United States Department of Labor 

Employees’ Compensation Appeals Board 

___________________________________________

I.H., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, 

MAINTENANCE WORKING CAPITAL FUND, 

RANDOLPH AIR FORCE BASE, TX, Employer 

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Docket No. 15-1798 

Issued: March 17, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On August 31, 2015 appellant filed a timely appeal from an August 14, 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 this case. 

ISSUE 

The issue is whether OWCP met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits effective August 23, 2015. 

FACTUAL HISTORY 

On February 9, 2001 appellant, then a 54-year-old air craft electrician, filed an 

occupational disease claim (Form CA-2) alleging that his right hand conditions caused him to 

                                                             1

 5 U.S.C. § 8101 et seq. 
2

overuse his left hand in performing his duties.2

 He stopped work on April 26, 2001. Initial 

medical reports diagnosed left hand and wrist tendinitis. February 21, 2001 left hand x-rays 

showed osteoarthritis of the interphalangeal joint of the thumb and index finger. 

Electrodiagnostic testing of the same date was consistent with moderate focal median neuropathy 

around the left wrist with motor and sensory involvement, but no evidence of radiculopathy. 

OWCP accepted the claim for left hand tendinitis and left carpal tunnel syndrome. 

Appellant received compensation benefits and was placed on the periodic compensation rolls. 

As part of receiving compensation under the periodic rolls, he is required to send to OWCP 

medical reports verifying his continuing disabled status. 

In a December 17, 2013 report, Dr. Raju M. Vanapalli, a Board-certified orthopedic 

surgeon and treating physician, noted appellant’s history of injury and treatment. He determined 

that appellant’s chief complaint was pain in the left elbow and along the left forearm into the 

fingers. 

Examination of the elbows bilaterally revealed no fixed flexion deformity, but negative 

10 degrees short of full extension to 130 degrees of flexion was present. Dr. Vanapalli found 

that the pain was radiating from the left elbow to the wrist and fingers. He found for the left 

wrist, that there was slight swelling on both sides, with mild crepitus. Dr. Vanapalli determined 

that appellant had forward flexion and dorsiflexion to 40 degrees and ulnar and radial deviation 

to 10 degrees. He examined the fingers of the left hand and found that the left thumb tip could 

be brought to the base of all the other fingers. Dr. Vanapalli further determined that, for the rest 

of the digits, appellant could bend and barely touch the palm from neural extension. He 

determined that sensations and circulation of the left hand were satisfactory, but there was 

paresthesia typically over the carpal tunnel distribution on both sides, but this had been released 

and improved since the surgeries, according to appellant. Dr. Vanapalli advised that appellant 

had a documented history of polyneuropathy related to diabetes mellitus. He recommended 

continued exercises, no yard work, and to return in approximately one year for a regular 

checkup. 

On March 20, 2014 OWCP referred appellant for a second opinion to Dr. Alexander N. 

Doman, a Board-certified orthopedic surgeon, to determine whether appellant continued to have 

any work-related residuals and or restrictions. In a May 13, 2014 report, Dr. Doman, noted 

appellant’s history of injury and treatment and provided results on examination. His findings 

included a well-healed surgical scar over the right and left wrist overlying the carpal tunnel. 

Dr. Doman also found full range of motion of the left and right wrist. He determined that 

appellant had a well-healed fusion of the interphalangeal joint of the opposite right thumb and 

his pulses were normal. Dr. Doman also indicated that appellant had decreased sensation to light 

touch in all the fingers of both hands as well as the feet. He diagnosed left carpal tunnel 

syndrome and indicated that it had resolved. Dr. Doman explained that there was no evidence of 

ongoing tendinitis of the left hand and wrist. He advised that the nonspecific decreased feeling 

in appellant’s fingers in the left hand was present in all four extremities and he attributed it to 

                                                             2

 The record indicates that appellant later had filed several claims including claims that OWCP accepted for 

aggravation of right thumb degenerative joint disease, status post fusion, as well as right hand carpal tunnel 

syndrome, status post release. Appellant received compensation benefits. These other claims are not before the 

Board on the present appeal. 
3

appellant’s nonwork-related medical condition of diabetes mellitus. It was Dr. Doman’s firm 

and definite opinion that appellant’s left hand condition was not due to the work injury of 

February 2, 2001. He explained that the present condition was related to a progressive 

neuropathy from diabetes and not to the accepted left carpal tunnel syndrome. Dr. Doman 

explained that the median nerve testing objectively showed no other incident of any further 

carpal tunnel syndrome. He opined that appellant was able to return to gainful employment. 

Dr. Doman further advised that the hand condition was not work related and reiterated that 

appellant’s left carpal tunnel syndrome had resolved. 

In an August 4, 2014 report, Dr. Vanapalli noted seeing appellant after Dr. Doman’s 

examination. He advised that he had reviewed the second opinion physician’s report. 

Dr.Vanapalli explained that he had been an orthopedic surgeon for 45 years, and a hand surgery 

fellow for 35 years, and had examined and treated many individuals with such conditions. He 

opined that he “strongly” disagreed with Dr. Doman’s second opinion report. Dr. Vanapalli 

advised that the symptoms and signs of carpal tunnel syndrome predated the onset of diabetes 

mellitus. He indicated that diabetes mellitus resulted in permanent aggravation of carpal tunnel 

syndrome and would not cure the work-related carpal tunnel syndrome. Dr. Vanapalli advised 

that, after many years of treating carpal tunnel syndrome as a hand surgeon, “it is my firm and 

definite opinion that there is no confirmatory test to prove that the work-related carpal tunnel 

syndrome was resolved, while the claimant continued to experience and suffer with the same 

subjective complaints and revealed the same objective findings.” 

On December 2, 2014 OWCP referred appellant along with a statement of accepted facts, 

and the medical record to Dr. Norman L. Donati, a Board-certified orthopedic surgeon, for an 

impartial medical evaluation to resolve the conflict in opinion between Drs. Vanapalli and 

Doman on the nature and extent of any ongoing residuals of the work injury and appellant’s 

resulting ability to work. 

In a report dated December 15, 2014, Dr. Donati noted appellant’s history of injury and 

treatment and provided findings on examination. His findings included full left elbow flexion 

and extension with no swelling. Appellant described pain on full flexion and extension posterior 

and anterior elbow, but there was no instability and no crepitus. The left forearm was diffusely 

tender in every area and no matter where Dr. Donati touched appellant described significant pain. 

Dr. Donati noted that appellant had skin color and texture changes which appellant advised that 

he had since Vietnam. He found no swelling, redness, or warmth of the left forearm. 

Regarding the left wrist, Dr. Donati found full range of motion with pain on all 

movement and even more pain on extremes of flexion and extension, and diffuse wrist 

tenderness more dorsal than volar, with no effusion and no instability. 

For the left hand, appellant had diffuse tenderness of all areas of his hand no matter 

where he touched and slightly more across the A-l pulleys. Dr. Donati explained that there was 

no swelling of his left hand passively and noted that he could move his metacarpophalangeal 

(MP) and proximal interphalangeal (PIP) joints completely and with full motion, although 

appellant described pain on doing this. Appellant’s distal interphalangeal (DIP) joints had slight 

loss of motion, with the left index finger displaying enlargement of the joint, and the third finger 

had a slight mallet deformity. He found that the first carpometacarpal (CMC) joint had near 

normal range of motion with pain and slight crepitus, but there was no instability with a normal 
4

IP joint of the thumb. The pulses were intact and the two-point discrimination testing revealed 

seven to eight millimeters at all fingers, but was inconsistent. Appellant had definite sensation to 

sharp pressure and a negative Tinel’s sign at the median nerve. 

Dr. Donati noted that when the median nerve was tapped appellant described pain 

shooting up his left forearm in a nonspecific way and not into his fingers. He also advised that 

appellant had the exact same sensation when he tapped over his ulnar nerve at the wrist. 

Dr. Donati indicated that appellant had a tender ulnar nerve at the elbow, but a negative 

percussion sign. He advised that manual muscle testing of appellant’s arm revealed an extremely 

poor effort and the testing was not accurate. Appellant also would not give a good effort to 

pinch and grip and adduction abduction of the fingers, but he was able to do all of this. 

Dr. Donati found “absolutely no evidence of any intrinsic wasting of his left hand.” He 

diagnosed chronic left upper extremity pain with no evidence of carpal tunnel syndrome or 

residuals of carpal tunnel syndrome. 

Dr. Donati found that appellant’s symptoms were inconsistent with carpal tunnel 

syndrome, but were consistent with nonspecific musculoskeletal complaints. He noted signs of 

arthritis and advised that appellant’s symptoms were not consistent with any form of carpal 

tunnel syndrome. Dr. Donati advised that appellant was diabetic and had a known peripheral 

neuropathy and thus many of his symptoms could be related to that, but that he could not provide 

a specific diagnosis.” There was no evidence of any specific carpal tunnel of the left upper 

extremity and all symptoms and physical findings were consistent with nonspecific 

musculoskeletal pain which was possibly related to peripheral neuropathy. Dr. Donati also 

indicated that recent diagnostic testing showed no evidence of carpal tunnel. He opined that 

appellant could return to work with full use of his left hand, and if appellant was unable to work, 

it had nothing to do with the carpal tunnel syndrome and it was purely due to some other type of 

musculoskeletal or neurological problem that he was unable to diagnose. In a December 16, 

2014 work capacity report, Dr. Donati noted appellant’s history and advised that the accepted left 

hand carpal tunnel syndrome had resolved. 

In a January 9, 2015 report, Dr. Vanapalli provided examination findings and diagnosed 

bilateral carpal tunnel syndrome, with residual symptoms as well as objective findings, diabetic 

peripheral neuropathy, migraine headaches, tennis elbow on the left, and severe degenerative 

arthritis of the fingers. He opined that the work-related conditions continued, were worsening 

and disabling, and opined that appellant was not capable of returning to any type of gainful 

employment. 

On June 11, 2015 OWCP issued a notice of proposed termination of compensation. It 

proposed to terminate appellant’s wage-loss compensation and medical benefits on the basis that 

the weight of the medical evidence, as demonstrated by the opinion of Dr. Donati, established 

that appellant no longer had disability or residuals of the work injury. Appellant was given 30 

days to submit additional evidence or argument. 

OWCP also received February 26 and March 26 and 31, 2015 hospital notes and 

laboratory reports, to include reports from Dr. Awharitefe Urhuago, a family practitioner, who 

advised that appellant came to him with chest pain and advised that it was a possible syncopal 

episode. It also received a March 26 and April 9, 2015 report from Dr. Talley F. Culclasure, a 

Board-certified internist and a May 7, 2015 report from Dr. Olena Klindukhova, a Board-
5

certified internist. They were related to appellant’s hospitalization of February 26, 2015 for a 

possible syncopal episode. OWCP also received copies of previously submitted medical 

evidence. 

In June 29, 2015 reports, Dr. Vanapalli again diagnosed bilateral carpal tunnel syndrome, 

status post release with residual symptoms as well as objective findings, diabetic neuropathy, 

tennis elbow on the left, resolved, and triggering of the left middle finger, resolved, degenerative 

arthritis of the finger joints still present, but range of movements improved since earlier 

examinations. He advised that appellant continued to experience disability due to his hands 

because of the persistent signs and symptoms of bilateral carpal tunnel syndrome. 

In a July 9, 2015 report, Dr. Udaya G. Moti, an internist, advised that appellant had 

multiple medical problems which included severe arthritis of the spine and a history of 

depression. He noted that appellant also had diabetes and high blood pressure and was on very 

strong medications. Dr. Moti opined that appellant was not employable for the rest of his 

lifetime in any occupation. 

In an August 14, 2015 decision, OWCP terminated appellant’s wage-loss compensation 

and medical benefits effective August 23, 2015. It found that the weight of medical evidence 

rested with Dr. Donati and supported that appellant no longer had any disability from work 

stemming from the accepted work-related conditions.

LEGAL PRECEDENT 

Once OWCP accepts a claim and pays compensation, it bears the burden to justify 

modification or termination of benefits.3 Having determined that an employee has a disability 

causally related to his or her federal employment, OWCP may not terminate compensation 

without establishing either that the disability has ceased or that it is no longer related to the 

employment.4 

Section 8123(a) of FECA provides, in pertinent part: “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.”5

 Where a case is 

referred to an impartial medical specialist for the purpose of resolving a conflict, the opinion of 

                                                             3 Curtis Hall, 45 ECAB 316 (1994). 

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

5

 5 U.S.C. § 8123(a); see also Raymond A. Fondots, 53 ECAB 637 (2002); Rita Lusignan (Henry Lusignan), 45 

ECAB 207, 210 (1993). 
6

such specialist, if sufficiently well rationalized and based on a proper factual and medical 

background, must be given special weight.6

ANALYSIS 

In the instant case, OWCP accepted that appellant sustained left hand tendinitis and left 

carpal tunnel syndrome. It developed the claim and determined that a conflict of medical 

opinion existed between Dr. Doman, the second opinion physician, who found that appellant had 

no work-related residuals and could perform his usual job, and Dr. Vanapalli, the treating 

physician, who disagreed with Dr. Doman and indicated that the accepted conditions had not 

resolved. Therefore, OWCP properly referred appellant to Dr. Donati, a Board-certified 

orthopedic surgeon, for an impartial medical examination to resolve the conflict, pursuant to 5 

U.S.C. § 8123(a). 

In his December 15, 2014 report, Dr. Donati noted appellant’s history and findings on 

examination, such as full range of motion in the left wrist with no effusion and no instability. 

There was no swelling of appellant’s left hand passively and he could move his joints completely 

and with full motion. The pulses were intact, but two-point discrimination testing was 

inconsistent. Dr. Donati found “absolutely no evidence of any intrinsic wasting of [appellant’s] 

left hand.” He diagnosed chronic left upper extremity pain with no diagnostic evidence of carpal 

tunnel syndrome or residuals carpal tunnel syndrome. 

Dr. Donati determined that appellant’s symptoms were not consistent with carpal tunnel 

syndrome, but were consistent with nonspecific musculoskeletal complaints. He also found 

signs of arthritis, and advised that appellant’s symptoms of discomfort were not consistent with 

any form of carpal tunnel syndrome. Dr. Donati opined that all symptoms and physical findings 

were consistent with nonspecific musculoskeletal pain which was possibly related to peripheral 

neuropathy. He opined that appellant could return to work with full use of his left hand. 

Dr. Donati pointed out that if appellant was unable to work, it had nothing to do with the carpal 

tunnel syndrome and it was purely due to some other type of musculoskeletal or neurological 

problem that he was unable to diagnose. In a December 16, 2014 work capacity report, he 

advised that the accepted conditions had resolved and that appellant had reached maximum 

medical improvement. 

The Board finds that Dr. Donati’s opinion is entitled to the special weight of the medical 

evidence as an impartial medical examiner. Dr. Donati’s report is sufficiently well rationalized 

and based upon a proper factual background and thorough examination. OWCP properly relied 

upon his reports in finding that appellant no longer had any employment-related residuals and 

was no longer disabled from work due to the accepted employment injuries. Dr. Donati did not 

attribute any current left hand or arm conditions to appellant’s employment. 

Prior to finalizing the termination, OWCP received January 9 and June 29, 2015 reports 

from Dr. Vanapalli, who argued that appellant had objective findings of bilateral carpal tunnel 

syndrome. Dr. Vanapalli explained that appellant continued to experience disability due to his 

hands because of the persistent signs and symptoms of bilateral carpal tunnel syndrome. 

                                                             6 See Roger Dingess, 47 ECAB 123, 126 (1995); Juanita H. Christoph, 40 ECAB 354, 360 (1988); Nathaniel 

Milton, 37 ECAB 712, 723-24 (1986). 
7

However, the Board notes that as Dr. Vanapalli had been on one side of the conflict in the 

medical opinion that the impartial specialist resolved, the treating physician’s report was 

insufficient to overcome the special weight accorded the impartial specialist or to create a new 

medical conflict.7

 Other medical reports submitted by appellant did not address the accepted 

conditions. 

For these reasons, OWCP properly terminated appellant’s wage-loss compensation and 

medical benefits effective August 23, 2015. Accordingly, the Board shall affirm OWCP’s 

August 14, 2015 termination decision. 

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 wage-loss compensation and 

medical benefits effective August 23, 2015, as he was no longer disabled from work as a result 

of his work-related injury. 

ORDER 

IT IS HEREBY ORDERED THAT the August 14, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 17, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

                                                             7 Alice J. Tysinger, 51 ECAB 638 (2000); Barbara J. Warren, 51 ECAB 413 (2000).