United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

I.S., Appellant 

and 

DEPARTMENT OF HEALTH & HUMAN 

SERVICES, OFFICE OF CIVIL RIGHTS, 

Dallas, TX, Employer 

__________________________________________ 

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Docket No. 15-0800 

Issued: July 7, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On February 26, 2015 appellant filed a timely appeal from a November 6, 2014 merit 

decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Act1

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.2

ISSUE 

The issue is whether OWCP properly suspended appellant’s compensation benefits 

effective November 16, 2014 for failure to complete an EN1032 form as requested. 

 1

 5 U.S.C. § 8101 et seq. 

2

 Appellant submitted two medical reports on appeal. The Board notes that it can only review evidence that was 

before OWCP at the time of the November 6, 2014 decision on appeal. 20 C.F.R. § 501.2(c)(1). 
2

FACTUAL HISTORY 

On December 18, 1978 appellant, then a 55-year-old equal opportunity specialist, filed an 

occupational disease claim (Form CA-2) alleging that she had an emotional condition causally 

related to her federal employment. OWCP accepted the claim for depression on March 21, 1980. 

Appellant stopped working and began receiving wage-loss compensation on the periodic rolls. 

OWCP periodically sent appellant a letter (Form CA-1032) requesting that she complete 

an enclosed form (Form EN1032) with regard to her employment activity, if any, within the past 

15 months.3

 By CA-1032 dated October 2, 2012, OWCP requested that she answer all questions 

on the EN1032 form within 30 days. Appellant was advised that failure to respond would result 

in suspension of benefits pursuant to 20 C.F.R. § 10.528. She submitted a completed EN1032 on 

November 2, 2012. 

OWCP sent appellant a CA-1032 dated October 2, 2013, again requesting that she 

complete an EN1032 form within 30 days. By decision dated November 18, 2013, it suspended 

appellant’s compensation effective December 15, 2013 for failure to submit the requested 

information. The record indicates that appellant submitted a completed EN1032 form on 

December 9, 2013 and the suspension was lifted. Appellant continued to receive wage-loss 

compensation. 

On October 2, 2014 OWCP again requested that appellant complete an enclosed EN1032 

form within 30 days. It again advised her that if she did not complete the form her compensation 

would be suspended pursuant to 20 C.F.R. § 10.528. 

By decision dated November 6, 2014, OWCP suspended appellant’s compensation 

effective November 16, 2014. It found that she had not submitted the requested information 

regarding her employment activity, if any. In addition, OWCP advised appellant that her 

compensation would be restored retroactively if she completed and submitted the EN1032 form. 

LEGAL PRECEDENT 

Section 8106(b) of FECA authorizes the Secretary of Labor to require a partially disabled 

employee to report his or her earnings from employment or self-employment, by affidavit or 

otherwise, in the manner and at the times the Secretary specifies.4

 

Under section 10.528 of OWCP’s implementing federal regulations, an employee in 

receipt of compensation benefits must complete an affidavit as to any work or activity indicating 

an ability to work which the employee has performed for the prior 15 months.5

 If an employee 

who is required to file such a report fails to do so within 30 days of the date of the request, his or 

her right to compensation for wage loss is suspended until OWCP receives the requested report. 

 3

 The EN1032 also requests information with respect to dependents, receipt of other federal benefits, third-party 

settlements, and fraud offenses. 

4

 5 U.S.C. § 8106(b). 

5

 20 C.F.R. § 10.528. See also A.H., Docket No. 15-241 (issued April 3, 2015). 
3

At that time, OWCP will reinstate compensation retroactive to the date of suspension if the 

employee remains entitled to compensation.6

 

ANALYSIS 

In the present case, OWCP sent appellant a letter dated October 2, 2014 requesting that 

she complete and return the enclosed EN1032 form. Appellant was advised that she must 

complete and return the form within 30 days, or her compensation would be suspended. This 

was consistent with previous requests sent periodically by OWCP. 

The record indicates that appellant failed to timely submit the EN1032 form within 30 

days. Appellant was receiving wage-loss compensation and she was required to complete the 

EN1032 form. The failure to file the EN1032 form within 30 days results in the suspension of 

compensation until OWCP receives the completed form. The Board finds that OWCP properly 

suspended appellant’s compensation pursuant to 20 C.F.R. § 10.528. 

On appeal, appellant states that she did not complete the forms in a timely manner 

because she has health issues and was hospitalized for a short period on two occasions. 

Appellant’s compensation will be reinstated retroactive to the date of suspension once she 

properly submits the requested information.7

 Based on the evidence of record, OWCP properly 

suspended compensation effective November 16, 2014 in this case. 

CONCLUSION 

The Board finds that OWCP properly suspended appellant’s compensation effective 

November 16, 2014. 

 6 Id.; see also 20 C.F.R. § 525. 

7 Supra note 4; see also T.G., Docket No. 14-952 (issued July 14, 2014). 
4

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated November 6, 2014 is affirmed. 

Issued: July 7, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board