L.R. and Department of Energy, Savannah River Site Operations Office, Aiken, SC (Board decision, December 21, 2015)

ECAB remand decision. The Board set aside OWCP’s July 22, 2014 decision denying surgery and directed a new decision with adequate factual findings and legal conclusions. Whether the requested surgery should be authorized remains unresolved. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a).

Plain-English summary

L.R. sought authorization for surgery involving fusion of foot bones. OWCP denied the request, saying the evidence was insufficient because a current MRI had not been provided. The Board found that the denial did not adequately explain the factual basis or how OWCP exercised its discretion. It set aside the denial and directed OWCP to issue a new decision with findings of fact and conclusions of law.

Decision snapshot

• Authority: Federal Employees’ Compensation Act, 5 U.S.C. § 8124(a); 20 C.F.R. § 10.126.
• Outcome: July 22, 2014 surgery denial set aside; case remanded.
• Key point: An adverse OWCP decision must explain the factual findings and reasons for denial.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
L.R., Appellant
)
)
and ) Docket No. 15-0235
) Issued: December 21, 2015
DEPARTMENT OF ENERGY, SAVANNAH
)
RIVER SITE OPERATIONS OFFICE,
)
Aiken, SC, 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
ALEC J. KOROMILAS, Alternate Judge
JAMES A. HAYNES, Alternate Judge

On November 10, 2014 appellant filed an application for review of a July 22, 2014 decision of the Office of Workers’ Compensation Programs (OWCP) which denied a request for surgery. The appeal was docketed as No. 15-235.

The Board has duly considered the matter and notes that section 8124(a) of the Federal Employees’ Compensation Act1 (FECA) and section 10.126 of the implementing regulations2 require that final decisions of OWCP contain findings of fact and a statement of reasons. A decision denying a claim for benefits should contain a correct description of the basis for the denial in order that the parties of interest will have a clear understanding of the precise defect of the claim and the kind of evidence which would overcome it.3 The Board notes that OWCP’s July 22, 2014 decision is incomplete and contains insufficient explanation of how OWCP exercised it discretion in denying appellant’s requested surgery. The portion of the decision entitled “Basis For Decision” states in its entirety: “The evidence is not sufficient to authorize the proposed fusion of foot bones is hereby declined for the reason that the evidence presented is 1 5 U.S.C. § 8124(a).
2
20 C.F.R. § 10.126.
3
Patrick Michael Duffy, 43 ECAB 280 (1991). not sufficient because you failed to provide a current MRI [magnetic resonance imaging scan] as requested for review by [OWCP].” In its decision of July 22, 2014, OWCP failed to conform to its established procedure, provisions of FECA, and its implementing regulations, and Board precedent, all of which require that a final adverse decision of OWCP contain findings of fact and a clear explanation of the deficiencies of the claim.4 Because its July 14, 2014 decision does not contain a complete description of the basis for the denial of the claim or the findings of fact reached therein, the Board finds that OWCP has not fulfilled its responsibility under section 8124 of FECA.

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ Compensation Programs dated July 22, 2014 is set aside and the case remanded for a de novo decision with appropriate findings of fact and conclusions of law.5

Issued: December 21, 2015
Washington, DC

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

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

4
Id.; see 5 U.S.C. § 8124(a); 20 C.F.R. § 10.126. See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Disallowances, Chapter 2.1400.5 (February 2013) (regarding the elements that an OWCP decision should contain). 5 James A. Haynes, Alternate Judge, participated in the original decision but was no longer a member of the Board effective November 16, 2015.

2