---
kind: "range"
citation: "20 C.F.R. §§ 30.805–30.807"
title: "20"
from: "30.805"
to: "30.807"
count: 3
url: "https://uscodex.org/cfr/20/30.805..30.807"
---

# §30.805. What are the criteria for eligibility for wage-loss benefits under Part E?

- (a) In addition to satisfying the general eligibility requirements applicable to all Part E claims, a claimant seeking benefits for calendar years of qualifying wage-loss has the burden of proof to establish each of the following criteria:
  - (1) He or she held a job at which he or she earned wages;
  - (2) He or she experienced a loss in those wages in a particular month (referred to as the “trigger month” in this section);
  - (3) The wage-loss in the trigger month was caused by the covered Part E employee's covered illness, i.e., that he or she would have continued to earn wages in the trigger month from that employment but for the covered illness;
  - (4) His or her average annual wage;
  - (5) His or her normal retirement age and the calendar year in which he or she would reach that age;
  - (6) Beginning with the calendar year of the trigger month, the percentage of the average annual wage that was earned in each calendar year up to and including the retirement year;
  - (7) The number of those calendar years in which the covered illness caused the covered Part E employee to earn 50% or less of his or her average annual wage; and
  - (8) The number of those calendar years in which the covered illness caused him or her to earn more than 50% but not more than 75% of his or her average annual wage.
- (b) OWCP will discontinue development of a request for wage-loss benefits, during which the claimant must meet his or her burden of proof to establish each of the criteria listed in [paragraph (a)](#a) of this section, at any point when the claimant is unable to meet such burden and proceed to issue a recommended decision to deny the request.

# §30.806. What kind of medical evidence must the claimant submit to prove that he or she lost wages due to a covered illness?


OWCP requires the submission of rationalized medical evidence of sufficient probative value to convince the fact-finder that the covered Part E employee experienced a loss in wages in his or her trigger month due to a covered illness, i.e., medical evidence based on a physician's fully explained and reasoned decision (see [§ 30.805(a)(3)](/cfr/20/30.805.md?p=a-3)). A loss in wages in the trigger month due solely to non-covered illness matters, such as a reduction in force or voluntary retirement, is not proof of compensable wage-loss under Part E.


# §30.807. What factual evidence does OWCP use to determine a covered Part E employee's average annual wage?

- (a) OWCP may rely on annual or quarterly wage information reported to the Social Security Administration to establish a covered Part E employee's presumed average annual wage (see [§ 30.810](/cfr/20/30.810.md)) and the duration and extent of any years of wage-loss that are compensable under Part E of the Act (see [§ 30.811](/cfr/20/30.811.md)). OWCP may also rely on other probative evidence of a covered Part E employee's wages, and may ask the claimant for additional evidence needed to make this determination, if necessary. For the purposes of making these two types of determinations, OWCP will consider all monetary payments that the covered Part E employee received as wages (see [§ 30.801(g)](/cfr/20/30.801.md?p=g)).
- (b) A claimant who disagrees with the evidence OWCP has obtained under [paragraph (a)](#a) of this section and alleges a different average annual wage for the covered Part E employee, or that there was a greater duration or extent of wage-loss, may submit records that were produced in the ordinary course of business due to the employee's employment to rebut that evidence, to the extent that such records are determined to be authentic by OWCP. The average annual wage and/or wage-loss of the covered Part E employee will then be determined by OWCP in the exercise of its discretion.