2022 FECA Bulletins which have previously been issued by the DFEC but have since expired or been superseded by another Bulletin, Circular or inclusion in the FECA Procedure Manual.
|
Bulletin |
Subject |
|---|---|
|
Coverage for Injuries Resulting from the COVID-19 Vaccination Mandate for Federal Employees. |
|
|
Processing Claims for Anomalous Health Incidents (AHI) under the Federal Employees Compensation Act (FECA) |
|
|
Compensation Pay: Compensation Rate Changes for 2022 |
|
|
Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments |
|
|
Updates to COVID-19 Claims Processing Guidelines Relating to Reinfections and Home Tests |
|
|
Special Case Handling in Certain Firefighter FECA Claims Processing and Adjudication |
|
|
Retention Pay for Wildland Firefighters |
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-01 October 1, 2021
Subject: Coverage for Injuries Resulting from the COVID-19 Vaccination Mandate for Federal Employees.
Background: On September 9, 2021, President Biden issued an executive order mandating COVID-19 vaccination for most Federal employees. The order directed each agency to implement a program to require COVID-19 vaccination for all of its employees, with exceptions only as required by law.
The Federal Employees' Compensation Act (FECA) covers injuries that occur in the performance of duty. The FECA does not generally authorize provision of preventive measures such as vaccines and inoculations, and in general, preventive treatment is a responsibility of the employing agency under the provisions of 5 U.S.C. 7901. However, care can be authorized by OWCP for complications of preventive measures which are provided or sponsored by the agency, such as adverse reaction to prophylactic immunization. See PM 3-0400.7(a).
Further, deleterious effects of medical services furnished by the employing establishment are generally considered to fall within the performance of duty. These services include preventive programs relating to health. See PM 2-0804.19.
However, this executive order now makes COVID-19 vaccination a requirement of most Federal employment. As such, employees impacted by this mandate who receive required COVID-19 vaccinations on or after the date of the executive order may be afforded coverage under the FECA for any adverse reactions to the vaccine itself, and for any injuries sustained while obtaining the vaccination.
Purpose: To provide guidance on coverage for claims for injury on or after September 9, 2021, resulting from receipt of the mandated COVID-19 vaccination for Federal employees.
Applicability: All FECA Program Staff and Other Stakeholders.
Reference: Federal (FECA) Procedure Manual, Part 2 Claims, Chapter 2-0804 Performance of Duty, and Part 3 Medical, Chapter 3-0400 Medical Services and Supplies; 20 CFR § 10.313; Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees.
Actions::
1. Because COVID-19 vaccination is a specific event occurring during a single day or work shift, any adverse reactions or injuries should be reported on Form CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay / Compensation. Where two vaccinations are required several weeks apart, reactions to each are considered separate claims.
2. When a claim is received for injury due to receipt of the COVID-19 vaccination, the claims examiner should determine if the vaccine was received prior to September 9, 2021. If the vaccination was received prior to this date, coverage is afforded only if the vaccine was administered or sponsored by the employing agency. See PM 2-0804.19.
3. The claims examiner should then confirm that the employee is covered by the September 9, 2021 executive order. The order applies to any executive agency as defined in 5 U.S.C. 105 – agencies that fall under the executive branch of the government (excluding the Government Accountability Office). The order does not apply to employees of the United States Postal Service. If there is any question regarding applicability of the executive order, the claims examiner should query the employing agency. If the employee is not covered by the executive order, coverage is afforded only if the vaccine was administered or sponsored by the employing agency. See PM 2-0804.19.
4. If the employee is covered by the executive order and vaccination was received on or after September 9, 2021, coverage may be afforded for (1) adverse reactions to the COVID-19 vaccination and (2) injuries sustained as the direct result of an employee receiving their mandated vaccination. Examples of such injuries include but are not limited to accidents while commuting a reasonable distance to and from the vaccination site and slip and fall injuries occurring at the vaccination site.
5. The claims examiner should, however, ensure that the employee followed any employing agency policy with respect to obtaining their mandatory vaccination. The executive order directs each agency to implement, to the extent consistent with applicable law, a program to require COVID-19 vaccination for all of its Federal employees.
a. If an employing agency requires employees to receive their mandatory vaccination at specific times and/or at a specific location(s), coverage is only afforded if the employee follows the agency’s vaccination policy.
b. If any employing agency allows employees to obtain their mandatory vaccination at any time or location, coverage is afforded regardless of where or when the employee receives their vaccination, with the only limitation being for that of reasonableness.
6. The executive order requires full vaccination, which is considered to be two shots of the Pfizer-BioNTech COVID-19 Vaccine, also known as Comirnaty, two shots of the Moderna COVID-19 Vaccine, or one shot of the Janssen COVID-19 Vaccine. The order does not cover or mandate booster vaccinations. Should there be any changes regarding approved vaccination brands or mandated vaccination frequencies, the FECA program will publish additional guidance.
Disposition: This bulletin should be retained until incorporated into Chapter 2-0804, Performance of Duty, of the FECA Procedure Manual.
ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All FECA Program Staff
Back to Top of FECA Bulletin No. 22-01
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-03 January 12, 2022
Subject: Processing Claims for Anomalous Health Incidents (AHI) under the Federal Employees Compensation Act (FECA)
Background: The FECA covers injury in the performance of duty; injury includes a disease proximately caused by federal employment. The U.S. Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation (DFELHWC) provides to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The FECA pays compensation for disability or death of an employee resulting from injury in the performance of duty.
In recent years, and predominantly overseas, some Federal employees have reported a series of sudden sensory events such as sounds, pressure, or heat concurrently or immediately preceding the sudden onset of symptoms such as headaches, pain, nausea, or disequilibrium (unsteadiness or vertigo). Symptoms were first reported by personnel stationed in Cuba and have since been collectively referred to as Havana Syndrome.
Purpose: To provide targeted guidance on the handling of claims resulting from AHIs.
Action:
1. Claim Intake
a. Claimants who sustain an injury as the result of an AHI should file Form CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay / Compensation, as current understanding of AHIs are that they are specific events that occur over a single day or work shift.
b. A new special indicator of AHI will be created within the Employees Compensation and Management Portal (ECOMP) for agency reviewers to select when submitting a claim resulting from these incidents.
c. Claims created with this special indicator will be processed by the Special Claims Unit to ensure consistency in adjudication. See FECA PM 1-0200.
2. Factual Review
a. The claims examiner should review the factual evidence and determine if the agency has concurred with the allegation that the claimant was exposed to an AHI.
b. If the agency concurs that an AHI occurred within the performance of duty, the claims examiner should accept the incident as factual and proceed with a review of the medical evidence of record.
c. If the agency does not concur or does not respond regarding whether an AHI occurred within the performance of duty, the claims examiner should further develop the claim, requesting a detailed statement from the agency as to whether it agrees with the claimant’s allegation(s).
d. If an employing agency fails to respond to the request for a statement, the CE may accept the claimant's statements as factual. See 20 CFR §10.117(b). The claims examiner may also reach out to National Office through their supervisor for escalation if unable to secure an adequate response from the employing agency.
e. In cases where the agency response is ambiguous, the case may be considered for conferencing. See FECA PM 2-0500.
3. Medical Review
a. The claims examiner should also review the medical evidence submitted to determine if any medical conditions have been diagnosed in connection with the AHI incident. Because of uncertainty in the medical community with respect to these incidents, claims examiners may see medical reports addressing symptoms such as headaches, pain, nausea, etc. rather than a concrete diagnosis. While symptoms are not compensable under the FECA, it is appropriate to accept such claims for a diagnosed traumatic brain injury, ICD-10 S06.301A. Additional conditions may be appropriate depending on the medical evidence submitted. The claims examiner may consider a referral to a District Medical Advisor (DMA) if needed for clarification of the diagnosed condition(s).
b. Once the factual component of the claim has been established and the employee has been diagnosed a traumatic brain injury, a fully rationalized medical opinion as to causal relationship is not needed. The physician's diagnosis and an affirmative statement are sufficient to accept the claim. However, additional diagnosed conditions beyond traumatic brain injuries (i.e. gastrointestinal conditions, cancer, etc.) require a well-rationalized opinion from a physician addressing causal relationship. The claims examiner may consider a referral to DMA if needed to determine if the AHI was competent to cause additional diagnoses indicated.
c. All medical evidence must be submitted from a qualifying physician. If medical evidence is submitted from an individual such as a nurse practitioner or physician’s assistant, a report from a physician should be requested. However, as some claimants are located in remote areas overseas and may have limited access to a qualifying physician, a claims examiner may refer the report of a nurse or physician’s assistant to a DMA for review and concurrence with the original provider’s assessment. If the employing agency has a qualifying physician available stateside, they may also review and provide concurrence with the initial provider’s report.
4. Adjudication/Disposition:
a. If the claim meets the five basic requirements for adjudication, given the caveats noted in items 1 and 2 above, the claim should be accepted. A claim that is compensable for some conditions should not be delayed for the final adjudication of all conditions, rather, the claims examiner should issue an acceptance letter on the claimed conditions that can be accepted and further develop the remaining claimed conditions.
b. If the claim does not meet the five basic requirements for adjudication, given the caveats noted in items 1 and 2 above, the claims examiner should proceed with a denial.
5. Claims for Compensation: Nothing in this bulletin alters the claimant's burden of proof for establishing disability, the need for ongoing medical treatment and any claim for a consequential condition. See PM 2-0901.5(a)(2).
6. Schedule Awards: Like any other FECA claim, claims resulting from AHIs may result in permanent impairment to certain parts of the body which will entitle the claimant to an award of compensation payable for a set number of weeks. The claims examiner should monitor medical reports for the possibility of eventual impairment to a schedule member and the date by which maximum medical improvement (MMI) is expected. Schedule awards are only payable to body parts covered by the FECA or subsequently added by regulation. See 5 U.S.C. 8107 and 20 C.F.R. §10.404. Examples of schedule members that may be impaired by an AHI include ears (hearing) and eyes (vision).
7. Dual Benefits: On October 8, 2021, President Biden signed the Havana Act into law. This legislation authorizes the Central Intelligence Agency, the Department of State, and other agencies to provide payments to agency personnel who incur brain injuries from hostilities while on assignment. Specifically, the bill allows agency personnel and their families to receive payments for brain injuries that are incurred (1) during a period of assignment to a foreign or domestic duty station; (2) in connection with war, insurgency, hostile acts, terrorist activity, or other agency-designated incidents; and (3) not as the result of willful misconduct. OWCP does not consider receipt of compensation under the Havana Act to be a prohibited dual benefit and no offset of FECA benefits is required.
Disposition: This Bulletin is to be retained until incorporated unto the DFELHWC Procedure Manual.
ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All DFELHWC Staff
Back to Top of FECA Bulletin No. 22-03
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-04 January 24, 2022
Subject: Compensation Pay: Compensation Rate Changes for 2022
Background: On December 22, 2021, the President signed an Executive Order increasing General Schedule basic pay rates for 2022.
Reference: 2022 General Schedule (Base).
Purpose: To inform the appropriate personnel of the minimum/maximum rates of compensation under the Federal Employees’ Compensation Act for affected cases on the periodic disability and death payrolls.
The maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10 of $146,757 per annum. The basis for the minimum compensation rate of $22,682 is the salary of a GS-2, Step 1. The actual rates are outlined below.
|
Type |
Minimum |
Maximum |
|---|---|---|
|
Weekly |
$327.14 |
$2,116.69 |
|
Daily (5-day week) |
$65.43 |
$423.34 |
|
Type |
Minimum |
Maximum |
|---|---|---|
|
28-Day Cycle |
$1,308.58 |
$8,466.75 |
|
Type |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,890.17 |
$9,172.31 |
Action: The integrated Federal Employees’ Compensation System (iFECS) will be updated with the rate changes for the periodic disability and death payrolls.
Applicability: Appropriate National and District Office personnel.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All FECA Staff
Back to Top of FECA Bulletin No. 22-04
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-05 January 24, 2022
Subject: Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments
Purpose: To furnish information on the CPI adjustment process for March 1, 2022.
The cost-of-living adjustments granted to a compensation recipient under the FECA are based on the “Consumer Price Index for Urban Wage Earners and Clerical Workers” (CPI-W) figures published by the Bureau of Labor Statistics (BLS). The annual cost of living increase is calculated by comparing the base month from the prior year to the base month of the current year, with the percentage of increase adjusted to the nearest one-tenth of 1 percent. 5 U.S.C. §8146(a) establishes the base month for the FECA CPI as December.
December 2020 had a CPI-W level of 254.081 and the December 2021 level was reported by BLS as 273.925. This means that the new CPI increase, adjusted to the nearest one-tenth of 1 percent, is 7.8 percent. The increase is effective March 1, 2022, and is applicable where disability or death occurred before March 1, 2021. In addition, the new base month for calculating the future CPI is December 2021.
The maximum compensation rates1, which must not be exceeded, are as follows:
$9,172.31 per month
$8,466.75 each four weeks
$2,116.69 per week
$423.34 per day (for a 5 day week)
Applicability: Appropriate FECA Program personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981; Bureau of Labor Statistics Consumer Price Index Publication for December 2021 (USDL-22-0028).
Action: National Office Production will update the iFECS CPI tables and recalculate all payment records when the iFECS system is not in use by Office personnel. The March 25, 2022 check will be the first check paid at the 2022 rate.
Please note that if there are any cases with fixed gross overrides, those cases must be reviewed to determine if CPI adjustment is necessary. If so, a manual calculation will be required. If the gross override payment is, in fact, eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a “Gross Override with CPI.”
- CPI Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated to indicate the increase for 2022. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2023, for reference.
- Verification of Compensation. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please continue to provide this data in letter form from the district office. Many times a Benefit Statement may not reach the addressee and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Attachment: Cost of Living Adjustments
Distribution: All FECA Program Staff
1 Per 2022 General Schedule (Base) 2022 General Schedule (Base).
ATTACHMENT TO FECA BULLETIN NO. 22-05
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
03/01/90 |
4.50% |
|
01/01/68 |
3.7% |
03/01/91 |
6.1% |
|
12/01/68 |
4.0% |
03/01/92 |
2.8% |
|
09/01/69 |
4.4% |
03/01/93 |
2.5% |
|
|
|
03/01/94 |
2.5% |
|
06/01/70 |
4.4% |
03/01/95 |
2.7% |
|
03/01/71 |
4.0% |
03/01/96 |
2.5% |
|
05/01/72 |
3.9% |
03/01/97 |
3.3% |
|
06/01/73 |
4.8% |
03/01/98 |
1.5% |
|
01/01/74 |
5.2% |
03/01/99 |
1.6% |
|
07/01/74 |
5.3% |
|
|
|
11/01/74 |
6.3% |
03/01/00 |
2.8% |
|
06/01/75 |
4.1% |
03/01/01 |
3.3% |
|
01/01/76 |
4.4% |
03/01/02 |
1.3% |
|
11/01/76 |
4.0% |
03/01/03 |
2.4% |
|
07/01/77 |
4.9% |
03/01/04 |
1.6% |
|
05/01/78 |
5.3% |
03/01/05 |
3.4% |
|
11/01/78 |
4.9% |
03/01/06 |
3.5% |
|
05/01/79 |
5.5% |
03/01/07 |
2.4% |
|
10/01/79 |
5.6% |
03/01/08 |
4.3% |
|
|
|
03/01/09 |
0.0% |
|
04/01/80 |
7.2% |
|
|
|
09/01/80 |
4.0% |
03/01/10 |
3.4% |
|
03/01/81 |
3.6% |
03/01/11 |
1.7% |
|
03/01/82 |
8.7% |
03/01/12 |
3.2% |
|
03/01/83 |
3.9% |
03/01/13 |
1.7% |
|
03/01/84 |
3.3% |
03/01/14 |
1.5% |
|
03/01/85 |
3.5% |
03/01/15 |
0.3% |
|
03/01/86 |
N/A |
03/01/16 |
0.4% |
|
03/01/87 |
0.7% |
03/01/17 |
2.0% |
|
03/01/88 |
4.5% |
03/01/18 |
2.2% |
|
03/01/89 |
4.4% |
03/01/19 |
1.8% |
|
03/01/20 |
2.3% |
||
|
03/01/21 |
1.4% |
||
|
03/01/22 |
7.8% |
Prior to September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).
| Prior to 09/07/74 | Eff. 11/1/74 |
|---|---|
|
.08-.34 = .23 |
.13-.37 = .25 |
|
.35-.57 = .46 |
.38-.62 = .50 |
|
.58-.80 = .69 |
.63-.87 = .75 |
|
.81-.07 = .92 |
.88-.12 = 1.00 |
Back to Top of FECA Bulletin No. 22-05
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-06 February 16, 2022
Subject: Updates to COVID-19 Claims Processing Guidelines Relating to Reinfections and Home Tests
Background: The Federal Employees' Compensation Act (FECA) covers injury in the performance of duty; injury includes a disease proximately caused by federal employment. The U.S. Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) administers the FECA. The FECA provides to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The FECA pays compensation for the disability or death of an employee resulting from injury in the performance of duty.
On March 11, 2021, the American Rescue Plan Act of 2021 (ARPA) was signed into law. This new legislation streamlined the process for federal workers diagnosed with COVID-19 to establish coverage under the FECA. On April 28, 2021, the FECA Program issued FECA Bulletin 21-09, which provided detailed processing procedures for claims for COVID-19 filed under the ARPA. Pursuant to Bulletin 21-09, a claim for COVID-19 would not be considered a new injury unless the date of injury was more than 1 year from the date of injury of any prior accepted COVID-19 claim for the same employee. Rather it would be combined with the existing claim and developed as necessary as a consequential or recurrence claim. This guideline was established to prevent a new injury claim being created based on a previously confirmed virus or test result used to establish the initial injury.
Bulletin 21-09 also provided that COVID-19 cases not expected to involve large medical expenses or extended disability may be administratively closed without formal adjudication by claims staff.
On August 28, 2021, the FECA Program issued FECA Bulletin 21-10, which further amended the processing procedures for claims for COVID-19 to the extent that in order to establish a diagnosis of COVID-19, an employee (or survivor) should submit medical evidence as noted below:
a. A positive Polymerase Chain Reaction (PCR) or Antigen COVID-19 test result; or
b. A positive Antibody test result, together with contemporaneous medical evidence that the claimant had documented symptoms of and/or was treated for COVID-19 by a physician (a notice to quarantine is not sufficient if there was no evidence of illness); or
c. If no positive laboratory test is available, a COVID-19 diagnosis from a physician together with rationalized medical opinion supporting the diagnosis and an explanation as to why a positive test result is not available.
In certain rare instances, a physician may provide a rationalized opinion with supporting factual and medical background as to why the employee has a diagnosis of COVID-19 notwithstanding a negative or series of negative COVID-19 test results.
Reinfection occurs when a person was infected with COVID-19, recovers and then becomes infected with COVID-19 again. Since the onset of the COVID-19 pandemic, research and studies have been conducted by the Centers for Disease Control and Prevention (CDC) and through the U. S. National Science Foundation. Current research supports COVID-19 reinfection (or the onset of a new COVID-19 virus) can occur as early as 90 days following the initial infection.
Self-administered COVID-19 tests, also called “home tests”, “at-home tests”, or “over-the-counter (OTC)” tests have become available and more prevalent over the course of the COVID-19 pandemic. Self-testing offers fast results and may be more convenient than laboratory-based tests and point-of-care tests. Self-tests can be purchased online or in pharmacies and retail stores. They are also available for free through some local health departments or Federally Qualified Health Centers (FQHC). Self-tests are available to detect current infection, but not to detect antibodies to the virus that causes COVID-19.
The research conclusions concerning COVID-19 reinfection as documented by the CDC and through the U. S. National Science Foundation; and the increase in accessibility to self-administered COVID-19 testing, have prompted the need for further guidance concerning the processing, and evidence required for adjudication, of COVID-19 claims under the FECA.
This Bulletin also provides clarity with respect to COVID-19 claims placed in an administrative closure status and the impact on Continuation of Pay (COP).
Purpose: To provide updated guidance regarding the processing of FECA claims with respect to handling reinfection claims, claims involving self-administered COVID-19 testing and administratively closed claims.
Applicability: All DFELHWC FECA Program Staff
Action:
Reinfection:
1. Effective the date of this Bulletin, a claim for COVID-19 will be considered a new injury when the employee tests positive for COVID-19 90 days or more from the date of the employee’s previous positive COVID-19 test. The 90 days is from the date the initial COVID-19 test is performed to the date the current COVID-19 test is performed. A claim based on a positive COVID-19 test which is performed fewer than 90 days after the initial positive COVID-19 test was performed will be combined with the existing claim and developed as necessary as a consequential or recurrence claim.
Self-Administered COVID-19 Testing:
2. Self-administered COVID-19 testing as defined above is insufficient to establish a diagnosis of COVID-19 under the FECA. This is because there is no way for FECA claims staff to affirmatively establish (1) the date and time the sample was collected and (2) that the sample collected is that of the injured Federal employee making the claim.
3. The only exception to this policy is where the administration of the self-test is monitored by a medical professional and the results are verified through documentation submitted by such professional.
4. There is no change to the established policy whereby if no positive laboratory test is available, a COVID-19 diagnosis from a physician together with rationalized medical opinion supporting the diagnosis and an explanation as to why a positive test result is not available may be submitted to establish a claim.
Administratively Closed Cases:
5. COVID-19 claims that close upon receipt are assigned case status code “C1” or “C4” pursuant to FECA Procedure Manual 01-0400. While case status code “C4” is indicative of lost time, COP is only payable if the requisite statutory and regulatory requirements are meti. If COP is claimed but not allowable, a formal decision denying COP may be issued even where the case remains in an administrative closure status.
Regardless of whether a COVID-19 claim administratively closes on receipt, the employing agency must continue the regular pay of employees who are eligible for COP, assuming the above referenced statutory and regulatory requirements are otherwise met.
Disposition: This Bulletin amends FECA Bulletins 21-09 and 21-10 and is to be retained until incorporated into the FECA Procedure Manual.
ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All DFELHWC FECA Program Staff
-------------
iSee 5 USC §8118, 20 CFR §205; 20 CFR §220
Back to Top of FECA Bulletin No. 22-06
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-07 Issue Date: April 19, 2022
Subject: Special Case Handling in Certain Firefighter FECA Claims Processing and Adjudication
Background: The Federal Employees' Compensation Act (FECA) covers injury in the performance of duty; injury includes a disease proximately caused by federal employment. The U.S. Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation (DFELHWC) administers FECA. FECA provides to an employee injured while in the performance of duty the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The FECA pays compensation for disability or death of an employee resulting from injury in the performance of duty.
Chapter 2-0805-6 of the FECA Procedure Manual provides for special case handling for those employees who are engaged in employment that places them at a high risk for exposure to infectious diseases. Conditions such as HIV infection and hepatitis B more commonly represent a work hazard in health care facilities, correctional institutions, and drug treatment centers, among others, than in Federal workplaces as a whole. More recently, the FECA program recognized high-risk employment for those employees who routinely came in contact with the public and were exposed to COVID-19. See FECA Bulletin 20-05. The same principle that applies for high-risk employment regarding exposure to infectious diseases, also applies to those positions that routinely expose employees to substances that increase the risk of occupational diseases such as cancers, heart disease and lung disease. While all federal employees who contract an occupational disease related to their federal employment are entitled to FECA coverage, special case handling considerations should apply to those employees engaged in high-risk employment.
As the result of the specific exposures that routinely occur in the course of their employment, Federal firefighters are at increased risk of certain types of cancers, heart disease and lung diseasei. Accordingly, firefighters may be considered to be in high-risk employment triggering the application of Chapter 2-0805-6 of the FECA Procedure Manual when filing claims for these specific medical conditions. In such cases, there is an implicit recognition of a higher likelihood of illness related to such federal employment.
OWCP will continue to monitor medical developments in this area and update its list of specific medical conditions as appropriate.
Purpose: To provide targeted instructions to claims staff on the handling of certain occupational disease claims filed by Federal firefighters.
Action: Firefighter FECA claims will be fully developed to establish the five basic elements set forth in 20 CFR 10.115, within the special handling procedures further addressed in items 1-5 below.
- The claim was filed within the time limits set by the FECA;
- The injured individual was an employee within the meaning of the FECA;
- The employee provided factual evidence confirming that the exposure occurred and provided the medical evidence to support the diagnosis;
- The employee was in the performance of duty when the exposure occurred; and
- The diagnosis was found by a physician to be aggravated, accelerated, precipitated, or directly caused by work-related activities/exposure.
1. Claim Intake
a. A new special indicator of FIR (Firefighter) has been created within the Employees Compensation and Management Portal (ECOMP) for Federal Firefighters who file claims under the FECA.
b. Claims created with this special indicator will be processed by the Special Claims Unit to ensure consistency in adjudication. See FECA PM 1-0200. After adjudication, these cases will be reassigned to a non-specialized claims examiner.
2. Medical Review
a. The claims examiner should review the evidence submitted to determine if any of the following conditionsii are diagnosed by a valid physician:
1. Esophageal Cancer
2. Colorectal Cancer
3. Prostate Cancer
4. Testicular Cancer
5. Multiple Myeloma
6. Non-Hodgkin’s Lymphoma
7. Leukemia
8. Kidney Cancer
9. Bladder Cancer
10. Brain Cancer
11. Lung Cancer
12. Mesothelioma
13. Buccal Cavity / Pharynx Cancer
14. Larynx Cancer
15. Melanoma
16. Thyroid Cancer
17. Hypertension
18. Coronary Artery Disease
19. A sudden cardiac event or stroke while, or not later than 24 hours after, engaging in engaged in the prevention, control, and extinguishment of fires or response to emergency situations where life, property, or the environment is at risk, including the prevention, control, suppression, or management of fires
20. Asthma
21. Chronic Obstructive Pulmonary Disease (COPD)
22. Pulmonary Fibrosis
b. If no medical documentation with a diagnosis from a valid physician is present, it should be requested by the claims examiner. The date of initial diagnosis of each qualifying condition should also be requested.
c. If, after appropriate development, no medical evidence is submitted from a valid physician establishing the diagnosis of any medical condition, the claim should be denied on that basis.
d. If, after appropriate development, medical evidence from a valid physician establishes a diagnosis not listed in subpart (a) above, the claims examiner should proceed with adjudication in accordance with established FECA case processing procedures. The claim will not be considered high-risk for purposes of this Bulletin.
e. If, after any necessary development, a diagnosis in subpart (a) from a valid physician is present, the claims examiner should proceed with the analysis addressed in item (4) below.
3. Factual Review
a. Concurrently with the medical review, the claims examiner should review the factual evidence and determine the nature and extent of the claimant’s employment history as it relates to performing fire protection activities. Employees engaged in fire protection activities means a firefighter, paramedic, emergency medical technician, rescue worker, ambulance personnel, or hazardous material worker, who (1) is trained in fire suppression (2) has the legal authority and responsibility to engage in fire suppression; (3) is engaged in the prevention, control, and extinguishment of fires or response to emergency situations where life, property, or the environment is at risk; and (4) performs such activities as a primary responsibility of their job.
b. The claims examiner should also ascertain the number of years of Federal employment in which the employee was actively engaged in fire protection activities.
c. If the factual evidence necessary for subparts (a) and (b) is not present with the submission of the claim, development should be undertaken and addressed to both the employee and the employing agency. A position description should also be requested.
4. Adjudication/Disposition:
a. The claims examiner should review and document the following information based on the evidence submitted with the claim and following any appropriate development:
1. Years of Federal employment engaged in fire protection activities.
2. Medical Diagnosis
3. Latency Period, defined as the number of years between the employee’s last date of exposure to Federal fire protection activities and the date of initial diagnosis of the qualifying medical condition.
b. In order to be considered a high-risk claim, it must meet all three of the conditions below:
1. The employee must have at least five years of Federal employment engaged in fire protection activities as defined in section 3(a) aboveiii. The five-year period does not need to be consecutive; any Federal employment that meets the definition can be included in the claims examiner’s assessment. For example, if an employee was first engaged in fire protection activities in January of 2008, stopped working in fire protection activities in December 2009, and returned to their fire protection activities from January 2013 through their retirement in November 2017, the total exposure is six years and nine months.
2. The employee must have been diagnosed, by a physician, with a medical condition noted in item 2(a) above.
3. The above diagnosis must have occurred within ten yearsiv of the date of last exposure to Federal firefighting activities. The only exception is with respect to sudden cardiac events or strokes as defined in item 2(a)(19) above. For such cases to meet the high-risk criteria, the cardiac event or stroke must occur while, or not later than 24 hours after, engaging in engaged in the prevention, control, and extinguishment of fires or response to emergency situations where life, property, or the environment is at risk, including the prevention, control, suppression, or management of fires
c. If the case does not meet all three of the high-risk criteria in 4(b), it does not mean it should automatically be denied. Instead, the claims examiner should develop the claim in accordance with established FECA case processing procedures.
d. If the case meets the high-risk criteria, the claims examiner should refer the case to a District Medical Advisor (DMA) for review and verification that the employee’s Firefighter employment was capable of producing the diagnosed condition. The DMA should be presented with the correct factual framework for the medical opinion requested. A Statement of Accepted Facts (SOAF) should be used for conveying this information and should include a detailed description of the employee’s fire prevention activities.
1. If the DMA responds in the affirmative, the claim should be accepted.
2. If the DMA responds in the negative or requests additional information, development should be undertaken in consultation with the OWCP Medical Director.
5. Death Benefits. Claims for Federal Firefighter death benefits are to be adjudicated in a manner similar to Federal Firefighter disability claims.
a. The claimant has the burden of establishing the essential elements of the claim, which includes the existence of a causal relationship between an employee’s death and a qualifying condition in item 2(a) above.
b. The qualifying medical condition as listed in action item 2(a) above need not be the sole cause of death, and as such the fact that the employee may have other non-work related conditions does not preclude a survivor’s entitlement to benefits.
c. Similar to disability cases, following appropriate development, the claims examiner should refer supportive medical evidence to a DMA in accordance with item 4(d) above.
Disposition: This Bulletin is to be retained until incorporated into the DFELHWC Procedure Manual.
ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All DFELHWC Staff
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i LeMaster GK, et al. Cancer risk among firefighters: A review and meta-analysis of 23 studies. J Occup Environ Med. 2006; 48(11): 1189-202; Daniels RD, et al. Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med. 2014; 71(6): 288-97; Muegge CM, Zollinger TW, Song Y, Wessel J, Monahan PO, Moffatt SM. Excess Mortality Among Indiana Firefighters, 1985-2013. American Journal of Industrial Medicine. 2018; 61:961-967; Tsai RJ et all. Risk of cancer among firefighters in California, 1988-2007. Am J Ind Med. 2015; 58:715-29.
iii Recent studies have demonstrated marked increase in incidence of certain cancers, heart and lung diseases in individuals engaged in fire protection activities for fire years or more. Daniels, RE,et al, Occup Environ Med 2015; 0:1-8. Doi:10.1136/oemed-2014-102671
iv Diana L. Nadler, Igor G. Zurbenko, "Estimating Cancer Latency Times Using a Weibull Model", Advances in Epidemiology, vol. 2014, Article ID 746769, 8 pages, 2014.
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 22-08 Issue Date: August 17, 2022
Subject: Retention Pay for Wildland Firefighters
Background: The Bipartisan Infrastructure Law (Infrastructure Investment and Jobs Act) was passed on November 15, 2021. Section 40803(d)(4) of the Act included a provision known as the “$20k/50% provision” that provides for additional compensation to be paid to wildland firefighters.
The definition of “wildland firefighter” as noted in the Bipartisan Infrastructure Law (BIL) applies to “Wildland fire employees that have status (primary or secondary) as firefighters under the retirement laws (5 U.S.C. 8331(21) and 8401(14)), or who would have such status but for exclusion from coverage under the retirement system based on a temporary appointment or intermittent work schedule”.
It has been determined that the provision applies to wildland firefighters with the U. S. Department of the Interior (DOI) and the U.S. Department of Agriculture-Forest Service (USDA). Section 40803(d)(4) of the BIL provides for a salary increase of $20,000 per year, or 50% of the firefighter’s base salary (whichever is less), if the Secretary of the Interior, in coordination with the Office of Personnel Management (OPM), determines the wildland firefighter is located in an area where it is difficult to recruit or retain wildland firefighters. The geographic areas used in making determinations regarding recruitment/retention difficulties are defined by the National Wildfire Coordinating Group (NWCG) Geographic Area Coordination Center (GACC) of the DOI and USDA.
Chapter 2-0900.6(b) of the FECA Procedure Manual provides for administrative inclusions in computing an employee’s pay rate, including retention pay when the employee is in a field which is difficult to staff or requires specific and/or difficult to hire employment.
It has been determined that the salary increase authorized by the BIL constitutes retention pay and should be included in the pay rate of the applicable employees.
Purpose: To provide targeted instructions to claims staff on the inclusion of retention pay in the pay rate for Federal Wildland firefighters per the provisions of the BIL.
Action: The firefighters who are affected by this legislation are those who have effective pay rate dates of October 1, 2021 or later.
A. Pay Rate Inclusion
1. Upon receipt of a compensation claim from a DOI or USDA Wildland Firefighter that yields an effective pay rate on or after October 1, 2021, the claims examiner (CE) should review to determine if the agency reported additional premium pay citing to the BIL. The CE should note that wildland firefighters may fall under the occupation title of Forestry Technician.
2. If DOI or USDA do not report BIL pay for a wildland firefighter for a pay rate effective date on or after October 1, 2021, clarification should be sought to determine why such employee does not qualify for the pay type.
3. If any agency other than DOI or USDA reports BIL pay for a Federal Firefighter, clarification should be sought to determine the legal authority for such a payment.
4. To include BIL pay, the CE should either add $20,000.00 or 50% of the firefighter’s base salary to the annual salary in the pay rate calculation, based upon a review of the firefighter’s base annual salary.
a. If the firefighter’s annual base salary is $40,000.00 or greater, the annual amount of BIL pay equals $20,000.00.
b. If the firefighter’s annual base salary is under $40,000.00, the annual amount of BIL pay equals 50% of the annual base salary.
5. The method for adding the retention pay to the pay rate will be dependent upon the firefighter’s appointment and tour of duty.
a. For firefighters who are paid a fixed annual salary, the CE should add the $20,000.00 annual increase or 50% of the claimant’s annual salary as an additional premium pay element in the pay rate calculation.
b. For firefighters who are paid using the Fair Labor Standards Act (FLSA)-144 hour calculation, the CE should add either $20,000.00 or 50% of the claimant’s annual salary to the base annual salary and recompute the pay rate pursuant to PM 2-0900.8(c).
For example, if yearly pay in the FLSA-144 hour calculation (PM 2-0900.8(c)(1)) was $50,000.00, the annual salary would be adjusted to $70,000.00 and the CE would follow the established formula to compute the pay rate.
6. The salary used for life insurance deductions is not affected by this additional pay and should not be adjusted.
B. Retroactive Pay Increases
OWCP will be reviewing all compensation payments made to USDA and DOI wildland firefighters with pay rate effective dates on or after October 1, 2021 and issuing compensation adjustment payments to reflect the entitlement to BIL pay.
Disposition: This Bulletin is to be retained until incorporated unto the DFELHWC Procedure Manual.
ANTONIO RIOS
Director for
Federal Employees’, Longshore and Harbor Workers’ Compensation
Distribution: All DFELHWC Staff
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