K.L. and Department of Health & Human Services, Administration for Children & Families, Washington, DC (Board decision, February 15, 2017)

ECAB remand decision. The Board set aside the OWCP decision and remanded the case. 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

OWCP denied a Health and Human Services employee’s request to reconsider her claim. The request consisted only of a checkmark on a form, but OWCP had received new medical evidence after the initial claim denial and before its reconsideration decision. The Board found that OWCP failed to discuss that evidence or explain the basis for denying the claim. It set aside the June 22, 2016 decision and ordered a new decision with proper findings.

Decision snapshot

• Authority: 5 U.S.C. § 8124.
• Outcome: June 22, 2016 denial set aside and remanded for a new decision.
• Key point: OWCP had to address the new evidence and explain its decision.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
K.L., Appellant
)
)
and ) Docket No. 16-1474
) Issued: February 15, 2017
DEPARTMENT OF HEALTH & HUMAN
)
SERVICES, ADMINISTRATION FOR
)
CHILDREN & FAMILIES, Washington, DC,
)
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
PATRICIA H. FITZGERALD, Deputy Chief Judge COLLEEN DUFFY KIKO, Judge

On July 11, 2016 appellant filed an appeal from a June 22, 2016 nonmerit decision of the Office of Workers’ Compensation Programs (OWCP) which denied appellant’s request for reconsideration, finding the evidence insufficient to warrant a merit review.

The request for reconsideration filed by appellant on April 22, 2016 consisted only of a checkmark on a form. The record did, however, include medical evidence which OWCP had received after its initial denial of the claim on May 6, 2015 and before the June 22, 2016 decision.

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 in 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 1 5 U.S.C. § 8124(a).
2
20 C.F.R. § 10.126.
3
Patrick Michael Duffy, 43 ECAB 280 (1991).
June 22, 2016 decision stated: “We have reviewed your letter dated 04/19/2016 requesting reconsideration of our decision dated 05/15/2015. Please refer to the information which accompanied the original decision. To require the Office to reopen your case, you must clearly identify the grounds upon which reconsideration is being requested. Also, you must either submit relevant evidence not previously considered or present legal contentions not previously considered. Because your letter neither raised substantive legal questions nor included new and relevant evidence, it is insufficient to warrant a review of our prior decision at this time. Any future request for reconsideration must be made within one year from the prior decision and must be accompanied by statements or evidence as described above.”

In its decision of June 22, 2016, OWCP failed to reference or review the new medical evidence which had been submitted by appellant. It 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 OWCP’s June 22, 2016 decision does not contain a clear 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 June 22, 2016 is set aside and the case remanded for a de novo decision with appropriate findings of fact and conclusions of law.

Issued: February 15, 2017
Washington, DC

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

Patricia H. Fitzgerald, Deputy Chief Judge Employees’ Compensation Appeals Board

Colleen Duffy Kiko, 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 2.1602.7 (October 2011) (regarding the format and contents of a nonmerit reconsideration decision).

2