United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.M., Appellant 

and 

SOCIAL SECURITY ADMINISTRATION, 

FIELD OFFICE, Dallas, TX, Employer 

__________________________________________ 

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Docket No. 16-0382 

Issued: May 19, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On December 24, 2015 appellant filed a timely appeal from a December 11, 2015 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 December 13, 2015 for failure to complete an EN1032 form as requested. 

                                                             1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that appellant submitted additional evidence after OWCP rendered its December 11, 2015 

decision. The Board’s jurisdiction is limited to reviewing the evidence that was before OWCP at the time of its final 

decision. Therefore, this additional evidence cannot be considered by the Board. 20 C.F.R. § 501.2(c)(1). 
2 

FACTUAL HISTORY 

OWCP accepted that on September 8, 1997 appellant, a 57-year-old service 

representative, suffered a lumbosacral strain as a result of moving chairs around “to open office 

and to pick up trash.” Continuation of pay commenced on September 16, 1997 and she was 

eventually placed on the periodic compensation rolls.3

 

Once on the periodic compensation rolls OWCP regularly sends 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.4

 By Form CA-1032 dated October 14, 

2015, it informed appellant that federal regulations required her to make an affidavit relative to 

any earnings or employment during the previous year and that an EN1032 form was enclosed for 

that purpose. OWCP notified appellant that she had to fully answer all questions on the form and 

return the statement within 30 days or her benefits would be suspended pursuant to 20 C.F.R. 

§ 10.528. The letter was mailed to her address of record. No response was received. 

By decision dated December 11, 2015, OWCP suspended appellant’s compensation 

benefits effective December 13, 2015 for failing to complete the EN1032 form as requested. It 

noted that, if she completed and returned an enclosed copy of the form, her compensation 

benefits would be restored retroactively to the date they were suspended. 

LEGAL PRECEDENT 

FECA authorizes the Secretary of Labor to require a partially disabled employee to report 

her earnings from employment or self-employment, by affidavit or otherwise, in the manner and 

at the times the Secretary specifies.5

 

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.6 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. 

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

employee remains entitled to compensation.7

 

                                                             3

 By decision dated October 9, 1998, OWCP adjusted appellant’s compensation to reflect her wage-earning 

capacity due to her reemployment as a modified service representative, four hours per day, effective 

January 15, 1998. 

4

 The EN1032 form also requests information with respect to dependents, receipt of other federal benefits, thirdparty settlements, and fraud offenses. 

5

 5 U.S.C. § 8106(b). 

6

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

7 Id.; see also id. at § 10.525. 
3 

ANALYSIS 

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

effective December 13, 2015 for failure to complete the EN1032 form as requested. 

On October 14, 2015 OWCP provided appellant with the EN1032 form. It notified her 

that federal regulations required her to complete the form and answer all questions concerning 

her employment or earnings. OWCP properly notified appellant that, if she did not completely 

answer all questions and return the statement within 30 days, her benefits would be suspended. 

The record reflects that OWCP’s letter was properly sent to her address of record.8

 Under the 

mailbox rule, a document mailed in the ordinary course of the sender’s business practices to the 

addressee’s last known address is presumed to be received by the addressee. 

Appellant failed to timely submit the EN1032 form within 30 days.9

 Appellant was 

receiving wage-loss compensation and she was required to complete the EN1032 form. The 

failure to file an EN1032 form within 30 days results in the suspension of compensation. Thus, 

the Board finds that OWCP properly suspended appellant’s compensation benefits effective 

December 13, 2015 pursuant to 20 C.F.R. § 10.528.10 

On appeal, appellant submitted additional evidence. The Board’s jurisdiction is limited 

to reviewing the evidence that was before OWCP at the time of its final decision.11 Therefore, 

this additional evidence cannot be considered by the Board. As noted, appellant’s benefits may 

be retroactively reinstated once she submits the EN1032 form to OWCP. 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

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

effective December 13, 2015 for failure to complete an EN1032 form as requested. 

                                                             8 See Kenneth E. Harris, 54 ECAB 502, 505 (2003); J.J., Docket No. 13-1067 (issued September 20, 2013). 

9 See I.S., Docket No. 15-0800 (issued July 7, 2015) (where the employee stated that she had not completed the 

forms in a timely manner because she had health issues and had been hospitalized for a short period on two 

occasions, the Board found that she had failed to timely submit the EN1032 form within 30 days and that suspension 

was proper; however, appellant was advised that compensation benefits would be reinstated retroactive to the date of 

suspension once she properly submitted the requested information to OWCP). 

10 See M.W., Docket No. 15-0507 (issued June 18, 2015). 

11 See supra note 2. 
4 

ORDER 

IT IS HEREBY ORDERED THAT the December 11, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 19, 2016 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board