Saturday, August 24, 2013

District Office Contact Information

NameBusiness PhoneBusiness Address
Boston District Office1 (857) 264-4600JFK Federal Building, Room E-260
New York District Office1 (212) 863-0800201 Varick Street, Room 740
Philadelphia District Office1 (267) 687-4160170 S. Independence Mall West
Jacksonville District Office1 (904) 366-0100400 West Bay Street, Room 826
Cleveland District Office1 (216) 902-56001240 East Ninth Street, Room 851
Chicago District Office1 (312) 789-2800230 South Dearborn Street, Eighth Floor
Kansas City District Office1 (816) 268-30402300 Main Street, Suite 1090
Denver District Office1 (303) 202-2500One Denver Federal Center, Bldg 53
San Francisco District Office1 (415) 241-330090 Seventh St. Suite 15-100F
Seattle District Office1 (206) 470-3100300 Fifth Avenue, Suite 1050
Dallas District Office1 (214) 749-2320525 South Griffin Street, Room 100
Washington District Office1 (202) 513-6800800 N. Capital Street, N.W., Room 800

District Office 1 Boston
(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

(857)-264-4600          Hearing Impaired: (857) 264-4605

U.S. Department of Labor OWCP
JFK Federal Building Room E-260
Boston MA 02203

District Office 2 New York
(New Jersey, New York, Puerto Rico and the Virgin Islands)

(212) 863-0800        Hearing Impaired: (212) 863-0802
World Trade Center (9/11) Cases: (646) 264-3030   
 Longshore: (646) 264-3010

U.S. Department of Labor OWCP
201 Varick Street Room 740
New York, New York 10014

District Office 3 Philadelphia
(Delaware, Pennsylvania and West Virginia)

(267) 687-4160      Hearing Impaired: (267) 687-4162

U.S. Department of Labor OWCP
Curtis Center Suite 715 East
170 South Independence Mall West
Philadelphia, PA 19106-3308

District Office 6 Jacksonville
(Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee

(904) 366-0100         Hearing Impaired: (904) 366-0102

U.S. Department of Labor OWCP
Charles E. Bennett Federal Building
400 West Bay Street Room 826
Jacksonville, FL 32202

District Office 9 Cleveland
(Indiana, Michigan, Ohio and all special claims and all areas outside the United States, its possessions, territories and trust territories)

(216) 902-5600         Hearing Impaired: (216) 902-5602

U.S. Department of Labor OWCP
1240 East Ninth Street Room 851
Cleveland, OH 44199

District Office 10 Chicago
(Illinois, Minnesota, Wisconsin)

(312) 789-2800         Hearing Impaired: (312) 789-2802

U.S. Department of Labor OWCP
230 South Dearborn Street Eighth Floor
Chicago, IL 60604

District Office 11 Kansas City
(Arkansas, Iowa, Kansas, Missouri and Nebraska. All employees of the Department of Labor except Job Corps and their relatives).

(816) 268-3040    Hearing Impaired: (816) 268-3042

U.S. Department of Labor OWCP
Two Pershing Square Building
2300 Main Street Suite 100
Kansas City, MO 64108-2416

(Colorado, Montana, New Mexico, No. Dakota, So. Dakota, Utah, and Wyoming)

(303) 202-2500         Hearing Impaired: (303) 202-2502

U.S. Department of Labor OWCP
P.O. Box 25602
One Denver Federal Center Building 53
Denver, CO 80225-0602

(Arizona, California, Hawaii, and Nevada)

(415) 241-3300   Hearing Impaired: (415) 241-3302

U.S. Department of Labor, OWCP
90 Seventh St., Suite 15-100F
San Francisco, CA 94103

(Alaska, Idaho, Oregon, and Washington)

(206) 470-3100    Hearing Impaired: (206) 504-5195

U.S. Department of Labor, OWCP
300 Fifth Avenue, Suite 1050F
Seattle, WA 98104-2429

(Louisiana, Oklahoma, and Texas)

(214) 749-2320   Hearing Impaired: (214) 749-2322

U.S. Department of Labor OWCP
525 South Griffin Street Room 100
Dallas, TX 75202

(District of Columbia, Virginia, parts of Maryland)

(202) 513-6800     Hearing Impaired: (202) 513-6802

U.S. Department of Labor OWCP

800 N. Capitol Street, N.W., Room 800

Washington, D.C. 20211

Saturday, August 17, 2013

Dr. Robert Mayo Israel

Effective June 07, 2013, Dr. Robert Mayo Israel (license number: 114345), an orthopedist regularly used by OWCP on the East coast for Referee examinations has been placed on probation for professional misconduct.

Dr. Israel testified he does Independent Medical Examinations, (IME) two-three days per week and does approximately 1,500 examinations per year. Dr. Israel testified he has performed these types of examinations since 1980. Dr. Israel also testified he’s been a witness in court hundreds of times.

This is why it is so important to research the referee physician and when necessary, file complaints against the physician with OWCP. There must not be even the appearance of bias against the claimant in an OWCP-directed Referee examination.

The Department of Health, Bureau of Professional Medical Conduct, (BPMC) issued BPMC Order #13-156 which states:

Misconduct Description: The physician asserted he could not successfully defend against at least one of the charged acts of misconduct alleging negligence on more than one occasion and failing to maintain accurate patient records.

License Restrictions: The physician’s license is limited precluding him from practicing as an Independent Medical Examiner. During the first two years of probation the physician may only practice medicine when is practice is being monitored by a licensed physician; board certified in an appropriate specialty.

Action: Probation for three years and the physician’s license is limited precluding him from practicing as an Independent Medical Examiner.

Dr. Israel’s last known business address is 942 Fifth Avenue, New York NY 10021.

Dr. Israel (cross examination): 

Friday, August 16, 2013

Dr. Michael J. Katz

Dr. Michael J. Katz an orthopedist regularly used as a Referee physician by OWCP on the East coast has come under investigation after his April 12, 2013 testimony in the labor law case of Manuel Bermejo (Bermejo vs. Amsterdam).

In addition to his examinations for OWCP, Dr. Katz is frequently hired as an Independent Medical Examiner, (IME) and “expert witness” by others and has testified he may make more than one million dollars per year from this business.

OWCP claimants often complain that the physicians hired by OWCP do not actually perform examinations and/or spend very little time performing the examination. Yet these physicians often produce wide-ranging reports containing opinion and results of tests never performed.

Although not an OWCP claimant, this was the case for Mr. Bermejo. Dr. Katz testified that according to his notes, his first examination of Mr. Bermejo lasted 45 minutes. Dr. Katz testified that his second examination of Mr. Bermejo lasted 10-20 minutes. Mr. Bermejo and his attorney, who attended the examinations, indicated Dr. Katz’ examinations lasted about five minutes.

For the second examination Dr. Katz performed on Mr. Bermejo, a secret video was made by Mr. Bermejo's attorney. The recording indicated Dr. Katz spent one minute fifty six seconds examining Mr. Bermejo.

Queens Supreme Court Justice Duane Hart, the judge in Mr. Bermejo’s case stated;

“He testified as to findings that he obviously could not have had in a minute and fifty six seconds.” 

Justice Hart also stated;

“It is that the tape shows that he didn’t do the tests that he spent a considerable period of time talking about that he did. That is the perjury. Yes, didn’t do the tests. It is not just me saying it. It is not just the plaintiff saying it. The defendants are saying it too. Does your client really think if the insurance industry or some of the insurance companies that hired him before when they find out that he lied, do you really think they are going near him?”

This is not the first time a Justice has been concerned with Dr. Katz’ testimony. In a case in Brooklyn approximately a year before the Bermejo case, Justice Francois Rivera stated he was;

“Satisfied that this witness is less than forthcoming” and was concerned Dr. Katz was; “Materially misleading the court.”

In light of the information, Justice Hart declared a mistrial and ordered a new trial for Mr. Bermejo, scheduled for September 09, 2013.

On July 08, 2013 Dr. Katz did not show up for his appearance in court in front of Justice Hart

Justice Hart offered Dr. Katz the option of leaving his lucrative IME business. After Dr. Katz refused, Justice Hart sent the matter to the District Attorney with a recommendation perjury charges be filed against Dr. Katz.

On July 01, 2013, the court ordered the trial transcripts be forwarded for further investigation to the Queens Administrative Judge for civil contempt of court for perjury, to the Queens District Attorney for prosecution for perjury against Dr. Katz and referred Dr. Katz to the New York Department of Health to evaluate his capability to continue to practice medicine.

As of July 01, 2013, Dr. Katz continued to work performing examinations.

This is why it is so important to research the referee physician and when necessary, file complaints against the physician with OWCP. There must not be even the appearance of bias against the claimant in an OWCP-directed Referee examination.

You can read the July 08, 2013 transcript here:

Some of the web sites Dr. Katz is listed as an “expert witness:

Monday, February 25, 2013

Change of Physician

If the physician originally chosen to provide treatment for a work-related injury refers a claimant to a specialist for further medical care, OWCP will honor the referral as long as it is for the work-related condition. The claimant DOES NOT need to consult OWCP for approval.

If the claimant wants to change their physician, the claimant MUST submit a written request to OWCP with a list of reasons for the change along with the name, address and specialty of the physician the claimant wishes to change to. 

OWCP must review all change of physician requests.

Reasons that are often approved include transfer of care from a general practitioner to a physician who specializes or when the employee moves. 

OWCP has determined that 50 miles one way or 100 miles round trip is a reasonable distance for a claimant to travel to a physician. Requests for a new physician that are over the 100 mile maximum will probably be denied. However, if a claimant lives in a rural area or in an area without a physician within the 100 mile distance, the CE has the authority to waive the 100 mile maximum. 

If a claimant cannot find a physician within the 100 mile round trip maximum, this should be one of the reasons listed to OWCP. If this is the case, w
ith their letter requesting a new physician, the claimant should include a list of the names, address', phone numbers and specialties of any physicians that the claimant has contacted that have declined and/or refused to treat the claimant with any reason given by the physician. For example, the physician isn't taking new patients, the physician refuses to accept OWCP claimant as a patient, etc...

The retirement of a claimant's treating physician warrants a change of physician. In this case, the claimant need only notify OWCP of the physician's retirement and provide the name, address and specialty of the new treating physician.

A request by the Attending Physician to be relieved of responsibility in a case, will be granted. The physician should be asked by OWCP to provide his/her reasons for the request, report the claimant's condition at the time and ask the physician to state any further medical recommendations.

When OWCP determines medical care will be transferred, the claimant and the previous attending physician must be notified in writing.

The ECAB states:

The Board has recognized that OWCP, acting as the delegated representative of the Secretary of Labor, has broad discretion in approving services provided under FECA.  OWCP has the general objective of ensuring that an employee recovers from his/her injury to the fullest extent possible in the shortest amount of time.  OWCP therefore, has broad administrative discretion in choosing means to achieve this goal.  The only limitation on OWCP’s authority is that of reasonableness.  

Abuse of discretion is generally shown through proof of manifest error, clearly unreasonable exercise of judgment or actions taken which are contrary to both logic and probable deductions from established facts.  It is not enough to show merely that the evidence could be construed to produce a contrary conclusion (The Board cites: Daniel J. Perea, 42 ECAB 221 (1990)).

Other information about physicians:

A claimant is entitled to choose the initial physician or facility for treatment of their injury as long as the provider meets OWCP's definition of "physician" and has not been excluded from payment by OWCP. 

Physicians employed by or under contract to the Agency may examine the claimant at the Agency's facility in accordance with Office of Personnel Management, (OPM) regulations. However, the claimant's choice of physician must be honored and treatment by the claimant's physician must not be delayed for the purpose of obtaining an Agency-directed medical examination. 

The definition of "physician" includes surgeons, podiatrists, dentists, clinical psychologists, psychiatrists, optometrists and osteopathic practitioners. 

Not considered a physician under the Act are Physician Assistants, RN's, Nurse Practitioners and Physical Therapists. Medical evidence by these providers will not be given any weight by OWCP as they are not considered physicians under the Act.

The services of Chiropractors may be reimbursed, but ONLY for treatment consisting of manual manipulation of the spine to correct a Subluxation. An X-Ray must demonstrate the Subluxation. The Chiropractor cannot read the X-Ray and provide the results to OWCP, OWCP requires that X-Rays taken by a Chiropractor be read by an individual trained in the reading of X-Rays.

Physicians whose licenses to practice medicine have been suspended or revoked by a State licensing or regulatory authority will not be recognized as 'Qualified Physicians' by OWCP. 

This information is also true for OWCP's physicians, so claimants should always check to see if the OWCP-directed physician has a valid license. You can do this by going to the Licensing Board of your State. 

The above information can be found in the Federal Employee's Compensation Act, (FECA) Manual part three at 3-0300 as well as the CA-810. The link to part three of the FECA Manual and the CA-810 can be found on the "Links" tab above.

This information is also covered under the Code of Federal Regulations, (C.F.R.) at 20 C.F.R. 10.316. I'm including the language below:

20 C.F.R 10.316: 
After selecting a treating physician, may an employee choose to be treated by another physician instead

(a) When the physician originally selected to provide treatment for a work-related injury refers the employee to a specialist for further medical care, the employee need not consult OWCP for approval. In all other instances, however, the employee must submit a written request to OWCP with his or her reasons for desiring a change of physician.

(b) OWCP will approve the request if it determines that the reasons submitted are sufficient. Requests that are often approved include those for transfer of care from a general practitioner to a physician who specializes in treating conditions like the work-related one, or the need for a new physician when an employee has moved. The employer may not authorize a change of physicians.

Thursday, February 21, 2013

What the Heck is LWEC?

LWEC is Loss of Wage-Earning Capacity and is found in the Federal Employees’ Compensation Act, (FECA) Manual part two at 2-0901-15.

Here’s the link to part two of the FECA Manual: http://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECA-Part2.pdf

A claimant is entitled to compensation for Partial Disability.  Where injury-related impairments prohibit the claimant from returning to the employment held at the time of injury, or from earning equivalent wages, but do not render the claimant Totally Disabled for all gainful employment, the claimant is considered Partially Disabled and is entitled to compensation for LWEC.

The FECA provides for a reduction in compensation to reflect a LWEC when the disability for work is partial (some ability to work).  The employee's actual earnings may be used to calculate reduced compensation if these earnings are found to fairly and reasonably reflect his or her earning capacity. 

The method of computing compensation for wage loss due to partial disability is set forth in the FECA at Section 8106(a) and states:

If the disability is partial, the United States shall pay the claimant during the disability monthly monetary compensation equal to 66 2/3% (or 75% if there are dependents) of the difference between the claimant’s monthly pay and the claimant’s monthly wage-earning capacity.

In the case of Albert Shadrick, 5 ECAB 376, issued March 23, 1953, the Employees' Compensation Appeals Board (ECAB) established a principle to eliminate economic factors such as inflation or recession when computing the amount of monetary compensation due for partial disability. This is known as the Shadrick Formula.

According to this 'formula', the injured worker would be paid compensation based on the difference between the pay which had been determined to be his or her post-injury WEC, and the contemporaneous pay of the date of injury job.  OWCP established the "Shadrick Formula" as the method of computing compensation when determining an injured worker's WEC. (See FECA Manual part two at 2-900.16).

There are three ways a LWEC can be put in place:

1). If the claimant returns to a new position or a modified version of the date of injury position with the previous employer (the Agency you were working for when you were injured) and is earning less than the current pay rate of the job held when injured, the claimant has sustained a loss in wage earning capacity as a result of the injury. 

Once the claimant has satisfactorily performed the position for a period of at least 60 days, the Claims Examiner, (CE) should review the case to determine whether the medical evidence establishes permanent restrictions and whether the position fairly and reasonably represents the claimant’s wage earning capacity.  If so, the CE should prepare a formal decision making this finding.  

If the position does not fairly and reasonably represent the claimant’s wage earning capacity, no decision can be issued.

2). If the claimant returns to work with a new employer and is earning less than the current pay rate of the job held when injured, the claimant has sustained a loss in wage earning capacity as a result of the injury.

Once the claimant has satisfactorily performed the position with the new employer for a period of at least 60 days and the medical evidence establishes permanent restrictions, the CE should prepare a formal decision addressing whether the earnings fairly and reasonably represent the claimant’s wage earning capacity.

If the position does not fairly and reasonably represent the claimant’s wage earning capacity, no decision can be issued.

3). Determination of LWEC without actual job placement: 
In these cases, the claimant has been notified that the OWCP will provide Vocational Rehabilitation assistance leading to re-employment.  The claimant is able to return to work and the file contains documentation that establishes appropriate work is reasonably available in the local labor market and benefits are adjusted to reflect any loss in wage earning capacity. 

This type of decision can be issued after the OWCP has made reasonable efforts to return the claimant to work and has advised the claimant of his or her rights and responsibilities. 

OWCP issues a formal decision based on the selected jobs, regardless of whether the claimant is working or not. In this instance, the CE will prepare a pre-reduction notice, addressing the claimant's loss of wage earning capacity based on a suitable position for which the claimant received training and/or placement efforts.  After the notice period ends, a formal decision establishing the claimant’s wage earning capacity will be issued, taking into account any evidence or arguments submitted by the claimant during the notice period.

A finding by OWCP that the claimant has no wage earning capacity or the claimant has no re-employment potential for the indefinite future can be made on the basis of a medical or vocational determination.

If no rehabilitation plan can be developed due to the severity of the claimant's medical condition and/or the limited job market in the claimant's commuting area, the CE may determine that the claimant has no wage earning capacity.  

If there is no expectation of further recovery or a change in the vocational determination or medical condition, the case can be placed in PN status with the concurrence of the Supervisory Claims Examiner. 
(*PN:  Entitled to payment on periodic roll; formally determined to have no wage earning-capacity or re-employment potential for indefinite future).

See more about Vocational Rehabilitation at the Vocational Rehab tab.

The FECA provides that a partially disabled employee shall be paid compensation equal to 66 2/3% (or 75% with dependents) of the difference between the claimant’s pay and his or her wage-earning capacity. 

The method for computing the compensation payable where an employee has actual earnings (is working) or a wage-earning capacity (is able to work) is called the Shadrick formula, as it reflects the principles set forth in Albert C. Shadrick, 5 ECAB 376.  In that decision the ECAB found that section 5 U.S.C. 8106(a) does not state that compensation is to be based on the difference between the employee's earnings at the time of injury and whatever variable dollar income the employee may have in the future.  Rather, it is to be based upon the loss of capacity to earn wages. 

The Shadrick formula:

(1)      Pay rate when:
(a)  Injured                                                        $_________
(b)  Disability began                                           $_________
(c)  Compensable disability recurred (if any)       $_________

(2)  Current pay rate for job and step when injured      $_________
(3)    (a) Is capable of earning                                      $_________
        (b) Has actual earnings of                                    $_________
(4) WEC [item (3) divided by item (2)]                          $________%
(5) WEC [item (4) x item (1)]                                        $_________
(6) Loss of WEC [item (1) minus item (5)]                      $_________
(7) Compensation [item (6) x 66 2/3% or 75%]                $_________
(8) CPI (expressed in decimal terms)
            (a)   Item (7) x 1                                    $________ (rounded)
*CPI: Consumer Price Index; periodic adjustments to compensation payments which are made to reflect increases in the cost of living.
(b)   Item (8a) x 1                                               $________ (rounded)
(c)   Item (8b) x 1                                               $________ (rounded)

In calculating LWEC, the direct comparison of wages in lines 2 and 3 of the formula above is always based on the current salary of the job when injured, not that held at the time disability began or the date disability recurred.

*Rural Letter Carriers Only: 
While the salaries for Rural Letter Carriers may vary over the life of the claim due to reevaluations of the route, the only salaries that affect the pay rate for compensation purposes is the pay rate on the date of injury, when disability began, or at the time of a qualifying recurrence.  The highest of the three is used to compute compensation.

Changes in route evaluations which occur after a final LWEC decision is issued do not alter that decision.

A Rural Carrier who returns to work but whose hours are restricted due to the effects of the job-related injury is entitled to compensation for any LWEC.

A Rural Carrier who returns to full duty but whose route was reduced during the period compensation was received is not entitled to continuing compensation, since the reduction is not due to injury-related disability.

The "current pay of job held when injured" is defined according to whether the boundaries of the carrier’s route have changed: If not, the hourly rate for the employee's grade and step when injured is multiplied by the number of hours representing the route's current evaluation.

If so, the date-of-injury job when injured no longer exists.  Therefore, the current pay for the grade and step when injured should be multiplied by the number of hours representing the route's evaluation at the time of injury.

Wednesday, February 20, 2013


Under the General Provisions of the Federal Employees Compensation Act, (FECA) part two at 2-0200-2, the definition of an "injury" includes all injuries/diseases proximately caused by the employment as well as damage to or destruction of medical braces, artificial limbs and other prosthetic appliances. Aggravation of a preexisting condition by the employment is also compensable. 

You must provide medical evidence that an injury or disease may be related to your employment factors. Types of casual relationship:

1. Direct Causation. This type of relationship is shown when the injury or factors of employment, through a natural and unbroken sequence, result in the condition claimed. A fractured arm sustained in a fall would be considered a direct result of the fall, and a sensor neural hearing loss might likewise be caused directly by occupational noise exposure over a period of time.

In occupational disease claims, however, the medical evidence needed to support the relationship will require greater rationale than in traumatic injury claims. The phrase "proximately caused" is used also to designate this kind of relationship.

2. Aggravation: OWCP defines an Aggravation as a documented physiological process by which a single occupational act or series of acts over a period of time intensified the severity of a physical or mental problem which preexisted the occupational disease.

This kind of relationship occurs if a preexisting condition is worsened, either temporarily or permanently, by an injury arising in the course of employment. For instance, a traumatic back injury may aggravate a claimant's preexisting degenerative disc disease, and compensation would be payable for the duration of the aggravation as medically determined.

Evidence Needed if an Underlying Condition Exists. When the issue of causal relationship involves aggravation, acceleration, or precipitation of a preexisting condition, the CE must ensure that the file reflects a full and accurate history of that condition.

If there is an aggravation to an underlying condition, from the claimant, the CE should obtain:

Full details of the preexisting condition, including the approximate date it first appeared, the names and addresses of all physicians who examined or treated the claimant for this condition, and the approximate dates of such examinations and treatment.

Reports and test results, if any, from all physicians who examined and/or treated the claimant for the preexisting condition.

From the employing agency, the CE should obtain a copy of the pre-employment physical examination, if one was performed.

A claimant should also request a copy of his/her pre-employment physical examination if one exists as this will more than likely show the employee was in good physical and/or mental condition at the date of hire. When compared to the current medical condition, it can help prove your claim.

Copies of any other pertinent medical records held by the employing agency.

A statement from the immediate superior describing the preexisting condition, the nature of any complaints made by the claimant, and any handicap suffered by the claimant in performing his or her duties because of this condition.

Lack of Evidence or Negative Evidence:

When the attending physician negates causal relationship between the condition and the employment and no medical evidence to the contrary appears in the file, the case may properly be disallowed. No other medical opinion is required to support the denial.

When the attending physician is silent with respect to causal relationship in a primary case, the claim may be denied without further development. 

Aggravation: A Claimant may sustain an aggravation of a preexisting condition due to an injury arising in the course of employment. This could result from a traumatic event or exposure to hazardous conditions.

Aggravation occurs if a preexisting condition is worsened, either temporarily or permanently, by an injury arising in the course of employment.
In determining whether a preexisting medical condition has been aggravated by an injury or by job duties, causal relationship can only be established by medical evidence. Where medical evidence establishes that a preexisting condition was aggravated, an aggravation will be accepted, not the underlying condition. A permanent aggravation will only be accepted after careful evaluation of the weight of the medical evidence of record, as discussed in FECA PM 2-0805.

Although a CE makes the final decisions in a claim, a CE can neither diagnose nor medically determine the extent and duration of an aggravation or any disability associated with the aggravation. This determination must be made based on the medical evidence. The extent and duration of work-related aggravation is one of the critical areas that should always be developed when an aggravation is diagnosed.
There are two kinds of aggravation:

Temporary Aggravation: The preexisting condition is worsened or made more severe for a period of time with no residual alteration of the underlying condition and without leaving any continuing impairment beyond that time.

Temporary aggravation involves a limited period of medical treatment and/or disability, after which the employee returns to his or her previous physical status. Compensation is payable only for the period of aggravation established by the weight of the medical evidence, and not for any disability caused by the underlying disease. This is true even if the claimant cannot return to the job held at time of injury because the preexisting condition will worsen if he or she does so. 

Temporary aggravations may involve either symptoms or short-term worsening of a condition. For instance, a claim may be accepted for angina, which is essentially a symptom, in which case medical treatment and compensation would be limited to the period of work-related angina and would not encompass treatment or disability due to the underlying condition.

Likewise, a claimant with a psychiatric condition may suffer a short-term worsening of the condition which then reverts to its prior state. Both of these situations qualify as temporary aggravation. 

Permanent Aggravation: There is continuing and irreversible change in the underlying condition, thus adversely altering the course of the condition or disease process.

Permanent aggravation occurs when a condition will persist indefinitely due to the effects of the work-related injury or when a condition is materially worsened such that it will not revert to its previous level of severity. For instance, an allergy which would have persisted in any event may be permanently aggravated by exposure to dust and fumes in the workplace such that subsequent episodes are more severe than they otherwise would have been.

In order to establish that permanent aggravation has occurred in a physical disability case, there should be objective evidence of a physiological change in the claimant's preexisting condition.

Federal Employees Compensation Act, (FECA) definitions:

Medical Rationale: A logical explanation for the physician's underlying opinions, fundamental reasons and beliefs concerning causal relationship.

Proximate Cause: That which produces the injury in a natural and continuous sequence, unbroken by an intervening cause and without which the resulting injury would not have occurred.

Acceleration: A documented physiological process by which a single occupational act, or series of acts, can be shown to have increased the expected speed of progression in a preexisting condition documented to be progressive in nature.

An employment-related injury or illness may hasten the development of an underlying condition, and acceleration is said to occur when the ordinary course of the disease does not account for the speed with which a condition develops. For example, a claimant's diabetes may be accelerated by a work schedule which is so erratic that it prohibits the regular food intake required by persons with this condition. An acceptance for acceleration of a condition carries the same force as an acceptance for direct causation. That is, the condition has been accepted with no limitation on its duration or severity.

Precipitation: Hastening the occurrence of an event or causing to happen or come to crisis suddenly, unexpectedly, or too soon.

A latent condition which would not have become evident but for the employment is said to have been precipitated by factors of the employment. For instance, tuberculosis may be latent for a number of years, and then become manifest due to renewed exposure in the workplace. The claim would be accepted for precipitation, but the acceptance would be limited to the period of work-related tuberculosis and OWCP’s responsibility for the condition would cease once the person recovered.

Any ensuing episode of the disease would be considered work-related only if medical evidence supported such a continued relationship. In this way acceptance for precipitation may resemble acceptance for temporary aggravation. A claim can also be accepted for precipitation of a condition with no limit on the duration of the acceptance.