United States Department of Labor 

Employees’ Compensation Appeals Board 

____________________________________________

L.B., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION NEW JERSEY 

HEALTH CARE SYSTEM, Lyons, NJ, Employer 

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Docket No. 14-1687 

Issued: June 10, 2015 

Appearances: Case Submitted on the Record

James D. Muirhead, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On August 4, 2014 appellant, through her attorney, filed a timely appeal of a July 3, 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 to consider the merits of the case. 

ISSUES 

The issues are: (1) whether OWCP has met its burden of proof to terminate appellant’s 

wage-loss compensation and medical benefits effective May 8, 2013; and (2) whether appellant 

has established any continuing disability or medical residuals after that date due to her May 16, 

2012 employment injury. 

Counsel argued that OWCP failed to meet its burden of proof to terminate appellant’s 

compensation and medical benefits due to an existing conflict of medical opinion evidence. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On May 18, 2012 appellant, then a 68-year-old nurse, filed a traumatic injury claim 

alleging that on May 16, 2012 that she sustained multiple contusions when the knob came off of 

a door she was closing, causing her to fall on the floor and land on her right hip, right shoulder, 

and the back of her head. OWCP accepted her claim for contusion of the right hip, contusion of 

the right shoulder, contusion of the scalp, and contusion of the coccyx on July 9, 2012. 

Appellant’s attending physician, Dr. Jerry L. Jurado, a family practitioner, completed 

form reports on June 6 and 14, 2012 and diagnosed contusions of the right shoulder, hip, scalp, 

and the coccyx. On July 21, 2012 he diagnosed right hip pain, lower back pain, and severe 

vertigo. Dr. Jurado completed a form report on September 11, 2012 diagnosing lower back pain 

and right hip pain. He continued to support appellant’s total disability for work. 

Dr. Monica Mehta, a Board-certified physiatrist, completed a form report on 

September 29, 2012 and diagnosed lumbosacral pain syndrome and found that appellant was 

totally disabled. 

OWCP referred appellant for a second opinion examination with Dr. Jeffrey Lakin, a 

Board-certified orthopedic surgeon, on September 13, 2012. In his September 27, 2012 report, 

Dr. Lakin described appellant’s history of injury and her accepted employment conditions. He 

noted that her right hip pain worsened with prolonged standing and walking. Dr. Lakin also 

stated that appellant’s shoulder pain had improved, but that she continued to experience pain in 

her lower back and coccyx pain increased with long sitting or standing, radiating to the right 

buttocks. Appellant was able to get on and off of the examination table with minimal difficulty. 

Upper extremity sensation was intact and that her head was atraumatic. Dr. Lakin reported that 

appellant’s shoulder examination had negative impingement with negative anterior apprehension 

and negative drop arm test and negative cross arm adduction test. Appellant was nontender over 

the sternoclavicular and acromioclavicular joints. 

Dr. Lakin reported that examination of the thoracic and lumbosacral spine revealed no 

tenderness in the lower right paravertebral musculature and no tenderness in the bilateral 

sacroiliac joints or bilateral sciatic notches. Appellant could bring her fingers within six inches 

from her toes on forward flexion. Dr. Lakin stated that ankle and knee jerks were equal 

bilaterally with normal muscle strength in the lower extremities. He reported full range of 

motion in the right hip symmetric to the left with a negative Romberg’s sign and an 

unremarkable gait. Dr. Lakin also reviewed a May 29, 2012 lumbar spine magnetic resonance 

imaging (MRI) scan and found multilevel disc bulges and herniations as well as grade 1 

anterolisthesis of L4 on L5 with spinal canal stenosis at L4-5 and a right paracentral annular tear 

at L5-S1. He found that appellant’s right hip MRI scan showed mild degenerative changes in 

both hips with mild insertional tendinosis involving the bilateral gluteus medius muscles. 

Dr. Lakin reviewed the films and found no arthritis. He concluded that appellant had minimal 

tenderness to the cervical and lumbosacral spine with an unremarkable right shoulder 

examination. Dr. Lakin opined that she had no disabling residuals of the accepted conditions and 

that there was no need for any further treatment due to her employment-related conditions. He 

stated that appellant was not disabled and was capable of returning to her full-duty, date-ofinjury position. Dr. Lakin further opined that there were no objective findings that she 
3

experienced an aggravation of a prior condition as a result of the employment injury. He 

indicated that appellant had reached maximum medical improvement. 

Dr. Mehta completed a form report on October 19, 2012 and opined that appellant could 

not return to work. She diagnosed cervical radiculopathy and an illegible lumbosacral condition 

with coccyx contusion. Dr. Mehta completed a narrative report on October 12, 2012 and listed 

appellant’s reported back pain, inability to stand and walk, neck pain, dizziness, and right 

shoulder pain. She described appellant’s employment injury. Dr. Mehta listed her findings on 

physical examination as limited range of motion of the lumbar spine, with multiple varicosities 

in the lower legs. Appellant had normal range of motion of the shoulders with pain. She had 

difficulty in ambulation on toes as well as on heels, with dizziness when she lied down in a 

supine position. Appellant demonstrated a broad-based antalgic gait. Dr. Mehta diagnosed 

probable lumbosacral pain, dizziness, and vertigo secondary to her employment-related head 

trauma. She suggested that appellant had intracranial pathology which required 

electroencephalogram (EEG) testing. Dr. Mehta also diagnosed probable cervical pain 

syndrome, probable cervical radiculopathy, probable rotator cuff tendinitis, and probable 

lumbosacral radiculopathy. She opined, “At the present time, it is my opinion within reasonable 

medical probability that the above complaints are permanent in nature and are due to the trauma 

sustained while at work on May 16, 2012. Dr. Mehta completed a form report on November 16, 

2012 and diagnosed lumbosacral radiculopathy and herniated disc. She indicated with a 

checkmark “yes” that this condition was caused or aggravated by an employment activity. 

OWCP proposed to terminate appellant’s wage-loss compensation and medical benefits 

in a letter dated December 18, 2012. It found that Dr. Lakin did not support appellant’s 

continuing disability or her need for additional medical treatment due to her accepted 

employment-related conditions. OWCP further noted that Dr. Mehta’s reports were speculative 

and did not provide medical reasoning to support causal relationship between appellant’s 

additional diagnosed conditions and her accepted employment injury. 

Dr. Mehta submitted a narrative report dated December 26, 2012 and described 

appellant’s employment injury and her medical treatment. She reported loss of range of motion 

in the cervical and lumbar spine and in both shoulders. Dr. Mehta found that sensations were 

diminished in the L5-S1 and C5-6 dermatomes. She stated that electromyogram (EMG) studies 

revealed the presence of right S1 radiculopathy with a large fiber right deep peroneal neuropathy 

at the fibular head as well as bilateral C6-7 radiculitis and moderate left median 

mononeuropathy. Appellant’s MRI scan of the lumbar spine demonstrated multilevel disc 

bulges and herniations with anterolisthesis of grade 1 at L4-5, spinal canal stenosis at L4-5 and 

right paracentral annual tear, and disc bulging at L5-S1 contacting the exiting right L5 and 

descending right S1 nerve roots. Dr. Mehta diagnosed cervical disc herniations, cervical spinal 

stenosis, cervical radiculopathy, peripheral nerve compromise, lumbar disc herniation, and neural 

foraminal stenosis with dizziness. She stated, “These complaints are due to trauma sustained 

while at work.” Dr. Mehta found that appellant was totally disabled. She further opined that 

OWCP had accepted incorrect diagnoses and that appellant’s correct diagnosis was lumbosacral 

radiculopathy. 
4

Dr. Mehta completed an additional form report on January 4, 2013 and diagnosed 

cervical and lumbar disc herniations as well as vertigo. She indicated with a checkmark “yes” 

that appellant’s conditions were caused or aggravated by her employment. 

OWCP requested clarification from Dr. Lakin on February 26, 2013. In a report dated 

March 4, 2013, Dr. Lakin stated that appellant had no objective findings in her right shoulder 

with full motion, no tenderness, and normal motor strength. He stated that appellant’s 

employment injury had resulted in a contusion to the right shoulder and no objective findings in 

the right hip as she had full range of motion and an unremarkable gait. Dr. Lakin further noted 

that appellant’s head was atraumatic. He stated that appellant’s coccyx and lower back were 

essentially unremarkable with forward flexion to within six inches of her toes and that she was 

intact neurologically. Dr. Lakin found that appellant’s accepted conditions had resolved. He 

stated that appellant was capable of performing her date-of-injury job as a nurse with excellent 

function of the spine and extremities. 

OWCP issued a notice of proposed termination on April 3, 2013 and again proposed to 

terminate appellant’s wage-loss compensation and her medical benefits due to her accepted 

employment injuries. It found that Dr. Lakin’s reports were entitled to the weight of the medical 

evidence. 

By decision dated May 8, 2013, OWCP terminated appellant’s wage-loss compensation 

and medical benefits effective that date based on Dr. Lakin’s reports. 

In a report dated May 17, 2013, Dr. Mehta reviewed her treatment of appellant and 

described the employment injury. She discussed test results and diagnosed positional nystagmus 

with aggravation secondary to the trauma sustained after the fall at work, cervical disc herniation 

due to the trauma at work, lumbar disc herniation due to the trauma at work, internal 

derangement of the shoulder due to the trauma at work, and gluteus medius and gluteus minimus 

tendinitis due to the trauma at work and microvascular ischemic changes in the internal auditory 

canals aggravated due to the trauma at work. Dr. Mehta opined that appellant was totally 

disabled. 

Appellant requested a review of the written record by an OWCP hearing representative 

on May 17, 2013. She retired from the employing establishment on June 30, 2013. Dr. Mehta 

submitted an additional report dated July 26, 2013 repeating her earlier findings and conclusions. 

By decision dated September 6, 2013, an OWCP hearing representative found that 

OWCP met its burden of proof to terminate appellant’s wage-loss and compensation benefits. 

He found that Dr. Lakin’s reports were entitled to the weight of the medical evidence. The 

hearing representative noted that Dr. Mehta did not provide any rationale in support of her 

opinion that appellant’s employment incident resulted in more serious diagnoses than those 

accepted by OWCP. 

Counsel requested reconsideration on April 8, 2014. He reviewed Dr. Lakin’s report and 

noted that the report did not discuss diagnostic test results. Counsel argued that there was a 

conflict of medical opinion evidence between Dr. Mehta and Dr. Lakin. 
5

By decision dated July 3, 2014, OWCP denied modification of the September 6, 2013 

OWCP hearing representative’s decision. 

LEGAL PRECEDENT -- ISSUE 1 

Once OWCP accepts a claim, it has the burden of proving that the disability has ceased or 

lessened in order to justify termination or modification of compensation benefits.2

 After it has 

determined that an employee has disability causally related to his or her federal employment, 

OWCP may not terminate compensation without establishing that the disability has ceased or 

that it is no longer related to the employment.3

 Furthermore, the right to medical benefits for an 

accepted condition is not limited to the period of entitlement for disability.4

 To terminate 

authorization for medical treatment, OWCP must establish that appellant no longer has residuals 

of an employment-related condition which require further medical treatment.5

 

A medical report is of limited probative value on a given medical question if it is 

unsupported by medical rationale.6

 Medical rationale includes a physician’s detailed opinion on 

the issue of whether these is a causal relationship between the claimant’s diagnosed condition 

and the implicated employment activity. The opinion of the physician must be based on a 

complete factual and medical background of the claim, 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 specific employment activity or factors identified by the 

claimant.7

ANALYSIS -- ISSUE 1 

Appellant fell in the performance of duty on May 16, 2012 and OWCP accepted her 

claim for contusion of the right hip, contusion of the right shoulder, contusion of the scalp and 

contusion of the coccyx on July 9, 2012. Her attending physician, Dr. Jurado, continued to 

support appellant’s total disability for work through September 11, 2012 diagnosing lower back 

pain and right hip pain. Dr. Mehta examined appellant on September 29, 2012 and diagnosed 

lumbosacral pain syndrome finding she was totally disabled. 

OWCP then referred appellant for a second opinion evaluation with Dr. Lakin, who 

reviewed the statement of accepted facts and performed a physical examination. Dr. Lakin stated 

that appellant was able to get on and off the examination table with minimal difficulty and that 

she had an unremarkable gait. He reported that upper extremity sensation was intact and that her 

head was atraumatic. Dr. Lakin reported that appellant had negative impingement of the right 

 2 Mohamed Yunis, 42 ECAB 325, 334 (1991). 

3 Id.

4 Furman G. Peake, 41 ECAB 361, 364 (1990). 

5 Id.

6 T.F., 58 ECAB 128 (2006). 

7 A.D., 58 ECAB 149 (2006). 
6

shoulder with negative anterior apprehension and negative drop arm test and negative cross arm 

adduction test. He stated that ankle and knee jerks were equal bilaterally with normal muscle 

strength in the lower extremities. Dr. Lakin reported full range of motion in the right hip 

symmetric to the left with a negative Romberg’s sign and an unremarkable gait. He concluded 

that appellant had minimal tenderness to the cervical and lumbosacral spine with an 

unremarkable right shoulder examination. Dr. Lakin opined that appellant had no disabling 

residuals of the accepted conditions and that there was no need for any further treatment due to 

her employment-related conditions. He stated that appellant was not disabled and was capable of 

returning to her full-duty, date-of-injury position. Dr. Lakin further opined that there were no 

objective findings that appellant experienced an aggravation of a prior condition as a result of the 

employment injury. 

In his supplemental report on March 4, 2013, Dr. Lakin responded to inquiries from 

OWCP and stated that appellant had no objective findings in her right shoulder with full motion, 

no tenderness and normal motor strength as a result of her employment-related right shoulder 

contusion. He reported no objective findings in the right hip noting appellant had full range of 

motion and an unremarkable gait. Dr. Lakin also stated appellant’s head was atraumatic on his 

examination. He reported that appellant’s coccyx and lower back were essentially unremarkable 

with forward flexion to within six inches of her toes. Dr. Lakin opined that appellant was intact 

neurologically. He concluded that appellant’s accepted conditions had resolved. Dr. Lakin 

stated that appellant was capable of performing her date-of-injury job as a nurse with excellent 

function of the spine and extremities. 

The Board finds that Dr. Lakin’s reports are sufficiently detailed and well-reasoned to 

constitute the weight of the medical opinion evidence and to meet OWCP’s burden of proof to 

terminate appellant’s wage-loss compensation and medical benefits. Dr. Lakin based his report 

of the statement of accepted facts and provided detailed findings on physical examination. He 

found that appellant’s accepted right shoulder contusion had resolved. Dr. Lakin found that her 

head was atraumatic and that her head contusion had therefore resolved. He found no positive 

neurological findings in the spine or extremities and stated that appellant’s gait was 

unremarkable supporting his opinion that appellant’s hip and coccyx contusions had resolved. 

Dr. Lakin further clearly opined that appellant could return to her date-of-injury position and that 

she had no medical residuals. His reports are sufficient to meet OWCP’s burden to terminate 

appellant’s wage-loss compensation and medical benefits for her accepted conditions of 

contusions to the scalp, shoulder, hip, and coccyx. 

Appellant submitted a series of reports from Dr. Mehta supporting additional diagnosis 

and periods of disability. The Board finds that these reports do not support continuing disability 

or medical residuals due to the accepted diagnoses of contusions to the scalp, shoulder, hip, and 

coccyx. Dr. Mehta specifically stated that she disagreed with the diagnoses accepted by OWCP 

and attributed appellant’s continuing disability to a variety of conditions including cervical disc 

herniations, cervical spinal stenosis, cervical radiculopathy, peripheral nerve compromise, 

lumbar disc herniation, and neural foraminal stenosis with dizziness. While she opined that 

appellant’s conditions were due to her employment incident, Dr. Mehta failed to provide any 

medical reasoning supporting her opinion. Dr. Mehta did not explain how the diagnosed 

conditions would result from the accepted fall and did not explain the delay in the onset of 

symptoms beyond those accepted by OWCP and initially diagnosed by Dr. Jurado. She further 
7

found that appellant was totally disabled due to the additional diagnosed conditions rather than as 

a result of her accepted employment injuries. 

Dr. Mehta also submitted a series of form reports indicating with a checkmark “yes” that 

various diagnosed conditions were due to appellant’s employment incident and opining that 

appellant was totally disabled. The Board has held that an opinion on causal relationship which 

consists only of a physician checking “yes” to a medical form report question on whether the 

claimant’s condition and resulting disability was related to the history given is of little probative 

value. Without any explanation or rationale for the conclusion reached, such report is insufficient 

to establish causal relationship.8

 As Dr. Mehta failed to provide any medical rationale supporting 

her opinions that appellant’s sustained additional conditions and disability due to her accepted 

May 16, 2012 employment injury, she failed to support appellant’s claim for additional 

conditions with medical residuals and resulting disability for work. 

Contrary to the arguments of counsel, the Board finds that Dr. Mehta’s reports are not 

sufficiently detailed and well-reasoned to create a conflict with Dr. Lakin’s reports and that OWCP 

therefore met its burden of proof to terminate appellant’s wage-loss compensation and medical 

benefits effective May 8, 2013. 

LEGAL PRECEDENT -- ISSUE 2 

As OWCP met its burden of proof to terminate appellant’s compensation benefits, the 

burden shifted to appellant to establish that she had disability causally related to her accepted 

employment injury.9 In order to prevail, appellant must establish by the weight of the reliable, 

probative and substantial evidence that she had an employment-related disability and medical 

residuals which continued after termination of compensation benefits.10 To establish a causal 

relationship between the condition, as well as any disability claimed, and the employment injury, 

the employee must submit rationalized medical opinion evidence, based on a complete factual 

background, supporting such a causal relationship. Rationalized medical opinion evidence is 

medical evidence which includes a physician’s detailed opinion on the issue of whether there is a 

causal relationship between the claimant’s diagnosed condition and the implicated employment 

factors. The opinion of the physician must be based on a complete factual and medical 

background of the claimant, 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. The weight of medical evidence 

is determined by its reliability, its probative value, its convincing quality, the care of analysis 

manifested and the medical rationale expressed in support of the physician’s opinion.11 

 8 Lucrecia M. Nielson, 41 ECAB 583, 594 (1991). 

9 George Servetas, 43 ECAB 424, 430 (1992). 

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

11 James Mack, 43 ECAB 321 (1991). 
8

ANALYSIS -- ISSUE 2 

OWCP terminated appellant’s wage-loss compensation and medical benefits upon a 

finding that Dr. Mehta did not provide any rationale in support of her opinion that appellant’s 

employment incident resulted in more serious diagnoses than those accepted by OWCP. 

Following OWCP’s termination of appellant’s wage-loss and medical benefits effective May 8, 

2013, appellant continued to submit reports from Dr. Mehta. On May 17, 2013 Dr. Mehta 

reviewed her treatment of appellant and described the employment injury. She discussed test 

results and diagnosed positional nystagmus with aggravation secondary to the trauma sustained 

after the fall at work, cervical disc herniation due to the trauma at work, lumbar disc herniation 

due to the trauma at work, internal derangement of the shoulder due to the trauma at work, 

gluteus medius and gluteus minimus tendinitis due to the trauma at work, and microvascular 

ischemic changes in the internal auditory canals aggravated due to the trauma at work. 

Dr. Mehta opined that appellant was totally disabled. 

Dr. Mehta’s opinion regarding the causal relationship between appellant’s currently 

diagnosed conditions and her accepted employment incident is not sufficient to meet appellant’s 

burden of establishing new injuries related to her May 16, 2012 traumatic injury or to establish 

continuing disability due to this incident. She has provided evidence that appellant suffers from 

the conditions diagnosed. Dr. Mehta has not, however, provided the necessary medical rationale 

explaining how the diagnosed conditions were caused or aggravated by the accepted employment 

incident. The Board is unable to determine from Dr. Mehta’s reports how conditions such as 

positional nystagmus or microvascular ischemic changes in the auditory canals would be 

aggravated by appellant’s fall which immediately resulted in only the diagnosis of contusions. 

Dr. Mehta also fails to explain the processes by which appellant’s employment incident caused 

or aggravated her spinal injuries or internal derangement of the shoulder or her gluteus 

tendonitis. Her reports are insufficient to establish disability or medical residuals continuing 

after May 8, 2013 due to the accepted employment injury as her reports presently of record do 

not provide any rationale in support of her opinion that appellant’s employment incident resulted 

in more serious diagnoses than those accepted by OWCP. 

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 met its burden of proof to terminate appellant’s wage-loss 

and medical benefits effective May 8, 2013. The Board further finds that appellant has not 

submitted sufficient rationalized medical opinion evidence to establish any continuing disability 

or medical residuals after that date due to her May 16, 2012 employment injury. 
9

ORDER 

IT IS HEREBY ORDERED THAT the July 3, 2014 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: June 10, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board