What Happened Before the Symptoms or Disability Returned?
DOL's CA-2a instructions make the dividing line unusually clear: if a new injury or new occupational exposure occurs and causes disability or the need for medical care, a new CA-1 or CA-2 should be filed—even when the same body part was injured before.
No New Work Event or Exposure
The accepted condition spontaneously worsened or symptoms returned without an intervening injury or new occupational exposure.
EXPLORE RECURRENCE →A New Specific Event Happened
A new identifiable work incident or series of incidents occurred during a single workday or shift and caused injury or renewed disability.
NEW TRAUMATIC INJURY →New or Continued Exposure Occurred
New or continuing work exposure over more than one workday or shift caused or contributed to the condition.
NEW OCCUPATIONAL DISEASE →Same Body Part Does Not Automatically Mean “Recurrence”
DOL's current CA-2a instructions expressly say a new CA-1 or CA-2 is appropriate when a new injury or occupational exposure occurs, even if the new event involves the same body part previously affected.
Medical Condition vs. Disability
Treatment Is Needed Again
A documented need for additional medical treatment after the employee had been released from treatment for the accepted work-related injury or condition. Continuing treatment for the original condition is not itself a recurrence.
Work Capacity Is Lost Again
A work stoppage caused by a spontaneous return of symptoms without an intervening cause, certain consequential injuries, or qualifying withdrawal/alteration of a light-duty assignment under the governing definition.
There Is a New Cause
A new work incident, new occupational disease, or new event contributing to an existing occupational disease generally belongs on the new-injury path rather than CA-2a.
The Evidence Should Explain the Change
Identify the Time Pattern of the New Cause
A new traumatic injury is tied to a specific work event or series of events within one workday or shift. A new occupational disease results from continued or repeated work exposure over a period longer than one workday or shift.
CA-1 GUIDECA-2 GUIDEThe Physician Should Connect the Renewed Problem to the Original Injury
The CA-2a instructions call for a detailed attending-physician report addressing examination/treatment dates, history, findings, test results, diagnosis, treatment course and plan, causal relationship to the original injury, and the employee's ability to perform regular duties.
Explain the History
Describe the course after the original injury, return to work or release from treatment, and how the current symptoms or disability developed.
Rule In the Original Condition
Give medical reasons why the current need for treatment or disability is causally related to the accepted injury rather than simply stating that it is.
MEDICAL EVIDENCE CENTERAddress Work Capacity
If the employee is disabled from regular work, identify the dates and provide medically supported work-tolerance limitations.
CA-17 / RESTRICTIONSConsequential Injury
DOL includes certain consequential injuries within recurrence of disability. A consequential injury is a new injury that results from weakness or impairment caused by the accepted work injury—for example, a medically supported injury resulting from instability caused by the accepted condition.
CA-2a and Compensation Are Related—but Not the Same Form
CA-2a gives notice of the recurrence. When wage-loss compensation is due, the compensation claim may also require CA-7. COP rules can apply in a narrower traumatic-injury recurrence situation.
Unused COP May Remain
For a traumatic injury, if the employee returned to work without using all 45 COP days and a qualifying recurrence of disability begins within 45 days of the first return to duty, remaining COP may be available.
CA-7 Wage Loss
If the 45-day COP entitlement has been exhausted—or the recurrence begins more than 45 days after first return to work—the employee generally claims wage-loss compensation on CA-7.
WAGE LOSS CENTEROccupational Disease
COP does not apply to occupational-disease claims; recurrent disability wage loss is handled through the compensation process when entitlement is established.
One More Important Exception: Existing LWEC Decisions
When OWCP has already issued a formal loss-of-wage-earning-capacity determination, additional wage loss can involve modification of the LWEC decision rather than an ordinary recurrence-of-disability claim. That deserves its own treatment in the Ellis Clinic OWCP system.