United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.J., Appellant 

and 

DEPARTMENT OF DEFENSE, DEFENSE 

FINANCE & ACCOUNTING SERVICE, 

Columbus, OH, Employer 

__________________________________________ 

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Docket No. 13-517 

Issued: May 19, 2014 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On January 3, 2013 appellant, through her attorney, filed a timely appeal from a 

September 26, 2012 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 medical benefits for 

left arm reflex sympathetic dystrophy (RSD) on June 9, 2010; and (2) whether appellant 

established that she had continuing residuals after that date. 

On appeal appellant’s attorney asserts that the September 26, 2012 decision is contrary to 

fact and law. 

 1

 5 U.S.C. §§ 8101-8193. 
2

FACTUAL HISTORY 

This case has previously been before the Board.2 On November 13, 2003 appellant, then 

a 34-year-old accounting technician, sustained an injury to her left hand when it became caught 

in a door. She returned to light duty on November 24, 2003. Appellant began working part time 

in January 2004 and stopped work on September 6, 2004. She did not return. OWCP accepted a 

contusion of the left hand, crush injury of the left hand except the fingers, RSD of the left arm, 

right carpal tunnel syndrome, bilateral tenosynovitis of the hands and wrists and a single episode 

of major depression. Appellant was placed on the periodic compensation rolls. In 2006 she 

moved to Georgia. 

On April 16, 2009 OWCP referred appellant to Dr. David A. Olson, a Board-certified 

neurologist, for a second opinion evaluation. In a May 11, 2009 report, Dr. Olson reviewed the 

medical record and noted her complaint of pain. He provided findings on physical examination 

and diagnosed weakness and pain. Dr. Olson found that appellant had no residuals or 

neurological impairment due to the accepted injury and that her accepted conditions had 

resolved. He found no objective evidence of RSD and advised that she had no work restrictions 

due to the employment injury. 

Appellant received wage-loss compensation for the accepted emotional condition. 

In an August 20, 2009 treatment note, Dr. Allan E. Peljovich, a Board-certified 

orthopedic surgeon, noted appellant’s complaint of left hand pain. He diagnosed RSD and 

possible left trigger thumb or stenosing tenosynovitis. X-rays of the left wrist and hand obtained 

that day demonstrated no abnormality. 

On September 1, 2009 OWCP proposed to terminate appellant’s medical benefits for the 

conditions of left arm RSD and the additional accepted orthopedic conditions on the grounds that 

the medical evidence established that she no longer had residuals of the conditions. 

Appellant disagreed with the proposed termination and submitted an August 28, 2009 

report from Dr. Erik T. Shaw, Board-certified in physical medicine and rehabilitation, who noted 

the history of injury and appellant’s complaints of neck and left arm pain. Dr. Shaw provided 

physical examination findings and diagnosed right upper extremity pain/RSD, myofascial pain, 

anxiety, depression and sleep disturbance. 

On October 5, 2009 OWCP terminated medical benefits for the conditions of left arm 

RSD, left hand contusion, crush injury of the left hand and fingers, right carpal tunnel syndrome 

and bilateral tenosynovitis of the wrists.3

 2

 Docket No. 10-743 (issued November 2, 2010). The Board affirmed the denial by OWCP of appellant’s request 

for authorization of her purchase of a home Jacuzzi. 

3

 The Board notes that in a June 19, 2009 decision, OWCP denied to accept appellant’s cervical radiculitis, 

anxiety or headaches as a consequence of the November 13, 2003 injury. This determination was affirmed in part 

by the December 15, 2009 decision of an OWCP hearing representative. The case was remanded for further 

development of the anxiety claim. 
3

In a March 30, 2010 decision, an OWCP hearing representative affirmed the October 5, 

2009 decision with regard to each of the orthopedic conditions except the left arm RSD, finding 

that a conflict in medical evidence arose between appellant’s attending physician, Dr. Shaw, and 

Dr. Olson, OWCP’s referral physician. 

On April 12, 2010 OWCP referred appellant to Dr. Michael S. Baugh, a Board-certified 

neurologist, for an impartial evaluation. In a May 17, 2010 report, Dr. Baugh reviewed the 

medical record and the statement of accepted facts. He noted appellant’s treatment by various 

medical specialists and the disagreement as to the diagnosis of left upper extremity RSD. 

Dr. Baugh also noted that she was diagnosed with depression and a personality disorder. He 

reviewed the diagnostic tests of record, noting that a January 23, 2004 whole body scan revealed 

only a questionable left 4th metacarpal possible occult fracture with no evidence of RSD. An 

MRI scan of the left wrist and hand in 2004 found no changes consistent with RSD. In 

September 2004, an electromyelogram and nerve conduction studies of the left arm were 

reported as normal. Another normal MRI scan was obtained on December 29, 2008, with the 

exception of a possible ganglion cyst. X-rays of the left hand and wrist obtained in August 2009 

were reported as normal. A repeat EMG and nerve conduction study of both upper extremities in 

January 2009 were also normal. Dr. Baugh stated that his review of the diagnostic reports did 

not evidence changes consistent with left upper extremity RSD. 

Dr. Baugh noted appellant’s complaint of constant left upper extremity pain from the 

base of her neck, over her shoulder into her arm and fingers, worst into digits 3 and 4. The pain 

was accompanied by weakness and numbness. On examination, appellant reported pain with 

range of motion testing. There was no significant temperature asymmetry or sweating 

asymmetry with possible slight edema of the left wrist and hand. Left upper extremity strength 

was limited by poor voluntary effort and notable give-way weakness. Muscle bulk was normal 

and reflexes were symmetrical. Sensory examination was symmetrically intact to light touch, 

vibration, graphesthesia and temperature with decreased sensation on the left upper extremity to 

pinprick on the lateral arm, forearm and hand. Dr. Baugh stated that appellant’s evaluation did 

not meet the diagnostic criteria for RSD. He noted that she should have an MRI scan of the 

cervical spine as her symptoms could be reproduced by cervical spinal cord disease. Dr. Baugh 

diagnosed limb pain and cervicalgia/neck pain. He advised that, while appellant was 

symptomatic in all subjective symptoms of RSD, she had no objective symptoms on examination 

or imaging studies to support that diagnosis and concluded that she did not meet the diagnostic 

criteria for RSD. Dr. Baugh noted that diagnostic testing showed some boney changes over the 

prior seven years. 

In a June 9, 2010 decision, OWCP found that appellant’s medical benefits for RSD 

remained terminated based on the referee opinion of Dr. Baugh.4

 4

 Concurrently, in a May 6, 2009 decision, OWCP denied appellant’s request for authorization for a home Jacuzzi 

on the grounds that the medical evidence failed to establish that a Jacuzzi was necessary and appropriate for 

effective treatment of her work-related RSD. Appellant filed an appeal with the Board, and in a November 2, 2010 

decision, the Board affirmed the November 5, 2009 OWCP decision. The law and facts of the previous Board 

decision are incorporated herein by reference. The record also contains an employing establishment investigative 

report dated June 30, 2010. 
4

Appellant, through her attorney, requested a hearing. She submitted reports from 

Dr. Shaw dated June 22 to November 18, 2010. Counsel noted appellant’s complaints of left 

arm pain and tenderness, provided examination findings and diagnosed left upper extremity 

pain/complex regional pain syndrome, extensive myofascial pain, anxiety and depression. At the 

October 7, 2010 hearing, appellant testified regarding her condition and medical treatment. 

By decision dated December 28, 2010, an OWCP hearing representative affirmed the 

June 9, 2010 decision. She found that the weight of the medical evidence rested with the opinion 

of Dr. Baugh, the referee physician, who determined that appellant did not have RSD of the left 

upper extremity.5

Appellant requested reconsideration of her claim on March 28, 2011, December 4, 2011 

and June 25, 2012. OWCP issued merit decisions on June 7, 2011, March 8 and September 26, 

2012, denying modification of the termination of her medical benefits for left arm RSD. 

The medical evidence submitted on reconsideration includes a partial report of a 

January 24, 2012 left upper extremity bone scan. While the report is incomplete, it indicates that 

evaluation of the left elbow and wrist was unremarkable with a normal appearance. 

In a January 30, 2012 report, Dr. Philip R. Kennedy, a neurologist, reported a history that 

in 2003 appellant caught her left hand in a door and since that time had symptoms suggestive of 

complex regional pain syndrome. He noted her complaints of an extremely sensitive and painful 

left hand with tingling, burning and numbness. Physical examination of the left upper extremity 

demonstrated some mild atrophy with no discoloration, normal tone, and give-way strength due 

to pain. Sensation to light touch was diminished from the shoulder down into the hand and 

pinprick demonstrated numbness in the shoulder and triggered pain in the hand. Dr. Kennedy 

advised that appellant unquestionably had complex regional pain syndrome. 

In reports dated March 1, 2011 and May 24, 2012, Dr. Shaw noted appellant’s complaint 

of left upper extremity pain. Findings on physical examination included significant pain and 

tenderness of the left upper extremity and myofascial tenderness through the shoulder and neck 

region. Dr. Shaw diagnosed left upper extremity pain/complex regional pain syndrome with 

involvement of the hand, extensive myofascial pain, anxiety and depression. On August 8, 2012 

he advised that appellant had good days and bad days. Musculoskeletal examination 

demonstrated decreased range of motion and no vasomotor, psychomotor or atrophic changes 

were noted. Temperature was grossly normal. Dr. Shaw reiterated his diagnoses. 

LEGAL PRECEDENT -- ISSUE 1 

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 

 5

 In a December 8, 2010 decision, an OWCP hearing representative reversed a June 23, 2010 decision that denied 

appellant’s claim for an anxiety condition. On December 15, 2010 OWCP informed appellant that her claim was 

accepted for major depression, single episode, moderate and anxiety state. Appellant also submitted medical reports 

dated October 8, 2009 to September 6, 2012 from treating psychologists regarding her emotional condition. She 

remains on the periodic compensation rolls, based on her accepted emotional condition. See supra note 2. 
5

establish that a claimant no longer has residuals of an employment-related condition that require 

further medical treatment.6 

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.7

 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 

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

connection with the case.8 When 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.9

ANALYSIS -- ISSUE 1 

The Board finds that OWCP met its burden of proof to terminate appellant’s medical 

benefits for left upper extremity RSD on June 9, 2010. OWCP found a conflict between 

appellant’s physician, Dr. Shaw, and the referral physician, Dr. Olson. Dr. Shaw supported that 

appellant had ongoing residuals of the accepted left arm RSD that required medical treatment. 

Dr. Olson, however, found that appellant did not have any residuals or neurological impairment 

and that the left arm RSD had resolved. OWCP properly found a conflict in medical opinion. 

In the May 17, 2010 report, Dr. Baugh, the impartial specialist, reviewed the history of 

injury, appellant’s medical treatment and the diagnostic testing performed. He addressed the 

reports of the examining physicians of record and the diagnostic studies obtained. Dr. Baugh 

stated that the test results obtained from 2004 through 2009 included MRI scan studies, EMG 

and nerve conduction studies and x-rays that were reported as normal for testing of the left upper 

extremity. He advised that the reports revealed no evidence of changes consistent with complex 

regional pain syndrome either acute or chronic on the early or later bone scans. On physical 

examination, Dr. Baugh noted that left upper extremity strength testing and range of motion was 

limited by poor voluntary effort and notable give-away weakness. Muscle bulk was reported as 

normal with symmetrical reflexes. While Dr. Baugh noted that appellant was symptomatic in all 

subjective symptoms of RSD, there were no objective symptoms on examination or diagnostic 

studies to support the diagnosis. He concluded that she did not meet the diagnostic criteria for 

left arm RSD. 

As noted, in situations where there are opposing medical reports of virtually equal weight 

and rationale and the case is referred to an impartial medical specialist for the purpose of 

 6 T.P., 58 ECAB 524 (2007). 

7

 5 U.S.C. § 8123(a); see R.H., 59 ECAB 382 (2008). 

8

 20 C.F.R. § 10.321. 

9 Manuel Gill, 52 ECAB 282 (2001). 
6

resolving the conflict, the opinion of such specialist, if sufficiently well rationalized and based on 

a proper factual background, must be given special weight.10

The Board finds that, as Dr. Baugh provided a comprehensive, well-rationalized opinion 

on the issue of whether appellant had residuals of her accepted left upper extremity sympathetic 

reflex dystrophy. He determined that at the time of his examination, appellant did not have 

findings on physical examination or prior diagnostic study to support ongoing residuals that 

required further medical treatment. Dr. Baugh noted that appellant should follow-up with further 

diagnostic study of her cervical spine as testing had revealed boney erosion. The Board finds 

that the opinion of Dr. Baugh is entitled to the special weight accorded an impartial examiner 

and constitutes the weight of the medical evidence.11 OWCP therefore properly terminated 

appellant’s medical benefits for RSD.12

LEGAL PRECEDENT -- ISSUE 2 

As OWCP met its burden of proof to terminate medical benefits for RSD on June 9, 

2010, the burden of proof shifted to appellant to establish continuing residuals causally related to 

the November 13, 2003 employment injury.13

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment injury, an employee must submit rationalized medical 

evidence, based on a complete factual and medical background, supporting such a causal 

relationship.14 Causal relationship is a medical issue and the medical evidence required to 

establish a causal relationship is rationalized medical evidence.15 The opinion of the physician 

must be based on a complete factual and medical background of the employee, must be one of 

reasonable medical certainty, and must be supported by medical rationale explaining the nature 

of the relationship between the diagnosed condition and the specific employment factors 

identified by the claimant.16

ANALYSIS -- ISSUE 2 

The Board notes that appellant continues to receive wage-loss compensation for her 

accepted psychological conditions. The Board finds that she submitted insufficient medical 

evidence to establish residuals of the left upper extremity RSD after June 9, 2010, due to the 

November 13, 2003 employment injury. 

 10 Id.

11 See Sharyn D. Bannick, 54 ECAB 537 (2003). 

12 Manuel Gill, supra note 9. 

13 See Joseph A. Brown, Jr., 55 ECAB 542 (2004). 

14 Jennifer Atkerson, 55 ECAB 317 (2004). 

15 Id.

16 Leslie C. Moore, 52 ECAB 132 (2000); Victor J. Woodhams, 41 ECAB 345 (1989). 
7

The medical evidence submitted by appellant includes a partial report of a January 24, 

2012 left upper extremity bone scan. The copy of record is not complete but indicates that 

evaluation of the left elbow and wrist was unremarkable with a normal appearance. This report 

is of limited probative value as it does not contain any opinion from a physician as to whether 

she has RSD of her left upper extremity that requires medical treatment. 

Dr. Kennedy noted physical examination findings of mild atrophy of the left upper 

extremity with no discoloration, normal tone, and give-way strength due to pain. Sensation to 

light touch was diminished from the shoulder down into the hand and pinprick demonstrated 

numbness in the shoulder and triggered pain in the hand and diagnosed complex regional pain 

syndrome. The Board, however, finds this report insufficient to overcome the special weight 

accorded to Dr. Baugh as the medical referee. Dr. Kennedy saw appellant in January 2012, more 

than eight years after the employment injury. While he diagnosed complex regional pain 

syndrome, he merely noted a history that her hand was caught in a door in 2003. He did not 

provide sufficient opinion on causal relation or address how such condition required further 

medical treatment related to the accepted injury.17

In treatment records dated March 1, 2011 to August 8, 2012, Dr. Shaw reiterated his 

opinion as to appellant’s complaints of left upper extremity weakness and the diagnosis of left 

arm RSD. The Board notes that Dr. Shaw was on one side of the conflict in medical opinion for 

which appellant was referred to Dr. Baugh. It is well established that reports from a physician 

who was on one side of a medical conflict that an impartial specialist resolved, are generally 

insufficient to overcome the weight accorded to the report of the impartial medical examiner or 

to create a new conflict.18 Dr. Shaw’s additional medical record essentially reiterated his prior 

findings regarding appellant’s left arm and his opinion on causal relationship and need for 

medical care. He did not specifically address the January 24, 2012 bone scan of the left arm 

which was reported as normal. Dr. Shaw’s reports are not sufficient to overcome the weight of 

medical opinion accorded Dr. Baugh as the impartial medical specialist. 

The Board finds that the medical evidence appellant submitted with her reconsideration 

requests is of diminished probative value and insufficient to meet her burden to establish the 

need for ongoing medical treatment.19

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

The Board finds that OWCP properly terminated appellant’s medical benefits for left 

upper extremity RSD. Further, she did not establish that she had any continuing employmentrelated residuals after June 9, 2010. 

 17 See S.S., 59 ECAB 315 (2008). 

18 I.J., 59 ECAB 408 (2008). 

19 Supra note 17. 
8

ORDER 

IT IS HEREBY ORDERED THAT the September 26, 2012 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 19, 2014 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board