United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.J., Appellant 

 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Amarillo, TX, Employer 

__________________________________________ 

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Docket No. 14-1682 

Issued: December 11, 2015 

Appearances: Case Submitted on the Record

Lonnie Boylan, Esq., for the appellant

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On July 29, 2014 appellant, through counsel, filed a timely appeal from a June 6, 2014 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act1

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case. 

ISSUES 

The issues are: (1) whether OWCP properly terminated appellant’s wage-loss 

compensation and medical benefits effective November 17, 2013 as she no longer had any 

residuals or disability causally related to her accepted employment-related injury; and 

(2) whether she had any continuing employment-related residuals or disability after 

November 17, 2013. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On June 24, 1993 appellant, then a 39-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1). She alleged that on that day she sprained both knees and her left ankle 

when she stepped in a deep hole and fell while delivering mail. OWCP accepted appellant’s 

claim for bilateral knee sprain and expanded the claim to include sprain of neck, derangement of 

left ankle, and left plantar fibromatosis. Appellant was paid compensation benefits and OWCP 

authorized a modified Elmslie reconstruction of her left ankle on August 11, 1994. 

By decision dated October 20, 2000, appellant received a schedule award for seven 

percent impairment of the left lower extremity. She sustained two subsequent employment 

injuries, one occurring in 1995 and the other in 1997.2

 Appellant returned to work in a full-time 

limited-duty capacity until April 28, 2010, when her modified duty was withdrawn pursuant to 

the National Reassessment Process (NRP). She was then placed on the periodic compensation 

rolls. 

Appellant was referred to Dr. Donald A. Mauldin, a Board-certified orthopedic surgeon, 

for a second opinion medical examination on May 19, 2011. In his July 25, 2011 report, 

Dr. Mauldin noted a history of the accepted 1993 injury and subsequent work injuries occurring 

in 1995 and 1997. He provided an impression of status post left ankle sprain. Dr. Mauldin noted 

a history of possible mild knee strains (resolved) with no documentation of any significant 

injury. He found that appellant developed chronic ankle instability, status post lateral ligament 

reconstruction, and chronic subjective ankle complaints with some dysesthesias in the 

distribution of the sural nerve. Dr. Mauldin also found appellant status post cervical strain with 

no objective documentation of a major structural injury and with chronic bilateral cervical 

radicular symptoms of a nonphysiologic nature. He opined that the accepted cervical strain had 

resolved. Dr. Mauldin noted a grossly stable left ankle postreconstruction surgery, but 

recommended a functional capacity evaluation (FCE) to assess appellant’s left ankle. A June 27, 

2011 FCE indicated that appellant could perform a sedentary job with no lifting or walking. In a 

July 5, 2011 supplemental report, Dr. Mauldin stated that there was no objective basis for 

continuing complaints of the cervical spine, but opined that appellant should be restricted to 

sedentary work due to her weight. 

An August 24, 2011 magnetic resonance imaging (MRI) scan stated an impression of 

stenosis at C3-4, C4-5, C5-6, and C6-7. An October 10, 2011 electromyogram/nerve conduction 

velocity (EMG/NCV) study revealed no upper extremity neuropathy or radiculopathy. 

In an October 15, 2012 report, Dr. Earl C. Smith, a Board-certified orthopedic surgeon, 

noted that appellant reported neck and left arm pain and numbness. He noted the results of the 

cervical spine MRI scan showing stenosis at multiple levels and examination findings of 4/5 

brachial strength, tenderness in cervical muscles, positive Tinel’s sign at the left cubital tunnel, 

and normal cervical range of motion. Dr. Smith diagnosed cervical radiculopathy and cubital 

 2

 OWCP file number xxxxxx235, date of injury November 3, 1995, was accepted for cervical sprain and 

spondylosis. In file number xxxxxx207, date of injury April 24, 1997, OWCP accepted cervical sprain, right hip 

enthesopathy, and right wrist sprain. The two files were merged with file number xxxxxx207 as the master file. The 

merged file was closed in 2008. 
3

tunnel syndrome. He found appellant able to work eight hours a day with restrictions of no 

lifting, no overhead work and no repetitive work. No further action was taken in this case until 

March 2013. 

In an effort to determine appellant’s updated work capacity, OWCP prepared a statement 

of accepted facts (SOAF) dated March 27, 2013 and referred appellant to a second opinion 

examination. The SOAF included a description of the June 24, 1993 work injury and related left 

ankle surgery. It did not mention either the 1995 or 1997 work injuries. 

Dr. Melburn Heubner, a Board-certified orthopedic surgeon and OWCP referral 

physician, conducted a second opinion examination. In his April 24, 2013 report, he noted a 

history of the 1993, 1995, and 1997 workplace injuries, reviewed medical records and presented 

examination findings. He diagnosed resolved cervical strain, left ankle status post successful 

ligamentous reconstruction without objective findings of instability with continued complaints of 

pain, and nonwork-related atopic dermatitis. He reviewed MRI scans and x-ray findings and 

determined that they reflected degenerative changes, but no acute disc disruption. Dr. Heubner 

opined that the accepted conditions had resolved. He found the ankle reconstruction was 

successful with no objective findings of instability and the MRI scan of the cervical spine 

showed degenerative stenosis not related to the 1997 work injury. Dr. Heubner concluded that 

work limitations were referable only to appellant’s nonwork-related conditions, such as body 

habitus and dermatitis. He also opined that appellant reached maximum medical improvement. 

On June 26, 2013 OWCP determined a conflict in medical opinion existed between 

Dr. Smith and Dr. Heubner as to whether appellant continued to suffer residuals of the June 24, 

1993 work injury and whether she could return to work with or without restrictions. Appellant 

was referred to Dr. Bobby L. Stafford, a Board-certified orthopedic surgeon, for an impartial 

medical evaluation. In his August 15, 2013 report, Dr. Stafford noted a history of the 1993, 

1995, and 1997 work injuries, reviewed the medical records and noted examination findings 

which included good range of motion in the neck, no upper extremity weakness of any type, 

well-healed left ankle surgical scar, and no restriction of range of motion of the left ankle. 

Vague numbness over the lateral aspect of left arm and hand and the ulnar aspect of the long 

finger was noted. Reflexes were normal. Appellant’s weight was noted at 340 pounds and she 

walked without the aid of a cane, crutches or walker, was in no acute distress, and was able to sit 

without difficulty. She also had severe dermatitis of both hands and feet, with weeping, cracked 

areas. Dr. Stafford opined that the accepted conditions of bilateral knee sprain/strains, cervical 

sprain/strain, left ankle joint derangement, and left plantar fibromatosis had all resolved. He 

explained that there was no laxity in the left ankle, no instability in the left knee, and difficulty in 

walking was due to body habitus and weight. Dr. Stafford further explained that the cervical 

spine condition disclosed by diagnostic testing was degenerative in nature and nonoccupational. 

He concluded that appellant could work eight hours a day in sedentary work only due to her 

weight and nonoccupational atopic dermatitis. 

On September 25, 2013 OWCP advised appellant of its proposed termination of her 

compensation and medical benefits as the weight of the medical evidence showed that she had no 

further residuals of her accepted 1993 work injury. It accorded the weight of the medical 

evidence to Dr. Stafford’s impartial opinion. 
4

In an October 24, 2013 letter, appellant disagreed with the proposed termination. She 

indicated that she had worked limited duty up to the time her work was withdrawn under NRP. 

By decision dated October 30, 2013, OWCP terminated appellant’s wage-loss 

compensation and medical benefits effective November 17, 2013. 

On November 27, 2013 appellant requested a hearing before an OWCP hearing 

representative. She subsequently changed her request to a review of the written record. 

In an April 23, 2014 letter, appellant’s counsel argued that the March 27, 2013 SOAF did 

not include a description of the 1995 or 1997 work injuries. He argued that, since Dr. Stafford 

was not provided with an accurate history, his opinion could not be accorded special weight. 

In an October 22, 2013 report, Dr. Smith provided an impression of cervical 

radiculopathy and cubital tunnel syndrome. He opined that appellant had activity restrictions of 

no lifting, overhead work or repetitive activity. An October 22, 2013 duty status report was also 

provided. 

By decision dated June 6, 2014, an OWCP hearing representative affirmed the 

October 30, 2013 OWCP decision. The hearing representative additionally found that 

Dr. Smith’s subsequent report did not overcome the weight accorded to Dr. Stafford’s opinion. 

LEGAL PRECEDENT -- ISSUE 1 

Once OWCP accepts a claim, it has the burden of justifying termination or modification 

of compensation. After it has been determined that an employee has disability causally related to 

his or her employment, OWCP may not terminate compensation without establishing that the 

disability had ceased or that it was no longer related to the employment.3 OWCP’s burden of 

proof includes the necessity of furnishing rationalized medical opinion evidence based on a 

proper factual and medical background.4 Furthermore, the right to medical benefits for an 

accepted condition is not limited to the period of entitlement for disability. To terminate 

authorization for medical treatment, OWCP must establish that a claimant no longer has 

residuals of an employment-related condition that requires further medical treatment.5

 

Section 8123(a) of FECA provides that, if there is disagreement between the physician 

making the examination for the United States and the physician of the employee, the Secretary 

shall appoint a third physician who shall make an examination.6

 The implementing regulations 

state that, if a conflict exists between the medical opinion of the employee’s physician and the 

medical opinion of either a second opinion physician or an OWCP medical adviser, OWCP shall 

appoint a third physician to make an examination. This is called a referee examination and 

 3 Jason C. Armstrong, 40 ECAB 907 (1989). 

4 See Del K. Rykert, 40 ECAB 284, 295-96 (1988). 

5 Mary A. Lowe, 52 ECAB 223 (2001); Wiley Richey, 49 ECAB 166 (1997). 

6

 5 U.S.C. § 8123(a). 
5

OWCP will select a physician who is qualified in the appropriate specialty and who has no prior 

connection with the case.7 In situations where there exist opposing medical reports of virtually 

equal weight and rationale and the case is referred to an impartial medical specialist for the 

purpose of resolving the conflict, the opinion of such specialist, if sufficiently well rationalized 

and based upon a proper factual background, must be given special weight.8

 

OWCP’s procedure manual provides as follows: 

“The [claims examiner] is responsible for ensuring that the SOAF is correct, 

complete, unequivocal, and specific. When the [district medical adviser], second 

opinion specialist, or referee physician renders a medical opinion based on an 

SOAF which is incomplete or inaccurate or does not use the SOAF as the 

framework in forming his or her opinion, the probative value of the opinion is 

seriously diminished or negated altogether.”9

 

ANALYSIS -- ISSUE 1 

OWCP accepted that appellant sustained bilateral knee sprain, neck sprain, derangement 

of left ankle, and left plantar fibromatosis due to the June 24, 1993 employment injury. It 

determined that a conflict arose between Dr. Smith, an attending physician, and Dr. Heubner, an 

OWCP referral physician, regarding whether she had any further residuals of her work injury and 

whether she was capable of working. Dr. Smith opined that appellant had cervical radiculopathy 

and cubital tunnel syndrome and was able to work with activity restriction. Dr. Heubner opined 

that the accepted conditions had resolved because there were no objective findings of ankle 

instability and the MRI scan of the cervical spine showed degenerative stenosis not related to the 

accepted injury. He opined that appellant could work with limitations related to appellant’s 

nonwork conditions. Accordingly, OWCP referred appellant to Dr. Stafford for an impartial 

medical examination. It terminated appellant’s wage-loss compensation and medical benefits 

finding that Dr. Stafford’s report constituted the weight of the evidence that she had no further 

employment-related disability. 

Before OWCP and on appeal, appellant contends that Dr. Stafford’s report should not be 

accorded special weight because the March 27, 2013 SOAF did not include a description of the 

1995 or 1997 accepted work injuries. Because of this omission, appellant argues that 

Dr. Stafford’s opinion was not based on an accurate factual and medical history. 

In requesting an opinion on whether work-related residuals remained and whether 

appellant was capable of working, OWCP provided a March 27, 2013 SOAF to both its second 

opinion examiners and Dr. Stafford. The March 27, 2013 SOAF failed to include appellant’s 

subsequent accepted work-related injuries in 1995 and 1997. The 1995 injury was accepted for 

cervical sprain and spondylosis. The 1997 injury was accepted for cervical sprain, right hip 

 7

 20 C.F.R. § 10.321. 

8 Gloria J. Godfrey, 52 ECAB 486 (2001); Jacqueline Brasch (Ronald Brasch), 52 ECAB 252 (2001). 

9

 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990). 
6

enthesopathy, and right wrist sprain.10 The subsequent work-related injuries are relevant to 

appellant’s current claim because they involve the body parts for which benefits were being 

terminated. 

OWCP provides a physician with a SOAF to assure that the medical specialist’s report is 

based upon a proper factual background.11 The SOAF must include the date of injury, claimant’s 

age, the job held on the date of injury, the employer, the mechanism of injury, and the claimed or 

accepted conditions.12 While the inclusion of other workers’ compensation injuries is optional, 

the claims examiner must decide all issues requiring a medical opinion for resolution and 

determine all facts relevant to the issues to be resolved in the current claim.13 

OWCP procedures further indicate that, when an OWCP medical adviser, second opinion 

specialist, or referee physician renders a medical opinion based on a SOAF which is incomplete 

or inaccurate or does not use the SOAF as the framework in forming his or her opinion, the 

probative value of the opinion is seriously diminished or negated altogether.14 

Dr. Stafford demonstrated some knowledge of the 1995 or 1997 work injuries based on 

appellant’s own description, but it is not clear whether he was aware that these conditions had 

been accepted by OWCP. Further, the Board notes that in his August 2013 report he concluded 

that appellant’s cervical spine condition was degenerative in nature and not occupational. 

Dr. Stafford rendered his opinion based on incomplete factual information. The opinion is 

therefore of limited probative value. OWCP has the responsibility to obtain from its referral 

physician an evaluation that will resolve the issue involved in this case.15 Accordingly, the 

Board finds that the case must be remanded for further medical development. 

On remand OWCP should prepare a complete, accurate, and updated SOAF and refer 

appellant to an appropriate medical specialist for examination and a reasoned opinion of whether 

appellant has any residuals from her accepted work-related injuries. Following such further 

development as deemed necessary, it shall issue a de novo decision.16 

 10 Those two files were merged with file number xxxxxx207 as the master file and closed in 2008. 

11 Helen Casillas, 46 ECAB 1044 (1995). 

12 Federal (FECA) Procedure Manual, Part 2 -- Claims, Statements of Accepted Facts, Chapter 2.809.5 

(September 2009); see also Darletha Coleman, 55 ECAB 143 (2003). 

13 Federal (FECA) Procedure Manual, id. at Chapter 2.809.6(a). 

14 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990). 

15 Richard F. Williams, 55 ECAB 343 (2004). 

16 In light of the disposition of this case, the second issue regarding whether appellant had any continuing 

employment-related residuals or disability after November 17, 2013 and the remaining issues raised on appeal are 

moot. 
7

CONCLUSION 

The Board finds that the case is not in posture for decision. 

ORDER 

IT IS HEREBY ORDERED THAT the June 6, 2014 decision of the Office of Workers’ 

Compensation Programs is reversed and the case is remanded for further proceedings consistent 

with this decision by the Board.17

Issued: December 11, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 17 James A. Haynes, Alternate Judge, participated in the original decision but was no longer a member of the 

Board effective November 16, 2014.