Recurrence or Not?

A recurrence of the medical condition is a documented need for additional medical treatment after release from treatment for the work-related injury. Continuing treatment for the original condition is not considered a recurrence.

A recurrence of disability is a work stoppage caused by a spontaneous return of the symptoms of a previous injury or occupational disease without an intervening cause; A return or increase of disability to a consequential injury (defined as one which occurs due to weakness or impairment caused by a work-related injury); or withdrawal of a specific light duty assignment when the employee cannot perform the full duties of the regular position. This withdrawal must have occurred for other reasons other than misconduct or non-performance of job duties.

If you returned back to work for more than 90 days, you have been re-exposed to the cause of your initial injury which is an intervening cause. Because of that, it would not be considered a recurrence. So, if exposure to the cause of a previous injury or occupational injury occurs and results in disability or the need for medical care results, a new Form CA-1 or CA-2 should be filed.

However, in some occupational disease cases where the diagnosis remains the same but disability increases, the injured worker may submit Form CA-2a rather than filing a new claim. For instance, an injured worker with carpal tunnel syndrome who has returned to work, but whose repetitive work activities result in the need for surgery would not be required to file a new claim.

If you were performing light duty, you are not considered fully recovered from your work-related injuries. So, the proof you have to provide is mainly to establish that any increase in your disability for work is due to the accepted injury rather than another cause. In other words, your doctor would have to prove that your injury worsened but it wasn’t due to the physical requirements of your job. The Employees Compensation Appeals Board has ruled that when an employee, who is disabled from the job he or she held when injured on account of employment-related residuals, returns to a light-duty position or the medical evidence of record establishes that he or she can perform the light-duty position, the employee has the burden of establishing by the weight of the reliable, probative and substantial evidence a recurrence of total disability and to show that he or she cannot perform such light duty. As part of your burden, you must show a change in the nature and extent of the injury-related condition or a change in the nature and extent of your light-duty job requirements. The OWCP considers an increase in pain as subjective or, in other words, a physician doesn’t know you are in pain unless you tell him. So, an increase in pain does not constitute objective evidence of disability.

Having a recurrence accepted is very difficult because Claims Examiners all tend to have different interpretations of what a recurrence is. If you returned to work and have been working for more than 90 days performing the work tasks that was the cause of your original injury, then file a new claim.

Without FECA competent representation, chances of having a recurrence accepted is slim at best.

The information provided above is verifiable as found in the FECA Procedure Manual.

Leave a reply