduct the examination can result in the suspension of compensation.

Paragraph 13, Subparagraph (d) has been revised in its entirety to provide examples and claims processing requirements necessary to suspend compensation due to obstruction of a medical examination.

(1) The revised procedures provide that engaging in hostile or threatening behavior is considered obstruction of the examination. The behavior can be in person, verbal, or in writing. The revisions provide some specific examples of the types of behavior that can be deemed to be obstruction.

(2) As part of a scheduled medical examination, the claimant must complete any necessary paperwork, including intake documentation, completely and truthfully. Failure to do so may be considered obstruction.

(3) The revised procedures advise that a claimant must provide full cooperation with all elements of the scheduled medical examination. This includes providing a truthful and complete medical history, participating in any testing and evaluations, and the claimant must put forth full effort in all aspects of the examination. There now, however, exists an additional requirement in scenarios where the claims examiner seeks to sanction the claimant for failing to cooperate with the physician while obtaining a clinical history and/or performing a physical examination or requested evaluations. In these cases, the CE should seek clarification from a district medical advisor (DMA) to review the totality of the medical documentation and provide a rationalized explanation as to whether the noncooperation was sufficiently detrimental to the outcome of the examination to reasonably be considered obstruction.

In all obstruction scenarios, the updated procedures also provide that a CE shall not be bound to accept the conclusion of obstruction where there is sufficient evidence that the claimant’s failure to demonstrate full effort is the result of exceptional circumstances.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers’ Compensation

Distribution: Applicable DFELHWC Staff

Back to Top of FECA Transmittal No. 22-05

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation, with this issuance, announces revisions to the above-referenced Procedure Manual Chapters. These changes convey the case management processing guidelines with respect to claims for increased schedule awards under the Federal Employees’ Compensation Act (FECA).

Permanent impairment to certain parts of the body will entitle the claimant to an award of compensation payable for a set number of weeks. The length of the schedule award is determined by the provisions of 5 U.S.C. 8107 or in 20 CFR §10.404. The resulting number of weeks is multiplied by the weekly wage and the compensation rate. Rated impairment should reflect the total loss as evaluated for the scheduled member (i.e. arm, leg, etc.) at the time of the rating examination.

There are no provisions for apportionment under the FECA. As such, schedule awards include permanent impairment resulting from conditions accepted by the Office of Workers’ Compensation (OWCP) as job-related, as well as any non-industrial permanent impairment present in the same scheduled member at the time of the rating examination. As long as the work-related injury has affected any residual usefulness, in whole or in part, of a scheduled member, a schedule award may be appropriate.

Similarly, an increase in schedule award may be appropriate as long as a material change in the work-related injury is at least in part contributory to an increase in impairment of the scheduled member. As noted in Procedure Manual (PM) 2-0808.7, any previous impairment to the member under consideration is included in calculating the percentage of loss except when:

(a) The prior impairment is due to a previous work-related injury and a schedule award has been granted for such prior impairment, in which case the percentage already paid is subtracted from the total percentage of impairment; or

(b) The VA has already paid a claimant for a previous impairment to the same member, in which case an election will be required if the VA has increased the percentage payable due to the injury in civilian employment. In this instance, an election will be required between the entire schedule award and all VA benefits prior to any increase and all VA benefits subsequent to the increase. Such an election should be offered only for the period of the schedule award.

With these updates to procedure, the FECA Program establishes the methodology for developing and processing subsequent claims for increased schedule awards. PM Chapter 2-0808, Paragraph 9; and PM 2-1601, Paragraph 8 have been revised as outlined below.

PM Chapter 2-0808, Paragraph 9, Claims for Increased Schedule Awards, has been reorganized and updated to reflect that claims for increased schedule awards should first be considered in order to determine that the claimant is actually requesting an increased award versus a request for a review of a prior schedule award determination. Clarification should be obtained from the claimant if the request is unclear. If it is subsequently determined that the request is for a review of a prior award, then it should be processed as an appeal in accordance with the appeal rights accompanying the prior schedule award decision.

In addition, the previous timeframe requiring the period of one year between filing a claim for an increased schedule award has been has been removed.

Although claims for increased schedule awards should follow the same medical development as claims for initial schedule awards (outlined in PM 2-0808.6), following any appropriate development, all claims for increased schedule awards should be referred for second opinion medical evaluations. Subsequent to receiving the second opinion’s medical report, the impairment evaluation carrying the weight of the medical evidence should be submitted to a District Medical Advisor (DMA) for review. However, a claim for increased schedule award where the prior decision found no ratable impairment does not require a second opinion medical evaluation if sufficient medical evidence is submitted by the claimant to proceed directly to a DMA review.

Finally, if a claim for increased schedule award yields a percentage of impairment lower than the original award, a finding should be made that the claimant has no more than the percentage of impairment originally awarded and that the evidence does not establish an increased impairment. An overpayment should not be declared. This applies specifically to claims for increased awards. Claims are still subject to overpayment if a schedule award decision is set aside as a part of the appellate process and a new schedule award decision is issued yielding a lower percentage of impairment.

PM Chapter 2-1601, Paragraph 8, Reaching a Determination, has been updated to emphasize that after a hearing, if a lesser degree of impairment than previously awarded is substantiated, the Office will ultimately issue a new schedule award decision and also make the finding that the claimant has no more than the percentage of impairment originally awarded; that the evidence does not establish an increased impairment; and that an overpayment will not be declared.

If, during the course of the appeals process, it is determined that the initial schedule award decision must be set aside, a new schedule award decision should be issued that addresses the reasons for the change in rating. Declaring an overpayment thereafter is appropriate if the de novo decision substantiates a lesser degree of impairment than previously awarded, so long as both ratings are based on the same edition of the Guides. The resulting overpayment should have a finding of without fault.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC Staff

Back to Top of FECA Transmittal No. 22-06

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces a revision to Procedure Manual Chapter 2-0901 pertaining to Claims Examiner certification authority with respect to compensation claims and a revision to Procedure Manual Chapter 2-1400 pertaining to authority under which Claims Examiners may release a Formal, Proposed or Final Decision under the Federal Employees’ Compensation Act (FECA).

Claims Examiners are responsible for adjudicating each claim for compensation under the FECA. They must determine all factors involved in calculating payments, to include the pay rate, compensation rate, number of days, insurance deductions, etc. Payments will not be issued without being properly certified. By certifying a payment, the certifier is verifying that the adjudication and calculation of the payment are correct, that all payment data is entered correctly in the case management system, and that all pay elements entered correspond with the documentation in the file.

With respect to compensation claims, this revision revises the certification criteria for claims examiners, to include secondary and self-certification.

Various formal appealable decisions are issued under the FECA. The scope of these decisions varies and may require different levels of review depending on the complexity and severity of the decision. This signature authority was itemized in Exhibit 1 to Chapter 2-1400.

This revision includes formal decisions related to suspensions for failing to cooperate with Vocational Rehabilitation (VR) efforts under 8113b that were previously omitted from the aforementioned Exhibit.

This revision also changes the title “District Directors” to “Office Directors” and addresses death claims due to suicide that require an Office Director signature.

Specific Changes:

PM 2-0901, Section 3, Subparagraph (a) has been revised to allow GS-12 claims examiners to certify payments up to $20,000.

PM 2-0901, Section 3, Subparagraph (b)(2) has been revised to indicate that Quality Assurance and Mentoring Examiners (QAM) and higher must certify placement on the periodic roll for loss of wage earning capacity (LWEC) as well as survivor compensation.

PM 2-0901, Section 3, Subparagraph (b)(3) has been revised to indicate that GS-12 claims examiners may now certify LWEC payments not involving periodic roll placement as well as death expenses, to include burial and administrative costs.

PM 2-0901, Section 3, Subparagraph (b)(4) has been revised to indicate that GS-12 claims examiners or higher authority may self-certify payments for intermittent wage loss (excluding LWEC payments).

PM 2-1400, Exhibit 1, GENERAL GS-12 CLAIMS EXAMINERS will include the following decisions:

Warning & Final Reduction to zero under 8113(b) for non-cooperation with VR

PM 2-1400, Exhibit 1, QUALITY ASSURANCE AND MENTORING EXAMINERS (QAM), SUPERVISORY CLAIMS EXAMINERS, TECHNICAL ASSISTANTS AND SPECIAL EXAMINERS will include the following decisions:

Warning & Final Reduction (non-zero) under 8113(b) for non-cooperation with VR

PM 2-1400, Exhibit 1, OFFICE DIRECTORS AND BRANCH CHIEFS, will include the following decisions:

All death claim decisions due to suicide (acceptances and denials)

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: Applicable DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC) with this issuance announces revisions to the above-referenced Procedure Manual (PM) Chapter. All cases on the periodic roll require completion of Form EN-1032 on a yearly basis, and cases where disability compensation is being received also require review of medical evidence to determine continuing entitlement. If the CA-1032 is not received, compensation benefits may be suspended until the report is received.

To that end, FECA Procedure Manual Chapter 2-0812 has been updated to address medical development actions to be taken when benefits are suspended for failure to return a CA-1032, when sufficient medical evidence hasn’t been received. The revisions also address actions to be taken when benefits are suspended for failure to return a CA-1032 when the case is in a PS status, and what specific disability management actions may be taken in a case when the CA-1032 has not been returned. Periodic Entitlement Review (PER) codes have been updated to reflect these actions.

The updates are outlined below.

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CLAIMS

Paragraph 5, Monitoring Claims on the Periodic Roll, (b) Timeframes for Medical Evidence, has been updated to clarify that when CA-1032s are not received in PS cases, that schedule award payments should not be suspended. The paragraph provides instructions to OWCP claims examiners that compensation should be reduced to the 2/3 compensation rate if being paid at an augmented compensation rate, and that no action should be taken if compensation is being paid at the 2/3 rate.

Paragraph 6, Medical Elements of Review (c) Changes in Medical Status, language was added concerning disability management actions that can be taken when compensation is suspended for failure to return the CA-1032.

Paragraph 14, Suspension of Compensation (f) Medical Development, instructions to Claims Examiners have been provided that when benefits are suspended for failure to return the CA-1032, if medical evidence is not sufficient to support current benefit level, that they should proceed with medical development until sufficient medical evidence is received.

Paragraph 15, Periodic Entitlement Review (PER) Codes (a) PER Development Codes and (b) PER Closure Codes, language was added concerning new PER codes 1MS and 2MS for medical development in claims where compensation has been suspended for failure to return the CA-1032, as well as an update to closure code 3ES.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFELHWC has discontinued the practice of inserting page numbers when an entire chapter is issued.

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation (DFELHWC), with this issuance, announces a minor revision to Procedure Manual Chapters 2-1400 pertaining to signature authority for the purposes of operational efficiency.

Specifically, 2-1400, Disallowances, Exhibit 1, is updated to give GS-12 (Journey Level) CEs the authority to issue schedule award decisions regardless of payment amount certification level.

The exhibit also notes that a supervisory claims examiner, in their sole discretion, may now grant any non-GS-12 claims examiner signature authority on any or all items that ordinarily require GS-12 claims examiner signature. Previously, this delegation of authority was limited to GS-11 claims examiners.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers' Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

FECA Procedure Manual Chapter 1-0400 describes the contents of new cases and the bases for creating them. Section 4, SHORT FORM CLOSURES (also sometimes referred to as administrative closure), defines how and when a new case can be administratively closed prior to formal adjudication by the claims staff. This procedure is a means of quickly, efficiently, and responsibly addressing the needs of Federal employees who have claimed injury in performance of their Federal employment. This procedure allows for the payment of minimal medical costs and entitles the injured worker to Continuation of Pay (COP) while under the status of a short form closure.

Exhibit 1: Edit Criteria for Short Form Closure of this Chapter defines the specific criteria needed for a new case to qualify for short form closure. This Exhibit also identifies the coded source of injury, cause of injury, and nature of injury as well as the employing agencies and case number prefixes excluded from consideration for short form closure.

The Office of Workers’ Compensation Programs’ Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFELHWC) recognizes that unique events or circumstances such as pandemics, natural disasters and other unforeseen emergencies may necessitate flexibility in how and when the short form closure procedure under the Federal Employees’ Compensation Act (FECA) is implemented, Exhibit 1: Edit Criteria for Short Form Closure, has been updated to recognize the following:

Where the Secretary of the Department of Health and Human Services has declared a Public Health Emergency, the President of the United States has declared a National Emergency or has identified an emergency situation under the Stafford Act, or a unique event or circumstance has been identified by the Secretary of Labor or their designee that may impact the safety of members of the Federal workforce, the criteria under which a case may be closed short form and the list of excluded coded source of injury, cause of injury, and nature of injury may be adjusted at the discretion of the Director of OWCP or their designee.

See e.g. FECA Bulletin 21-01 D-3 (issued October 21, 2020).

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers’ Compensation

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees’ Longshore and Harbor Workers’ Compensation, with this issuance, announces revisions to the above-referenced Procedure Manual Chapters. These changes establish a uniform policy with respect to the effective date of compensation termination when issuing an adverse decision under the Federal Employees’ Compensation Act (FECA).

Where the evidence establishes that compensation should be either reduced or terminated, the Office of Workers’ Compensation Programs will provide the beneficiary with written notice of the proposed action and give him or her 30 days to submit relevant evidence or argument to support entitlement to continued payment of compensation. 20 CFR § 10.540(a).

Payment of compensation will continue until any evidence or argument submitted has been reviewed and an appropriate decision has been issued. 20 CFR § 10.540(b).

Prior to this update, procedures varied with respect to the appropriate effective date of termination of benefits following an adverse decision. In some instances, termination was made effective the date of the decision. In other scenarios, termination was made effective the first date of the next periodic roll cycle following issuance of the decision. In certain cases, procedure was silent on the issue and the effective date of termination was set at the discretion of the claims examiner.

With these updates to procedure, the FECA Program establishes that compensation will be terminated, reduced, or suspended effective the date the final adverse decision is issued. This will ensure that cases are treated equitably regardless of the type of decision issued, or the claims office or examiner involved. It also furthers the principle that a beneficiary is not entitled to continued compensation beyond the date of the issuance of a formal determination of non-entitlement by the office.

To that end:

Procedure Manual (PM) Chapter 2-0600, Paragraph 14, Resolution of Disability Management Cases, was updated to reflect the revised policy in Loss of Wage Earning Capacity (LWEC) and suspension decisions.

PM Chapter 2-0700, Paragraph 18, Suspension of Benefits, was updated to reflect the revised policy in death suspension decisions.

PM Chapter 2-0807, Paragraph 11, COP and Modified Duty Assignments, was updated to reflect the revised policy regarding refusal of suitable work.

PM Chapter 2-0812, Paragraph 14, Suspension of Compensation, was updated to reflect the revised policy regarding decisions suspending compensation for failure to timely report earnings.

PM Chapter 2-0813, Paragraph 17, Non-Cooperation and Sanction Decisions, was updated to reflect the revised policy regarding decisions suspending compensation for failure to cooperate with vocational rehabilitation. Paragraph 19, Possible Outcomes of Vocational Rehabilitation, was updated to reflect the revised policy regarding the refusal of suitable work.

PM Chapter 2-0814 was updated in multiple paragraphs to reflect the revised policy regarding the refusal of suitable work.

PM Chapter 2-0816, Paragraph 8, Issuance of Decision, was updated to reflect the revised policy in regarding constructed LWEC decisions.

Within PM Chapter 2-1400, Paragraph 3, Responsibilities, new subpart (i) was added to explain the revised policy and its applicability to all disallowance decisions.

PM Chapter 2-1501, Paragraph 3, Criteria for Modification, was updated to reflect the revised policy regarding termination decisions. Paragraph 8, Decision, was updated to reflect the revised policy regarding modification of LWEC decisions.

ANTONIO RIOS
Director for
Federal Employees' Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) with this issuance addresses the format of oral hearings by the Branch of Hearings & Review.

OWCP's regulations at 20 CFR 10.616(b) establishes that OWCP will schedule an oral hearing and determine whether the oral hearing will be conducted in person, including whether the in person hearing will be conducted by teleconference, videoconference or other electronic means.

The Branch of Hearings & Review has the discretion to determine the appropriate format for oral hearings, for timeliness and efficiency. Given the success of telephonic hearings in increasing the speed of the hearing process, hearings will generally be scheduled in a telephonic format. Telephonic hearings will be scheduled unless it is determined that a hearing should be conducted in person, or via videoconference or other electronic means.

To that end, FECA Procedure Manual Chapter 2-1601 has been updated to reflect the choice of format for oral hearings.

CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD

Paragraph 6, Arranging for Hearings, has been modified, with language added that oral hearings will generally be conducted telephonically, with certain exceptions for reasonable accommodation, or if a hearing in another format would be necessary to ascertain the facts of the case or to better assess the merits of the claim.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

Distribution: All DFEC staff

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EXPLANATION OF MATERIAL TRANSMITTED:

DFEC Procedure Manual Chapter 2-0700 describes procedures for developing and adjudicating death claims under the FECA. Form CA-12, Claim for Continuation of Compensation, is sent annually to all recipients of death benefits to verify continued entitlement to compensation.

Paragraph 18, Suspension of Benefits, Part (a) has been updated to reflect that if the Form CA-12 has not been returned after 30 days, a second request should be made allowing the beneficiary an additional 30 days to return the completed form.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: Applicable DFEC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and census field supervisors to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 56 days. These employees will work an average of 96 hours during a four to five week period, one week of which will be training. After evaluating work patterns for the 2010 Census, the Department of Commerce has provided data regarding pay rates and standard workdays derived from the 2010 Census. The work patterns for the 2020 Census are expected to closely resemble the 2010 Census.

Chapter 2-0900-12 and Chapter 2-0901-10 have both been updated to reflect information pertaining to the 2020 Decennial Census.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

Distribution: Applicable DFEC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

DFEC Procedure Manual Chapters 5-0200 and 5-0202 describe the policies and procedures which pertain to the financial aspects of the Federal Employees' Compensation program. Affiliated Computer Services (ACS) provided all medical bill payment and medical authorization services, including enrolling providers, maintaining the provider file, performing bill resolution, processing adjustments, and issuing payments. Effective April 27, 2020, medical bill processing responsibilities were moved to a different contractor. Conduent, formerly XEROX ACS, will continue to provide pharmacy processing services.

Paragraph 3, AFFILIATED COMPUTER SERVICES, Part (a) has been updated to read MEDICAL BILL PAY CONTRACTOR. All references to ACS have been removed and the Medical Bill Pay Contractor (MBPC) contact information has been updated.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC staff

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EXPLANATION OF MATERIAL TRANSMITTED:

Effective August 2020, the Divisions of Federal Employees’ Compensation and Longshore and Harbor Workers’ Compensation merged to create a single Division (DFELHWC). To that end, the FECA Procedure Manual was updated to remove references to “DFEC.” References to DFEC were replaced with DFELHWC or the Federal Employees’ Compensation Act (FECA) Program as appropriate for clarity.

The DFELHWC with this issuance makes a number of additional updates to FECA procedures due to organizational restructuring. The FECA Program has progressively moved from a regional and geographic based structure to a more centralized and cohesive organization. Operations and policies have been realigned to build seamless lines of communication, eliminating barriers and distinctions between the national office and the field offices. Many positions previously located in field offices have also been realigned. Staff Nurse and Rehabilitation Specialists are now under the Branch of Regulations and Procedures, Fiscal Officers and Medical Coding Specialists are now under the Branch of Fiscal Operations and Customer Service Representatives are now under the Branch of Technical Assistance.

In furtherance of this reorganization, effective September 28, 2020, the FECA Program will eliminate jurisdictional boundaries and cease geographic-based jurisdictional case assignments. Claims examiners will now handle cases based on a rotational assignment model regardless of the claimant’s geographic location.

These changes will allow equitable distribution of cases among FECA Claims Examiners and optimize consistent case processing across the country. Further, this reorganization will afford the FECA Program increased flexibility in the hiring process as well as provide the Program with greater agility to respond to unanticipated events.

Also effective September 28, 2020, the position of Senior Claims Examiner will be retired and a new position, the Quality Assurance and Mentoring Examiner (QAM), created. Historically, Senior Claims Examiners have been utilized differently with many engaged in more routine Claims Examiner duties. The new role will focus primarily on helping ensure the quality of Claims Examiner work as well as mentoring and developing staff. The procedure manual has been updated to reflect this new position.

Chapter 0-0100 has been updated to address changes in the organizational structure of the FECA program and to remove references to “District Offices” and discussion regarding the jurisdiction of cases.

Chapters 0-0200 and 1-0100 have been updated to remove references to “District Offices” and discussion regarding the jurisdiction of cases.

Chapter 1-0200, Jurisdiction, was updated in its entirety to reflect one single consolidated FECA office with multiple claims units that will be handling claims without regard to jurisdictional boundaries.

Chapters 2-0200, 2-0400, 2-0401, 2-0402, 2-0500, 2-0600, 2-0601, 2-0700, 2-0809, 2-0810 and 2-0811 were updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction.

Chapter 2-0300 was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. It was also updated to memorialize the FECA Program’s policy on outgoing correspondence, with specific reference to signatures on outgoing correspondence.

Chapter 2-0802 was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. It was also updated with ECAB case precedent regarding workers serving without compensation.

Chapter 2-0813, Vocational Rehabilitation Services, was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. It was also updated to describe revised procedure for supervisory level review and approval of the Assisted Reemployment agreement.

Chapters 2-0814 and 2-0900 were updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction.

Chapter 2-0901, Compensation Claims, was updated to remove all references to the “District Office” and Senior Claims Examiner, replacing with Office and Quality Assurance and Mentor Examiners or QAME. Corresponding updates were made to payment certification requirements.

Chapters 2-1000, 2-1200 and 2-1300 were updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction.

Chapter 2-1100, FECA Third Party Subrogation Guidelines, was updated to remove references to the “District Office,” and “Senior Claims Examiner.” It was also updated to reflect minor process changes in processing of third party debts by the Office of the Solicitor.

Chapter 2-1400 Disallowances (including 2-1400 Exhibit 1: Signature Authority), has been updated with new signature authority for GS-12 Claims Examiners, Customer Services Representatives, Special Examiners, and Technical Assistants. It also eliminates the Senior Claims Examiner, replaced with the Quality Assurance and Mentoring Examiner, as well as removal of all references to the “District Office.”

Chapters 2-1402, 2-1600, 2-1601, 2-1602 and 2-1700 were updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction.

Chapter 2-1603, Appeals, was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. It was also updated to include current policy regarding transmission of cases to and from the ECAB.

Chapter 2-1700, Special Act Cases, was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. Duplicative information regarding Peace Corps claims was also removed; claims from the Peace Corps are fully addressed in Chapter 2-1701. Lastly, updated information regarding Job Corps centers was added.

Chapter 2-1800, Housing and Vehicle Modifications, was updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction. It was also updated to describe revised procedure for supervisory level review and approval of housing and vehicle modification requests. New procedure has also been provided on two issues: (1) the determination of medical necessity for vehicle modification requests where the claimant does not own a vehicle and did not own one on date of injury and (2) the reimbursement responsibilities of a claimant’s spouse or other co-owner of the home or vehicle to be modified.

Chapters 6-0100, 6-0200, 6-300, 6-0400 and 6-0500 were updated to remove references to the “District Office,” “Senior Claims Examiner” and other discontinued positions, and geographic jurisdiction.

Chapter 8-0800, Assisted Reemployment, was updated to describe revised procedure for supervisory level review and approval of assisted reemployment requests.

The corresponding dated references to Parts 3-5 of the FECA Procedure Manual will be updated at a later date.

ANTONIO RIOS
Director for
Federal Employees', Longshore and Harbor Workers' Compensation

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 4-0600 has been updated to provide additional clarification regarding Reserve Officers' Training Corps (ROTC) "line of duty" determinations and the allowance of certain ROTC traumatic injury claims to be considered for short form closure.

Paragraph 6, Conditions of Coverage for Injuries On and After October 1, 1988, has been revised to remove the reference to the employer's "line of duty" determination as being subject to OWCP review. In addition, an update was provided to advise that ROTC cases filed by the employer will now be considered to have an affirmative "line of duty" determination unless the employer specifically challenges the Performance of Duty element of the claim.

Chapter 1-0400, Paragraph 4 (Short Form Closures) and the associated Exhibit 1 (Edit Criteria for Short Form Closure) have been revised and updated to refine the wording and explanation of the short form closure process as it now occurs within the iFECS computer system and to remove the exclusion of ROTC cases from the short form closure process. As certain ROTC cases may involve a traumatic injury with minimal medical billings, inclusion of ROTC as possible short form closure cases will streamline medical bill processing and avoid delays in minor injury cases.

For traumatic injury claims, unless the employer challenges "performance of duty" on the Form CA-1, the claim can now be considered for short form closure.

ANTONIO RIOS
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: Applicable DFEC Staff

Back to Top of FECA Transmittal No. 19-01

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0812 has been updated to provide additional guidance regarding timeframes for periodic entitlement reviews (PER). Additionally, new PER codes have been added and previous codes removed for both PER development and PER closure in conjunction with updated to the Division of Federal Employees' Compensation (DFEC) claims management system.

Paragraph 5, part b, Timeframes for Medical Evidence, was updated to reflect that there must be medical evidence within 1 year of the PER create date (PR), 2 years of PER create date (PW), or 3 years of PER create date (PN).

Paragraph 15, Periodic Entitlement Review (PER) Codes, was updated with the following new PER development and PER closure codes:

PER Development Codes

1AP – Medical development only, attending physician
1SR – Medical development only, SECOP or Referee
1FO – Factual development only, dependency, SSA/FERS offset, employment info., dual benefits, etc.
1MF – Medical and Factual development
2SR – SECOP/Referee, or follow up if previously scheduled
2PR – Proposal to terminate/reduce compensation
2FO – Factual only, second request
2MF – Medical and Factual development

PER Closure Codes

3EA – PER Closed with Payment/Entitlement Adjustment
3ES – PER Closed with Payment Entitlement Suspension
3ET – PER Closed with Payment/Entitlement Termination
3PN – PER Closed with no payment change/PN final memo
3NC – PER Closed with no payment/Entitlement change

The following PER development and closure codes have been removed:

AI – Payment/Entitlement Adjustment in Development
NI – PN Memo in Development
SI – Payment/Entitlement Suspension in Development
TI – Payment/Entitlement Termination in Development
UD – Under Development
EA – Payment/Entitlement Adjustment
ES – Payment/Entitlement Suspension
ET – Payment/Entitlement Termination
NC – No Payment/Entitlement Change
PN – PN Memo

Paragraph 16, Disability Management (DM) Status Codes, was updated with the addition of the WTL and WTX codes. The entry of the WTL or WTX codes is mandatory when completing a PER record for any case with a status of PR or PN (via auto-population).

WTL. This code will auto-populate in the DM record if the CE answers "Yes" to the PER question "Valid work restrictions in file for all conditions?", and entry of the date of the most recent medical work release outlining the necessary work restrictions in the PER record is required. The effective date of the status will auto-populate with the date entered in the PER record (i.e. the date of the most recent medical work release outlining the necessary work restrictions).

WTX code. If the CE answers "No" to the PER question "Valid work restrictions in file for all conditions?", the PER will auto-populate the WTX code in the DM record. The effective date of the status will auto-populate with the date of the PER record closure.

ANTONIO RIOS
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: Applicable DFEC Staff

Back to Top of FECA Transmittal No. 19-02

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 was revised and updated in its entirety in October, 2011. The chapter was then updated in November, 2012 and November 18, 2013. Additional updates are being made at this time as outlined below.

Paragraph 1, Purpose and Scope, has updated to include references to the COP Nurse Handbook, the Field Nurse Handbook and the Vocational Rehabilitation Counselor Handbook.

Paragraph 3, DM Goals, has been renamed DM Objectives. Reference to the expired 2010 Presidential POWER Initiative has been removed, as well as specific Operational Plan goals. Instead, the paragraph now discusses the overall objectives of successful DM and resolution, including the importance of taking timely and substantive DM case management interventions.

Paragraph 6, DM Codes, was updated to indicate that there are additional types of mandatory CE intervention codes. The portion of this paragraph pertaining to mandatory CE intervention codes now includes a reference to codes for the following circumstances: when a second opinion or referee report has been received; when a second opinion or referee follow-up action has been taken; when a job offer has been requested or a suitable job offer letter has been issued; and when a pre-reduction or pre-termination has been issued. The codes are then described in more detail in other paragraphs within the chapter.

Paragraph 7, CE Intervention Codes, which outlines mandatory CE codes, was updated to include a more specific and clarified explanation for the appropriate use of the OIC (Other Intervention by CE) code. The updated description for the already existing OIC code is as follows:

• OIC (Other Intervention by CE). Used when the CE contacts the claimant or Employing Agency (EA) to discuss a RTW date and/or the availability of limited duty once work limitations and a release to work have been obtained. This code may be used more than once in a given DM record, but it may not be used when the conversation concerns bill payment, compensation payment, or other case issues not specific to disability management. The OIC intervention should be focused on RTW. The effective date of the status is the date of the letter or telephone conversation. It may be used in the following instances:
  
  • (1) The CE contacts the claimant to specifically discuss return to work issues. Topics would include the anticipated return to work date (for either regular or light duty); the current work limitations and, if applicable, why they preclude any work at all, or preclude a return to the claimant's regular job; and whether the claimant has contacted the employer about the availability of light duty. This type of contact will usually occur by telephone and should be documented in the file via a CA-110 (or equivalent). The conversation should be substantive and serve to remind the claimant of his or her responsibility to return to work.
    
  • (2) The CE contacts the EA to discuss recent work limitations/release to work and the availability of light duty, or to solicit a job offer. Once the claimant has been released to work, the description of work limitations should be available on the date of the contact. If the use of OIC is based on a telephone call, the CE should fully document the conversation in a CA-110 (or equivalent).

Paragraph 7 was also updated to include the addition of nine (9) codes that were previously considered optional codes under Paragraph 12. NOTE: The explanation for the appropriate use of the already existing TTD code, as well as the need for documented supervisory approval, has been updated. The previous optional codes that are now considered mandatory include:

• JOL (Suitable Job Offer Letter Issued). JOL can be entered when the job offer suitability determination is sent to the claimant. The code can be used for both the 30-day letter and the 15-day letter. This code is useful for alerting the CE that a follow-up action is necessary so that a final decision can be reached.
  
• JOR (Job Offer Request / Work Restrictions to EA). JOR can be entered when the CE solicits a job offer from the EA. This code is useful for alerting the CE that a follow-up action may be necessary. The effective date of code JOR should be the date that the job offer is actually requested.
  
• MSC (Second Opinion Report Received). MSC can be entered when the CE receives a second opinion examination report. It is useful to alert the CE that a follow-up action may be necessary. The effective date of the MSC code should be the date the report is received.
  
• MSF (Second Opinion Follow-up Taken). MSF can be entered when the CE follows up with the second opinion examiner after receiving a second opinion examination report. This code is useful for alerting the CE to follow up if the information requested is not received in a timely fashion. The effective date of code MSF should be the date the follow-up action is taken.
  
• MRC (Referee Report Received). MRC can be entered when the CE receives a referee examination report. It may be useful to alert the CE that a follow-up action may be necessary. The effective date of the MRC code should be the date the report is received.
  
• MRF (Referee Follow-up Taken). MRF can be entered when the CE follows up with the referee examiner after receiving a referee examination report. This code can be used to alert the CE to follow up if the information requested is not received in a timely fashion. The effective date of code MRF should be the date the follow-up action is taken.
  
• PRL (Pre-reduction notice sent). PRL can be entered when a proposed notice of reduction is sent to the claimant. This code is useful for alerting the CE that a follow-up action is necessary so that a final decision can be reached.
  
• PTL (Pre-termination notice sent). PTL can be entered when a proposed notice of termination is sent to the claimant. This code is useful for alerting the CE that a follow-up action is necessary so that a final decision can be reached.
  
• TTD (Continuing Total Disability per Secop/Referee). TTD should generally be entered only after a second opinion or referee examination report substantiates that the claimant is temporarily totally disabled due to his or her accepted work injury and the condition is not expected to improve within the foreseeable future. However, in rare instances, it may be used following an extremely thorough and well-rationalized medical report from an attending physician or when a case is considered catastrophic in nature. This code should be documented with a memorandum to file countersigned by a Supervisory Claims Examiner or higher authority. The effective date of this code is the date of the signed memorandum.
  

Paragraph 12, Optional Codes, was updated to remove the nine (9) codes outlined and described above. The codes removed are now considered mandatory DM intervention codes.

Paragraph 13, Closure Codes and Resolutions, was updated to include the already existing DM code of CCL (LWEC Modification-Cost Savings). This code has existed in the IFECS Disability Management application, but had been inadvertently omitted from prior revisions of the FECA Procedure Manual. It has now been included in PM 2-0601-13b(2).

• CCL (LWEC Modification-Cost Savings). This code should be used when a previous formal LWEC decision was modified resulting in the issuance of a new formal LWEC decision with a greater wage-earning capacity and less wage loss. While this code is considered a resolution for PRM cases, it is not a closure code and the PRM case will remain in the DM category of PRM-LWEC since the claimant is still receiving monetary compensation.
  

In addition, the explanation for the appropriate use of the already existing CSB (Compensation Not Claimed) code has been updated to clarify that it should not be used as a substitute for situations where a formal decision would be more relevant. The updated description of the already existing CSB code is as follows:

• CSB (Compensation Not Claimed). This code is used in conjunction with the OPM code when a claimant elects OPM benefits. This code is also appropriate when a claimant has elected to receive increased VA disability benefits in lieu of FECA benefits. In situations other than an OPM or VA election, there should be a memorandum to the file to explain the use of this code. This code should not, however, be used as a substitute for a formal decision. For example, if a claimant has been released to return to his/her date of injury job but neglects to do so, it is more appropriate to issue the formal decision advising that there is no continuing disability. The CSB code will count as a resolution for both QCM and PRM.
  

ANTONIO RIOS
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: Applicable DFEC Staff

Back to Top of FECA Transmittal No. 18-01

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1701 has been updated to amend the list of medical conditions for which the Peace Corps may, at its discretion, pay medical costs less than $1500 directly.

Paragraph 10, Payment of Medical Costs by Peace Corps, has been revised to include the condition of schistosomiasis (both urinary and intestinal).

This addition is based, in part, on the fact that the Centers for Disease Control and Prevention has determined that, "Safe and effective medication is available for treatment of both urinary and intestinal schistosomiasis. Praziquantel, a prescription medication, is taken for 1-2 days to treat infections caused by all Schistosoma species."

ANTONIO RIOS
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: Applicable DFEC Staff

Back to Top of FECA Transmittal No. 18-02

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) with this issuance amends an area of procedure with respect to the adequacy of a medical report in certain periodic roll cases.

Per FECA Procedure Manual 2-0812.5, medical evidence in a periodic roll case is reviewed annually and the file should contain a physician's rationalized opinion with regard to whether continued disability is causally related to the employee's accepted injury or illness. There are timeframe guidelines associated with the case status: PR – cases in which temporary total disability payments are being paid require medical evidence once a year; PW – Cases in which payments are being made for a loss of wage-earning capacity require medical evidence every two years; PN – Cases in which the CE has determined, and the Supervisory Claims Examiner has verified, that no wage-earning capacity exists, require medical evidence every three years.

Per 20 C.F.R. §10.501(a)(2), "For those employees with more serious conditions not likely to improve and for employees over the age of 65, OWCP may require less frequent documentation, but ordinarily not less than once every three years."

Per FECA Procedure Manual 2-0812.6, when reviewing the adequacy of a medical report in order to determine the progress of the employment-related condition and the extent of impairment resulting from this condition, the content of a medical report should include:

(1) The date of most recent examination.
(2) Results of recent objective testing.
(3) Physical examination findings.
(4) The diagnosis of any conditions present.
(5) A well-reasoned medical opinion supported by the physical findings and objective testing as to whether the current condition(s) is related to the employment.
(6) The claimant's work restrictions, including a completed Form OWCP-5, if applicable.
(7) The type and frequency of medical treatment being provided or recommended.
(8) Prognosis for continued recovery.

However, in some instances due to extenuating circumstances, a claims examiner may need to use discretion when determining whether a medical report sufficiently supports the ongoing benefit level. To that end, FECA Procedure Manual Chapter 2-0812.6 has been amended to allow for limited flexibility when determining the adequacy of medical evidence in the file for some employees with more serious conditions not likely to improve and for those over the age of 65.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: All applicable DFEC Staff

Back to Top of FECA Transmittal No. 18-03

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EXPLANATION OF MATERIAL TRANSMITTED:

Part 6, Debt Management, has been revised in its entirety to streamline the overpayment process for ease of use for claims staff and for better understanding for employing agencies, attorneys and other interested parties. This Procedure Manual release completely overhauls the debt management processes, including identifying and calculating an overpayment, making Preliminary and Final Determinations, and liquidating the debt.In keeping with other recent updates to the Procedure Manual, Part 6 has been increased to five chapters, complementing the DFEC's overall proactive approach to more efficient claims management.

CHAPTER 6-0100, INTRODUCTION

Chapter 6-0100, previously entitled Overpayment Overview, is now titled Introduction. The contents of the new chapter parallel the old chapter but are revised and rearranged for flow.

Paragraph 1, Purpose and Scope, provides the definition of an overpayment and summarizes the Claims Examiner's (CE) overpayment responsibilities.

Paragraph 2 was previously paragraph 3 and is now titled Legislative Authority and Regulatory Provisions. It provides the legislative and regulatory authorities pertaining to overpayments and debt recovery including authorities for debt collection from FECA accrued compensation and continuing benefits payments, and through assistance by other agencies (Office of Inspector General, the Department of Justice, and the Department of the Treasury, etc.) upon referral.

Paragraph 3 was previously paragraph 2, and is now titled Basic Chronology of an Overpayment. It has been largely enhanced, providing a detailed summary of a typical sequence of events when an overpayment has occurred, including identifying and calculating an overpayment, administrative terminations, Preliminary Overpayment Determinations, and Final Overpayment Determinations.

CHAPTER 6-0200, IDENTIFYING AND CALCULATING AN OVERPAYMENT

Chapter 6-0200, previously titled Initial Overpayment Actions, has been updated and revised in its entirety. It has been reduced to include only three paragraphs pertaining to identifying and calculating an overpayment and system coding. Paragraphs pertaining to administrative terminations, fault determinations, Preliminary Overpayment Determinations, Final Overpayment Determinations, and waivers have been moved to chapters 6-0300 and 6-0400. This allows for a more detailed discussion of each piece of the overpayment process, providing better direction for CEs and more detailed information for employing agencies, attorneys and other vested parties alike.

Paragraph 1 has been renamed Identifying an Overpayment. It details the most common reasons that overpayments occur including return to work with wage loss and without, payment made at an incorrect pay rate, payment made with improper deductions for life insurance and/or health benefits, payment made using an improper payment period, etc.

Paragraph 2 has been renamed Calculating the Overpayment. It explains that an overpayment is calculated by comparing the difference between what was paid and what should have been paid in order to calculate the final overpayment amount and provides three calculation examples.

Paragraph 3 has been renamed System Coding and discusses creation of a debt record for monitoring and tracking the debt, including data entry for the date that the debt record is created, the date of the overpayment identification, and other pertinent items. The most common reasons for adjusting a debt are also outlined.

CHAPTER 6-0300, INITIAL DETERMINATIONS IN AN OVERPAYMENT

Chapter 6-0300, has been revised and updated in its entirety and renamed Initial Determinations in an Overpayment. It was previously titled Debt Liquidation, which is now addressed in Chapter 6-0500. 6-0300 details the procedures for making initial determinations in an overpayment after it has been identified and calculated.

Paragraph 1, Purpose and Scope, summarizes that the chapter provides guidance for making initial determinations regarding assessment for administration termination, making rationalized fault determinations, and issuing Preliminary Overpayment Determinations.

Paragraph 2, Regulatory Provisions, provides the basic rules as to how the OWCP notifies an individual that payment has been made, what the OWCP does when an overpayment is identified where administrative termination is not in posture, and whether an individual is responsible for an overpayment that resulted from an error made by the OWCP or another Government agency.

Paragraph 3, Administration Termination of Debt Collection, signifies a change in procedures that the acceptable amount for administrative termination has increased from $200 to $300 with no requirement to complete any due process actions and has increased from $700 to $1,000 following the issuance of a Preliminary Overpayment Determination and evaluation of several factors such as costs of pursuing collection, whether the debtor can be located, the likelihood of collection, the outcome of any prior overpayments, and the circumstances that resulted in the creation of the debt. Procedures for handling the overpayment when the claimant requests a hearing or waiver or is in receipt of OPM or OWCP benefits are detailed. Explanation is provided that agencies may establish "minimum debt amounts" and realistic "points of diminishing returns" in their debt collection activities to determine when collection action need not be initiated and when it will be discontinued if the costs of action or additional action would exceed the amounts likely to be recovered. An outline of the debts that do not qualify for administrative termination is provided, as is the required content of an administrative termination of debt collection action memorandum to the file.

Paragraph 4, Fault Findings, remains largely unchanged from that which was previously in 6-0200 under Fault Determinations. However, many more detailed examples of common with fault and without fault circumstances are provided, with ECAB references, to promote clarity and consistency in making such decisions.

Paragraph 5, Preliminary Overpayment Determinations, details the content of a Preliminary Overpayment Determination including new information as to how to explain the overpayment calculations and the actions a claimant may take in response.

Paragraph 6, System Coding, provides guidance as to how the debt record should be updated upon issuance of an administrative termination and Preliminary Overpayment Determination.

CHAPTER 6-0400, FINAL OVERPAYMENT DECISIONS

Chapter 6-0400 is a new chapter devoted entirely to actions taken following a Preliminary Overpayment Determination, waivers, and Final Overpayment Determinations. Most of the content was previously addressed under chapter 6-0200. It has been revised, updated, and expanded in order to provide CEs with more detailed guidance.

Paragraph1, Purpose and Scope, summarizes that the chapter details actions to be taken following the issuance of a Preliminary Overpayment Determination including where: payment towards the debt is received; the overpaid individual provides a response to the Preliminary Overpayment Determination; and/or the overpaid individual fails to provide a response to the Preliminary Overpayment Determination. It also notes that waivers and Final Overpayment Determinations are discussed.

Paragraph 2, Regulatory Provisions, provides the basic rules as to how an overpaid individual can present evidence to the OWCP following the issuance of a Preliminary Overpayment Determination, the circumstances under which the OWCP can waive recovery of an overpayment, the criteria used to decide whether to waive recovery of the overpayment, the requirements of the overpaid individual to submit additional financial information, what is addressed at a pre-recoupment hearing, and how the OWCP communicates its final decision concerning recovery of an overpayment.

Paragraph 3, Actions Following the Preliminary Overpayment Determination, details the appropriate actions to take where the overpaid individual did not respond, made payment towards the debt, requested a pre-recoupment hearing from the Branch of Hearings and Review, or requested that the District Office issue a Final Overpayment Determination based on the written evidence only. A procedural change is outlined, indicating that conferences are now at the sole discretion of the CE to conduct if there is an outstanding issue that needs to be resolved, such as where the financial data on file is inadequate, where fault is in question, or where no possible offset for recovery exists and compromise is possible.

Paragraph 4, Waiver of Recovery, was previously addressed under 6-0200.6 and is largely unchanged with the exception of an increase in resource base amounts based on Bureau of Labor Statistics data (20 CFR 10.436(b)). The amounts have been increased from $4,800 to $6,200 for an individual and from $8,000 to $10,300 for an individual with a spouse or one dependent plus $1,200 (previously $960) for each additional dependent. An example of waiving the overpayment due to recovery causing hardship by depriving the claimant of income and/or resources needed for his/her ordinary and necessary living expenses was added and the number of examples for detrimental reliance was reduced from seven to three.

Paragraph 5, Final Overpayment Determinations, is a new paragraph completely devoted to Final Overpayment Determinations, which were previously addressed and included with preliminary determinations under 6-0200.6. Details of the proper actions to take are outlined depending on whether the claimant responded to the Preliminary Overpayment Determination, is with or without fault, and/or requested/granted a waiver. A discussion of the procedures for whether or not the claimant responded to the Preliminary Overpayment Determination both with and without fault is provided, as is the content of the Final Overpayment Determination.

Paragraph 6, System Coding, reflects the updates that should be made to the debt record where no payment has been received, full payment has been received, partial payment has been received, and the fault finding has been changed.

CHAPTER 6-0500, DEBT LIQUIDATION

Chapter 6-500 is a new chapter that details the Debt Liquidation process, previously addressed under Chapter 6-0300.

Paragraph 1 remains Purpose and Scope and is expanded to summarize the contents of the chapter devoted to managing and collecting debts.

Paragraph 2, Legislative Authority and Regulatory Provisions, is a new paragraph that provides the basic authorities for overpayment collection, including the responsibilities of the overpaid individual to refund the monies and the various resources where the debt can be recovered from, if necessary, such as from future compensation, through the Treasury Department, from the estate, and from taxes.

Paragraph 3, Responsibility for the Collection and Settlement of Debts, is rearranged for flow but largely unchanged from that previously in 6-0300.

Paragraph 4, Collection Strategies, was previously paragraph 7. It is unchanged with an addition for salary offset deducted by a federal employer.

Paragraph 5, Assessment of Charges, was previously paragraph 3. The content is unchanged.

Paragraph 6, Compromise to Limit the Repayment Agreement, was previously paragraph 5. The content is largely unchanged but has been reorganized for flow.

Paragraph 7 has been renamed Compromise in Consideration of Debt Disposal and is largely unchanged.

Paragraph 8 has been renamed Recovery from Continuing OWCP Entitlement and has been updated to explain that slightly delaying payment of benefits can occur if the delay will assist with the debt collection. For example, if a schedule award is in posture to pay, but a Final Overpayment Determination has not yet been issued, payment of the award can be delayed until the Final Overpayment Determination is issued in order to aid recovery of the debt. Additionally, procedures were added to clarify that if the overpaid individual does not respond to the Preliminary Overpayment Determination, the CE should set the rate of repayment at 25% of the 28 day net compensation amount until the balance of the overpayment is paid in full. If a response is later received, the financial information should be thoroughly examined and the CE should set a reasonable rate of repayment with intent to recover the overpayment within three years.

Paragraph 9, Salary Offset, is a new paragraph which outlines that recovering a debt owed to the OWCP from another federal agency through regular installments from the employee's pay will not generally be utilized as Treasury referrals take precedence. However, guidance is provided so that if a request for salary offset is received from the claimant, the National Office should be contacted.

Paragraph 10, previously paragraph 9, has been renamed Administrative Offset from OPM Benefits. As with salary offset, it is indicated that generally OPM offset will not be utilized as Treasury referrals take precedence. However, explanation is provided that if a request for OPM offset is received from the claimant, the National Office should be contacted.

Paragraph 11 has been renamed Recovery Where No Compensation, Salary Offset, or OPM Offset is Available, and has been updated to correspond with current practices. Emphasis is made that in most cases, after the 30th day following the third demand letter (when the debt is between 90 and 120 days delinquent), if no payment is received, if regular payments are not received, or if the payment is unreasonable to reduce the debt timely, the CE should refer the debt to the Department of the Treasury for debt collection or termination.

Paragraph 12 has been renamed Referral to the Department of the Treasury, and is a new chapter devoted to the procedures for referring a debt to treasury after prior collection efforts have failed and proper due process has been afforded. The primary debt collection tools, Treasury Offset Program (TOP) and Cross-Servicing, are detailed.

Paragraph 13, Referral to the Justice Department, was previously paragraph 12. The content is largely unchanged.

Paragraph 14, Termination of Collection Action (Write-off), is largely unchanged but has been reorganized for flow.

Paragraph 15, Recovery of an Existing Debt from a Deceased Debtor's Estate, has been largely enhanced. Procedures are now detailed for recovering an existing debt from the deceased claimant's estate and the strict timeframes associated with taking proper action to enhance opportunity for recovery.

Paragraph 16, Compensation Paid after Death, was previously paragraph 19. It is largely unchanged but has been reorganized for flow.

Paragraph 17, Bankruptcy, is a new paragraph. Bankruptcy in overpayments was previously addressed under 6-0200. The new paragraph details procedure, beginning with the urgency of ceasing all collection actions and automatic deductions and notifying the Regional Solicitor or SOL/FEEWC when the CE learns of the bankruptcy. The CE is also directed to secure any information pertaining to the bankruptcy. If the court requests that a Proof of Claim be completed, referral to the Regional Solicitor or SOL/FEEWC should be immediate.

Paragraph 18, Third Party Liability Debts, was previously paragraph 16. The paragraph is largely enhanced, detailing procedures for SOL/FEEWC and the claims staff in proper collection efforts, including referrals (where applicable) to the Departments of the Treasury and Justice.

Paragraph 19, Court Ordered Restitution in Fraud Cases, was previously paragraph 18 and is largely unchanged.

Antonio Rios
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: All DFEC Staff

Back to Top of FECA Transmittal No. 18-04

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 1-0200, Jurisdiction, has been updated to reflect the change in how jurisdiction is assigned upon case create for claimants who reside in Maryland. As in the past, cases are created and assigned based on the claimant's home address, and in the extremely rare case where a home address is not available, then from the claimant's duty station state. If neither are available, jurisdiction is based on the state where the injury occurred.

Previously, updates were made to include a change in the jurisdiction of claims filed by claimants who reside in all zip codes in Maryland, aside from those within a designated area primarily consisting of Prince George's County. District Office 03, Philadelphia, continued to be assigned claims arising in Delaware, Pennsylvania, West Virginia, and Maryland when the claimant's residence had a zip code beginning with "21" and, effective October 1, 2014, their jurisdictional authority was expanded to include new claims for claimants who reside in all zip codes in Maryland, aside from those within an area primarily consisting of Prince George's County which remained under the jurisdiction District Office 25, Washington, DC.

Effective August 22, 2016, jurisdiction for newly created cases for all claimants who reside in Maryland was transferred from Washington, DC's jurisdiction to Philadelphia's jurisdiction. In addition, effective October 1, 2016, jurisdiction for all previously existing cases within all zip codes in the state of Maryland will be transferred from Washington, DC's jurisdiction to Philadelphia's jurisdiction.

Paragraph 2, General Jurisdiction, defines home address state, duty station state, and state where the injury occurred, and explains the previous change in procedure based on duty station state to home address state, providing examples for emphasis. Each District Office's general jurisdiction by state is outlined with changes to District Office 03 (Philadelphia) and District Office 25 (Washington, DC) to coincide with Philadelphia's expanded jurisdictional authority for all zip codes in Maryland.

Based on the revision of Chapter 1-0200 which addresses the jurisdictional changes for Maryland, a minor update has also been made to Chapter 0-0100, Introduction to FECA and DFEC, paragraph 5a.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 17-01

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) with this issuance clarifies and amends several areas of procedure with respect to the processing of schedule awards.

First, it clarifies the actions to be taken when a District Medical Adviser (DMA) provides a detailed and rationalized review that does not concur with an impairment rating provided by a second opinion examiner.

Per FECA Procedure Manual 3-0700.3, one of the functions of the DMA is to review case files in posture for a schedule award, particularly the medical report on which the impairment rating is to be based, and then independently calculating the award.

Section 8123(a) of the Federal Employees Compensation Act provides that when there is a disagreement between a physician making the examination for the United States and a physician of the employee, a third physician shall be appointed to make an examination to resolve the conflict. The Act does not provide for a conflict in opinion between two physicians making an examination for the United States, i.e., a DMA and a second opinion examiner.

To that end, FECA Procedure Manual Chapter 2-0808.6 has been clarified to reflect that when the DMA provides a detailed and rationalized review of an impairment rating that does not concur with the second opinion examiner, the DMA's opinion may not create a conflict with a second opinion examiner.

Second, it amends established procedure, removing the requirement of DMA review of a referee medical examiner's impairment evaluation.

20 C.F.R. 10.502 provides that if medical reports that are equally well-reasoned support inconsistent determinations of an issue under consideration, OWCP will direct the employee to undergo a third, impartial referee examination to resolve the issue, which will be given special weight in determining the issue.

Because of the authoritative weight given to the report of an impartial referee examiner, DFEC has determined that additional review of the referee report is unnecessarily duplicative. Accordingly, FECA Procedure Manual Chapter 2-0808.6 has been updated to advise that it is no longer absolutely required to route a referee's impairment evaluation to another DMA as long as the referee's report fully resolves the conflict and provides a thorough explanation of impairment, citing to the applicable tables and charts in the AMA Guides.

Lastly, this update further emphasizes that rated impairment should reflect the total loss as evaluated for the scheduled member at the time of the rating examination. There are no provisions for apportionment under the FECA and the Employees Compensation Appeals Board (ECAB) has long held that an impairment assessment should include both work-related impairment as well as non-industrial impairment of the same scheduled member. See Raymond E. Gwynn, 35 ECAB 247, 253 (1983). To that end, FECA Procedure Manual Chapter 2-0808.5 has been updated with additional language and examples emphasizing this point of law.

CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS

Paragraph 5, Evaluation of Schedule Awards, paragraph (d) has been updated with additional clarity, emphasizing that schedule awards include permanent impairment resulting from conditions accepted by the OWCP as job-related as well as and any non-industrial permanent impairment present in the same scheduled member as a work-related condition at the time of the rating examination.

Paragraph 6, Obtaining Medical Evidence, (f) District Medical Advisor (DMA) Review (2)(e) concerning DMA review that does not concur with the impairment rating, the language has been modified to remove "second opinion" to clarify the actions to be taken by the claims examiner when the DMA does not concur with the second opinion examiner's impairment rating.

In Paragraph 6, Obtaining Medical Evidence, (f) District Medical Advisor (DMA) Review, the language has been modified slightly to remove language referring to the second opinion physician.

In Paragraph 6, Obtaining Medical Evidence, (g) If a case has been referred for a referee evaluation, the language has been modified to remove the requirement that a referee report be referred to the DMA. It is noted that the DMA can still be utilized for interpretation of the referee medical report but only if the CE determines such review is necessary.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: Applicable DFEC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

With this issuance, the Division of Federal Employees' Compensation (DFEC) addresses the transition to the ICD-10 diagnostic system.

When conditions are accepted as work related in a case, a corresponding diagnosis code is entered into the case management system for maintenance and bill payment purposes. Diagnosis codes are established by the International Classification of Diseases (ICD). The U.S. Department of Health and Human Services (HHS) determined that October. 1, 2015 is the compliance date for health care providers, health plans, and health care clearinghouses to transition from ICD-9 to ICD-10, the tenth revision of the ICD.

FECA Procedure Manual Chapter 2-401.10 has been updated accordingly to reflect coding changes due to the transition to ICD-10.

References to the prior version of the ICD have been removed from Part 2 and Part 3 of the DFEC Procedure Manual: Chapter 2-0600, Disability Management, Chapter 2-0800, Initial Development of Claims, Chapter 2-0806, Initial Acceptances, Chapter 2-0811, Nurse Case Management, Chapter 3-0201, Staff Nurse Services.

Part 5 of the DFEC Procedure Manual will be updated at a later time.

CHAPTER 2-0401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS

Paragraph 10 is now titled ICD Codes. This section has been revised to cover the changes to the structure and composition of codes from ICD-9 to ICD-10. The paragraph explains the number of digits in the new codes and the new structure that takes into account the etiology, anatomic site and severity of the injury, with extensions designating the episode of care.

CHAPTER 2-0600, DISABILITY MANAGEMENT

Paragraph 7, Medical Intervention, d, Authorization for Medical Treatment, (2) Requests for Surgery, a reference has been changed from ICD-9 to ICD.

CHAPTER 2-0800, INITIAL DEVELOPMENT OF CLAIMS

Paragraph 11, Withdrawal of Claim, a - Upon Receipt of a Written Request, (3), a reference has been changed from ICD-9 to ICD.

CHAPTER 2-0806, INITIAL ACCEPTANCES

Paragraph 2, Accepting the Claim, c – Enter the Accepted Condition(s), a reference has been changed from ICD-9 to ICD.

CHAPTER 2-0811, NURSE CASE MANAGEMENT

Paragraph 7, Field Nurse Referral, a – The Nurse Referral, a reference has been changed from ICD-9 to ICD.

CHAPTER 3-0201, STAFF NURSE SERVICES

Exhibit 1, Initial Evaluation of Claimant, a reference has been changed from ICD-9 to ICD.

Exhibit 2, Progress Record, a reference has been changed from ICD-9 to ICD.

Exhibit 5, Suggested Training Topics, a reference has been changed from ICD-9 to ICD.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Fiscal Personnel, Systems Managers, and Technical Assistants)

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EXPLANATION OF MATERIAL TRANSMITTED:

With this issuance, the Division of Federal Employees' Compensation (DFEC) addresses the time limitations on requests for reconsideration.

OWCP's regulations at 20 CFR 10.607(a) establish that an application for reconsideration must be received by OWCP within one year of the date of the OWCP decision for which review is sought. While this one-year period had previously been construed to begin on the date of the original decision, the Employees Compensation Appeals Board (ECAB) has held that the one-year period should begin to run on the date after the decision was issued. ECAB has also held that when determining the one-year period for requesting reconsideration, the last day of the period should be included unless it is a Saturday, a Sunday or a legal holiday.

To that end, FECA Procedure Manual Chapter 2-1602.4 has been updated to reflect OWCP's incorporation of ECAB's interpretation of the precise determination of the one-year period.

CHAPTER 2-1602, RECONSIDERATIONS

Paragraph 3, Preliminary Processing, has been modified slightly, with language advising that with review of a request, sufficient detail should be provided to discern the decision being contested and in effort to ascertain that another form of appeal is not being requested.

Paragraph 4, Time Limitations, clarifies that the one-year period to request reconsideration begins to run on the first day after the original decision rather than on the date of the original decision, and to clarify what is the last day of the one-year period.

Paragraph 5, Untimely Application, inclusion of an additional citation.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

Distribution: All DFEC Staff

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 1-0200, Jurisdiction, has been updated and streamlined to reflect the change in how jurisdiction is assigned upon creation of a case. Previously, cases were created and assigned based upon the claimant's duty station state, and if that was not available then from the claimant's home address, and if that was not available then from the state where the injury occurred. Now, cases are created and assigned based upon the claimant's home address state, and in the extremely rare case where the home address is not available then from the claimant's duty station state. If neither are available, jurisdiction is based upon the state where the injury occurred.

The Division of Federal Employees' Compensation has determined that it would improve overall service to DFEC claimants and Federal employing agencies by making a shift in jurisdiction for certain claims. Updates have been made to include a change in the jurisdiction of claims filed by claimants who reside in all zip codes in Maryland, aside from those roughly encompassing Prince George's County. Previously, District 3, Philadelphia, handled claims arising in Delaware, Pennsylvania, West Virginia, and Maryland when the claimant's residence had a zip code beginning with "21" and all other Maryland claims fell under the jurisdiction of District 25, Washington, DC. Effective September 1, 2014, Philadelphia's jurisdictional authority was expanded to include new claims for claimants who reside in all zip codes in Maryland, aside from those within an area roughly encompassing Prince George's County which will remain under the jurisdiction of Washington, DC. Effective October 1, 2014, jurisdiction for existing claims with all zip codes in Maryland, aside from those within an area primarily within Prince George's County, were transferred from Washington, DC's jurisdiction to Philadelphia's jurisdiction.

The number of paragraphs in this chapter has been reduced from 5 to 4.

Paragraph 2, General Jurisdiction, defines home address state, duty station state, and state where the injury occurred, and explains the change in procedure based upon duty station state to home address state, providing examples for emphasis. Each district office's general jurisdiction by state is outlined with changes to District 3, Philadelphia, and District 25, Washington, DC, to coincide with Philadelphia's expanded jurisdictional authority for all zip codes in Maryland, aside from those roughly encompassing Prince George's County.

Paragraph 3, Special Jurisdiction, has been modified to emphasize the use of the home address state assignation, where applicable, in special jurisdiction cases. Additionally, special jurisdiction cases (with the exception of national security cases) are identified and assignment outlined as being managed by District 9, Cleveland.

Paragraph 4, Jurisdiction Before Adjudication, has been removed and its contents fully incorporated into Paragraph 2, General Jurisdiction.

Paragraph 5, Jurisdiction After Adjudication, has become Paragraph 4, and defines jurisdiction after adjudication in fatal and non-fatal cases and for those claimants who have seasonal residences. A clarification statement that cases should be transferred when the claimant's home address state changes, unless under special jurisdiction or seasonal residency, has been added.

Based on the rewrite of Chapter 1-0200 which addresses the need to provide a home address, minor updates have been made to Chapter 1-0100, Introduction to FECA and DFEC, paragraphs 5a and c; Chapter 2-0400, File Maintenance and Management, paragraph 2; Chapter 2-0802, Civil Employees, paragraph 33; Chapter 2-1700, Special Case Procedures, paragraph 3; Chapter 4-0100, Special Case Procedures, paragraph 3; Chapter 4-0200, Non-Federal Law Enforcement Officers, paragraph 4; Chapter 4-0300, War Hazards, paragraph 4; Chapter 4-0400, War Claims, paragraph 4; Chapter 4-0500, Civil Air Patrol, paragraph 3; Chapter 4-0600, Reserve Officers' Training Corps, paragraph 3; Chapter 4-0700, Federal Relief Workers, paragraph 4; Chapter 4-0801, Foreign National Claims, paragraph 5; and Chapter 4-802, Panama Canal Cases, paragraphs 3 and 4.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Chapter 1-200-3 has been amended. Chapter 2-1701 is entirely new. Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0810, paragraph 9, Second Opinion Examinations, and Chapter 3-0500, paragraph 3, Second Opinion Examinations, have been revised to reflect the specific medical documentation required to be sent to a second opinion physician upon referral. These requirements are based on the age of the case and/or the nature of the referral.

Subparagraph (a) of 2-0810.9 and subparagraph (c) of 3-0500.3 define the new requirements and outline that in addition to a Statement of Accepted Facts (SOAF) and a list of pertinent questions or issues to be addressed, the second opinion physician should be provided with copies of the following:

1. For unadjudicated case referrals and all referrals for medical management, disability management or surgery: all operative reports regardless of age, all diagnostic tests regardless of age and all medical records from any qualified physician as defined in 5 U.S.C. 8101(2) authored within three years of the date of the second opinion referral.

2. For schedule award case referrals: all operative reports regardless of age, all diagnostic tests regardless of age, all medical records from any qualified physician as defined in 5 U.S.C. 8101(2) that address permanent partial impairment and maximum medical improvement and the most current comprehensive medical narrative report from a qualified physician as defined in 5 U.S.C. 8101(2).

3. New procedure also provide that should the Claims Examiner determine, in the exercise of his or her judgment, that the unique circumstances of a case file suggest that additional information would be of assistance to the examiner, documentation of such circumstances and the specific changes should be outlined in a Memorandum to the File and made part of the case record.

DOUGLAS C. FITZGERALD
Director for Federal
Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) and the Peace Corps have historically worked together to improve the workers' compensation experience for returning volunteers who have sustained an injury or occupational illness as a result of service with the Peace Corps. In an effort to provide better outreach to Peace Corps volunteers, DFEC has a link on its home page with information specific to Peace Corps volunteers.

To further improve the quality of the information provided in relation to Peace Corps cases and to update its own internal guidance for even more consistent claims handling, DFEC with issuance of this transmittal is releasing an entirely new Procedure Manual (PM) chapter pertaining solely to claims devoted to Peace Corps volunteers, PM 2-1701.

Information relative to Peace Corps volunteers used to be found in three separate places within the Federal Employees' Compensation Act (FECA) PM: Chapter 1-200-3, Chapter 2-1700-4 (and Exhibit 1 in that chapter) and Chapter 3-300-7. Chapter 3-300-7 had been updated in February, 2012 via FECA Transmittal 12-05 and some specific changes pertaining to Peace Corps cases were made at that time, to include the addition of new conditions for which the Peace Corps could provide treatment if the cost was less than $1000. PM 2-1700-4 had not been updated since early 2007 and PM 1-200-3 had not been updated since May, 2010.

Chapter 1-200-3 is amended to reflect that all Peace Corps cases (including National office claims) will initially be handled in the Cleveland District Office, as the Cleveland office has ongoing close contacts with that office.

New PM chapter 2-1701 incorporates the information pertaining to Peace Corps cases that had been in 2-1700 and 3-300 and includes additional and newly updated information as outlined below; it also removes outdated citations and references that were contained the Peace Corps section of 2-1700. PM chapter 1-200-3 was amended to correspond with the jurisdictional rules provided in Paragraph 5, below.

Paragraph 1, Introduction, provides the genesis for the establishment of the Peace Corps and outlines that the chapter will focus on the unique aspects of coverage under that pertain specifically to volunteers in the Peace Corps. It also notes that claims for Peace Corps employees who work for the Peace Corps, other than as volunteers or volunteer leaders, are handled in the same manner as other claims and that there are no special rules for handling claims from such employees.

Paragraph 2, Statutory Provisions of the FECA, provides the text of §8142 of the FECA, which pertains specifically to Peace Corps.

Paragraph 3, Regulatory Provisions under the FECA, provides the text of 20 C.F.R §§8 10.730 and 10.731, which pertain specifically to Peace Corps.

Paragraph 4, Statutory Authority for Peace Corps, provides relevant references to specific sections of Peace Corps Act.

Paragraph 5, Jurisdiction, outlines that Peace Corps claims are initially adjudicated in the Cleveland District Office, after which they are transferred to other district offices if approved.

Paragraph 6, FECA Coverage of Employees/Volunteers, discusses the differences in coverage for Peace Corps volunteers, staff employees, and staff spouses (while performing service or engaged in official travel).

Paragraph 7, Conditions of Coverage During Training, explains that Peace Corps applicants have the protection of the FECA while performing their training assignments or while engaged in any activity which is a reasonable incident of the training assignment.

Paragraph 8, Conditions of Coverage while Serving Abroad, provides information relative to section 5(d)(2) of the Peace Corps Act. This paragraph explains that injuries of trainees and volunteers while abroad are deemed to have occurred while in the performance of duty, and any disease contracted abroad is deemed to have been proximately caused by the employment. The exclusions for willful misconduct, intent to bring about injury or death of self or another, or intoxication, which appear in §8102 of the FECA and section 5(d)(2) of the Peace Corps Act, are noted as exceptions.

A discussion of various types of medical conditions, such as dental disease, mental illness and pregnancy, is included in this paragraph as well. Also, as first noted in FECA Transmittal 12-05, this paragraph specifically notes that injury due to assault or sexual assault (including treatment for sexually transmitted disease and mental health treatment) are covered under the FECA.

Paragraph 9, Conditions of Coverage Returning from Service Abroad, outlines that a volunteer who returns to the United States immediately after completing service abroad has the protection of the FECA while traveling to the United States unless a material deviation occurs. If the volunteer is terminated at a foreign post of duty, the volunteer has the protection of the FECA only during that part of the trip when on the direct or most usually traveled route between the foreign post of duty and the United States.

Paragraph 10, Payment of Medical Costs by Peace Corps, provides that where treatment of certain specified service-related medical conditions or injuries costs less than $1500, the Peace Corps will, at its discretion, pay medical costs directly. If the cost for necessary treatment is $1500 or more, a claim must be filed under the FECA using normal procedures.

• The $1500 dollar limit is an update effective with this transmittal. The prior dollar limit of $1000 was re-evaluated at the request of the Peace Corps. In keeping with FECA procedures regarding cases which are simple or do not involve large expenses, and in recognition that medical costs have risen since the $1000 amount was implemented, the dollar amount was increased.
• Likewise, DFEC also considered expansion of additional medical conditions that can be considered under this authority. In February, 2012 new conditions were added to the previously approved list of medical conditions (see FECA Transmittal 12-05). Additions at that time included: vaginal yeast infections (candidiasis); acute otitis media; acute sinusitis; constipation; and hemorrhoids.
• With the issuance of this transmittal, DFEC is adding giardia to this list (as long as the condition requires only a one-time treatment).
• DFEC is also adding initial tuberculosis treatment to this list, with a caveat. Tuberculosis can be classified as either latent tuberculosis or tuberculosis disease. Treatment for latent tuberculosis is optional for the infected individuals and there is no time sensitivity for treatment since they are asymptomatic; however, volunteers who develop tuberculosis disease do need immediate treatment. As a result, the discretionary conditions for which the Peace Corps can provide up to $1500 in treatment includes tuberculosis with the caveat that a claim form must be submitted in all tuberculosis claims.

Paragraph 11, Initial Authorization for Medical Care, outlines that requests for initial authorization of medical care in emergency situations (prior to creation of a case) should be directed to the Cleveland District Office and requests for treatment, after a case has been created, should be referred to OWCP's authorized billing agent (like all other cases).

Paragraph 12, Reporting Injuries and Deaths, outlines that Peace Corps volunteers are required to report injuries in the manner required by 20 C.F.R §§ 10.100 and 10.101; however, for ease of handling while the volunteer is overseas, some special handling processes are used.

• With respect to timely filing of the claim, if the volunteer sustains an injury or occupational disease while abroad, the volunteer should notify his/her supervisor/team leader. The Peace Corps will then typically provide for any medical care needed while abroad and should document the volunteer's medical file accordingly. By documenting the medical file with any treatment provided, a claim (if filed later) will meet the eligibility for timely filing, which is one of the five necessary elements for acceptance of a claim. See FECA PM 2-0801. Upon separation, the volunteer should then submit Form CA-1 (for traumatic injury) or Form CA-2 (for occupational disease) to the Peace Corps. Upon receipt of a form, the Peace Corps should then assist with questions; complete its part of the form; and forward the claim to OWCP.
• The Peace Corps should provide the dates of enrollment and separation, and the dates of service abroad with any claim submitted.
• With the claim form, the Peace Corps should also submit the volunteer's medical record, which usually includes the results of the pre-employment and termination examinations and a record of medical care received during service. This medical information is needed when adjudicating claims, as noted above. While in some instances OWCP may only need limited information from the medical record, OWCP reserves discretion to request and receive the entire medical record from Peace Corps.

Paragraph 13, Claims for Disability Compensation, provides specific information relative to the filing and payment of compensation claims for Peace Corps volunteers. It is noted that the date of the volunteer's separation will be the date pay stops and that entitlement to compensation for temporary or permanent disability begins on the date following the date of separation. Specific information on other elements related to payment of compensation, such as pay rates, effective payrate dates, and waiting days, is also provided. Continuation of Pay is not paid to Peace Corps volunteers. See 20 C.F.R. 10.200 (d).

Paragraph 14, Disability Management, outlines that Peace Corps volunteers (and all employees of the Peace Corps) are entitled to all services provided for under the FECA. This includes the full complement of nurse intervention and vocational rehabilitation services provided as part of the Disability Management process.

Exhibit 1, Annual Pay Rates for Computing Compensation for Peace Corps Volunteers, provides the payrate amounts, effective the date of injury (separation) through the present year.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Chapter 1-200-3 has been amended. Chapter 2-1701 is entirely new. Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Fiscal Personnel, Systems Managers, and Technical Assistants)

Back to Top of FECA Transmittal No. 14-01

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 was revised and updated in its entirety in October, 2011. The chapter was then updated in November, 2012, and additional updates are being made at this time as outlined below. These updates include new coding logic that was added to iFECS effective November 18, 2013.

Paragraph 1, Purpose and Scope, was updated to include references to other relevant parts of the Procedure Manual, Part 7 Nurse Intervention and Part 8 Rehabilitation.

Paragraph 6, DM Codes, was updated to indicate that there are six, not five, types of mandatory codes since Dual Tracking codes are really specific unto themselves. The portion of this paragraph pertaining to mandatory CE Intervention Codes also now includes a reference to codes for the following circumstances: a second opinion examination has been determined to be unnecessary; valid work tolerance limitations are in file, but the claimant has not returned to work; and valid work tolerance limitations are not in file. The codes are then described in more detail in other paragraphs. Additional information was also added relative to the RMV code to clarify that it should be entered after concurrence by a Supervisor that the DM record should be deleted and that valid DM cases should not be removed from DM via the RMV code.

Paragraph 7, CE Intervention Codes, which outlines mandatory CE codes, was updated in a few places, and some reorganization took place so that the codes are listed in alpha order within the chapter.

• The explanation of the MSN code was moved into this paragraph and out of the Optional Code paragraph, since this code is mandatory if it is determined that a second opinion in a total disability case is not necessary. The description remained essentially the same; however, more detail was added to remind staff that the fact that a claimant is released to limited duty and/or is participating in Vocational Rehabilitation is not in itself a valid reason to use the MSN code. To use the code in such cases, the file should reflect that there are no pending issues related to (1) continuing causal relationship of the condition(s) to the work injury/illness, or (2) whether the claimant could return to full duty.
• WTL (Valid WTLs in File-No RTW) is a new code. This code is required when valid work restrictions for all conditions have been obtained but the claimant has not yet returned to work. "All conditions" include those which have been accepted in the current claim as well as any other accepted conditions in other case files, conditions which pre-existed the injury, and conditions which arose after the injury. There are two options for entry of the WTL code in the DM record:

(1) Manual Entry by the CE. The effective date of the status is the date of the most recent medical work release outlining the necessary work restrictions.

(2) Auto-Population from the response provided in the Periodic Entitlement Review (PER) record. If the CE answers "Yes" to the PER question "Valid work restrictions in file for all conditions?", the PER will then require entry of the date of the most recent medical work release outlining the necessary work restrictions. After entry of this information in the PER record, the DM record will auto-populate the WTL code in the DM record. The effective date of the status will auto-populate with the date entered in the PER record (i.e. the date of the most recent medical work release outlining the necessary work restrictions). The pertinent question in the PER will only activate for cases in a PR or PN status since cases in a PW status already have a determined wage earning capacity.

• WTX (Valid WTLs not in File) is a new code and complements the WTL code. If the claimant has not been released to work and remains totally disabled from reemployment, code WTX is required. This code is also required when a claimant who previously had been given a work release, but had not returned to work, is no longer released to work due to an increased disability or when the work tolerance limitations have changed such that they are no longer considered valid (in these situations, the WTX code can be entered in the DM record subsequent to the previously entered WTL code - the previously entered WTL code should not be deleted from the DM record). Like the WTL code, there are two options for entry of the WTX code in the DM record:

(1) Manual Entry by the CE. The effective date of the status is the date the CE determines that valid work restrictions are not file for all conditions.

(2) Auto-Population from the response provided in the PER record. If the CE answers "No" to the PER question "Valid work restrictions in file for all conditions?", the PER will auto-populate the WTX code in the DM record. The effective date of the status will auto-populate with the date of the PER record closure.

NOTE: Entry of either the WTL or WTX code can be made and updated at any time during the life of a DM case/record, but it is mandatory upon Field Nurse closure when a claimant has not returned to work (via CE manually entry) and when completing a PER record for any case with a status of PR or PN (via auto-population). However, for optimal case management, the CE should also update the DM record with a WTL or WTX code whenever the claimant's ability to work changes, not just at the time of nurse closure and during the annual PER review.

Paragraph 12, Optional Codes, was updated as outlined below.

Additional DM codes were added to assist with the management and monitoring of disability cases:

PRX (Pre-reduction cannot be finalized). PRX can be entered after a proposed notice of reduction has been sent to the claimant and subsequent evidence or argument is received which hinders the CE from proceeding with a final notice of reduction. The effective date of code PRX should be the date of the notification sent to the claimant advising him/her of the determination to discontinue with the proposed reduction.

PTX (Pre-termination cannot be finalized). PTX can be entered after a proposed notice of termination has been sent to the claimant and subsequent evidence or argument is received which hinders the CE from proceeding with a final notice of termination. The effective date of code PTX should be the date of the notification sent to the claimant advising him/her of the determination to discontinue with the proposed termination.

An explanation was added for the already existing TRL code:

TRL (Transfer of case). TRL can be entered to denote a transfer of a case file from one District Office to another. The TRL code can be entered by the receiving District Office effective the date it received the transferred case.

The explanation of the SUR code was updated to indicate that the effective date for the code can be a future date, which was a change made in the noted iFECS release.

SUR (Surgery Authorized). SUR can be entered when the claimant has approved surgery. This code is useful for alerting the CE to re-evaluate the disability management options for this case. The effective date of code SUR should be the date the surgery is performed. If the surgery is scheduled for a date in the future, entry of this future date is allowed.

Paragraph 13, Closure Codes and Resolutions, was updated in a few places primarily to account for coding associated with return-to-work in temporary positions and failure to accept appropriate temporary light duty assignments commensurate with 20 C.F.R. 10.500. See FECA Transmittal 13-09 and PM chapter 2-814 for more detail.

• In sub-paragraph "c" in this section, the explanation of CNC was updated slightly but the meaning remains essentially unchanged. This code is used if the claimant's work restrictions have reached a stable and well-defined state, the claimant has returned to a full-time light duty work assignment with no wage loss, and a formal LWEC decision cannot be issued due to the work assignment being a non-classified and/or temporary position.
• Also in sub-paragraph "c", an explanation for a new code, TNW (RTW temp LD w/wage loss-10.500), was added. This code is similar to the CNC code but is to be used in cases where a formal LWEC decision cannot be issued, but the claimant is receiving wage loss compensation on the periodic roll based upon his/her actual earnings. It is similar to a CNC in that the claimant's work restrictions have reached a stable and well-defined state and the EA is providing a consistent light duty work assignment in a non-classified position and/or a position that is temporary in nature. However, unlike a CNC case, the claimant's employment is either less than full-time or full-time with lower wages than what the claimant earned in his/her date of injury job.
• In sub-paragraph "d", which addresses cases where there was NO actual RTW, but the claimant is medically able to RTW, an explanation of the new code TNX (Comp reduced/declined temp LD-10.500) was added. TNX should be used when a claimant is provided a temporary light duty assignment that is either less than full-time or full-time with lower wages than what the claimant earned in his/her date of injury job; the temporary assignment appropriately accommodates the claimant's medically-imposed work restrictions; and the claimant declines the assignment. A formal decision should be issued in this instance and the effective date of the TNX code is the date of the final decision.
• Sub-paragraph "e", which addresses situations where there is no disability from work, has been updated with an explanation of the new CCT code (Comp terminated/declined temp LD-10.500). CCT should be used when a claimant is provided a temporary light duty assignment that would result in no wage loss; the temporary assignment appropriately accommodates the claimant's medically-imposed work restrictions; and the claimant declines the assignment. A formal decision should be issued in this instance and the effective date of the CCT code is the date of the final decision.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 8-0200, Referrals for Rehabilitation, is a new chapter in FECA Procedure Manual (PM), Part 8 - Vocational Rehabilitation Intervention.

Currently, Referral Screening (Development) is discussed in Part 3 of the OWCP PM, Chapter 3-0300. As outlined in FECA Transmittal No. 12-12, however, it has been decided that moving information pertaining to DFEC's Rehabilitation Program into the FECA PM is warranted. The OWCP PM chapter will remain, and that chapter may be referenced for a historical perspective, but since it has not been recently updated, this new chapter (FECA PM 8-0200) should be consulted for any rehabilitation referral issues, since it contains the most current policies and procedures for DFEC.

Paragraph 1, Authority, provides a reference for relevant statutory and regulatory provisions and provides Employees' Compensation Appeals Board (ECAB) precedent pertaining to the provision of rehabilitation services.

Paragraph 2, Purpose and Scope, defines referral screening and identifies the two related steps.

Paragraph 3, Referral Sources and Mechanics, explains the importance of early case referral and identifies the various sources of referrals for rehabilitation.

Paragraph 4, Referral Requirements, outlines the information which each referral for rehabilitation should include and provides the process by which such referral should be transmitted to the RS.

Paragraph 5, Active Field Nurse Cases and Dual Tracking, identifies those instances in which a case may be referred for rehabilitation concurrently with active Field Nurse (FN) services.

Paragraph 6, Screening, defines the goal of screening and provides the time frame within which such screening should be completed. This paragraph also explains the three components required for review (medical, non-medical, and injured worker information) and provides guidance on how to clarify any vague or missing information.

Paragraph 7, Referral Outcome, explains how to open an active rehabilitation case and assign a Rehabilitation Counselor (RC) when necessary or close a case from referral when the case is not in posture for rehabilitation services.

Paragraph 8, Limited Referrals, defines those instances in which a referral to an RC on a limited basis may be appropriate even though one or more of the referral requirements has not technically been met.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Chapter 1-200-3 has been amended. Chapter 2-1701 is entirely new. Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

The exhibit outlining the special case designations is being updated. Two new case designations are being added, as outlined below.

NYS (Navy Yard Shootings) – This case designation will be used to identify cases containing reports of injuries related to the Navy Yard shootings at the headquarters of the Naval Sea Systems Command inside the Washington Navy Yard in Southeast Washington, D.C. on September 16, 2013.

LAX (LAX Shootings) – This case designation will be used to identify cases containing reports of injuries related to the shootings inside Terminal 3 of the Los Angeles International Airport on November 1, 2013.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0901 paragraph 12 has been updated to reflect that a claimant who is legally married to a same sex spouse is entitled to the augmented compensation rate per the June 26, 2013 Supreme Court decision of United States vs. Windsor, which struck down the provision of the Defense of Marriage Act (DOMA) that prohibited the federal government from recognizing legally married same sex couples. See also FECA Bulletin 14-01 (issued December 12, 2013).

Chapter 5-0400 paragraph 3 Health Benefits Insurance has been updated to reflect that OWCP will administer health benefits to same sex spouses and children of same sex marriage in accordance with OPM's guidance following the ruling in United States vs. Windsor.

DOUGLAS C. FITZGERALD
Director for
Federal Emp

loyees' Compensation

These chapters are being updated. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0810, paragraph 17, has been revised in its entirety. This subsection now provides a comprehensive discussion of the requirements for authorizing purchases and/or rentals of durable medical equipment (DME), including hearing aids.

Paragraph 17, subparagraph (c) provides new procedures for authorization of "miscellaneous DME" requested under code E1399. Before authorizing E1399 or any unlisted procedure code, the CE should request that the provider identify and submit a procedure code from the AMA booklets that describes the equipment. If the provider is unable to do so, it should submit justification for the use of the E1399 or unlisted code.

Subparagraph (d) provides the basic evidentiary requirements for authorization of DME.

Subparagraph (e) provides further guidance with respect to purchasing DME. It advises that purchases over $2500 require estimates from at least two providers. It should be noted that some agencies have contracted with DME providers to provide items at a discount. These agency programs are voluntary on the part of the claimant, however, OWCP remains the decision maker on what DME is authorized and how. If an agency has contracted with such a provider, the claimant may if he or she so chooses use that provider if the cost of the equipment is $2500 or less -- for amounts greater than that, the comparison should still be followed and the contract provider may form one of the estimates. It also notes that the basic, unadorned DME with the lowest cost that meets the physician's specifications should be authorized. It should be further noted that while the FECA regulations require all DME providers to be registered in Medicare's Durable Medical Equipment, Prosthetics, Orthotics and Supplies Accreditation process, due to changes in the authorizing legislation and other regulations, this Medicare process is not due to be completed nationwide until 2016. See Center for Medicare & Medicaid Services, DMEPOS Competitive Bidding Program Overview, available online at cms.gov. Accordingly, OWCP will not implement this accreditation process until it is available nationwide.

Subparagraph (f) is new procedure and describes when and how to perform a rental versus purchase analysis. A medical provider or claimant may sometimes request authorization for rental of DME rather than purchase. In such cases, rental of DME may be authorized for up to 60 days if supported by the medical evidence. Rental of DME beyond 60 days requires the CE to perform a rental versus purchase analysis as described in this subparagraph.

Subparagraph (i) provides procedures on authorizing new and replacement hearing aids. Price quotes from multiple suppliers are not necessary for hearing aids. However, the CE should still ensure that the hearing aids requested represent the basic, unadorned aids that meet the prescribing physician's specifications. Most importantly, the CE should not approve hearing aids costing in excess of $5,000 (monaural) or $10,000 (binaural) absent well-rationalized medical evidence supporting more expensive aids.

Subparagraph (k) emphasizes the importance of advising the claimant in writing of any DME authorization denials. It notes that a formal decision with appeal rights should be provided upon the claimant's request.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1401, Initial Denials, is a new chapter in Part 2 of the Federal Employees' Compensation Act (FECA) Procedure Manual (PM).

This chapter describes the steps involved in processing an initial case denial if any one of the five basic requirements has not been established. Along with FECA PM 2-0801 through 2-0805, it covers the factors that should be addressed when denying an initial claim and preparing the formal Notice of Decision.

Currently, formal decisions are discussed in Chapter 2-1400 (Formal Decisions). The issuance of an initial denial is a distinct process, though, and as such, it has been decided that moving information pertaining to the initial denial of a claim to an entirely new chapter is warranted. In doing so, the process for denying all initial claims (including claims for emotional conditions) will be updated and expanded to provide clear guidelines for the denial of an initial claim when one of the five basic elements has not been met.

Paragraph 1, Purpose and Scope, outlines that the chapter will focus solely on the process of issuing a denial on an initial claim when one of the five basic elements has not been met.

Paragraph 2, Statutory and Regulatory Requirements, provides references to Section 5 U.S.C. 8124(a) of the FECA, as well as 20 C.F.R. §§10.115 and 10.121, as the authority for the information contained in the chapter.

Paragraph 3, Burden of Proof, discusses the claimant's burden of proof for establishing a claim, and the necessary steps the Claims Examiner (CE) must take before an initial claim can be formally denied.

Paragraph 4, Element for Denial, outlines the procedure for reviewing the claim to determine whether the five basic elements have been met after the claimant has been provided the opportunity to submit necessary evidence. It outlines that the five basic elements should be considered in a hierarchical manner.

Paragraph 5, Writing the Initial Denial, discusses how to prepare the initial denial once it has been determined which of the five basic elements has not been established. It notes that the initial denial is a legal document which serves as a basis for further action in the claim, including appeals, and that it should provide a clear explanation of the disallowance of the claim.

Paragraph 6, Emotional Condition Denials, discusses the denial of an initial claim for an emotional condition, and the importance of identifying and discussing all evidence that pertains to the specific issue, including any unsuccessful attempts to obtain significant evidence. It also discusses the need to distinguish between those workplace activities and circumstances which are factors of employment and those which are outside the realm of employment for purposes of compensation, as well as determining whether the event or situations alleged actually existed or occurred.

Paragraph 7, iFECS Coding, outlines proper case coding for iFECS when an initial claim is denied.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

This is a new chapter. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Fiscal Personnel, Systems Managers, and Technical Assistants)

Back to Top of FECA Transmittal No. 13-01

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 was updated in its entirety in October, 2011. Additional updates are being made at this time to provide more clarity with regard to DM Track Dates for Traumatic Injury cases which did not meet the eligibility requirements to become Triage COP Cases. In addition, clarification is also being provided on the use of an existing Optional DM Code (MNR), as well as the introduction and explanation of several new Optional DM Codes.

Paragraph 4, DM Records, now provides instructions on how to set the DM Track Dates for manually created DM Records for Traumatic Injury cases which did not meet the eligibility requirements to become Triage COP Cases. Instructions are provided for those cases where the DM record is created prior to the expiration of the COP period, as well as those cases where the disability extends beyond the COP period.

Paragraph 12, Optional Codes, now includes additional new DM codes to assist with the management and monitoring of disability cases:

This paragraph has also been revised to provide further clarification regarding the use of code MNR (Narrative Report Received). Specifically, the use of the MNR code was further defined as being used only when a narrative medical report is submitted in response to a specific request from the CE (after the entry of the QAP code). In order to input the MNR code, the narrative report should address the questions posed by the CE in the QAP letter.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

The exhibit outlining the special case designations is being updated. Two new case designations are being added, as outlined below.

CLJ (Camp Lejeune Water Contamination) – This case designation will be used to identify cases containing reports of injuries related to contaminated water in Camp Lejeune, North Carolina. On August 6, 2012, the President signed the "Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012" (Camp Lejeune Act), which provides for medical care for certain conditions for veterans and their families who were exposed to contaminated water while stationed in Camp Lejeune, North Carolina. The passage of the Camp Lejeune Act highlighted the need for special tracking of these claims.

A federal employee would be entitled to FECA benefits for a timely claimed medical condition (including a latent condition) caused by water contamination at Camp Lejeune if he or she was exposed to such water contamination in the performance of duty (including through employer-provided housing) and could provide medical evidence that such exposure caused, contributed to or aggravated that medical condition.

HSA (Hurricane Sandy 2012) – This case designation will be used to identify cases containing reports of injuries related to Hurricane Sandy (which made landfall in late October, 2012) and its aftermath.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 13-03

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Background: Section 8123(a) of the Federal Employees' Compensation Act (FECA) and 20 CFR §10.321 provide for the appointment of a referee physician to examine the claimant and resolve a conflict of medical opinion in a case. This medical appointment is also referred to as an Impartial Medical Examination (IME). The selection of a physician to perform an IME is done by the district offices using the Medical Management application within the Integrated Federal Employees' Compensation System (iFECS).

FECA Procedure Manual (PM) 3-500-5 outlines how the Division of Federal Employees' Compensation (DFEC) uses the Medical Management application. When a physician is selected, the scheduler inputs the appointment date and time into the Medical Management application. The application then saves the appointment information and prompts the scheduler to generate the ME023, Appointment Notification Report, for imaging into the case file. Since the ME023 report can only be generated through the Medical Management application, it serves as documentary evidence that the referee appointment was scheduled through the use of the rotational system in the Medical Management application.

However, over the past year the Employees' Compensation Appeals Board (ECAB) has questioned the DFEC's documentation of this process and indicated that there was other documentation available that was not being presented as evidence of the rotational selection, and that the ME023 report alone was insufficient to substantiate proper selection of the impartial specialist. The ME023 report can only be generated through the Medical Management application, and the information contained therein cannot be altered; therefore, the ME023 report serves as documentary "best" evidence that the referee appointment was in fact scheduled through the use of the rotational system in the Medical Management application.

To satisfy the concerns and questions raised by the ECAB, and to further document the referee selection process, the DFEC has enhanced the current ME023 report effective December 17, 2012 to provide more information relative to the scheduling of an IME appointment. The enhancements include a listing of all physicians contacted and bypassed prior to the selection of the IME physician, as well as a certification statement. This information was previously included in certain case files via screen shots, but in many cases that information was not readable due to the quality of the screen shots.

This updated version of the ME023 report can only be generated for new appointments created on and after the date of this update in iFECS. It cannot be accurately generated for appointments made prior to December 17, 2012, and the prior version of the ME023 report (without bypass information) can no longer be duplicated.

As system updates were required to modify this report, updates were also made to the Medical Management application so that the physicians were automatically grouped into zip clusters based upon specified mileage ranges outside of the initial zip cluster (50 miles, 75 miles, and continuing in 25 mile increments up to 200 miles), as seen on the report.

Explanation of Changes: The process for IME selection and scheduling has not changed. The DFEC will continue to use a rotational method for selection of IME physicians. However, to further explain the rotational process and to document the new MEO23 report, paragraph 5, Medical Management Application, has been outlined as described below.

The initial paragraph was updated to note that on rare occasions the Medical Management Application (MMA) will be used to locate a qualified second opinion examiner if a second opinion examiner within the second opinion contract for the District Office cannot be utilized. In these instances, the rotational requirement does not apply.

In sub-paragraph 5a, a typographical error was corrected. The DFEC's data system was known as FECS, not iFECS, in 2000, so this reference was corrected.

Sub-paragraph 5b was updated to clarify that the specified 200-mile radius is calculated from the claimant's home zip code.

Sub-paragraph 5c was re-worded slightly for clarity.

Sub-paragraph 5d was shortened significantly, since a complete explanation of the rotational process was moved to a new paragraph, 5e.

Sub-paragraph 5e (Presentation of Physicians) is completely new. This section provides detail regarding how physicians are presented to the scheduler in both the initial zip cluster and then outside of the initial zip cluster. This paragraph also describes the order the physicians are presented within each of these ranges – first those who have not had a previous appointment scheduled within the Medical Management application (presented alphabetically), and then those that have had a previous appointment scheduled within the Medical Management application (by the date that the last appointment was scheduled, with the most recent being at the bottom of the presentation order).

Sub-paragraph 5f, formerly sub-paragraph 5e, was not changed.

Sub-paragraph 5g, formerly sub-paragraph 5f, was updated slightly to reference the rotation previously described in sub-paragraph 5e. Former sub-paragraph 5g was separated into two distinct paragraphs – 5h and 5i. And former sub-paragraph 5h, which described the order in which physicians were presented for selection, has been deleted since the information has been absorbed into sub-paragraph 5e.

New sub-paragraph 5h outlines that when the scheduler inputs the appointment date and time into the Medical Management application, the ME023, Appointment Notification Report, is generated for imaging into the case file.

New sub-paragraph 5i describes in detail the data contained in the ME023 report based upon the system updates made as of December 17, 2012.

Sub-paragraph 5j, formerly sub-paragraph 5i, was not changed.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 13-04

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0805 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, renamed, consolidated, and updated. The number of paragraphs in the chapter has been reduced from 8 to 7.

No substantive changes were made to paragraph 1, but the title was updated to Purpose and Scope.

Paragraph 2, Types of Causal Relationship, added some language to clarify the types of causal relationship, and outdated language was deleted.

Paragraph 3, Evidence Needed, has been amended to include a reference that a report of a physician assistant or a certified nurse practitioner will be considered medical evidence if countersigned by a qualified physician. Some outdated language has been removed, more detail was added, and the information within the paragraph was reorganized.

Paragraph 4, Evaluating Medical Opinions, has been reconstructed, with new sections addressing when an attending physician negates causal relationship and actions to take when insufficient evidence has been submitted.

Paragraph 5, Obtaining Additional Medical Opinion, has been completely rearranged. It addresses when additional medical development may be warranted and how to proceed with such development.

Paragraph 6, High-Risk Employment (formerly paragraph 8), contains essentially the same information as the prior paragraph 8. Former paragraph 6, Consequential and Intervening Injuries, is now paragraph 7.

Paragraph 7, Consequential and Intervening Injuries, provides greater detail as to what factual and medical evidence is needed to properly develop these claims. Prior paragraph 7, Psychological Factors Affecting Medical Condition, has been removed.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, the DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 13-05

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0901 has been updated in its entirety, and pertinent information pertaining to death claims, schedule awards, and loss of wage-earning capacity (LWEC) payments has moved into other Procedure Manual chapters for ease of referencing related guidance within one subject chapter. The chapter has also been renamed Compensation Claims (rather than Calculating Compensation), since the chapter discusses receipt and development of claims, as well as the actual payment process.

CHAPTER 2-0901, COMPENSATION CLAIMS

Paragraph 1, Purpose and Scope, provides a summary of the information provided in the chapter, as well as pertinent references to other chapters that reference payments.

Paragraph 2, Responsibilities, outlines the Claims Examiner's (CE's) responsibility for adjudicating each claim for compensation, determining the pay elements necessary for calculation of the payment, and for entering all necessary data into the case management system.

Paragraph 3, Certification, discusses the various certification levels and outlines that by certifying a payment, a certifier is verifying that the adjudication and calculation of the payment (including all pay elements) are correct, that all payment data is entered correctly in the case management system, and that all pay elements entered correspond with the documentation in the file.

Paragraph 4, Receipt of Claims, discusses the actions to take upon receipt of a claim initially following the Continuation of Pay (COP) period (and references PM 2-807 for further guidance). This paragraph also discusses receipt of subsequent claims for compensation and reminds examiners that for these claims the Employing Agency must verify work/leave status when submitting claims forms, and this can only be done once the period has passed.

Paragraph 5, Development of Compensation Claims, provides a discussion of the development actions that may be needed when adjudicating and paying compensation claims. This paragraph also reminds CEs to initiate Disability Management actions in wage claims where the claimant has not returned to full duty at the time payment is being made.

Paragraph 6, Factors in Calculating Compensation, provides a brief outline of the items to consider when paying a compensation claim, and cites the sections within the chapter that discuss those factors.

Paragraph 7, Period of Entitlement, discusses the period of entitlement as a factor in determining whether to pay the claimant on the Daily Roll (DR) or on the Periodic Roll (PR). This paragraph also reminds CEs that payment should be made on the daily roll for intermittent hours lost when a claim is made for intermittent hours only, i.e. partial days or partial hours lost during a period. Payment for straight total disability should not be made based on hours lost.

Paragraph 8, Work Days/Calendar Days, discusses the difference between "calendar day" and "work day" calculations and when each is appropriate. The paragraph also stresses the importance of using the correct schedule (days and hours) when paying "work days."

Paragraph 9, Basic Calculations, outlines basic calculations and has examples of such calculations.

Paragraph 10, Special Determinations, provides detailed information for Census workers and Firefighters.

Paragraph 11, Waiting Days, provides information pertaining to waiting days and the application differences for Postal and non-Postal cases.

Paragraph 12, Compensation Rate, explains the basis for payment of augmented compensation and provides a discussion of dependents. This includes not only references to a spouse, but also details relating to children over the age of 18 and those incapable of self-support.

Paragraph 13, Minimum Compensation, provides information pertaining to the minimum (MIN) compensation rate and how it is applied.

Paragraph 14, Maximum Compensation, provides information pertaining to the maximum (MAX) compensation rate and how it is applied.

Paragraph 15, Insurance Deductions, discusses insurance deductions and the effective date for necessary deductions. The importance of timely deductions and transferring the health benefits insurance enrollment is stressed. This paragraph also provides an overview of the various types of life insurance coverage, as well as dental and vision insurance coverage.

Paragraph 16, Consumer Price Index Adjustments, outlines the basis for cost of living adjustments (CPIs) and how these are applied.

Paragraph 17, Other Payees, discusses the various payees that may exist in a case other than the claimant. Further information was added in particular to the discussion of Representative Payees.

Paragraph 18, Leave Buy Back, provides detailed information on the leave buy back process.

Paragraph 19, Wages Lost for Medical Examination or Treatment, discusses payment for time lost due to medical appointments for treatment of the work-related condition, as well as payment of compensation for time lost due to an OWCP-directed examination.

Exhibit 1, Minimum Compensation Rates, outlines the historical MIN rates through the current year.

Exhibit 2, Maximum Compensation Rates, outlines the historical MAX rates through the current year.

Exhibit 3, Cost-Of-Living Adjustments, outlines the historical CPIs through the current year.

Exhibit 4, Activity Codes, provides a list of all Activity Codes, which are used for payments in certain types of cases.

CHAPTER 2-0700, DEATH CLAIMS

PM 2-0700 already contains a discussion of several elements of pay pertaining strictly to death cases, including an extensive discussion of the various types of possible beneficiaries (2-0700-7 through 2-0700-10). Payment in death cases is also discussed in 2-0700-11, and burial and termination payments are discussed in 2-0700-14 and 2-0700-15, respectively.

A new paragraph has been added to 2-0700 for elements of pay previously mentioned in PM 2-0901 but not already specifically covered in this chapter. The information has been added to this chapter so that the CE can find all relevant information pertaining to payments in death cases in one chapter, to the extent possible.

Paragraph 22, Additional Payment Considerations, was added to the end of the chapter. This paragraph discusses the period of entitlement, MIN and MAX rates, CPI adjustments, and health benefits deductions. Clarification was also added outlining that if a widow/widower receiving death benefits dies, compensation is payable through the date of death, just as it is if a claimant dies while receiving compensation.

Paragraph 21, FECA Death Gratuity, was also updated to include that on December 31, 2011, Congress amended 5 U.S.C. 8102a, the law authorizing death gratuities under FECA, by Section 1121 of Public Law 112-81. Pursuant to that amendment, federal employees may now designate the entire FECA death gratuity to an alternate beneficiary (previously, this designation was limited to 50% of the FECA death gratuity). Effective December 31, 2011, the employing agency is required to notify the federal employee's spouse, if one exists, if that employee designates a person other than the spouse to receive all or a portion of the FECA death gratuity. These changes took effect on enactment.

CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS

While incorporating the information pertaining to schedule awards from the previous 2-901, this chapter was updated and revised throughout.

Paragraph 1, Purpose and Scope, states that the primary focus of the chapter is to focus on the development, adjudication and payment of schedule awards.

Paragraph 2, Impairment and Disability, remains essentially unchanged, except that statutory and regulatory references and ECAB citations were added.

Paragraph 3, Permanent Total Disability, also remains essentially unchanged from the prior paragraph of the same name, except the paragraph was re-numbered from paragraph 4 to paragraph 3. A note was added to clarify that there is no specific case status to differentiate or classify a claimant as permanently, totally disabled as defined by 5 U.S.C. 8105(b).

Paragraph 4, Entitlement to Schedule Awards, includes much of the information in the prior paragraph 5 of the same name. A reference to possible entitlement to a lump sum was added with a citation for PM Chapter 2-1300. This paragraph was also updated to include a new section referencing that effective August 29, 2011 the Secretary added by regulation the skin as a new schedule member, for up to 205 weeks of compensation, for injuries sustained on or after September 11, 2001. An update was also made to explain that if a claimant loses wages to obtain medical treatment during the period of a schedule award (e.g. claims hours due to a medical appointment with the treating physician), compensation for the hours lost may be paid concurrently with a schedule award, as time lost for medical appointments is not considered disability.

Paragraph 5, Evaluation of Schedule Awards, includes much of the information in the prior paragraph 6 of the same name. A new section on skin impairment was added. A point of clarification was added noting that impairment ratings for schedule awards include those conditions accepted by the OWCP as job-related, and any pre-existing permanent impairment of the same member or function. Also, a section was added addressing how to calculate impairment for adjoining members. The prior portions pertaining to obtaining medical evidence and review by the District Medical Advisor (DMA) were moved into new paragraph 6.

Paragraph 6, Obtaining Medical Evidence, discuses the development to be taken when a schedule award is requested, as well as the necessary review by the DMA.

Paragraph 7, Schedule Award Payments, is new and discusses all elements of pay for schedule awards. PM 2-0808 previously had a discussion of several elements of pay pertaining strictly to schedule awards (prior paragraph 7, titled Payment of Schedule Awards). The information contained within that paragraph was combined with the information pertaining to schedule awards in the prior 2-0901, and a new paragraph 7 was created. This compilation was done so that the CE can find all relevant information pertaining to schedule award payments in one chapter, to the extent possible. This paragraph includes general considerations such as previous impairment to the same schedule member and the interruption of awards. There is also a discussion of the various payment elements, including the beginning date of the award, the percentage of loss, the period of the award, the pay rate (with a reference to PM 2-900), compensation rate, MIN/MAX applications, and the effective date for CPI adjustments.

Paragraph 8, Schedule Award Decisions, is new and discusses the necessary elements of a formal schedule award decision, including a reference that the medical report used for the final determination should be included with the decision.

Paragraph 9, Claims for Increased Schedule Awards, includes information from the prior paragraph 7, but is now its own section for ease of reference. New information in this paragraph addresses claims for increased awards calculated under the same edition of the AMA Guides and the resulting overpayments that may occur, along with a few other updates for clarification.

Paragraph 10, Disfigurement, is not new and remains essentially unchanged from the previous paragraph of the same name. The only real difference is the paragraph number based on the insertion of new material described above, a new section (f) that outlines that a schedule award for the skin may be payable in addition to an award paid for disfigurement, and a reference to the $3500 possible award amount in section (d).

Paragraph 11, Schedule Awards after Termination of Compensation and Medical Benefits, is new and outlines the actions to take if a claim for a schedule award is received after a formal decision denying compensation and/or medical benefits has been issued.

Paragraph 12, Schedule Awards and Refusal of Suitable Work, is new and discuses that once an §8106(c) sanction decision has been issued, the claimant has no ongoing entitlement to compensation for continuing TTD or schedule award payments, but then clarifies that the commencement of the schedule award begins on the date of MMI. Therefore, if MMI was obtained prior to invoking the §8106(c) sanction, the claimant is entitled to schedule award payments from the date of MMI through the date of the §8106(c) sanction decision.

Exhibit 1, Percentage Table for Schedule Awards, was added. The percentage table for schedule awards was moved from 2-0901 into the schedule award chapter for ease of reference.

CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY

A discussion of Loss of Wage-Earning Capacity (LWEC) payments had been previously included in 2-0901-15. That entire paragraph has been moved into the chapter that discusses LWECs and LWEC decisions. This move was made so that the CE can find all relevant information pertaining to LWECs and LWEC payments in one chapter, to the extent possible.

Paragraph 14, Loss of Wage-Earning Capacity (LWEC) Payments, was added. The information previously contained in 2-0901-15 was essentially moved without any changes, except that references to other chapters or paragraphs were updated as needed based on the movement of this information.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Updates to Existing Procedure Manual Chapters:

Completely New/Revised Procedure Manual Chapters:

The following chapters have been updated in their entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1400, Disallowances, has been updated and revised in its entirety.

This chapter describes various types of disallowances and details the steps involved in preparing and issuing the formal decision. Initial denials of claims are discussed in detail in PM 2-1401.

Paragraph 1, Purpose and Scope, outlines that the chapter will focus on the process of issuing post-adjudicatory disallowances, although the general requirements outlined pertain to all types of formal decisions issued by the OWCP.

Paragraph 2, Regulatory Provisions, provides references to 20 C.F.R. § 10.540 and 20 C.F.R. § 10.541 as the authority for the information contained in the chapter.

Paragraph 3, Responsibilities, discusses the OWCP's burden of proof in issuing a post-adjudicatory disallowance. It outlines the necessary steps the Claims Examiner (CE) must take before a formal decision can be issued and during the adjudication process. It also details the CE's responsibilities with timeframes, signature authority, appeal rights, decision copies, and iFECS coding.

Paragraph 4, Whether Pre-Termination Notices are Required, discusses the instances in which terminations do not require notice prior to cessation of benefits, and the instances in which terminations do require notice prior to cessation of benefits.

Paragraph 5, Decision Format and Content, discusses that all decisions should contain findings of fact sufficient to identify the benefit being denied, the reason for the disallowance, and be tailored to the specifics of the individual case so that the claimant understands the specific defect in his/her claim for benefits. It outlines the use of the Letter Decision when denying less complex issues, and the Notice of Decision when denying more complex issues or when a more detailed discussion of the evidence is required.

Paragraph 6, Writing the Decision, discusses that the disallowance is a legal document which should be clearly written and easily understood by all audiences. It outlines that when writing the decision, the CE should use basic language, cite specific references, draw clear findings of fact from the evidence, and consider all of the evidence which bears on the issue at hand.

Paragraph 7, Pre-Termination Notices, discusses the process for issuing decisions when the weight of medical evidence establishes that the claimant is no longer entitled to benefits previously authorized. It outlines the necessary steps the CE must take before a final termination can be issued, such as evaluating evidence to ensure it supports the conclusion and affording the claimant 30 days to submit additional evidence to maintain the current level of benefits he/she has been receiving. It also outlines follow-up actions and potential outcomes to the pre-termination notice.

Paragraph 8, Termination Decisions, discusses the key points of the pre-termination that need to be included in the final decision, and outlines that the case management system must be properly coded to reflect the termination.

Paragraph 9, Claims for Compensation, discusses the formal disallowance process for claims filed for leave without pay, leave buy back, or other wage loss.

Paragraph 10, Medical Authorization Requests, discusses the process of formally denying medical authorization requests, when needed, after any necessary development.

Paragraph 11, Additional Diagnoses and Consequential Injuries, discusses the formal disallowance process for additional diagnoses and consequential injuries when the medical evidence establishes that they are not a result of the original injury/illness.

Paragraph 12, Recurrences, discusses the formal disallowance process for both a recurrence of a medical condition and a recurrence of disability.

Paragraph 13, Reductions/Loss of Wage-Earning Capacity, discusses issuing formal decisions when it has been determined that the claimant has the capacity to earn wages, even if not employed.

Paragraph 14, Sanctions for Failure to Accept Suitable Work, discusses the process for issuing sanction decisions due to the claimant's refusal or abandonment of suitable work per Section 8106 of the FECA.

Paragraph 15, Forfeiture, discusses issuing formal decisions when a claimant fails to make an affidavit or report when required, or knowingly omits or understates any part of his earnings per Section 8106 of the FECA.

Paragraph 16, Suspensions, discusses issuing suspension decisions when a claimant fails to cooperate with the OWCP's direction.

Paragraph 17, Convictions for FECA fraud, discusses issuing a termination of benefits when the claimant is convicted of defrauding the FECA, or pleads guilty to defrauding the FECA per Section 8148 of the FECA.

Paragraph 18, Imprisonment for Felonies Other Than Fraud, discusses issuing suspension decisions and terminating entitlement to all medical and compensation benefits when the claimant has been convicted and imprisoned due to a felony per Section 8148 of the FECA.

Paragraph 19, Rescissions, discusses the process of issuing formal disallowances per Section 8128 of the FECA when it has been determined that the original decision was issued in error.

Exhibits 1-10 have been deleted from the chapter. Exhibit 11, Signature Authority, is now Exhibit 1, Signature Authority, and it has been updated. Signature authority for attorney fee limits is now outlined in Chapter 2-1200, Representative's Services, and certification authority for payments is discussed in Chapter 2-901, Compensation Claims.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

This chapter has been updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, and Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 13-07

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EXPLANATION OF MATERIAL TRANSMITTED:

To satisfy the concerns and questions raised by the Employees Compensation Appeals Board (ECAB), and to further document the referee selection process, the DFEC enhanced the ME023 report effective December 17, 2012 to provide more information relative to the scheduling of the appointment. See FECA Transmittal 13-04 for an explanation of these updates.

The DFEC continues to use the Medical Management application in iFECS to schedule referee examinations. This has not changed. Paragraph 5 of PM Chapter 3-500 discusses this application in detail. Effective May 13, 2013, the Medical Management application in iFECS has again been updated; therefore, paragraph 3-500-5e(3) is being updated accordingly to discuss the new functionality.

The Medical Management application sets 200 miles as the maximum limit for a zip code range; this has not changed. Previously, though, if that 200-mile range was exhausted without making an appointment, the scheduler had to document the case file by imaging a copy of the bypass report to show that a search within the Medical Management application had been exhausted. A copy of the bypass report was necessary because an ME023 report could not be generated since an appointment was unable to be scheduled. Once the scheduler had documented the case file with the complete bypass report, s/he could then proceed with an alternative scheduling method as outlined in paragraph 5b of the chapter.

With this May 13, 2013 update to the Medical Management application, the scheduler no longer has to independently run the complete bypass report in order to document the file. iFECS will now automatically generate a "Zip Code Exhausted" report if the 200-mile range is exhausted. The scheduler can then proceed with scheduling via an alternative method, including entry of a different zip code in the Medical Management application. This may be necessary, for instance, if the claimant lives in a very remote area and will need to travel to a larger city in order to attend a scheduled examination. In this instance, the scheduler will enter the zip code of the city to which the claimant will be traveling.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 13-08

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) with this issuance outlines a comprehensive strategy for return to work in all situations where a certain defined level of return to work is possible. This Procedure Manual release complements the DFEC's overall proactive approach to more efficient claims management, which includes claims intake via electronic filing and ECOMP to improve benefit delivery; earlier field nurse intervention to facilitate more effective medical management; active disability management; and a more dynamic and interactive approach to claims management of return to work wherever medically and vocationally feasible.

The DFEC has taken the unusual step of releasing five entirely new chapters that discuss each topic relating to return to work in greater depth for ease of use for claims staff. Our program focus on return to work, coupled with the changing dynamics in the federal workforces including telework and more flexible scheduling, has caused us to revisit program policies that in some instances posed artificial barriers to return to work for workers and their agencies. Since the passage of the Federal Employees Compensation Act (FECA) in 1916, administrators of the program have been charged with administering the program in a cost effective manner comporting with the intent of Congress as set forth in the legislative history of the 1916 Act that "an employee is bound to do what work he can." Statement of Congressman McCoy, Federal Employees' Compensation Hearings, April 3, 1914 at 53.

To that end, FECA Procedure Manual Chapter 2-0814 has been updated in its entirety, and pertinent information pertaining to loss of wage-earning capacity (LWEC) determinations has been moved into new Procedure Manual chapters for ease of referencing related guidance within one subject chapter. 2-0814 now only addresses job offers, temporary light duty assignments, and abandonment of employment, including what instances the sanction provisions of 5 U.S.C. §8106(c) will newly apply. The new chapter 2-0815 address wage-earning capacity decisions based on actual earnings, including new use of part-time positions, and the new chapter 2-0816 addresses wage-earning capacity decisions based on a constructed position.

Chapter 2-1500, Recurrences, has also been updated and revised. This chapter describes policies and procedures for developing claims for recurrent medical conditions and recurrent disability. It also addresses return to work issues related to recurrences. Updates were made throughout the chapter to remove discussion of recurrences as the result of a withdrawal of limited duty with a formal Loss of Wage-Earning Capacity (LWEC) decision in place. This information was moved to new Chapter 2-1501, Modification of LWECs, and references were provided in 2-1500 accordingly. Chapter 2-1501, Modification of LWECs, is an entirely new chapter. Prior to this release, modification of a formal LWEC was discussed in Chapters 2-0814 and 2-1500. The information in both of these chapters has been absorbed into this new chapter and it has been updated throughout. This chapter describes the process for modifying a formal LWEC and discusses the three criteria for modification. This chapter also describes the criteria for developing and making a determination on claims for compensation for disability following the issuance of a formal LWEC decision.

Note - FECA Bulletin 09-05 (United States Postal Service National Reassessment Program Guidance), issued August 18, 2009, describes the procedures for possible modification of an LWEC if circumstances in the case indicate that the position in question may have been withdrawn (in whole or in part) as a result of the United States Postal Service's National Reassessment Process. This bulletin has not been modified, replaced or incorporated herein, as the National Reassessment Process concluded on January 31, 2011, per documentation received from the United States Postal Service dated July 1, 2011.

CHAPTER 2-0814, JOB OFFERS AND RETURN TO WORK

Beyond removal of the paragraphs concerning wage-earning capacity, multiple updates were made to this chapter to provide more detail throughout and to update previous guidance based on the dynamics of the changing federal workforce. Given the more targeted focus of the chapter, the chapter name was also changed from "Reemployment: Determining Wage-Earning Capacity" to "Job Offers and Return to Work."

Former Paragraph 1, Purpose and Scope, and Paragraph 2, Introduction, have been combined into a new Paragraph 1 entitled Purpose and Scope. It has been updated to reflect the more focused nature of this chapter.

Paragraph 2 is now titled Statutory and Regulatory Provisions and provides the statutory and regulatory authority pertaining to job offers and return to work. This section contains the regulatory provisions that outline an employee's responsibilities to work where medically feasible, both where temporary light duty within restrictions is offered and available, and where sanctionable suitable employment is offered.

Paragraph 3, Policy, has been modified slightly, and the language dealing with wage-earning capacity determinations has been removed.

Paragraph 4, Offers of Employment, has been updated in its entirety.

• This paragraph still outlines the necessary elements of a job offer, and while the existing requirements are still in effect, a new requirement to include the claimant's work schedule has been added. Also, if the job offer is for a site outside of the claimant's residential area, the EA must document that it first searched for suitable employment in the claimant's geographic area before it settled for a position outside of it and provide this statement to the OWCP.
• The prior language that stated that a job which involved less than 4 hours of work per day where the claimant could work more than 4 hours per day could not be found suitable has been removed. Due to the current dynamics of the changing federal workforce, the OWCP acknowledges that Employing Agencies (EAs) may need flexibility to provide suitable work to their employees. Given that one of the OWCP's primary missions is facilitate return to work where possible, paragraphs 4c(1) and (2) now provide that while ideally a job offer should be made for the number of hours for which a claimant has been released to work, other alternatives are acceptable and will be found suitable. The EA may offer a job for fewer hours than the claimant was actually released to work, and as long as the job offer is for at least half of the total hours for which the claimant has been released to work, the job offer can be found suitable. However, a job offer of less than 2 hours per day and less than 20 hours per pay period will always be considered unsuitable for purposes of an §8106(c) sanction. If the EA cannot accommodate the full number of hours for which the claimant has been released to work, the EA must provide written verification that it is unable to provide work for the full number of hours for which the claimant has been released to work. If this written verification is on file, a position with less than that number of hours can be found suitable. Examples are provided in this paragraph to illustrate some hypothetical circumstances that are both acceptable and unacceptable.
• The distinction between temporary and permanent job offers has been clarified, indicating that the CE should contact the EA if it is not clear whether a position is temporary or permanent and ask the EA to clarify in writing the nature of the offer.
• New references to telework as a viable option for offering suitable employment have been added. Factors to consider are included, and a reference was added that a limited referral for vocational rehabilitation services may be considered if the claimant alleges that any of the necessary factors have not been met. Any refusal to cooperate with a Rehabilitation Counselor in this capacity should be pursued under §8113(b), not under §8106(c).
• Language has been added outlining that the CE should explain to the claimant how the job was deemed to be suitable and identify the medical evidence which represents the weight of medical opinion with respect to the claimant's work capacity.

Paragraph 5, Job Offer Refusal, remains largely unchanged, but more detail has been added.

• Additional guidance was provided with regard to actions to take if the claimant provides evidence that his or her refusal of a job offer was based upon the attending physician's advice.
• A new section was added which addresses job offer refusals where a formal Loss of Wage-Earning Capacity (LWEC) rating is in place. It is noted that the existence of an established LWEC decision alone is not a valid reason for refusing suitable work in all instances; however, the CE must carefully evaluate the prior LWEC decision to determine if it can be modified. If the CE determines that the offered job is suitable and that the LWEC is in posture for modification on the basis of an improved medical condition, the CE should prepare the 30-day notice of suitability and simultaneously propose to modify the LWEC.

Paragraph 6, Issuing a Final 8106(c) Decision, is a new paragraph that expressly deals with issuing a final decision under the penalty provision of 5 U.S.C. §8106(c).

Paragraph 7, Relocation Expenses, is former Paragraph 6, and while updated for current practices, it remains largely unchanged.

Paragraph 8, Abandonment of a Suitable Job, is former Paragraph 10, and has been updated to provide greater instruction in cases where a claimant returns to work and then stops working and submits a claim for compensation. In such cases, the CE should evaluate any evidence submitted and the reasons for the work stoppage. If the evidence of file is insufficient to establish a recurrence and the CE has determined that the job is suitable, the CE must advise the claimant simultaneously of the penalty provision of 5 U.S.C. §8106(c) and of the evidence necessary to establish a recurrence of disability.

Paragraph 9, Temporary Assignments, is a new section that addresses the requirements of 20 C.F.R. §10.500, which provides that -

(a) Benefits are available only while the effects of a work-related condition continue. Compensation for wage loss due to disability is available only for any periods during which an employee's work-related medical condition prevents him or her from earning the wages earned before the work-related injury. For example, an employee is not entitled to compensation for any wage-loss claimed on a CA-7 to the extent that evidence contemporaneous with the period claimed on a CA-7 establishes that an employee had medical work restrictions in place; that light duty within those work restrictions was available; and that the employee was previously notified in writing that such duty was available. Similarly, an employee receiving continuing periodic payments for disability was not prevented from earning the wages earned before the work-related injury if the evidence establishes that the employing agency had offered, in accordance with OWCP procedures, a temporary light duty assignment within the employee's work restrictions. (The penalty provision of 5 U.S.C. §8106(c)(2) will not be imposed on such assignments under this paragraph.) [Emphasis added]

The meaning and intent of 20 CFR §10.5(f) is also emphasized. This section defines disability as "the incapacity, because of an employment injury, to earn the wages the employee was receiving at the time of injury. It may be partial or total." If the claimant was provided with a light duty assignment within his or her restrictions, total disability for the period of the assignment has not been substantiated. [Emphasis added]

This new paragraph addresses when a temporary light duty assignment is appropriate outside the confines of §8106, and establishes the principle that a claimant who is capable of earning wages equivalent to his date-of-injury wages is not entitled to compensation. It explains the different actions required when such a temporary light duty assignment is offered to a claimant who is on the periodic roll versus a claimant who is not, and describes the requirements for an offer of a temporary, light-duty assignment made to a claimant on the periodic roll. This paragraph also emphasizes that when a temporary light duty assignment ends or the work is no longer available, the claimant should submit Form CA-2a through the EA, and that the claimant is entitled to be placed back on the periodic roll (PR) immediately as long as medical evidence supports that any disabling residuals of the work-related condition still exist. No development is typically needed prior to placing the claimant back on the PR and resuming wage-loss compensation, and payment should not be unnecessarily delayed.

The prior exhibits have been removed.

CHAPTER 2-815, DETERMINING WAGE-EARNING CAPACITY BASED ON ACTUAL EARNINGS

Chapter 2-815, Determining Wage-Earning Capacity Based on Actual Earnings, is an entirely new chapter of the FECA Procedure Manual, Part 2 - Claims. The chapter replaces, revises, and expands upon procedure previously located in Chapter 2-814.7 and 2-814-14.

This chapter explains the procedures for determining entitlement to compensation after reemployment. It also provides guidance on making a determination as to whether the alternative employment fairly and reasonably represents the employee's wage-earning capacity (WEC), and presents procedures for issuance of the formal loss of wage-earning capacity (LWEC) decision.

Paragraph 1, Purpose and Scope, indicates that this chapter provides guidance on calculating LWEC compensation, determining whether earnings fairly and reasonably represent the WEC, and issuing the formal LWEC decision.

Paragraph 2, Statutory and Regulatory Provisions, provides the statutory and regulatory authority for determining a WEC based on actual earnings.

Paragraph 3, Initial Fiscal Actions, provides a summary of the immediate actions the CE should take following notification that a claimant has returned to work.

Paragraph 4, Computing Entitlement to Compensation, provides a detailed discussion of how to compute the compensation of a partially disabled claimant using the Shadrick formula. Significant clarification has been provided on the computation of the "Current Pay Rate for Job/Step When Injured." See (c)(2) and (d)(2) in this paragraph. Additional guidance has also been provided in computing compensation for claimants whose agencies use pay banding. See (e)(3) in this paragraph.

Paragraph 5, Determination of Whether Earnings are Representative of the Wage-Earning Capacity, outlines the criteria that a CE should use to determine whether the claimant's actual earnings fairly and reasonably represent his or her WEC. The paragraph is broken down into cases where the alternative employment was (1) within and (2) outside of the Federal Government.

• For return to work within the Federal Government, further explanation has been added to make clear that a part-time position may fairly and reasonably represent the WEC of a claimant whose stable, established medical restrictions limit him or her to part-time work, even when the claimant was a full-time employee on the DOI. See (c)(1)(b) in this paragraph. However, even though a job offer for less than the number of hours that the claimant has been released to may be found suitable (see 2-0814-4), for a part-time position to fairly and reasonably represent the WEC of a claimant, the position should involve the number of hours the claimant is capable of working as indicated in the current, stable medical restrictions.
• Clarification has also been added to assist CEs in determining when a position is temporary, and whether a position represents "classified" work. See (c)(3) in this paragraph.
• The section addressing return to work outside the Federal Government is entirely new procedure. It provides guidance on the criteria needed to establish that such a position represents the WEC. It also addresses the evidence that should be provided by the Rehabilitation Specialist (RS) or Rehabilitation Counselor (RC) to support such a finding, depending on the circumstances of the case.

Paragraph 6, Issuance of Decision, discusses the appropriate time to issue a formal loss of wage-earning capacity decision, and addresses the elements such a decision should generally contain.

Paragraph 7, Retroactive Determinations, details the limited circumstances in which a retroactive formal loss of wage-earning capacity decision may be issued, and reiterates that the CE must address that the work stoppage or change in alternative positions did not occur because of any change in the claimant's injury-related condition affecting ability to work.

CHAPTER 2-0816, DETERMINING WAGE-EARNING CAPACITY BASED ON A CONSTRUCTED POSITION

Chapter 2-0816, Determining Wage-Earning Capacity Based on a Constructed Position, is a new chapter in the FECA Procedure Manual (PM), Part 2 – Claims. The chapter replaces, revises, and expands upon procedure previously located in Chapter 2-814.8.

Paragraph 1, Purpose and Scope, identifies those situations in which it may be appropriate to determine a WEC based on a constructed position.

Paragraph 2, Statutory and Regulatory Provisions, provides the statutory and regulatory authority for determining a WEC based on a constructed position.

Paragraph 3, Factors Considered, defines the factors established in §8115 which require consideration in determining a WEC based on a constructed position.

Paragraph 4, Medical Suitability, outlines the evidence necessary to establish that a selected position is medically suitable.

Paragraph 5, Vocational Suitability, discusses the criteria used to determine whether the claimant is vocationally capable of performing the selected position.

Paragraph 6, Reasonable Availability, describes how to establish that a selected position is reasonably available within the claimant's commuting area.

Paragraph 7, Special Determinations, discusses those circumstances when the additional factors may need to be considered.

Paragraph 8, Issuance of Decision, outlines the steps the CE should take to notify the claimant of the office's WEC determination based on a constructed position and the general requirements for such a decision.

Paragraph 9, Retroactive Determinations, discusses the very limited instances in which a determination of WEC based on a constructed position may be issued on a retroactive basis.

CHAPTER 2-1500, RECURRENCES

Paragraph 1, Purpose and Scope, was modified slightly to include a cross-reference to new chapter 2-1501, which addresses modifications of formal LWEC decisions.

Paragraph 2, Regulatory References, defines a recurrence of a medical condition and recurrence of disability as outlined in 20 C.F.R. §§10.5(y) and 10.5 (x). 20 C.F.R. §10.104, addressing how a recurrence claim is filed, and 20 C.F.R. §10.509, addressing reductions in force, were also cited.

Paragraph 3, Claims for Recurrence, which was prior paragraph 4, was revised to expand the discussion of the types of prior decisions that may impact the recurrence claim. It was also clarified that a Form CA-7 may constitute a valid claim for recurrent disability in certain circumstances.

Paragraph 4, Recurrence of Medical Condition, which was prior paragraph 5, was modified slightly to further explain the type of evidence the claimant should submit to support the claim for recurrence of a medical condition.

Paragraph 5, Recurrent Disability for Work within 90 Days of Return to Duty, which was prior paragraph 6, was modified to include a cross-reference to Chapter 2-1501, Modification of LWECs, for cases where a formal LWEC decision is in place at the time of the recurrence claim.

Paragraph 6, Recurrent Disability for Work after 90 Days of Return to Duty, which was prior paragraph 7, was revised to further explain, in detail, the type of evidence necessary to support a recurrence claim. The discussion of a withdrawal of limited duty with an existing LWEC determination has been moved to Chapter 2-1501, and a reference was provided in this section accordingly.

Paragraph 7, Termination Including for Cause, outlines that when a claimant stops work for reasons unrelated to the accepted employment injury, there is no disability within the meaning of the FECA. The procedures addressing this topic were revised to provide guidance that comports with the ECAB caselaw in this area, the seminal case being John W. Normand, 39 ECAB 1378 (1988). For Normand principles to apply, it should be established that the employing agency offered light duty; the claimant had been working the light duty position at the time of termination; that the employing agency noted that light duty would have still been available if the claimant had not been terminated for cause; and, most importantly, there is no evidence in the record that the claimant was unable to perform the light duty position.

Paragraph 8, Compensation for Recurrent Disability, was modified slightly to include information on recurrent pay rates and the responsibilities of the certifier.

Paragraph 9, Disability Management Actions, is a new paragraph that was added to stress the importance of ascertaining the claimant's work status upon acceptance of a recurrence and then taking prompt disability management actions as needed.

CHAPTER 2-1501, MODIFICATION OF LWECs

Paragraph 1, Purpose and Scope, outlines that the chapter provides information on modifying a formal LWEC decision. A reference to 2-1500 is provided, as well as a reference to FECA Bulletin 09-05.

Paragraph 2, Regulatory References, references 20 C.F.R. §§ 10.5(f), 10.509 and 10.511.

Paragraph 3, Criteria for Modification, discusses each of the three criteria for modification of an LWEC.

This paragraph now also provides guidance for when a claimant with a prior formal LWEC rating accepts a position with no wage loss and returns to work. In this instance, no employment-related disability or wage-loss entitlement continues, and the CE should terminate compensation on the basis that there is no disability within the meaning of the Act despite the fact that an LWEC is in place. Because the claimant was previously receiving compensation in accordance with a formal LWEC decision, the termination should be made prospectively so that no overpayment results. The prior LWEC should then be reviewed to determine if modification is necessary.

Paragraph 4, Initial Actions, discusses that the party seeking modification of the LWEC has the burden to prove that one of the three criteria outlined above has been met and evaluating the request for modification.

Paragraph 5, Development, discusses the procedures for development of the evidence to determine if modification of the formal LWEC decision is appropriate. This paragraph outlines the actions to take if the claimant has requested a modification, as well as the actions to take if the OWCP is seeking modification. New guidance is specifically provided with regard to actions to take if the claimant returns to work in a position with increased work hours or more strenuous duties, resulting in reduced or zero wage loss.

Paragraph 6, Termination of Employment, notes that when an employee is terminated while in the receipt of an LWEC, one of the three criteria must still be met for modification of the LWEC to occur.

Paragraph 7, Withdrawal of Light Duty, discusses the withdrawal of a light duty position when an LWEC is in place and how one of the three criteria must still be met.

Paragraph 8, Decision, outlines the decisions issued when the evidence does and does not support modification of the LWEC rating. This paragraph also includes guidance for terminations for no residuals (when the evidence substantiates that there are no residuals of the work injury).

Paragraph 9, Disability Management Actions, stresses the importance of taking prompt disability management actions if an LWEC decision is modified.

Paragraph 10, Intermittent Claims for Wage Loss, outlines when and how a claim for intermittent disability can be paid without modifying a formal LWEC determination.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Fiscal Personnel, Systems Managers, and Technical Assistants)

Back to Top of FECA Transmittal No. 13-09

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 has been revised in its entirety. This chapter now provides an overview of the goals and coding associated with the entire Disability Management (DM) process. The coding applies to both the Quality Case Management (QCM) and Periodic Roll Management (PRM) portions of DM; therefore, the chapter has been renamed Disability Management Tracking.

Paragraph 1 outlines the purpose and scope of the chapter, and provides related references to Chapter 2-0600 (Disability Management), Chapter 2-0810 (Developing and Evaluating Medical Evidence), Chapter 2-0811 (Nurse Case Management) and Chapter 2-0813 (Vocational Rehabilitation Services).

Paragraph 2 provides an overview of the DM process and the differences between QCM and PRM. This paragraph also stresses the importance of consistent and accurate coding in the DM Tracking application for proper analysis and measurement of actions taken during the DM process.

Paragraph 3 outlines the two primary goals of Disability Management - return to work and resolution - and how these goals are measured.

Paragraph 4 discusses the actual DM records, including when to create a record, the meaning of a Track Date vs. a Start Date and how to maintain a DM record.

Paragraph 5 discusses the various DM categories and their meanings.

Paragraph 6 outlines the differences between mandatory and optional codes, and how and why the RMV code should be used to remove a record from DM Tracking.

Paragraph 7 outlines the mandatory Claims Examiner (CE) Intervention codes and when they should be used.

Paragraph 8 discusses the mandatory codes to be used during the Nurse Intervention Phase of DM.

Paragraph 9 discusses the codes that are used to designate that a case has a dual tracking effort with both a Field Nurse (FN) and a Rehabilitation Counselor (RC).

Paragraph 10 focuses on the various codes that are used during the Vocational Rehabilitation portion of DM.

Paragraph 11 details when and how the return-to-work (RTW) codes are to be used.

Paragraph 12 outlines the optional codes that are available for use and how they can assist the CE with management of the DM record.

Paragraph 13 provides guidance on the use of closure codes and the interplay between closure codes and resolutions. This paragraph outlines which closure codes count as resolutions and the differences depending on whether the case is in the QCM or PRM portion of DM.

Paragraph 14 acknowledges that some DM codes have become obsolete; therefore, when reviewing previous coding in a DM record some codes may appear that are no longer available for use.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-01

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1601 has been revised in its entirety to reflect changes that have taken place both throughout the Division of Federal Employees' Compensation (DFEC) and specifically within the Branch of Hearings and Review.

References to case files being transferred upon request of a hearing have been removed. Several changes have been made to the sections on arranging for and conducting hearings due to the fact that most hearings are no longer held in-person but are conducted electronically via telephone or videoconference. Other changes were made in response to the changes in the Code of Federal Regulations (20 CFR §§ 10.615 through 10.622) published on June 28, 2011, effective August 29, 2011.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-02

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1602 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, consolidated, and updated to reflect the reconsideration process in its entirety. Exhibits 1-6 have been deleted.

Paragraph 5 "Special Evidence or Argument" has been moved and incorporated into a new paragraph 3 titled "Preliminary Processing."

Paragraphs 4 "Evidence or Argument Required" and 7 "Evaluating Sufficiency of Evidence" have been moved and incorporated into a new paragraph 6 titled "Timely Applications."

Paragraphs 6 "Prima Facie Denials" and 9 "Protecting Claimant's Further Appeal Rights" are now incorporated into a new paragraph 7 titled "Non-Merit Decisions."

Other changes were made in response to the changes in the Code of Federal Regulations (20 CFR §§ 10.605 through 10.610) published on June 28, 2011 and effective August 29, 2011. These changes include a distinction in the requirement regarding when a reconsideration request must be sent to the employing agency. Where there is a legal argument or factual basis for a merit review, the application together with copies of pertinent supporting documentation should be sent to the employing agency, and the employing agency is provided with 20 days to submit comments or documentation. Medical evidence submitted with the request, however, shall not be furnished to the employing agency since it does not constitute documentation that is pertinent for review and comment by the employing agency. Therefore, where a reconsideration request pertains only to a medical issue, the employing agency should be notified that a request for reconsideration has been received, but OWCP is not required to wait 20 days for comment before reaching a determination, except when that claimant is deployed in an area of armed conflict.

The other significant change is to the timeliness standards for reconsideration requests. The regulations at §10.607 now provide that the request for reconsideration must be received within one year, which is a change from the prior standard for timeliness (that an application for reconsideration must be sent within one year).

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-03

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EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) has at times used specific case numbering series to designate cases that are related to a particular event. DFEC will no longer use numbering series and will instead now use 3-character case designations within the Integrated Federal Employees Compensation System (iFECS). The exhibit outlining the prefixes and the previously-used numbering series has, therefore, been updated. Also, since case prefixes are part of the case number itself, whereas case designations are only viewable in iFECS, the one exhibit has been split into two.

Exhibit 1 now lists the prefixes used for FECA cases. The prefixes are reflected in the case number.

Exhibit 2 now lists the case designations used for FECA cases. The designations are viewable only in iFECS. Also, two additional case types were added. Although never given a special numbering series and never listed in a previous exhibit, cases associated with the bombing of the United States embassy in Nairobi on August 7, 1998 and the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995 were identified. They were provided with a case designation in the new scheme, OKC and NAI respectively, so these case types are now specifically listed in the exhibit.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-04

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 3-0300 has been revised in its entirety. The chapter includes new language and updated references throughout. Other updates have been made based on changes in the regulations. On August 13, 2010, the Office of Workers' Compensation Programs (OWCP) published in the Federal Register a proposal to amend the regulations governing the administration of the Federal Employees' Compensation Act (FECA). On June 28, 2011, the new Regulations became final with an effective date of August 29, 2011. The regulations pertaining to medical and related benefits in Section 10.300 through 10.315 had minimal changes; some of those changes are reflected in this chapter. Also, exhibit 1 (a copy of the CA-16) has been deleted.

Paragraph 1 outlines the purpose of the chapter, which is to describe the circumstances under which OWCP or, in some instances, the employing agency, may authorize medical services for injured claimants.

Paragraph 2 provides an overview of the authorization process and specifies that the majority of such requests are received initially by the Office of Workers' Compensation Programs' (OWCP) designated bill processing agent. The paragraph also discusses the types of treatment requested. Changes made based on the updated regulation at 20 CFR §10.310 include the following: specifically noting OWCP's authority to utilize field nurses in facilitating and coordinating medical care; clearly stating that certain non-physician providers (physicians' assistants, nurse practitioners and physical therapists) may provide authorized services to injured employees, to the extent allowed under Federal and state law, including licensure by any appropriate regulating body for that profession; and clarifying that for a chiropractor's service to be considered under the direction of a qualified physician, a physician must actually prescribe those services.

Paragraph 3 discusses the CA-16, Authorization for Examination and/or Treatment, which is the vehicle by which the employing agency authorizes initial examination and/or medical treatment for an employee who sustains a traumatic injury at OWCP expense. Based on the updated regulation at 20 CFR §10.300, Form CA-16 authorizes treatment for 60 days from the date of injury, not the date the form is signed.

Paragraph 4 briefly outlines the various types of prohibited authorizations, including excluded providers, issuance to oneself, issuance to minors, etc.

Paragraph 5 outlines the various types of medical facilities where care may be authorized, such as physicians' offices, hospitals, and federal medical facilities. This paragraph also stipulates that ordinarily the physician selected for treatment should be located within a reasonable distance of the employee's home or place of employment, and travel should be undertaken by the shortest route, and, if practical, by public conveyance. Per 20 CFR §10.315, a "reasonable distance of travel" is further defined as a roundtrip distance of up to 100 miles.

Paragraph 6 discusses transfer of termination of medical care and outlines the procedures for making these decisions.

Paragraph 7 focuses on Peace Corps cases and entitlement to medical care for these specific injured workers based on their status with the Peace Corps, both prior to and after separation. Information regarding Peace Corps cases is also contained in PM 2-1700-4, and some of the information in Paragraph 7 of this chapter is duplicative. Specifically, 2-1400-4c(2)(d) discusses that the Peace Corps will, at its discretion, pay medical costs directly for treatment of certain specified service-related medical conditions or injuries costing less than $1,000. Conditions covered by this provision are listed in 2-1400-4c(2)(d), and they are also listed in this chapter. The list in this chapter, however, has been updated to include additional conditions in which Peace Corps and OWCP have agreed that Peace Corps can cover costs directly. These new conditions include the following: vaginal yeast infections (candidiasis); acute otitis media; acute sinusitis; constipation; and hemorrhoids. This paragraph also now specifically notes that injury due to assault or sexual assault (including treatment for sexually transmitted disease and mental health treatment) are covered under the FECA.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-05

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EXPLANATION OF MATERIAL TRANSMITTED:

FECA PM Chapter 2-0812 has been updated and revised.

Updates were made based on the changes in the Code of Federal Regulations (20 CFR §§ 10.417 and 10.537) effective August 29, 2011. These regulations outline the reporting requirements for students and dependents over the age of 18 who are incapable of self support.

Updates were also made as a result of an updated Social Security Administration Form SSA-581. The new version of this form, which was approved by the Office of Management and Budget, is now in such a format (with bar codes and fill in boxes) that the Division of Federal Employees' Compensation (DFEC) can no longer automatically generate this form with the annual Form CA-1032 that is sent to the claimant. Therefore, rather than automatically issuing the form with every Form CA-1032 issued, the Claims Examiner should selectively request submission of the form when there is any evidence of earnings or employment.

• Form CA-0936 (the cover letter to the claimant asking for completion of Form SSA-581) can still be found in Correspondence Library. Form SSA-581 can be found on DFEC's intranet site. The CE should write the claimant's case number on the SSA-581 before it is mailed to the claimant.

The chapter was also reorganized to more closely tailor the evidence review required with the annual Form CA-1032 (with EN-1032 attachment). Further detail was also added with regard to the information provided to the claimant and requested by the claimant on Form EN-1032.

Lastly, the section on Forfeiture was deleted from Chapter 2-812 and a new chapter devoted entirely to Forfeiture, Chapter 2-1402, was created.

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CLAIMS

Paragraph 1, Purpose and Scope, was updated slightly to cross-reference the new chapter 2-1402, and also to make it clear that the purpose of this chapter was to discuss the periodic review of the medical evidence, as well as the key factual elements to review in conjunction with the annual CA-1032 form.

No changes were made to paragraph 2, Statutory Provisions.

Paragraph 3, Burden of Proof for Terminating Benefits, was modified only slightly to include a cross reference to FECA PM 2-810-13 when discussing grounds for suspension of benefits under section 8123 of the FECA.

The information contained in the prior paragraph 4 was split into two distinct paragraphs (4 and 5). Paragraph 4, Placement on the Periodic Roll, reminds CEs that when the medical evidence indicates that disability is expected to continue for more than 60-90 days, compensation should usually be paid on the periodic roll, and that the CE should advise the claimant when such payments are initiated.

Paragraph 5, Monitoring Claims on the Periodic Roll, outlines the necessary elements for review in general terms and establishes the timeframe guidelines (based on case status) that should be used when determining the adequacy of medical evidence in the file.

Paragraph 6, Medical Elements of Review, outlines the elements of the medical review for periodic roll cases, including the expected content of the medical report, necessary follow-up actions, and guidance regarding changes in medical status and review of existing attendant allowances. Chapter 2-0810, Developing and Evaluating Medical Evidence, should also be consulted for a more detailed discussion of reviewing medical evidence.

Paragraphs 7 through 12 correspond with topics covered on Form EN-1032.

Paragraph 7, Employment and Earnings, reminds CEs that if there is any evidence on Form EN-1032 that the claimant has any type of employment or earnings, further action is warranted. Further information can be obtained directly from the claimant, and issues to be developed are provided based on whether the work activity is characterized as a sole proprietorship, a partnership or a corporation. Information can also be obtained from the Social Security Administration (SSA) if the claimant completes Form SSA-581; benefits may not be suspended for failure to complete Form SSA-581, however, as authorization to obtain reports from the SSA is not a requirement for receipt of compensation.

Paragraph 8, Dependents, outlines the criteria to review when the claimant is receiving augmented compensation based on one or more dependents. This paragraph includes updated material based on the new criteria in 20 CFR §§ 10.417 and 10.537 for reporting requirements for dependents. References to the CA-1615 and CA-1618 letters were deleted, since these letters no longer exist; the Student Dependency letter is now the letter to use. For students, the reporting requirement has been changed from twice-yearly to annually. The claimant, however, is required to report any changes to student status in the interim. For dependents over the age of 18 but incapable of self support, a review is also required annually. However, if the status of such a dependent is unlikely to change, the claimant may establish the permanency of the condition by submitting a well rationalized medical report which describes that condition and the ongoing prognosis of that condition. Once the permanency of the condition is established, the CE does not need to seek further information regarding that condition; however, if there is a change in that condition, the claimant is required to immediately report that change to OWCP. If the permanency of such a condition is established, the CE should prepare a memorandum to the file for concurrence by the Supervisory Claims Examiner.

Paragraph 9, Dual Benefits, provides the basic criteria to review to determine if the claimant is in receipt of benefits from other Federal agencies such as the Office of Personnel Management, Social Security Administration, or the Department of Veterans' Affairs, as receipt of one of these benefits may require an election or offset. FECA PM Chapter 2-1000 has a detailed discussion of dual benefits, but this paragraph now clearly notes that the CE should review the case for a possible SSA/FERS dual benefit regardless of the claimant's response to the relevant question on the EN-1032.

Paragraph 10, Third Party Settlements, reminds CEs to refer any case in which a new settlement has been made or reported to the Office of the Solicitor.

Paragraph 11, Fraud and Felony Conviction, outlines that if a claimant is convicted of fraud in connection with the application for or receipt of benefits under the FECA, 5 U.S.C. 8148(a) requires termination of all future benefits, including medical benefits. And if a claimant is imprisoned based on a felony conviction unrelated to the FECA claim, 5 U.S.C. 8148(b) requires suspension of benefits to the claimant, but allows payment of benefits to eligible dependents during the time that the claimant is imprisoned.

Paragraph 12, Address Changes, simply reminds CEs to be sure that any address change is updated in the case management system.

Paragraph 13, Actions Based on Form EN-1032 Responses, emphasizes that follow-up action in response to an outstanding issue on Form EN-1032 should be taken promptly in order to avoid or minimize any improper payment.

Paragraph 14, Suspension of Compensation, outlines the process for suspending compensation for non-receipt of the Form EN-1032.

Paragraph 15, Periodic Entitlement Review (PER) Codes, outlines how these codes are used for documenting the periodic entitlement review that is to take place on an annual basis in conjunction with the release of Form CA-1032.

Paragraph 16, Disability Management (DM) Status Codes, outlines that DM codes are used to document actions that may coincide with the development undertaken as the result of a PER review or a final PER action, but that a PER action or closure code will not always coincide with a DM status code, since the PER application is distinct from DM Tracking, each serving a unique purpose. For a complete explanation of DM coding, see FECA PM Chapter 2-0601.

No changes were made to Exhibit 1, PN Memo Example, but the remaining exhibits were deleted.

CHAPTER 2-1402, FORFEITURE

Paragraph 1, Purpose and Scope, outlines the limited scope of this chapter and cross references FECA PM 2-0812 for a more detailed discussion of reviewing cases on the periodic roll.

Paragraph 2, Statutory Provisions, provides the reference to Section 8106(b) of the FECA and clarifies that the statutory authority for forfeiture applies to the omission or understatement of earnings and work activity; it does not apply to similar misrepresentations of dependent status, receipt of dual benefits, etc.

Paragraph 3, Periodic Roll Review, sets the foundation for reviewing periodic roll cases in conjunction with the release of the annual Form CA-1032.

Paragraph 4, CA-1032 Reporting Requirements, provides an overview of the specific directions provided to the claimant when responding to the questions regarding work and volunteer activity.

Paragraph 5, Key Elements of a Forfeiture Decision, clarifies that there are two key requirements for a finding of forfeiture under Section 8106(b)(2): 1) whether the claimant failed to report earnings; and 2) whether he/she did so knowingly. It is not enough to merely establish that there were unreported earnings. The evidence must demonstrate the claimant knowingly failed to report the earnings or activity.

Paragraph 6, Definition of Earnings, provides the regulatory references for the definition of earnings and the requirements for reporting volunteer activity.

Paragraph 7, Definition of Knowingly, provides the regulatory definition for the term, as well as discussion regarding what to look for when making this determination. Relevant decisions of the Employees' Compensation Appeals Board (ECAB) are also included.

Paragraph 8, Penalty Decision, discusses the formal decision and the necessary elements, as well as direction on issuing the simultaneous overpayment decision.

Paragraph 9, Form CA-7, Claim for Compensation, provides guidance on issuing a forfeiture decision based on a Form CA-7, as opposed to the Form EN-1032, with the essential difference being that a forfeiture in this instance is based only on the period claimed on the form, rather than the 15-month period prior to the signature date on the Form EN-1032.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Transmittal No. 12-06

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EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0807 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, renamed, consolidated, and updated to reflect the Continuation of Pay (COP) process in its entirety. The number of paragraphs in the chapter has been reduced from 17 to 15.

The amendment to the Federal Employees' Compensation Act (FECA), which moved the 3-day waiting period for US Postal Service workers to the beginning of the COP period, rather than the period after COP, has also been incorporated. This amendment was Title IX of the Postal Service Accountability and Enhancement Act, effective 12/20/06.

No substantive changes were made to paragraph 1, but the title was updated to Purpose and Scope.

Paragraph 2 was renamed Statutory Authority and has been updated to include a reference to Title IX of the Postal Service Accountability and Enhancement Act.

Paragraph 3, COP Defined, has been amended to include that COP is allowable for time lost for medical care.

Prior paragraph 5, Employee Status, was moved to paragraph 4 and retained the same name and information.

Paragraph 5, Employee Responsibilities, is a compilation of the information contained in previous paragraphs 4 and 7.

Paragraph 6, Employing Agency Responsibilities, contains essentially the same information as the prior paragraph 8.

Paragraph 7, Controversion of COP, contains essentially the same information as the prior paragraph 9, but the reasons for controverting COP have been reorganized based on the applicable regulatory references.

Paragraph 8, Counting COP Days, is a compilation and reorganization of the information previously found in paragraph 6 (Period of Entitlement), paragraph 12 (Delayed Disability), and paragraph 13 (Recurrence of Disability).

Paragraph 9, Interruption and Suspension of COP, and paragraph 10, Termination of COP, provide the information previously found in paragraph 14.

Paragraph 11, COP and Modified Duty Assignments, covers the information found previously in paragraph 16 and includes additional guidance.

Paragraph 12, Payment of COP, provides details regarding the three-day waiting period before COP may be granted to Postal employees. 20. C.F.R. §10.200(c) also reflects this statutory change to 5 U.S.C 8117 (per Title IX of the Postal Service Accountability and Enhancement Act, effective 12/20/06), which provides that Postal Service employees are not entitled to continuation of pay for the first 3 days of temporary disability unless that disability exceeds 14 days or is followed by permanent disability.

Paragraph 13, COP and Leave Election, contains essentially the same information contained in prior paragraph 15, but the information has been reorganized and supplemented.

Paragraph 14, Formal Adjudication of COP, discusses the information contained in the prior paragraph 10, and also provides more detailed information regarding the development, approval, and denial of COP.

Paragraph 15, Initial Claims for Compensation Following COP, updates the information previously found in paragraph 15 and emphasizes the commitment of the Division of Federal Employees' Compensation (DFEC) that claimants are not without income during the period immediately following the expiration of COP. This paragraph outlines how the initial payment should be made. The examiner is then directed to FECA Procedure Manual Chapter 2-901 for further guidance regarding ongoing payments.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.