United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

H.S., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

U.S. CITIZENSHIP & IMMIGRATION 

SERVICES, Laguna Niguel, CA, Employer

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Docket No. 23-0557

Issued: October 5, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 10, 2023 appellant filed a timely appeal from a January 13, 2023 merit decision 

of the Office of Workers’Compensation Programs (OWCP).1 Pursuant to the Federal Employees’

Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction to 

consider the merits of this case.

ISSUE

The issue is whether OWCP properly denied appellant’s request for a home health aide.

1 The Board notes that,following the January 13, 2023 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record 

that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the 

Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id.

2

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On June 13, 2005 appellant, then a 58-year-old assistant, filed an occupational disease 

claim (Form CA-2) alleging that she developed basilar joint arthritis in both hands due to factors 

of her federal employment. She stopped work on August 6, 2005 and accepted a position as a 

legal assistant with the Department of Health and Human Services. OWCP accepted the claim for 

aggravation of bilateral thumb basilar joint arthritis. OWCP paid appellant wage-loss 

compensation on the periodic rolls beginning April 3, 2006.

By decision dated June 6, 2008, OWCP reduced appellant’s compensation, pursuant to 5 

U.S.C. §§ 8106 and 8115, to find that she was capable of earning wages in the constructed position 

of receptionist, at the rate of $400.00 per week. It continued to pay her wage-loss compensation 

on the periodic rolls based on this loss of wage-earning capacity determination.

Beginning on August 9, 2010 Dr. Badi Durain Jeffers, an osteopath, diagnosed 

osteoarthritis and provided work restrictions including no lifting over 5 pounds, very little 

computer work or grasping, no repetitive motion of the hands and wrists, exceeding more 15 

minutes each every hour. On March 16, 2016 he recounted appellant’s difficulty with household 

activities and activities of daily living. Dr. Jeffers noted that she was requesting home health 

assistance. He prescribed home health assistance for activities of daily living twice per week for 

four hours per day. On December 23, 2016 Dr. Jeffers repeated his findings and conclusions and 

noted that appellant had not received a response from OWCP regarding her request for home health 

assistance.

In a December 30, 2016 development letter, OWCP noted that appellant had requested 

assisted care. It advised that house cleaning and cooking were not covered by workers’

compensation. OWCP requested additional information from Dr. Jeffers explaining the 

symptoms, findings, or event which precipitated the need for assisted case, whether it was related 

to the accepted work condition, and whether skilled nursing or simple custodial care was required. 

It afforded appellant 30 days to respond.

On March 22, 2018 Dr. Jeffers diagnosed a mild degree of diffuse degenerative joint 

disease (DJD) changes involving the joints of multiple fingers of both hands and multiple joint 

spaces of the bilateral wrists, and a moderate degree of DJD change of the bilateral first carpal 

metacarpal joints. He reported that appellant had bilateral hand/thumb pain that limited her ability 

to grip and grasp. Dr. Jeffers recounted that she dropped things due to her hand/thumb pain.

Dr. Jeffers completed an additional note on October 18, 2019, repeating appellant’s 

diagnoses and work restrictions. He related that pain in her bilateral extremities was worse at the 

base of the thumbs, right greater than left, and that it affected the activities of daily living. 

Dr. Jeffers recounted that appellant dropped things due to the pain in her hands.

In a June 9, 2020 note, Dr. Jeffers, diagnosed mild degree of diffuse DJD changes 

involving joints of multiple fingers of both hands and multiple joint spaces of the bilateral wrists. 

He also found a moderate degree of DJD changes of the bilateral first carpal metacarpal joint. On 

August 25, 2020 Dr. Jeffers recounted appellant’s symptoms of worsening pain in her right hand
3

which was interfering with her activities of daily living and related that she needed help with these 

activities.

Dr. Jeffers completed a report on August 24, 2021 repeating his diagnoses and appellant’s 

work restrictions. He recounted that her activities of daily living were limited due to pain. 

Appellant had difficulty gripping, grasping, and lifting which limited her activities of daily living. 

Dr. Jeffers found decreased range of motion and weakness of her bilateral hands which were 

specific residuals of her accepted conditions.

On March 29, 2022 Dr. Jeffers requested assistance to help appellant perform household 

chores due to worsening pain in her hands, right more than left, causing her to drop things.

In an April 1, 2022 development letter, OWCP informed appellant that the services of an

attendant were allowed where it was medically documented that assistance was required to care 

for personal needs such as bathing, dressing, and eating, but not for cooking or housekeeping. It 

requested that she complete a questionnaire and provide additional medical information. OWCP

afforded appellant 30 days to respond.

OWCP subsequently received a March 31, 2022 note, wherein Dr. Jeffers prescribed a 

home health aide for appellant twice a week for four hours a day to perform household chores due 

to pain and limitations of her hands. Dr. Jeffers recounted that appellant asserted that she was 

having worsening pain in her hands, which was limiting her ability to perform household chores.

In an April 6, 2022 development letter, OWCP informed appellant that, pursuant to 20 

C.F.R. § 10.314, a home health aide may be authorized to provide assistance for personal needs 

such as bathing, dressing, and eating, but not for tasks as cooking and housekeeping. It afforded

her 30 days to respond.

In a letter dated April 15, 2022, appellant requested assistance for personal hygiene 

activities. She asserted that hygienic tools needed to perform these tasks required precision, and 

that constantly holding these tools hurt her hands.

In a May 24, 2022 development letter, OWCP requested that appellant and her treating 

physician complete questionnaires regarding her need for a home health aide. It afforded 30 days 

for a response.

On June 1, 2022 Dr. Jeffers recounted appellant’s statements that she was having pain and 

difficulty with personal hygiene.

Appellant subsequently submitted a May 3, 2022 report, wherein Dr. Jeffers noted that 

appellant had decreased strength in her hands and had difficulty performing tasks. Dr. Jeffers

indicated that appellant was able to perform the following tasks unassisted: travel; walk; feed 

herself; dress herself; bathe, with pain and difficulty; use the bathroom; get out of bed, with 

difficulty; get out of doors; and take exercise, with difficulty. He noted that she did not currently 

have an attendant, but that she had pain and difficulty performing tasks due to dropping things and 

weakness of her hands. 
4

In a June 1, 2022 response to OWCP’s development questionnaire, appellant noted that it 

was painful and difficult to perform certain hygienic activities. She requested an attendant for 45 

minutes to 1 hour once a week to perform these tasks.

In an August 16, 2022 note, Dr. Jeffers again reported that appellant did not need a home 

health aide for bathing or personal care, but that she was having difficulty cutting her nails and 

removing hair from her face. He diagnosed right-hand joint pain. Dr. Jeffers requested 

authorization for hygiene care.

On August 26, 2022 appellant submitted medical reimbursement forms for July 5 and 22, 

2022 for the hygienic procedures.

By decision dated January 13, 2023, OWCP denied appellant’s request for a home health 

aide in accordance with section 8103 of FECA (5 U.S.C. § 8103), finding that there was no 

rationalized medical opinion evidence establishing the need for such care to redress the effects of 

her accepted employment injury.

LEGAL PRECEDENT

Section 8103(a) of FECA states in pertinent part: “The United States shall furnish to an 

employee who is injured while in the performance of duty, the services, appliances, and supplies 

prescribed or recommended by a qualified physician, which the Secretary of Labor considers likely 

to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of 

the monthly compensation.”

3

 

Section 10.314 of OWCP’s regulations establish that the cost of providing attendant 

services will be paid under section 8103 of FECA as medical bills, so long as the personal care 

services have been determined to be medically necessary and are provided by a home health aide, 

licensed practical nurse, or similarly trained individual, subject to requirements specified by 

OWCP.

4

 Attendant services, however, are not intended for performance of domestic and 

housekeeping chores such as cooking, cleaning, doing the laundry, or providing transportation 

services. It is intended to pay an attendant for assisting a claimant in his or her personal needs 

such as dressing, bathing, or using the toilet.5

3

5 U.S.C. § 8103(a); 20 C.F.R. § 10.310(a); Federal (FECA) Procedure Manual, Part 3 --Medical, Medical Services 

and Supplies, Chapter 3.400.3.d(5) (October 1995); id. at Chapter 2.810.17.h (June2014); 20 C.F.R. S10.314; id. at 

Chapter 3.300.2a)5) (February 2012) (OWCP will pay for the services of an attendant under section 8103 of FECA, 

instead of section 8111(a)); J.F., Docket No. 22-0164 (issued November 28, 2022); J.M., Docket No. 20-0457 (issued 

July 16, 2020); D.W., Docket No. 19-0402 (issued November 13, 2019).

4

20 C.F.R. § 10.314; id. at Chapter 3.300.2a(5) (February 2012).

5 L.H., Docket No. 15-1239 (issued August 22, 2016); Nowling D. Ward, 50 ECAB 496 (1999); Allison Maxine 

McCauley, 27 ECAB 128 (1975).
5

The Board has found that OWCP has discretion in determining whether a particular type 

of service or treatment is likely to cure or give relief.6 The only limitation on OWCP’s authority 

is that of reasonableness.7 Abuse of discretion is generally shown through proof of manifest error, 

clearly unreasonable exercise of judgment, or actions taken which are contrary to both logic and 

probable deductions from established facts. It is not enough to merely show that the ev idence 

could be construed so as to produce a contrary factual conclusion. 8 In order to be entitled to 

reimbursement of expenses, it must be shown that the expenditures were incurred for treatment of 

the effects of an employment-related injury or condition.9 Proof of causal relationship in a case 

such as this must include supporting rationalized medical evidence. 10

ANALYSIS

The Board finds that OWCP properly denied appellant’s request for a home health aide.

Dr. Jeffers provided a series of reports dated August 9, 2010 through August 16, 2022,

indicating that appellant did not require a home health aide for bathing or personal care, but that 

she was having difficulty with hygienic activities. On March 22, 2018 he diagnosed moderate 

degree of DJD change of the bilateral first carpal metacarpal joints and reported that she had 

bilateral hand/thumb pain that limited her ability to grip and grasp causing her to drop things. 

Dr. Jeffers completed a May 3, 2022 development questionnaire and indicated that appellant was 

able to travel, walk, feed herself, dress herself, bathe, use the bathroom, get out of bed, get out of 

doors, and take exercise without assistance. He did not opine that a home health aide was

medically necessary to assist appellant with hygiene activities.

The Board finds that OWCP did not abuse its discretion by finding that appellant had not 

submitted a rationalized medical opinion supporting the need for a home health aide for hygiene 

purposes and explaining how this need related to appellant’s work-related conditions. Dr. Jeffers 

also failed to explain how the personal care services requested were medically necessary.

As noted above, the Board has found that OWCP has discretion in determining whether a 

particular type of service is likely to cure, give relief, reduce the degree or the period of disability, 

or aid in lessening the amount of the monthly compensation, and the only limitation on OWCP’s 

authority is that of reasonableness.11 Abuse of discretion is generally shown through proof of 

manifest error, clearly unreasonable exercise of judgment, or actions taken which are contrary to 

6 A.R., Docket No. 21-0097 (issued February 24, 2023); R.C., Docket No. 18-0612 (issued October 19, 2018); 

Vicky C. Randall, 51 ECAB 357 (2000).

7 A.R., id.; B.L., Docket No. 17-1813 (issued May 23, 2018); Lecil E. Stevens, 49 ECAB 673, 675 (1998).

8

S.W., Docket No. 18-1529 (issued April 19, 2019); Rosa Lee Jones, 36 ECAB 679 (1985).

9

J.R., Docket No. 17-1523 (issued April3, 2018); Bertha L. Arnold, 38 ECAB 282, 284 (1986); Zane H. Cassell, 

32 ECAB 1537, 1540-41 (1981).

10 A.R., supra note 6; Zane H. Cassell, id.; John E. Benton, 15 ECAB 48, 49 (1963).

11 See A.R., Docket No. 21-0907 (issued February 24, 2023); S.N., Docket No. 21-0070 (issued March 9, 2022); 

W.M., Docket No. 18-0957 (issued October 15, 2018).
6

both logic and probable deductions from established facts.12 The Board finds that OWCP’s denial 

of appellant’s request for a home health aide was reasonable and did not constitute an abuse of 

discretion.

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 denied appellant’s request for a home health aide.

ORDER

IT IS HEREBY ORDERED THAT the January 13, 2023 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 5, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

12 Supra note 8.