United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.T., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Rainier, OR, Employer 

__________________________________________ 

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Docket No. 15-1114 

Issued: February 1, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On April 20, 2015 appellant filed a timely appeal from an April 10, 2015 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 the claim. 

ISSUE 

The issue is whether appellant met her burden of proof to establish a recurrence of her 

medical conditions causally related to her March 9, 2002 employment injury. 

FACTUAL HISTORY 

On March 11, 2002 appellant, then a 48-year-old rural carrier associate, filed an 

occupational disease claim (Form CA-2) indicating that her arm, back, and leg had been 

bothering her for some time and that on March 9, 2002 her condition worsened after she heard a 

 1

 5 U.S.C. § 8101 et seq. 
2

“pop.” OWCP accepted the claim for left gluteus muscle strain.2

 The record indicates that 

appellant stopped work on July 3, 2002, returned to light duty on April 3, 2003, and returned to 

full duty on July 8, 2003. 

Appellant filed a recurrence of disability on May 14, 2004 alleging that on May 12, 2004 

she again stopped work due to the March 9, 2002 employment injury. By decision dated July 21, 

2004, OWCP expanded her claim to include lumbar strain and lumbar herniated nucleus 

pulposus and accepted that she had sustained disability as of May 12, 2004. Additional 

conditions of sprain of lumbosacral (joint)/(ligament) and displacement of lumbar intervertebral 

disc without myelopathy were also accepted. The record substantiates that appellant received 

wage-loss benefits on the short-term rolls from May 12, 2004 until June 3, 2005. OWCP 

terminated appellant’s wage-loss compensation regarding this claim by decision dated 

June 3, 2005. 

On March 2, 2015 appellant filed a claim for a recurrence of disability (Form CA-2a) for 

medical treatment of the accepted injury-related back conditions. She claimed her back 

condition has not resolved. Appellant stated that her doctor treated her injuries under both the 

current claim and claim number xxxxxx974, which was accepted for bilateral carpal tunnel 

syndrome, but failed to submit bills to OWCP when she was treated for her back injury. She 

stated that her work-related back injury remained static until recently. Appellant indicated that 

her treating doctor retired and her accepted claim for back conditions had been closed, but that 

she now needed a new doctor and additional medical treatment. The employing establishment 

noted on the claim form that appellant was on OWCP periodic compensation rolls under claim 

number xxxxxx974. No medical evidence was submitted with her recurrence claim. 

In a February 13, 2015 letter, appellant explained that she saw the same doctor for her 

back and carpal tunnel syndrome conditions. She alleged that the doctor mistakenly thought she 

needed reports for her carpal tunnel claim and had focused on her wrist injury, which she 

indicated had caused pain for the past years and for which she receives compensation. Appellant 

stated that every three or four months, she saw her doctor for her back injury, but the doctor’s 

office failed to bill under the correct claim number. She subsequently learned that OWCP was 

not paying the bills for medical treatment of her back. 

In a March 4, 2015 letter, OWCP noted that there was limited evidence of medical 

treatment for appellant’s accepted back conditions since April 24, 2007. It requested that she 

provide additional factual evidence along with copies of all medical records for the work-related 

lumbar condition and a comprehensive, narrative medical report from her treating physician, 

which contained an opinion supported by medical rationale as to the relationship between her 

current medical conditions and the accepted injury. Appellant was afforded 30 days to submit 

the requested evidence. 

In response, OWCP received correspondence from appellant and OWCP regarding her 

authorized representatives; correspondence pertaining to a request for extension of time; 

 2

 Appellant also has an accepted claim for bilateral/lateral epicondylitis, with a date of injury of June 14, 2002 

under OWCP File No. xxxxxx943, and an accepted claim for bilateral carpal tunnel syndrome under OWCP File 

No. xxxxxx974. 
3

correspondence regarding bill payment issues; appellant’s supplemental statements of April 3, 6, 

and 9, 2015 and copies of diagnostic testing from 2014. 

Authorization requests and treatment reports from different physicians covering the 

period February 25, 2010 through March 26, 2015 were submitted.3

 

Medical reports from Dr. Donald S. Orr, a Board-certified neurologist, from 2010 

through 2014 were received. The majority of the reports pertained to appellant’s upper extremity 

conditions and occasionally mentioned low back pain syndrome. In treatment notes dated 

April 22, 2013 through September 16, 2014, Dr. Orr mentioned a low back condition, back pain, 

and lumbar-related conditions. In a July 17, 2014 report, he reported that appellant had 

significant low back pain, right upper extremity pain, and fully resolved left wrist pain. With 

respect to the back, Dr. Orr diagnosed low back pain syndrome. He noted that he was suspicious 

of an underlying discogenic lumbar pain component and noted results from an April 30, 2003 

magnetic resonance imaging (MRI) scan of the lumbar spine. In a September 16, 2014 report, 

Dr. Orr reported that appellant recognized, over the past week, a pain in her left groin and 

beginning today, a pronounced discomfort at her left hemipelvic area when she placed weight 

onto her left lower extremity. An assessment of lumbar disc herniation without myelopathy, 

sacroiliac pain, and low back pain syndrome was provided. Appellant received left-sided S1 

joint injection. Dr. Orr noted that he was suspicious that appellant’s low back generator was that 

of a damaged intervertebral disc with an internal annual tear. He suspected that she has 

developed, secondarily due to mechanical stresses, subluxation of her left sacroiliac joint, which 

manifested as left groin pain and gait difficulty. 

In a January 2, 2015 report, Dr. Orr summarized that on November 6, 2014 appellant was 

found to have a fracture in her left hip at the femoral neck. Appellant recalled in retrospect that 

in late August or early September she tripped going up steps at home and went back down about 

five of those steps while somehow maintaining an upright position as she landed hard on her 

feet. Dr. Orr noted that it now seemed that appellant very likely sustained the fracture at that 

time. After appellant was seen in mid-September her left hip pain intensified and her primary 

care physician took a radiograph of her left hip, which was read as normal. Dr. Daniel 

Nicholson, a Board-certified orthopedic surgeon, had appellant undergo a left hip MRI scan, 

which showed the fracture. Appellant was to undergo a bone density study. Dr. Orr advised that 

the bone density scan showed osteopenia at her femoral heads, just past borderline osteoporosis 

in her lumbar spine. He noted that Dr. Daniel Kingloff, a Board-certified orthopedic surgeon, 

had indicated that appellant would not require surgery for the nondisplaced fracture of the left 

femoral head. Dr. Orr related that appellant understood that her hip injury/fracture lay outside 

the purview of workers’ compensation. No assessment/diagnosis was provided regarding 

appellant’s back condition. 

Reports from Dr. Daniel A. Nicholson, a Board-certified orthopedic surgeon, were 

received and contained handwritten comments. In an October 15, 2014 report, he noted that 

appellant reported an onset of left hip pain/groin pain three weeks previously, but that there was 

no injury that caused the onset of the pain. The pain worsened approximately one week prior, 

 3

 Medical reports received for the period February 25, 2010 to March 19, 2013 pertained to treatment of 

appellant’s carpal tunnel and upper extremity conditions. 
4

after she stumbled and fell, landing on her left leg.4

 Dr. Nicholson found that appellant had a 

herniated lumbar disc, but no other back issues. Appellant had no previous history of injury to 

the hip and had not had any treatment. Dr. Nicholson noted that at this point in time the etiology 

of appellant’s pain was unclear. There were no radiographic signs of acetabular impingement or 

significant degenerative joint disease. Dr. Nicholson advised appellant’s known lumbar 

pathology may be playing a role in her complex of symptoms. However, he noted the majority 

of the pain appeared to be in the left groin. Additional diagnostic testing was recommended. 

In an October 27, 2014 report, Dr. Nicholson reported that appellant had a fractured hip. 

In an October 30, 2014 report, Dr. Nicholson diagnosed a closed fracture at the base of 

the neck of the femur, along with joint pain involving the pelvic region and thigh. Appellant was 

scheduled for surgery on November 3, 2014 for left hip percutaneous pinning. 

In a January 28, 2015 report, Dr. Kevin Sheahan, a Board-certified anesthesiologist and 

certified pain specialist, noted that appellant was seen for upper extremity pain. An assessment 

of reflex sympathetic dystrophy (RSD) upper extremity, lumbar spondylosis without myelo/facet 

arthrophy, and carpal tunnel syndrome was provided. 

In a March 13, 2015 report, Dr. Damon Kimes, a Board-certified family practitioner, 

reported that appellant was a new patient. He reported that appellant had seen another physician 

for her chronic lower back and left hip pain for over seven years, but the physician had retired 

and closed his office. Appellant reported a history of a work-related back strain in 2002 

followed by disc disease. She reported a left hip fracture in September, which a prior MRI scan 

showed was a fractured femoral head. Dr. Kimes noted his review of appellant’s records from 

Southeastern Interventional Pain Associates, including Dr. Orr’s notes, and provided 

examination findings. The following assessments were provided: encounter for long-term 

(current) use of other medications; lumbago; facet arthropathy lumbar and cervical; carpal tunnel 

syndrome; chronic pain syndrome; pain hip; sacroiliitis; lumbosacral radiculopathy; and cervical 

radiculopathy. Follow-up reports from Dr. Kimes dated March 26, 2015 contained the same 

assessments. 

By decision dated April 10, 2015, OWCP denied the recurrence claim and found that 

medical treatment was not authorized because the medical evidence was insufficient to establish 

a recurrence of appellant’s accepted conditions causally related to the March 9, 2002 accepted 

back conditions. 

LEGAL PRECEDENT 

A recurrence of a medical condition is defined as a documented need for further medical 

treatment after release from treatment for the accepted condition or injury.5

 Continuous 

treatment for the original condition or injury is not considered a recurrence of a medical 

 4

 A handwritten note on the report stated, “never told him I fell ... told him about when @ park with/ kids, when I 

hit that tree root hard & Tim had to help me back to the car.” 

5

 20 C.F.R. § 10.5(y). 
5

treatment nor is an examination without treatment.6

 As distinguished from a recurrence of 

disability, a recurrence of a medical condition does not involve an accompanying work 

stoppage.7

 

It is the employee’s burden to establish that the claimed recurrence is causally related to 

the original injury.8 Causal relationship is a medical issue that can generally be resolved only by 

rationalized medical opinion evidence.9 This requires furnishing medical evidence from a 

physician who, on the basis of a complete and accurate factual and medical history, concludes 

that the condition is causally related to the employment injury and who supports that conclusion 

with sound medical reasoning.10 Where no such rationale is present, medical evidence is of 

diminished probative value.11 

In order to establish that a claimant’s alleged recurrence of the condition was caused by 

the accepted injury, medical evidence of bridging symptoms between her present condition and 

the accepted injury must support the physician’s conclusion of a causal relationship.12 

ANALYSIS 

OWCP accepted that appellant’s March 9, 2002 employment injury resulted in left 

gluteus muscle strain, sprain of back, lumbar region, sprain of lumbosacral (joint)/(ligament), 

and displacement of lumbar intervertebral disc without myelopathy. Appellant returned to work. 

She was eventually totally disabled as a result of conditions in other accepted claims and placed 

on the periodic compensation rolls. On March 2, 2015 OWCP received appellant’s Form CA-2a 

claim for a recurrence due to her March 9, 2002 employment injury. 

Appellant submitted authorization requests and treatment reports from different 

physicians covering the period February 25, 2010 through March 26, 2015. The medical records 

from February 25, 2010 to March 19, 2013 do not mention a back condition. Rather, they are 

treatment notes for carpal tunnel and upper extremity problems. In treatment notes for the period 

April 22, 2013 through September 16, 2014, Dr. Orr mentioned a low back condition, back pain 

and lumbar-related conditions, but provided no opinion with medical rationale as to how the 

diagnoses were due to, caused by, or related to the original injury. Medical evidence that does 

not offer any opinion regarding the cause of an employee’s condition is of limited probative 

value on the issue of causal relationship.13 Although Dr. Orr did not formally discharge 

 6 Id. 

7 Id. at § 10.5(x). 

8 Id. at § 10.104. See also Mary A. Ceglia, 55 ECAB 626, 629 (2004). 

9 See Jennifer Atkerson, 55 ECAB 317 (2004). 

10 Dennis E. Twardzik, 34 ECAB 536 (1983); Max Grossman, 8 ECAB 508 (1956). 

11 Michael Stockert, 39 ECAB 1186, 1187-88 (1988); see Ronald C. Hand, 49 ECAB 113 (1957). 

12 Mary A. Ceglia, 55 ECAB 626 (2004). 

13 Jaja K. Asaramo, 55 ECAB 200 (2004). 
6

appellant from treatment for her back conditions, a sufficiently lengthy gap in treatment has the 

same effect as a formal discharge.14 Appellant has the burden of proof to establish that her need 

for medical treatment beginning April 22, 2013 through September 16, 2014 was causally related 

to her March 9, 2002 employment injury. 

In September 2014 appellant reported left groin pain and discomfort in her left 

hemipelvic area, which was later diagnosed as left hip fracture at the femoral neck. In his 

September 16, 2014 report, Dr. Orr reported that appellant recognized, over the past week, a pain 

in her left groin and beginning today, a pronounced discomfort at her left hemipelvic area when 

she placed weight onto her left lower extremity. An assessment of lumbar disc herniation 

without myelopathy, sacroiliac pain, and low back pain syndrome was provided. Dr. Orr 

subsequently related in his January 2, 2015 report that appellant was found to have a fracture in 

her left hip at the femoral neck. He noted that appellant recalled in retrospect that in late August 

or early September she tripped while walking up steps at home and fell back down 

approximately five of those steps while somehow maintaining an upright position as she landed 

hard on her feet onto the landing. Dr. Orr noted that she very likely sustained fracture at that 

time. While he previously suspected a damaged intervertebral disc with an annual tear, and 

subluxation of her left sacroiliac joint secondarily due to mechanical stresses, which manifested 

as left groin pain and gait difficulty, it is not possible to verify that appellant’s current condition 

is causally related to the original injury due to the void of ongoing treatment records or any 

medical evidence bridging the gap of treatment. Furthermore, the history of injury reflects that 

appellant either tripped going up steps or stumbled over a tree root and fell. 

The October 15, 2014 treatment note from Dr. Nicholson provided a history that 

appellant stumbled and fell landing on her left leg. The handwritten note on the report alleged 

that “never told him I fell ... told him about when @ park with/ kids, when I hit that tree root 

hard & Tim had to help me back to the car.” This exposure over stumbling over a tree root and 

falling and/or tripping while walking up steps are incidents which break the chain of causation to 

establish a recurrence of disability. Additionally, the medical histories provided to Dr. Orr and 

Dr. Nicholson are inconsistent and cast doubt on the validity of the claim. 

Appellant also submitted reports dated January 28, 2015 from Dr. Sheahan, and 

March 13, 2015 from Dr. Kimes. While these physicians provided diagnoses of appellant’s 

conditions, they did not offer any opinion regarding the cause of the diagnosed conditions or 

whether they required further medical treatment. The other medical reports submitted fail to 

provide a rational medical opinion with an accurate factual and medical history causally relating 

appellant’s current condition to the March 9, 2002 injury. 

The Board finds that the evidence submitted by appellant lacks adequate rationale to 

establish a causal connection between the alleged recurrence of her medical conditions and the 

accepted employment injury. Appellant had the burden of submitting sufficient medical 

evidence to document the need for further medical treatment. She did not submit such evidence 

as required and failed to establish a need for continuing medical treatment.15

 14 See Kent W. Rasmusen, Docket No. 04-1137 (issued August 4, 2004). 

15 See P.Q., Docket No. 14-1905 (issued May 26, 2015); J.F., 58 ECAB 331 (2006). 
7

On appeal appellant notes her frustration with an OWCP claims examiner and her desire 

to reopen her claim. In a separate letter, she also expressed her belief that her former physician, 

Dr. Orr, engaged in improper billing practices and that this gave the appearance that she stopped 

treatment for her back. As noted, appellant’s recurrence claim was denied as the medical 

evidence lacked adequate rationale to establish a causal connection between the alleged 

recurrence of her medical condition and the accepted employment injury. She did not submit 

such evidence as required and failed to establish a need for continuing medical treatment. 

Appellant may submit new evidence or argument as part of a formal 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 appellant has not met her burden of proof to establish a recurrence 

of her medical conditions causally related to her March 9, 2002 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated April 10, 2015 is affirmed. 

Issued: February 1, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board