United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.B., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS,

MOUNTAIN HOME VETERANS MEDICAL 

CENTER, Mountain Home, TN, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 22-0162

Issued: May 24, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 14, 2021 appellant filed a timely appeal from a November 5, 2021 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 over the merits of this case.3 

1 The Board notes that appellant indicated that he was appealing from a July 10, 2019 decision. However, the 

record does not contain a July 10, 2019 decision. Further, the Board’s jurisdiction is limited to decisions issued within 

180 days from issuance to the filing of this appeal, the Board lacks jurisdiction over the denial of appellant’s expansion 

claim. See 20 C.F.R. § 501.3.

2

5 U.S.C. § 8101 et seq.

3 The Board notes that following the November 5, 2021 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

ISSUE

The issue is whether OWCP properly suspended appellant’s wage-loss compensation, 

effective November 5, 2021, due to his failure to complete a Form EN-1032 as requested.

FACTUAL HISTORY

On August 27, 1981 appellant, then a 42-year-old federal employee, filed a traumatic injury 

claim alleging that on April 9, 1980 he sustained sprains and strains in the sacroiliac region and 

displacement of lumbar intervertebral disc without myelopathy while in the performance of duty. 

OWCP paid him wage-loss compensation on the periodic rolls commencing June 16, 2002.

OWCP periodically requested that appellant submit financial disclosure statements (Form 

EN-1032), which solicited information about his employment, volunteer work, dependent(s) 

status, receipt of other federal benefits and/or payments, and third-party settlements.

On May 10, 2021 OWCP notified appellant that he was required to fully answer all 

questions on the enclosed EN-1032 form and return it within 30 days or his benefits would be 

suspended. It mailed the notice to his last known address of record.

On May 26, 2021 OWCP received a partially completed EN-1032 form. Appellant had 

not completed the “certification” section of the form.

In a July 8, 2021 letter, OWCP resent the partially completed EN-1032 form to appellant 

and requested that he complete the “certification” section of the form. It notified appellant that he 

was required to fully answer all questions on the enclosed EN-1032 form and that the letter served 

as a second and final request for him to fully complete and return the enclosed EN-1032 form 

within 30 days or his benefits would be suspended. OWCP mailed the notice to his last known 

address of record.

On July 22, 2021 OWCP received another partially completed EN-1032 form. Appellant 

again had not completed the “certification” section of the form.

By decision dated November 5, 2021, OWCP suspended appellant’s wage-loss 

compensation benefits, effective that date, due to his failure to complete the EN-1032 form, as 

requested. It advised that, if he were to certify the information by signing the form and return the 

form, his wage-loss compensation benefits would be restored retroactively to the date they were 

suspended.

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

4

5 U.S.C. § 8106(b).
3

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. At that, 

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

remains entitled to compensation.6

ANALYSIS

The Board finds that OWCP properly suspended appellant’s wage-loss compensation, 

effective November 5, 2021, due to his failure to complete a Form EN-1032 as requested.

On May 10, 2021 OWCP provided appellant with an EN-1032 form. It properly advised 

him that, if he did not fully complete and return the form within 30 days, his benefits would be 

suspended. In response, on May 26, 2021, appellant submitted an EN-1032 form that was only 

partially completed. He had not responded to the section which required that he certify the EN1032 form. OWCP resent appellant the form on July 8, 2021 and requested that he complete, sign,

and return it within 30 days. On July 22, 2021 it received another partially completed EN-1032 

form, which appellant again left the certification section incomplete. 

OWCP was paying appellant wage-loss compensation on the periodic rolls and he was, 

therefore, required to complete the EN-1032 form. The record indicates that appellant failed to 

submit a fully completed EN-1032 form within 30 days of OWCP’s request. Appellant’s failure 

to file a complete EN-1032 form within 30 days required the suspension of his wage-loss 

compensation.7 Thus, the Board finds that OWCP properly suspended his wage-loss 

compensation, effective November 5, 2021.

On appeal appellant contends that he forgot to sign the form when he sent it in. As 

explained above, OWCP properly suspended his wage-loss compensation benefits. If, however,

appellant signs and submits the completed EN-1032 form, OWCP will reinstate compensation 

retroactively to the date of suspension if he remains entitled to compensation.8

CONCLUSION

The Board finds that OWCP properly suspended appellant’s wage-loss compensation, 

effective November 5, 2021, due to his failure to complete a Form EN-1032 as requested.

5

20 C.F.R. § 10.528. See also P.B., Docket No. 21-069 (issued October 27, 2021); H.B., Docket No. 19-0405 

(issued June 26, 2019); M.S., Docket No. 18-1107 (issued December 28, 2018); C.C., Docket No. 17-0043 (issued 

June 15, 2018); A.H., Docket No. 15-0241 (issued April3, 2015).

6

Id.;see also id. at § 10.525.

7

Id.

8

Id.
4

ORDER

IT IS HEREBY ORDERED THAT the November 5, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 24, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board