J.G. and Department of Veterans Affairs, Veterans Health Administration, Albany, NY (Board decision, December 23, 2014)

ECAB remand decision. The Board set aside OWCP’s January 28 and June 18, 2014 decisions and directed it to assemble the related injury files before deciding J.G.’s occupational disease claim again. Entitlement to compensation remains unresolved. Under 20 C.F.R. § 501.6(d), this Board order becomes final 30 days after issuance. A party may petition the Board for reconsideration within 30 days unless this order specifies another period, under 20 C.F.R. § 501.7(a).

Plain-English summary

J.G., a Veterans Affairs nurse, claimed a recurrence of a lower back injury after returning to work. OWCP treated her claim as a new occupational disease claim and denied it for lack of medical evidence. The Board found that a separate file for a recent accepted back injury might contain evidence needed to decide the new claim. It set aside both OWCP decisions and directed the agency to combine and reconstruct the records before issuing a new decision.

Decision snapshot

• Authority: OWCP procedure for combining related claim files, cited in the order.
• Outcome: January 28 and June 18, 2014 decisions set aside; claim remanded for record assembly and a new decision.
• Key point: Evidence in the recent traumatic injury file could bear on the later back condition claim.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
J.G., Appellant
)
)
and ) Docket No. 14-1558
) Issued: December 23, 2014
DEPARTMENT OF VETERANS AFFAIRS,
)
VETERANS HEALTH ADMINISTRATION,
)
Albany, NY, Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

ORDER REMANDING CASE

Before:
CHRISTOPHER J. GODFREY, Chief Judge
COLLEEN DUFFY KIKO, Judge
PATRICIA HOWARD FITZGERALD, Judge

On July 1, 2014 appellant filed an appeal from a June 18, 2014 nonmerit decision and a January 28, 2014 merit decision of the Office of Workers’ Compensation Programs (OWCP). The Board assigned Docket No. 14-1558.

Appellant, a 29-year-old registered nurse, filed a claim for recurrence of an accepted lower back injury on October 30, 2013. She had previously filed a claim for traumatic injury under File No. xxxxxx164, which was accepted on December 12, 2013. The traumatic incident related to this claim occurred on October 10, 2013, and appellant returned to work on October 16, 2013. Appellant stated that her recurrence occurred over the course of several weeks as her injury had not completely healed, and she noted that she had reinjured her lower back due to performing everyday duties of her position.

On December 26, 2013 OWCP notified appellant that it had administratively converted her claim for recurrence to a new occupational disease claim based upon her description of the circumstances related to her condition. It noted in a memorandum dated December 12, 2013 that she had been released to full duty twice before the alleged recurrence. OWCP denied this occupational disease claim, by decision dated January 28, 2014, on the grounds that appellant had not submitted sufficient medical evidence to establish a diagnosis in connection with duties of her employment. On June 10, 2014 it received her request for reconsideration of its January 28, 2014 decision. By decision dated June 18, 2014, OWCP denied appellant’s request for reconsideration, finding that she did not raise substantial legal questions or included new and relevant evidence, as she had only submitted the appeal request form.

The record on appeal indicates that File No. xxxxxx164 may contain evidence pertinent to the present claim under File No. xxxxxx311. Appellant’s claim was denied on the basis that she had not submitted a firm medical diagnosis in connection with duties of her federal employment. As appellant’s claim for occupational disease occurred within a month of her claim for traumatic injury, dealt with the same bodily member, and alleged that her back condition had worsened after the traumatic event over the period of several weeks due to duties of her employment, medical evidence relating to the earlier traumatic injury under File No. xxxxxx164 would be relevant to the present claim. The Board, therefore, finds that the appeal docketed as No. 14-1558 is currently not in posture for decision. Because the record is incomplete, the Board is unable to render a fully informed adjudication of the case. OWCP procedures also require that cases should be combined where proper adjudication depends on cross-referencing evidence between files, such as when “a new injury case is reported for an employee who previously filed an injury claim for a similar condition or the same part of the body. For instance, a claimant with an existing case for a back strain submits a new claim for a herniated lumbar disc.”1 In the instant appeal, it appears that for a full and fair adjudication, appellant’s occupational injury claim should be combined with her traumatic injury claim pertaining to an incident on October 10, 2013. Accordingly, the case is remanded to OWCP for reconstruction and proper assemblage of the case record, to be followed by the issuance of an appropriate decision.

1
Federal (FECA) Procedure Manual, Part 2 -- Claims, File Maintenance and Management, Chapter 2.400.8(c)(1) (February 2000). See also J.M., Docket No. 13-1111 (issued July 15, 2013).

2
 IT IS HEREBY ORDERED THAT the June 18 and January 28, 2014 decisions of the Office of Workers’ Compensation Programs is set aside and the case is remanded for further action consistent with this order of the Board.

Issued: December 23, 2014
Washington, DC

Christopher J. Godfrey, Chief Judge
Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Patricia Howard Fitzgerald, Judge
Employees’ Compensation Appeals Board

3