FEDERAL (EEOICPA) PROCEDURE MANUAL Chapter 2-1400 

Part 2 – Claims Wage-Loss Determinations 

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TABLE OF CONTENTS 

Paragraph and Subject Page Date Trans. No. 

Chapter 2-1400 Wage-Loss Determinations 

 

 Table of Contents. . . . . . . i 07/09 09-05 

 1 Purpose and Scope. . . . . . . 1 07/09 09-05 

 2 Policy . . . . . . . . . . . . 1 07/09 09-05 

 3 Definitions. . . . . . . . . . 1 07/09 09-05 

 4 General Requirements for 

 Wage-Loss. . . . . . . . . . 3 07/09 09-05 

 5 How to Claim Wage-Loss . . . . 4 07/09 09-05 

 6 Development of Wage- 

 Loss Claims. . . . . . . . . 6 07/09 09-05 

 7 Medical Evidence to Establish 

 Wage-Loss. . . . . . . . . . 6 07/09 09-05 

 8 Wage Evidence Required 

 to Establish Wage-Loss . . . 8 07/09 09-05 

 9 Calculation of Average Annual 

 Wage (AAW) . . . . . . . . . 13 07/09 09-05 

 10 Determination of Wage-Loss 

 Percentage . . . . . . . . . 17 07/09 09-05 

11 Employee Wage-Loss 

 Compensation . . . . . . . . 18 07/09 09-05 

 12 Survivor Wage-Loss 

 Compensation . . . . . . . . 19 07/09 09-05 

13 Maximum Aggregate 

 Compensation . . . . . . . . 21 07/09 09-05 

14 Wage-Loss Calculator . . . . . 21 07/09 09-05 

15 Recommended Decisions and 

 Final Decisions. . . . . . . 21 07/09 09-05 

 16 Additional Filings for 

 Wage-Loss Compensation . . . 22 07/09 09-05 

 

 

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Paragraph and Subject Page Date Trans. No. 

Exhibits 

 

 1 Normal Social Security 

 Retirement Age Table . . . . 07/09 09-05 

 2 Initial Solicitation Letter. . 07/09 09-05 

 3 Follow-Up Solicitation Letter. 07/09 09-05 

 4 Final Solicitation Letter. . . 07/09 09-05 

 5 SSA 581 Form . . . . . . . . . 07/09 09-05 

 6 Telephone Inquiries to SSA . . 07/09 09-05 

 7 Part E Wage-Loss Worksheet #1 

 Calculate Average Annual 

 Wage. . .. . . . . . . . . . 07/09 09-05 

 8 Part E Wage-Loss Worksheet #2 

 Adjust Wages for Each Year 

 Of Claimed Wage-Loss . . . . 07/09 09-05 

 9 Part E Wage-Loss Worksheet #3 

 Determine Percentage of 

 Wage-Loss and Award Amount . 07/09 09-05 

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1. Purpose and Scope. This chapter contains the procedures to 

solicit, develop, calculate, and issue wage-loss determinations 

under Part E of the Energy Employees Occupational Illness 

Compensation Program Act (EEOICPA). This chapter also describes 

some relevant terminology and definitions. The Claims Examiner 

(CE) determines whether a claim for wage-loss, as a result of a 

covered illness contracted through work related exposure to a 

toxic substance at a Department of Energy (DOE) facility or 

Radiation Exposure Compensation Act (RECA) section 5 facility, 

needs to be solicited for a covered Part E employee or survivor 

claim. If claimed, the CE develops for the necessary wage and 

medical evidence, calculates the amount of compensable wage-loss 

and issues a recommended decision for Final Adjudication Branch 

(FAB) review and issuance of a final decision. 

2. Policy. Division of Energy Employees Occupational Illness 

Compensation (DEEOIC) staff is responsible for processing wageloss determinations and ensuring that benefits are appropriately 

paid as defined under 42 U.S.C. §7385s, §7385s-1, 

§7385s-2(a)(2), §7385s-3, §7385s-5, § 7385s-11, and §7385s-12. 

3. Definitions. 

a. Average Annual Wage (AAW) refers to four (4) times the 

average quarterly wages for the twelve (12) quarters that 

preceded the quarter during which the covered Part E 

employee first experienced wage-loss due to a covered 

illness that was caused by exposure to a toxic substance at 

a DOE facility or RECA section 5 facility, excluding any 

quarter during which the employee was unemployed.(See 

subparagraph f below). The calculated AAW is the baseline 

wage against which the CE measures a subsequent calendar 

year wage earned by a covered Part E employee. 

b. A calendar year is defined as the twelve-month period 

from January through December. 

c. The Consumer Price Index (CPI) is a measure of the 

average change over time in the prices paid by urban 

consumers for a market basket of consumer goods and 

services. The CPI is the most widely used measure of 

inflation. The CPI is often used to adjust benefit 

payments (for example, Social Security and Federal Employee 

Compensation Act payments) and income eligibility levels 

for government assistance, and to automatically provide 

cost-of-living wage adjustments. 

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d. Normal Social Security Retirement Age is the age at 

which an employee receives unreduced Social Security 

retirement benefits. This age varies by date of birth and 

is set by §216(1) of the Social Security Act, 42 U.S.C. 

§416(1). 

In general, persons born during or before 1937 are eligible 

for unreduced Social Security retirement benefits at age 

65. The eligibility age increases in two-month increments 

for persons born between 1937 and 1960 until it reaches 67, 

which is the age at which persons born during or after 1960 

become eligible for unreduced Social Security retirement 

benefits. (See Exhibit 1) 

To determine the normal Social Security retirement age for 

a covered Part E employee, the CE may also use the Social 

Security Administration website 

http://www.socialsecurity.gov/OACT/ProgData/nra.html. 

e. A quarter is defined as the three-month period of 

January through March, April through June, July through 

September, or October through December. 

f. A quarter during which the employee was unemployed 

(for purposes of determining AAW) is a quarter during which 

$700 (in constant 2005 dollars) or less in wages were 

earned by the covered Part E employee, unless the quarter 

is one where the employee was retired. If the CE determines 

that the adjusted value is $700 or less, then the employee 

is considered to have been unemployed during that quarter 

and it will not be included in the calculation of the AAW. 

g. A quarter during which the employee was employed (for 

purposes of determining AAW) is a quarter in which the 

adjusted value of the employee’s wages for the quarter 

exceeds $700 in constant 2005 dollar values. For example, 

$700.01 in adjusted value is considered to be a quarter of 

employment. A quarter in which the employee was employed 

will be included in the AAW calculation. 

h. A year of wage-loss is defined as a calendar year in 

which the covered Part E employee’s wages were less than 

the employee’s AAW, as a result of the covered illness that 

is due to the covered Part E employee’s exposure to a toxic 

substance at a covered facility. Prior to making this 

finding, the CE adjusts the yearly wages for inflation to 

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determine their values during the calendar year in which 

the covered Part E employee first experienced wage-loss due 

to a covered illness. 

4. General Requirements for Wage-Loss. Wage-loss 

determinations are based upon the calendar years of wage-loss 

occurring up to and including either the calendar year the 

employee reaches normal Social Security retirement age or the 

last calendar year of wage-loss prior to the submission of the 

wage-loss claim, whichever occurs first. 

a. Criteria to Establish a Claim for Wage-Loss: 

(1) Covered Part E Employee. The employee is, or 

was, an employee of a covered DOE contractor or 

subcontractor; and 

(2) Covered Illness. The employee developed a 

covered illness as a result of exposure to a toxic 

substance at a covered DOE facility or RECA section 5 

facility; and 

(3) Documented Wage-Loss. The employee experienced 

wage-loss as a result of the covered illness prior to 

his or her normal Social Security retirement age. 

b. Instances When Wage-Loss Is Not Developed: 

(1) The employee is not a covered Part E employee if 

he or she worked for an atomic weapons employer or for 

a beryllium vendor (unless the employee was employed 

during a period in which the facility was designated 

as a DOE facility for remediation and the employee was 

employed by a remediation contractor). 

(2) The covered Part E employee experiences wage-loss 

(as a result of contracting a covered illness) only 

after his or her normal Social Security retirement 

age. 

(3) The covered Part E employee dies no more than 10 

years before his or her normal Social Security 

retirement age and does not experience any wage-loss 

prior to his or her death (for survivor claims). 

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5. How to Claim Wage-Loss. The Resource Centers (RCs) and the 

district offices (DOs) solicit wage-loss claims from claimants 

who are potentially eligible for wage-loss benefits. 

a. RCs’ Role: RCs engage in outreach efforts and educate 

employees on the requirements for filing and obtaining 

wage-loss benefits. The RCs also assist employees with the 

submission of their wage-loss claims. 

(1) When a final decision is issued to a living 

employee with a positive causation determination under 

Part E, the FAB sends a copy of the final decision to 

the designated RC. This is done only in situations 

where there is no indication that a claim has already 

been made for wage-loss. Final decisions that pertain 

strictly to survivors of a deceased employee are not 

referred to the RC, but instead processed as described 

in subparagraph b below. 

 

(2) Upon receipt of the final decision, the RC calls 

the employee to provide information about the 

potential wage-loss benefits available, explains 

eligibility requirements or program procedures, and 

responds to any questions. The RC then memorializes 

the telephone call in the Telephone Management System 

(TMS) section of ECMS and forwards a printout to the 

appropriate DO or Co-Located Unit (CE2) for 

association with the case file. 

b. District Offices’ Role. In conjunction with the RCs’ 

outreach of the employee as mentioned in paragraph 6a 

above, the CE sends initial wage-loss solicitation letter 

(Exhibit 2) to the claimant (employee or potentially 

eligible survivor). 

(1) Timeframe. This solicitation letter is sent 

after issuance of a final decision to accept under 

Part E. 

(2) Explanation. The letter explains the criteria to 

establish wage-loss. 

(3) Request for Wage-Loss Claim. The letter requests 

that the claimant advises DEEOIC in writing if 

claiming wage-loss, identify the condition(s) for 

which he or she is claiming wage-loss, and provide the 

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dates (month and year) of claimed wage-loss. Evidence 

of 12 quarter wages prior to the first quarter of 

claimed wage-loss is also required. An SSA Form 581 

(Authorization to Obtain Earnings Data from the Social 

Security Administration) is enclosed with the 

solicitation letter. Additional factual employment 

evidence that supports the claimed wage-loss is also 

requested, along with medical evidence supporting a 

causal relationship between the covered illness and 

the wage-loss claimed. 

(4) Follow-up Solicitation Letter. The claimant is 

allotted 60 days to respond to the initial 

solicitation letter with a follow-up solicitation 

letter (Exhibit 3) sent to the claimant at the first 

30 day interval. Prior to mailing the follow-up 

solicitation letter, the CE calls the claimant to 

ensure the receipt of the initial solicitation letter 

and determines if the claimant wants to file a wageloss claim. 

(5) Final Solicitation Letter. If a written response 

to initiate a claim for wage-loss is not received 

within 30 days of the follow-up solicitation letter or 

if the claimant informs the CE that he or she does not 

want to pursue a claim for wage-loss, the CE sends a 

letter to the claimant advising that DEEOIC will not 

develop the claim for wage-loss at this time (Exhibit 

4). The CE also advises the claimant of his or her 

right to claim wage-loss in the future. 

6. Development of Wage-Loss Claims. Upon receipt of a signed 

statement claiming wage-loss, the CE determines if there is 

sufficient medical and wage evidence to develop for wage-loss. 

If not, the CE sends a letter requesting the required evidence 

from the claimant. If there is no response within 30 days, the 

CE sends a follow-up letter to the claimant. Prior to mailing 

the follow-up letter, the CE contacts the claimant by telephone 

to assist the claimant with obtaining the required evidence. If 

the claimant does not submit the necessary evidence within the 

allotted 60 days from the first development letter, the CE may 

proceed by issuing a recommended decision to deny the claim for 

wage-loss benefits. 

7. Medical Evidence to Establish Wage-Loss. The claimant is 

required to submit medical evidence that is of sufficient 

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probative value to establish that the period of wage-loss 

claimed is causally related to the covered Part E employee’s 

covered illness. 

There are instances when the medical evidence shows multiple 

conditions contributing to the wage-loss. As long as the 

evidence establishes that any covered illness contributed to the 

employee’s wage-loss, then the medical evidence is sufficient to 

prove causal relationship. 

An acceptance of Social Security Disability benefits alone is 

not sufficient evidence to establish a causal relationship, 

unless accompanied by supporting medical evidence. 

If a secondary cancer is the accepted covered illness but the 

primary is not accepted(e.g., secondary bone cancer is accepted 

but the primary prostate cancer is not accepted), the medical 

evidence needs to support that the wage-loss is causally related 

to the secondary cancer, because the causation requirement has 

not been met for the primary cancer. 

The CE develops the case for a causal relationship between the 

claimed years of wage-loss and the covered Part E employee’s 

covered illness by requesting medical evidence from the claimant 

and/or medical provider. Medical evidence can include the 

following: 

a. Narrative Report from a Physician. A physician’s 

narrative report needs to explain the causal relationship 

between the covered illness and the period(s) of wage-loss 

and reference medical evidence that is contemporaneous to 

the claimed period(s) of wage-loss. A narrative report 

that is based solely on the physician’s expectations is not 

considered sufficient evidence of probative value. 

b. Return to Work Slips Signed by a Physician. 

c. Physician’s Office Notes. Physician notes that 

indicate the covered Part E employee had stopped working, 

reduced his work hours or missed work due to the covered 

illness. 

d. District Medical Consultant (DMC) Opinion. The CE 

must use discretion when determining if a DMC referral is 

warranted. A referral to a DMC is not required when the 

wage evidence supports that the employee’s adjusted wages 

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is greater than 75% of his or her AAW. Additionally, the 

CE does not refer to a DMC if the claimant and/or treating 

physician have not been contacted first for the requisite 

medical information. 

The CE may request the opinion of a DMC on causal 

relationship between the covered illness and wage-loss if 

the evidence is inconclusive. The DMC may also provide an 

opinion regarding the period of illness-related wage-loss. 

In most instances, wage-loss questions are best handled by 

a DMC who specializes in occupational medicine. In the DMC 

referral, the CE must specify the period of wage-loss in 

question and the accepted covered illness. The DMC must be 

instructed to provide a detailed rationale for his or her 

opinion. 

Example of a wage-loss question to DMC: Please review 

the case records to determine if the employee’s wageloss for the period from June 1975 to August 1999 is 

causally related to the accepted illness of 

asbestosis. If the available medical evidence is 

insufficient to make a wage-loss determination for a 

certain period, please indicate the dates. Please 

provide your rationale to support your conclusion. 

Procedures for referring a case to a DMC and “Prompt Pay” 

of DMC bills can be found in EEOICPA Procedure Manual (PM) 

Chapter 2-0300 and will be in the new EEOICPA PM 2-0800 

Developing and Weighing Medical Evidence. 

8. Wage Evidence Required to Establish Wage-Loss. Wages are 

defined as all monetary payments that the covered Part E 

employee earns from employment or services that are taxed as 

income by the Internal Revenue Service. Salaries, overtime 

compensation, sick leave, vacation leave, tips, and bonuses 

received for employment services are considered wages. However, 

capital gains, IRA distributions, pensions, annuities, 

unemployment compensation, state workers’ compensation benefits, 

medical retirement benefits, and Social Security benefits are 

not considered wages. The CE obtains evidence of the employee’s 

wages for the calendar year(s) during the claimed period(s) of 

wage-loss and for the 12 quarters immediately preceding the 

first quarter of claimed wage-loss. These 12 quarters wages 

immediately preceding the first quarter of claimed wage-loss are 

used to determine the AAW. (See paragraph 9) 

 

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The CE generally relies upon the earnings information that has 

been reported to the Social Security Administration (SSA), but 

can also rely upon additional wage information submitted by the 

claimant. 

 

a. SSA earnings records are received from the claimant if 

available or the CE submits a signed Form SSA-581 (see 

Exhibit 5) from the claimant to SSA to gather this 

information. 

 

(1) RC staff are responsible for obtaining a 

completed SSA-581 from all employees and from clearly 

eligible survivors at the time the employee or 

survivor completes or submits his or her claim form at 

the RC in person. Each DO has an office specific form 

indicating where SSA must send the results of the 

inquiry. The SSA-581 forms for each office are 

located on the Share Drive in the Policies and 

Procedures folder, Forms subfolder. 

(2) If the RC does not obtain a signed SSA-581, or if 

a claim (EE-1 or EE-2) is submitted directly to the DO 

or mailed to the RC, the CE should send an SSA-581 to 

the claimant, if it is needed for employment 

verification and/or determination of wage-loss. 

(3) To be processed by SSA, a signed SSA-581 must be 

dated no earlier than 60 days from the date of 

submission to the SSA. If the timeframe between the 

signature date of the SSA-581 and submission to SSA 

exceeds sixty (60) days, the CE or RC staff will need 

to obtain a new, signed and dated SSA-581. 

 

(4) Whenever subsequent development is undertaken 

with regard to employment verification, a request 

should be made to the claimant to complete a SSA-581 

form, if pertinent wage and earning documentation is 

not present in the case record. A claimant should be 

advised that completion of the SSA-581 is a crucial 

part of the employment verification and/or wage-loss 

process and that their signature on the SSA-581 is 

only valid for sixty (60) days. 

The information required on the SSA-581 form depends 

on the type of request. In a development letter, the 

CE advises the claimant of the information needed on 

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the SSA-581: 

(a) Employee Claims: The employee, authorized 

representative, CE or the RC staff is to complete 

the following section of the SSA-581: name of 

employee; social security number; date of birth 

of employee; and other name(s) used. The employee 

or the authorized representative will fill-in the 

employee’s address/daytime telephone number, and 

date the form was signed. The employee or the 

authorized representative must sign the SSA-581 

and print his or her name. 

(b) Survivor Claims: The survivor, CE or the RC 

staff is to complete the following sections of 

the SSA-581 form: name of social security number 

holder (employee); employee’s social security 

number; date of employee’s birth; date of 

employee’s death; and other name(s) used. The 

survivor will fill-in the survivor’s 

address/daytime telephone number; indicate the 

appropriate box to show relationship; add the 

date signed; sign the form; and print his or her 

name in the requested space. 

The CE or the RC staff explain that the survivor 

must provide proof of the employee’s death and 

his or her relationship to the employee. Proof 

of death includes: a copy of the death 

certificate, mortuary or interment record, or 

court issued document. Proof of relationship 

includes: marriage certificate, birth 

certificate, adoption papers, or other court 

issued document(s). SSA requires that these 

documents be submitted in order to process 

requests from survivors. 

(5) Once the claimant returns the signed SSA-581 

document and any accompanying documents, the CE or RC 

staff complete the following sections: 

(a) The CE or RC staff fill in the years deemed 

necessary to verify employment and/or establish 

wage-loss on the “Periods Requested” line. The 

CE or RC staff is to identify the time period for 

employment history by searching the Energy Case 

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Management System (ECMS), the records in the case 

file, wage-loss claims, or other documents or 

forms in the file. 

In the box titled, “Requesting Organization’s 

Information,” the CE or RC staff sign in the 

section, “Signature of Organization Official” as 

well as provide the district office toll free 

telephone number and fax number. 

 

(b) The CE or RC staff ensure that the upper 

right hand corner of the form allocated for 

“Requesting Organization:” indicates the correct 

district office where the SSA’s response should 

be sent. 

(6) The original (signed) SSA-581, and supporting 

documents (if the request is submitted by a survivor) 

must be submitted via Federal Express to the SSA, 

Wilkes Barre Data Operations Center (WBDOC), at the 

following address: 

The Social Security Administration 

Wilkes Barre Data Operations Center 

PO Box 1040 

Wilkes Barre, PA 18767-1040 

The CE updates the case status screen in ECMS and date 

stamp the forms at the time that the form is sent to 

SSA. This date serves as the status effective date. 

A copy of the form is retained in the case file. 

(7) Following submission of a Form SSA-581, the CE or 

someone designated by the District Director, is 

responsible for determining if SSA has received the 

earnings request (Form SSA-581) and for obtaining a 

status update on the employment verification request. 

(a) If there has been no response from SSA 

within thirty (30) calendar days of the date of 

the submission to SSA, the CE calls for status 

update. The telephone call is documented in the 

TMS section of ECMS and a printed copy placed in 

the case. If SSA indicates that no SSA-581 form 

has been received, the CE must resubmit the form. 

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Otherwise, the CE obtains the status and monitors 

for further follow-up. 

(b) Inquiries to SSA are made by calling one of 

ten phone numbers (Modules) depending on the last 

four digits of the relevant employee’s Social 

Security number (Exhibit 6). 

(c) If the CE does not receive a completed SSAL460 within thirty (30) days of the first inquiry 

call to SSA (the 60th day), the CE makes another 

follow-up call to determine the status of the 

request and proceeds as necessary. At this point, 

it will be necessary to obtain a newly signed 

SSA-581 from the claimant and resubmit the SSA581 to SSA as outlined above. 

(8) After the completed SSA-581 form is sent, and a 

copy is placed in the case file, a SSA Point of 

Contact (POC) designated by the District Director 

ensures that the form is logged into a tracking 

spreadsheet. The spreadsheet should contain, at 

minimum, the case number, date sent to SSA, and cost 

of the request. 

(a) DO determines the cost of the request 

according to the number of years for which 

information is sought. Form SSA-7050-F4 (Request 

for Social Security Earnings Information, 

available on the SSA website at 

http://www.ssa.gov/online/ssa-7050.pdf) 

identifies the cost by the number of years 

requested. For example, if one (1) year of 

earnings information is requested, the cost is 

$15.00. The cost increases incrementally by year, 

up until forty (40) years of requested 

employment. For each year after forty (40) 

years, add $1.00 for each year. 

(9) At the end of each quarter, the DOL National 

Office SSA POC obtains the SSA-581 submission logs 

maintained in each DO and sample the contents to 

properly evaluate contract outlays. 

(10) Upon receipt of a completed SSA-L460, the CE 

updates the case status screen in ECMS. The designated 

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employee confirms that the years received by SSA 

equals the years used to determine the cost. If there 

is a discrepancy, the DO SSA POC must contact SSA 

immediately to rectify the issue. 

 

b. Tax Returns and W2 Forms provide proof of the covered 

employee’s wages in instances where the employer did not 

report accurate and/or complete earnings to SSA or when the 

covered Part E employee worked for an employer where there 

was no reporting of income to SSA. If a W2 Form is 

submitted, the claimant must also submit an affidavit 

attesting that he or she has submitted all W2 Forms for 

that calendar year; 

c. Pay Stubs that provide proof of the employee’s wages; 

 d. Union records that provide proof of the employee’s 

wages; 

 

e. Pension records that provide proof of the employee’s 

wages; and 

f. Document Acquisition Request (DAR) for Pay and Salary 

Records that provide an employee’s pay, salary, any 

workers’ compensation claim or other documents affecting 

wage. Examples of records from the DOE database include, 

but are not limited to, Official Personnel Files of 

Contractor Employees, Contractor Job Classification, 

Employee Awards Files, Notification of Personnel Actions, 

Classification Appraisals, Wage Survey Files, and 

Unemployment Compensation Records. 

9. Calculation of Average Annual Wage (AAW). The AAW is the 

baseline wage against which the CE measures each claimed year of 

wage-loss to determine wage-loss percentage. To calculate the 

AAW, the CE adds up the wages from the quarters (up to 12 

quarters) immediately prior to, but not including, the quarter 

where the covered Part E employee first experiences wage-loss 

due to a covered illness. The CE must exclude the wages from any 

quarter during which the employee was unemployed (See paragraph 

3f). The sum of the total wages must be divided by the number of 

quarters included in the sum to get the average quarterly wage. 

The CE then multiplies the average quarterly wage by four (4) to 

determine the AAW. 

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To determine if a quarter must be excluded because the employee 

was unemployed, the CE must determine if the employee earned 

$700 or less in constant 2005 dollars for that quarter. The 

following chart provides the value of $700 in constant 2005 

dollars from the years of 1942 through 2008. 

1942 1943 1944 1945 1946 1947 1948 1949

$58.66 $62.26 $63.34 $64.78 $70.18 $80.26 $86.74 $85.66

1950 1951 1952 1953 1954 1955 1956 1957

$86.74 $93.57 $95.37 $96.09 $96.81 $96.45 $97.89 $101.13

1958 1959 1960 1961 1962 1963 1964 1965

$104.01 $104.73 $106.53 $107.61 $108.69 $110.13 $111.57 $113.37

1966 1967 1968 1969 1970 1971 1972 1973

$116.61 $120.21 $125.24 $132.08 $139.64 $145.76 $150.44 $159.79

1974 1975 1976 1977 1978 1979 1980 1981

$177.43 $193.62 $204.78 $218.10 $234.65 $261.29 $296.56 $327.15

1982 1983 1984 1985 1986 1987 1988 1989

$347.30 $358.46 $373.93 $387.25 $394.45 $408.84 $425.76 $446.27

1990 1991 1992 1993 1994 1995 1996 1997

$470.39 $490.18 $504.94 $520.05 $533.37 $548.48 $564.68 $577.63

1998 1999 2000 2001 2002 2003 2004 2005

$586.63 $599.59 $619.74 $637.38 $647.46 $662.21 $679.85 $700.00

2006 2007 2008

$722.58 $743.16 $771.70

The CE may also calculate the dollar value of any wages for any 

given year to reflect their value (buying power/worth) to 2005 

dollars by using the CPI Inflation Calculator on the Bureau of 

Labor Statistics’ website 

http://www.bls.gov/data/inflation_calculator.htm. 

Example: If the evidence indicates the employee earned $100 

in a quarter of employment in 1963, the CE, using the CPI 

Inflation Calculator, determines that $100 in 1963 has the 

same adjusted value as $638.24 in 2005 dollars. Since the 

adjusted value of $638.24 is less than $700 in constant 

2005 dollars, the CE considers the employee to have been 

EEOICPA Tr. No. 09-05 13 

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________________________________________________________________ 

unemployed for that quarter and that quarter is excluded in 

the calculation of the AAW. 

If a covered employee is unemployed for three quarters 

during the AAW period; the CE adds the wages from the nine 

(9) quarters of employment (excluding the wages from the 

three quarters of unemployment) and divides by nine (9) 

rather than twelve (12) to get the average quarterly wages. 

The CE then multiplies the average quarterly wages by four 

(4) to obtain the AAW. (See Exhibit 7 for Wage-Loss 

Worksheet #1, Calculate Average Annual Wage) 

a. Retirement. If a covered Part E employee is retired 

prior to his or her normal Social Security retirement age, 

he or she is not considered unemployed under Part E. Even 

though the retired employee has no wages reported to SSA, 

this time period is not excluded from the calculation of 

the AAW. The CE determines that the AAW of the employee is 

$0 if he or she was retired (prior to his or her normal 

Social Security retirement age) during the entire twelve 

(12) quarters immediately preceding the quarter during 

which he or she first experienced wage loss due to a 

covered illness. 

 

If the employee earned wages during any of the 12 quarters 

and then retired before the end of the 12 quarters, those 

earned wages are included in the AAW calculation. 

Example: If the covered employee earned no wages for 

two quarters during the AAW period due to retirement, 

the CE adds the covered employee wages for the 12 

quarters including the two quarters of retirement and 

divides the sum by twelve (12) to get the average 

quarterly wages. The CE then multiplies the average 

quarterly wages by four (4) to obtain the AAW. 

b. Maximum Amount of Taxable Earnings. If the employee’s 

earnings meet SSA’s maximum amount of taxable earnings for 

that year, those earnings that exceed the maximum limit are 

not reflected in the SSA statement. The CE can find the 

maximum amount of taxable earnings under the SSA for a 

specific year at the SSA website: 

http://www.ssa.gov/OACT/COLA/cbb.html. 

(1) Multiple Employers. For any year in which the 

covered Part E employee is employed by multiple 

EEOICPA Tr. No. 09-05 14 

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________________________________________________________________ 

employers, according to SSA, each of the employers 

withholds Social Security taxes on the wages without 

regard to what the other employers may have withheld. 

Therefore, the covered Part E employee can potentially 

meet the maximum amount of taxable earnings under SSA 

from each employer for the same year in question. 

To determine if any additional wages may have been 

unaccounted for in the SSA earnings summary, the CE 

contacts the claimant by telephone and requests evidence to 

support additional wages (see paragraph 8 for different 

types of wage evidence). The CE must memorialize the 

claimant’s response in the TMS section of ECMS. The CE 

follows up with a letter notifying the claimant of the 

earnings information included in the SSA earnings summary 

for the applicable year(s). The letter requests that the 

claimant submit evidence of wages that may have been 

unaccounted for as a result of reaching the maximum amount 

of taxable earnings under the SSA. If the claimant does not 

submit additional evidence within 30 days of the letter, 

the CE uses the earnings summary information as reported by 

the SSA. 

 

 c. Additional Wages. If there is evidence of wages based on 

records other than SSA, the CE adds any additional wages 

earned by the employee during those same quarters as 

supported by the submitted evidence. 

 d. Annual SSA Earnings Report. In the late 1970’s, SSA 

began reporting yearly earnings summary instead of 

quarterly earnings summary. In instances when only a 

detailed SSA yearly earnings summary is available, the CE 

divides the yearly earnings by 4 (representing 4 quarters 

in a year) to estimate the quarterly earnings for each 

year. 

10. Determination of Wage-Loss Percentage. The CE compares the 

AAW of a covered Part E employee with his or her adjusted (for 

inflation) wages in later calendar years to determine the wageloss percentage. The CE begins with the calendar year that 

includes the quarter in which the claimed wage-loss commenced, 

and concludes with the last calendar year of claimed wage-loss, 

the calendar year in which the employee reached normal Social 

Security retirement age or the calendar year in which the 

employee would have reached his normal Social Security 

retirement age but for his covered illness related death. 

EEOICPA Tr. No. 09-05 15 

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________________________________________________________________ 

a. Adjustment of Wages for Inflation. Wages must be 

adjusted for inflation for each calendar year that wageloss is claimed. The wages are adjusted for inflation to 

reflect the value (buy power/worth) during the calendar 

year in which the covered Part E employee first experienced 

wage-loss due to a covered illness. The CE can perform this 

calculation by using the CPI Inflation Calculator on the 

Bureau of Labor Statistics’ website 

http://www.bls.gov/data/inflation_calculator.htm. 

 

Example: The employee claims wage-loss first 

commencing in 1993 and ending in 2002 when the 

employee reaches normal Social Security retirement 

age. The CE must adjust the yearly wages for inflation 

to reflect the value of the wages for the calendar 

year in which the wage-loss first commenced (which in 

this example is 1993). If the employee earned $38,000 

in 1995, this wage is adjusted for inflation using the 

CPI Inflation Calculator to $36,030.20 to reflect the 

value in 1993 dollars. (See Exhibit 8 for Wage-Loss 

Worksheet #2, Adjust Wage for Each Year of Claimed 

Wage-Loss) 

 

b. Comparison with the AAW. The CE compares the AAW of 

the covered Part E employee with his or her adjusted wages 

in later calendar years to ascertain the wage-loss 

percentage for each claimed year of wage-loss. For example, 

$36,030.20 (Adjusted Wage) ÷ $46,000 (AAW) = 78% (Wage-Loss 

Percentage). (See Exhibit 9 for Wage-Loss Worksheet #3, 

Determine Percentage of Wage-Loss and Award Amount). 

11. Employee Wage-Loss Compensation. The CE uses the wage-loss 

percentage to determine the amount of the employee’s wage-loss 

compensation. 

a. If the employee’s adjusted wages during a claimed 

calendar year is greater than 75% (X > 75%) of his or her 

AAW, then the employee is not considered to have wage-loss 

for that calendar year and the employee is not awarded 

wage-loss benefits for that calendar year. 

 Example #1: AAW = $46,000 

 Adjusted wages = $36,030.20 

 Percentage of AAW = 78% 

EEOICPA Tr. No. 09-05 16 

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b. $10,000 is awarded for each year in which the 

employee’s adjusted wages during a claimed calendar year is 

greater than 50% but less than or equal to 75% (50% < X < 

75%) of his or her AAW. 

Example #1: AAW = $46,000 

Adjusted wages = $34,662.00 

 Percentage of AAW = 75% 

Example #2: AAW = $46,000 

 Adjusted wages = $23,661.80 

 Percentage of AAW = 51% 

 c. $15,000 is awarded for each year in which the 

employee’s adjusted wages during a claimed calendar year is 

equal to or less than 50% (X ≤ 50%) of his or her AAW. 

Example #1: AAW = $46,000 

Adjusted wages = $23,076.00 

 Percentage of AAW = 50% 

Example #2: AAW = $46,000 

 Adjusted wages = $11,646.75 

 Percentage of AAW = 25% 

The following is an example of a Wage-Loss Calculation: 

AVERAGE ANNUAL WAGE: $46,000.00 

Year Actual Wages Adjusted 

Wages

Percent of 

AAW

Compensation

1993 $44,000.00 $44,000.00 96% $0

1994 $40,000.00 $39,001.30 85% $0

1995 $38,000.00 $36,030.20 78% $0

1996 $35,000.00 $32,233.90 70% $10,000.00

1997 $38,500.00 $34,662.00 75% $10,000.00

1998 $30,000.00 $26,595.10 58% $10,000.00

1999 $26,000.00 $22,551.00 49% $15,000.00

2000 $27,500.00 $23,076.00 50% $15,000.00

2001 $29,000.00 $23,661.80 51% $10,000.00

2002 $14,500.00 $11,646.75 25% $15,000.00

Total Compensation for Wage-Loss $85,000.00

12. Survivor Wage-Loss Compensation. The CE first determines 

whether the survivor is entitled to benefits under Part E of the 

EEOICPA Tr. No. 09-05 17 

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EEOICPA. If the survivor is found to be entitled to survivor 

benefits, he or she may also be entitled to additional 

compensation for wages lost by the employee as a result of the 

covered illness. The CE undertakes the same medical and 

employment development and AAW calculation as if the employee 

had filed a claim. The difference is that the monetary benefit 

provided to a survivor is limited to an additional $25,000 or 

$50,000 based on the number of years in which the employee’s 

adjusted wages during a claimed calendar year is equal to or 

less than 50% (X ≤ 50%) of his or her AAW.

a. Percentage of Loss: If the covered Part E employee 

dies as a result of the covered illness prior to his or her 

normal Social Security retirement age, the CE performs the 

same inflation adjustment calculation as an employee claim 

for each calendar year of wage-loss claimed through and 

including the calendar year of death to determine the 

percentage of loss. 

For the years after the employee’s death, the CE assumes 

that the employee had no wages and therefore the adjusted 

wages were less than or equal to 50% of the AAW for each 

year after the year of the employee’s death up to and 

including the calendar year of his or her normal Social 

Security retirement age. 

In some instances, the employee may have lost wages due to 

a covered illness prior to his or her death. In this 

situation, the CE calculates the period of wage-loss (prior 

to and including the calendar year of the employee’s death) 

and adds any calendar years in which adjusted wages were 

less than or equal to 50% of the employee’s AAW to the 

number of calendar years after the year of the employee’s 

death up to and including the calendar year of his or her 

normal Social Security retirement age (based on the 

assumption that the employee did not earn any wages after 

his or her death) in order to determine the survivor’s 

entitlement. 

 (1) $25,000 Award. For the survivor to be awarded an 

additional $25,000, the employee must have 10 to 19 

years in which the employee’s adjusted wage is equal 

to or less than 50% (X ≤ 50%) of his or her AAW. 

(2) $50,000 Award. For the survivor to be awarded an 

additional $50,000, the employee must have 20 or more 

EEOICPA Tr. No. 09-05 18 

July 2009

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Part 2 – Claims Wage-Loss Determinations 

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years in which the employee’s adjusted wage is equal 

to or less than 50% of his or her AAW. 

b. Survivor Election. If a covered Part E employee dies 

after submitting a wage-loss claim but before compensation 

is paid and death is caused solely by a non-covered illness 

or illnesses, the survivor may elect to receive the 

compensation that would have been payable to the employee, 

including wage-loss and/or impairment. 

13. Maximum Aggregate Compensation. The amount of monetary 

compensation provided under Part E (impairment and wage-loss 

compensation), excluding medical benefits, cannot exceed 

$250,000. The CE considers any previous compensation awarded 

under Part E for impairment and/or wage-loss to determine if a 

subsequent award needs to be reduced to ensure that it does not 

exceed the $250,000 maximum aggregate compensation. In 

determining the aggregate compensation, reduction of 

compensation based on state workers’ compensation coordination 

or tort offset is not taken into consideration. For example, if 

the employee was previously awarded benefits for impairment in 

the amount of $100,000 but his compensation was reduced because 

of tort offset to $60,000, the amount of compensation used to 

determine the maximum aggregate compensation is $100,000. 

14. Wage-Loss Calculator. The Wage-Loss Calculator in ECMS is 

an instrumental tool and the preferred method to calculate wageloss benefits. The CE enters the employee’s wages for all 

claimed years of wage-loss and the twelve (12) quarters 

immediately prior to the first quarter of experienced wage-loss 

into the Wage-Loss Calculator. The Wage-Loss Calculator will 

calculate the twelve (12) quarterly wages immediately prior to 

the first quarter of experienced wage-loss into 2005 dollar 

value. The CE must designate any quarter that is below the $700 

in constant 2005 dollar threshold as either unemployed or 

retired quarters (See paragraph 9 above) before the Wage-Loss 

Calculator determines the AAW. The Wage-Loss Calculator adjusts 

for inflation the annual wages for each calendar year that wageloss is claimed and compares the adjusted wages with the AAW to 

determine the percentage of loss. The Wage-Loss Calculator 

calculates the wage-loss compensation that is payable. Detailed 

instructions on the use of the Wage-Loss Calculator are located 

on the National Office Shared Drive. 

15. Recommended Decisions and Final Decisions. The CE first 

determines if the employee contracted a covered illness due to 

EEOICPA Tr. No. 09-05 19 

July 2009

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

exposure to a toxic substance at a DOE facility or RECA section 

5 facility prior to making a determination on wage-loss. The CE 

can develop for the wage-loss simultaneously with the 

development of other aspects of the case, but this development 

should not delay the issuance of a recommended decision to award 

medical or impairment benefits. If a Part E claimant files a 

signed statement requesting wage-loss, CE must develop the wageloss claim and issue a recommended decision for potential wageloss benefits. If the claimant formally files a claim for wageloss and then subsequently submits a signed written request to 

withdraw the wage-loss claim, a recommended decision on wageloss benefits is not required. 

Prior to the issuance of a recommended decision that deals with 

wage-loss benefits, it is important that either the Part E WageLoss Worksheets are completed or the Wage-Loss Calculator in 

ECMS has been used, and printouts of the calculation are placed 

in the case file. The recommended decision must include a 

discussion of the figures used to come to a wage-loss decision. 

Wage-loss calculations must be clearly explained so that a 

claimant may request a hearing if he or she disagrees. 

The FAB Representative must evaluate the figures and 

calculations used by the CE. Printouts of the calculation 

performed by the FAB Representative are placed in the case file. 

If the FAB Representative cannot determine the basis for a wageloss calculation made by the CE in a recommended decision the 

case file may be remanded. 

16. Additional Filings for Wage-Loss Compensation. A covered 

Part E employee who has been previously awarded compensation for 

wage-loss may file a Form EE-10 for subsequent calendar years of 

wage-loss. The covered Part E employee may file a Form EE-10 on 

a yearly basis, or for an aggregate of calendar years in which 

wage-loss is alleged. The EE-10 must be supported by sufficient 

employment and medical evidence to establish that the claimant 

is entitled to additional wage-loss benefits. 

a. The RCs maintain a list of employees that have 

received wage-loss awards. When one year following 

issuance of the last wage-loss award has elapsed, the RC 

contacts the employee to determine if he or she wishes to 

claim an additional year of wage-loss. 

EEOICPA Tr. No. 09-05 20 

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________________________________________________________________ 

Normal Social Security Retirement Age Table

Normal retirement age is the age at which an employee may receive unreduced Social Security 

retirement benefits. This age varies by date of birth and is set by section 216(1) of the Social 

Security Act, 42 U.S.C. 416(1). In general, persons born during or before 1937 are eligible for 

unreduced Old Age, Survivors, and Disability Insurance (OASDI) (i.e. Socjial Security) retirement 

benefits at age 65. The eligibility age increases in two-month increments for persons born 

between 1937 and 1960 until it reaches 67, which is the age at which persons born during or after 

1960 become eligible for unreduced OASDI retirement benefits. 

• The normal retirement age is age 65 for a covered Part E employee born on 1/1/38 or earlier. 

• For a covered Part E employee born on 1/2/38 or later, please refer to the chart below for the 

normal retirement age respectively:

 

If the Birth Date is... The Normal Retirement Age is...

1/2/38 thru 1/1/39 65 years and 2 months 

1/2/39 thru 1/1/40 65 years and 4 months

1/2/40 thru 1/1/41 65 years and 6 months 

1/2/41 thru 1/1/42 65 years and 8 months

1/2/42 thru 1/1/43 65 years and 10 months 

1/2/43 thru 1/1/55 66 years 

1/2/55 thru 1/1/56 66 years and 2 months 

1/2/56 thru 1/1/57 66 years and 4 months 

1/2/57 thru 1/1/58 66 years and 6 months 

1/2/58 thru 1/1/59 66 years and 8 months 

1/2/59 thru 1/1/60 66 years and 10 months

1/2/60 and later 67 years 

EEOICPA Tr. No. 09-05 Exhibit 1 

July 2009 

Superseded
FEDERAL (EEOICPA) PROCEDURE MANUAL Chapter 2-1400 

Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

INITIAL SOLICITATION LETTER 

U.S. Department of Labor

Employment Standards Administration

Office Of Workers’ Compensation Programs

Division of Energy Employees’ Compensation

DO Address

City, State Zip

Phone: (xxx) xxx-xxxx or (xxx) xxx-xxxx

Fax: (xxx) xxx-xxxx

Date: File Number: 

 

Response requested

Name 

Address 

Address 

Dear Ms./Mr. : 

I am writing in regards to your claim for employee benefits under Part E of the Energy Employees’ 

Occupational Illness Compensation Program Act (EEOICPA). Your claim has been accepted for the 

following covered illness(es): . Therefore, you may now be eligible for wage-loss benefits due 

to your covered illness(es). 

Wage - Loss: Wage-loss compensation is awarded if 1) an employee’s loss of earnings was caused 

by his/her covered illness and 2) is payable for only the years of wage-loss experienced before 

normal Social Security Administration retirement age; usually 65 years of age (see enclosed chart to 

find your normal retirement age). We have also provided a brochure that provides additional 

information on how wage-loss awards are calculated. 

Based on the above criteria, if you believe you would qualify and you wish to file for wage-loss

benefits, this is what we will need from you to make a determination for an entitlement to wage-loss. 

Please provide a signed written response that includes the following: 

• An indication whether you would like to claim wage-loss; 

• The month and year you first and last experienced wage-loss as a result of the accepted 

covered illness(es): . 

• The earnings and medical documentation to support the period of wage-loss being claimed as 

discussed below. 

Earnings: For proof of wage-loss, we need records of your earnings 12 quarters (3 years) prior to 

when you first experienced wage-loss to the present. To assist us in this effort, you may submit any 

legible copies of trustworthy earnings records for this period of time. This includes, but may not be 

limited to:

EEOICPA Tr. No. 09-05 Exhibit 2 

July 2009 

Page 1 of 2 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

• Social Security earnings statements • Social Security disability records

• Tax Returns • Pay Stubs

• Union Records • Pension Records

To assist you, we will also attempt to obtain your social security earnings records. Please complete 

and sign the attached Form SSA-581 and return it to our office. It is very important that you return the 

SSA-581 Form signed and completed in order for our office to request and obtain your earnings 

records. This form is time sensitive; please sign and return to our office as soon as possible.

Medical: In addition, you must provide medical evidence establishing a causal relationship between 

the accepted covered illness(es) and when you first and last experienced wage-loss. Examples of 

this may include:

• Medical reports or doctor’s notes showing you were unable to work as a result of one of the 

above accepted covered illnesses; 

• Return to work slips signed by a doctor;

• A doctor’s signed statement explaining the causal relationship between the accepted covered 

illness(es) and the period(s) of wage-loss

Please submit the requested information to our office by . If you need additional time to obtain 

and submit the information, please call me as soon as you can to discuss an extension. You may 

contact me toll free at 1-( )- - . 

Sincerely,

 

Claims Examiner

Enclosure: SSA-581

Pamphlet, “Wage- Loss Benefits”

Social Security Retirement Age Table

EEOICPA Tr. No. 09-05 Exhibit 2 

July 2009 

Page 2 of 2 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

FOLLOW-UP SOLICITATION LETTER 

U.S. Department of Labor

Employment Standards Administration

Office Of Workers’ Compensation Programs 

Division of Energy Employees’ Compensation

DO Address

City, State ZIP 

Phone: DO Phone No.

Fax: DO FAX No.

Date: File Number: 

 

2nd Inquiry - Response requested

Name

Address

Address

Dear Ms./Mr. : 

I am writing in regards to your claim for employee benefits under Part E of the Energy Employees’ 

Occupational Illness Compensation Program Act (EEOICPA). On , I wrote to you outlining 

wage-loss benefits that you might be entitled to due to your covered illness(es). I have not heard 

from you so please let me recap your potential benefits.

Wage- Loss: Wage-loss compensation is awarded if an employee’s loss of earnings was caused by 

his/her covered illness. Wage-loss compensation is payable for only years before normal Social 

Security Administration retirement age; usually 65 years of age (see chart to find your normal 

retirement age). 

Based on the above criteria, if you believe you would qualify and you wish to file for wage-loss

benefits, this is what we will need from you to make a determination for entitlement to wage-loss. 

Please provide a signed written response that includes the following: 

• An indication whether you would like to claim wage-loss; 

• The month and year you first and last experienced wage-loss as a result of the accepted 

covered illness(es): . 

• The earnings and medical documentation to support the period of wage-loss being claimed as 

discussed below. 

Earnings: For proof of wage-loss, we need records of your earnings 12 quarters (3 years) prior to 

when you first experienced wage-loss to the present. To assist us in this effort, you may submit any 

legible copies of trustworthy earnings records for this period of time. This includes, but may not be 

limited to:

EEOICPA Tr. No. 09-05 Exhibit 3 

July 2009 

Page 1 of 2 

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FEDERAL (EEOICPA) PROCEDURE MANUAL Chapter 2-1400 

Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

• Social Security earnings statements • Pay Stubs

• Social Security disability records • Union Records

• Tax Returns • Pension Records

To assist you, we will also attempt to obtain your social security earnings records. Please complete 

and sign the attached Form SSA-581 and return it to our office. It is very important that you return the 

SSA-581 Form signed and completed in order for our office to request and obtain your earnings 

records. This form is time sensitive please sign and return to our office as soon as possible. 

Medical: In addition, you must provide medical evidence establishing a causal relationship between 

the accepted covered illness(es) and when you first and last experienced wage-loss. Examples of 

this may include:

• Medical reports or doctor’s notes showing you were unable to work as a result of one of the 

above accepted covered illnesses; 

• Return to work slips signed by a doctor;

• A doctor’s signed statement explaining the causal relationship between the accepted covered 

illness(es) and the period(s) of wage-loss

Please submit the requested information to our office by . If I do not hear from you by , I 

will assume you are not interested in filing for wage-loss benefits at this time and I will suspend 

development of your wage-loss claim until further notice from you. If you have any questions about 

your claim or wage-loss in general you may contact me toll free at 1-( )- - . 

Sincerely,

 

Claims Examiner

Enclosure: SSA-581

Pamphlet, “Wage- Loss Benefits”

Social Security Retirement Age Table

EEOICPA Tr. No. 09-05 Exhibit 3 

July 2009 

Page 2 of 2 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

FINAL SOLICITATION LETTER 

U.S. Department of Labor

Employment Standards Administration

Office Of Workers’ Compensation Programs

Division of Energy Employees’ Compensation

DO Address

City, State ZIP 

Phone: DO Phone No.

Fax: DO FAX No.

Date 

File Number: 

 

 

 

 

Dear Mr./Ms. : 

On and again on , I sent you letters asking if you would like to file a claim for wage-loss 

benefits. As of this date, I have not received a response from you.

I would like to thank you for taking the time to consider our request to file for benefits. Your decision 

not to respond at this time does not relinquish your right to file a claim for wage-loss benefits in the 

future; therefore, I will put this issue on hold until further notice from you. 

If at anytime you would like to pursue wage-loss benefits or if you would like to discuss this issue 

further or other benefits available under this program, do not hesitate to call me toll-free, at . If 

it is more convenient, you may visit one of our local resource centers for additional help. 

Sincerely,

 

Claims Examiner

EEOICPA Tr. No. 09-05 Exhibit 4 

July 2009 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

SSA 581 FORM 

EEOICPA Tr. No. 09-05 Exhibit 5 

July 2009 

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________________________________________________________________ 

EEOICPA Tr. No. 09-05 Exhibit 5 

July 2009 

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________________________________________________________________ 

Telephone Inquiries to SSA

Modules SSN Last 4 Group Telephone Number

Module 1 (0000-0999) (410) 966-1247

Module 2 (1000-1999) (410) 966-5657

Module 3 (2000-2999) (410) 597-1045

Module 4 (3000-3999) (410) 597-1049

Module 5 (4000-4999) (410) 966-8512

Module 6 (5000-5999) (410) 597-1053

Module 7 (6000-6999) (410) 597-1057

Module 8 (7000-7999) (410) 597-1061

Module 9 (8000-8999) (410) 966-8844

Module 10 (9000-9999) (410) 597-1065 

EEOICPA Tr. No. 09-05 Exhibit 6 

July 2009 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

PART E WAGE-LOSS WORKSHEET #1 

Part E Wage-Loss Worksheet - # 1

Employee’s Name: 

 

File #:

 

Claims Examiner’s Name:

 

District Office:

 

Calculate Average Annual Wage

1. Enter date of first wage-loss (MM/DD/YYYY)

2. 

Enter the total number of quarters (of the 12 quarters prior to but not including the 

quarter of the date entered in line 1) in which the employee was employed (Earned 

more than $700 in constant 2005 dollars) 

 

3. Enter the combined total of wages of the quarters (quarter in which the employee 

was employed) included on Line 2. 

4. Divide line 3 by line 2.

5. Multiply line 4 by 4. This is the Average Annual Wage. 

EEOICPA Tr. No. 09-05 Exhibit 7 

July 2009 

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Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

PART E WAGE-LOSS WORKSHEET #2 

Part E Wage-Loss Worksheet - # 2

Employee’s Name: 

 

File #:

 

Claims Examiner’s Name: District Office:

 

Adjust Wages for Each Year of Claimed Wage-Loss

1. Calendar year in which wage-loss commenced. 

2. Calendar year in which wage-loss is claimed. 

3. Total amount of wages earned in the claimed year of wage-loss.

4.

Using CPI Inflation Calculator

 a. Dollar amount from line 3. 

 b. Year from line 2.

 c. Year from line 1. 

 d. Press “Calculate” button. This is the Adjust Earnings for this year of wage-loss. 

a. 

b. 

c. 

d. 

EEOICPA Tr. No. 09-05 Exhibit 8 

July 2009 

Superseded
FEDERAL (EEOICPA) PROCEDURE MANUAL Chapter 2-1400 

Part 2 – Claims Wage-Loss Determinations 

________________________________________________________________ 

PART E WAGE-LOSS WORKSHEET #3 

Part E Wage-Loss Worksheet - # 3

Employee’s Name: 

 

File #:

 

Claims Examiner’s Name: District Office:

 

Determine Percentage of Wage-Loss and Award Amount

1. Adjusted Earnings (from Worksheet # 2, line 4d). 

2. Divide line 1 by the Average Annual Wage (from Worksheet # 1)

3. Multiply line 2 by 100 (line 2 X 100). Enter percentage.

4.

If percentage from line 3 is less than or equal to 50% (line 3 < 50%), enter $15,000.

If percentage from line 3 is greater than 50 %, but less than or equal to 75% (50% < line 

3 < 75%), enter $10,000.

This is the award amount for claimed year of wage-loss.

 

EEOICPA Tr. No. 09-05 Exhibit 9 

July 2009 

Superseded