United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

J.S., Appellant 

and 

U.S. POSTAL SERVICE, MAIN POST OFFICE, 

Dallas, TX, Employer 

__________________________________________ 

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Docket No. 16-0457 

Issued: June 6, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On January 8, 2016 appellant filed a timely appeal of a July 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)(1) and 501.3, the Board has jurisdiction 

to consider the merits of the case. 

ISSUE 

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

her medical conditions on January 27, 2015 causally related to her 2001 accepted lumbar strain. 

FACTUAL HISTORY 

On August 1, 2001 appellant, then a 41-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that she developed back spasm on the left side of her spine 

due to her employment duties of pushing and pulling carts of mail, unloading mail while lifting, 

 1

 5 U.S.C. § 8101 et seq.
2

bending, and squatting. She first became aware of her condition on July 23, 2001 and also first 

attributed her condition to her employment duties on that date. Appellant stopped work on 

July 17, 2002. OWCP accepted appellant’s claim for lumbar strain on October 17, 2001. On 

July 30, 2002 appellant’s physician released her to return to work. Appellant returned to work 

eight hours a day on September 23, 2002 with restrictions in her capacity as a modified mail 

handler. 

By decision dated September 16, 2003, OWCP reduced appellant’s wage-loss 

compensation benefits to zero as her position as a modified letter carrier effective September 23, 

2002 fairly and reasonably represented her wage-earning capacity. It noted that appellant’s 

actual earnings met or exceeded the current wages of her date-of-injury position.2 She continued 

to receive medical benefits. Physical therapy was authorized and in 2006 and 2007 she was 

authorized to receive facet injections for pain. 

Appellant was later, in 2009, authorized to receive acupuncture treatment. However, 

after a period of time, OWCP denied any further medical treatment without a statement on causal 

relationship. 

Accordingly, OWCP referred appellant for a second opinion evaluation on March 11, 

2011 with Dr. Marvin Van Hal, a Board-certified orthopedic surgeon. In a report dated 

March 31, 2011, Dr. Van Hal diagnosed lumbar strain/sprain without radiculopathy with 

prolongation of symptoms greater than what would be physiologically reasonable. He opined 

that appellant had no need of further physical therapy or other formal care. Dr. Van Hal found 

that appellant was at maximum medical improvement, that she had no permanent impairment, 

and that he was unable to determine why she continued to require limited duty. 

Dr. Van Hal’s report was forwarded to appellant’s attending physician, Dr. Louis D. 

Zegarelli, an osteopath, for review. He completed a report on June 8, 2011 and explained 

appellant’s chronic pain and requested that her conditions be upgraded to include chronic 

mechanical lumbosacral sprain syndrome, posterior facet syndrome, and lumbar myofibrositis. 

Accordingly, OWCP referred appellant for an impartial medical examination with 

Dr. Bernie L. McCaskill, a Board-certified orthopedic surgeon, to resolve the conflict between 

Drs. Zegarelli and Val Hal. In his August 2, 2011 report, Dr. McCaskill diagnosed 

spondylogenic lumbosacral spine pain associated with bilateral lower extremity symptoms, 

anatomic etiology undetermined. He opined that appellant’s lumbar sprain/strain had resolved as 

there was no objective evidence of injury. Dr. McCaskill recommended no further treatment. 

On December 5, 2011 appellant filed a recurrence claim (Form CA-2a) claiming 

weakness in his hands and problems with his knee due to no modified job. She stopped work on 

November 4, 2011 as the employing establishment indicated that no work was available for her. 

By decision dated December 13, 2011, OWCP denied appellant’s claim for recurrence of 

disability finding that the weight of the medical evidence rested with Dr. McCaskill, the 

 2

 Appellant accepted modified mail handler positions on February 2, 2005 and July 28, 2009. 
3

impartial medical examiner who found that appellant’s work-related condition had resolved and 

that she could return to her date-of-injury position. 

Appellant continued to submit requests for authorization of various medical procedures 

and treatment but, by letter dated July 21, 2014, OWCP denied authorization as the requests had 

not been accompanied by a statement on causal relationship to the 2001 lumbar strain. 

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

alleging on January 27, 2015 her condition worsened with more pain, stiffness, and tingling in 

her lower back and leg. She did not stop work and noted that she had performed various 

modified jobs with restrictions since July 23, 2001. Appellant claimed medical treatment only 

and noted that her condition had never ceased, but that OWCP had closed her claim as her 

physician failed to change her medical code to upgrade her injury status. She asserted that she 

had changed physicians. 

The most recent medical report in the record is dated November 11, 2014 from Dr. Jeff 

Fritz, a Board-certified anesthesiologist, He described appellant’s symptoms of low back pain 

and tightness, noted her accepted condition of lumbar sprain, and diagnosed chronic low back 

injury. Dr. Fritz recommended therapy, orthotics, and weight loss. 

In a letter dated June 8, 2015, OWCP requested additional supporting documentation 

including medical evidence to support her claim. It allotted her 30 days to submit supporting 

evidence. Appellant did not respond within the time allotted. 

By decision dated July 14, 2015, OWCP denied appellant’s claimed recurrence as there 

was insufficient medical evidence to support the need for continuing medical treatment of her 

2001 accepted lumbar strain. 

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.3

 Continuous 

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

treatment nor is an examination without treatment.4

 As distinguished from a recurrence of 

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

stoppage.5

 

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

the original injury.6 Causal relationship is a medical issue that can generally be resolved only by 

 3

 20 C.F.R. § 10.5(y). 

4 Id. 

5 Id. at § 10.5(x). 

6 Id. at § 10.104. See also D.T., Docket No. 15-1114 (issued February 1, 20016); Mary A. Ceglia, 55 ECAB 626, 

629 (2004). 
4

rationalized medical opinion evidence. A medical report is of limited probative value on a given 

medical question if it is unsupported by medical rationale.7

 Medical rationale 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 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.8

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.9 

ANALYSIS 

OWCP accepted that appellant’s August 1, 2001 employment injury resulted in a lumbar 

strain. Appellant returned to modified work beginning September 23, 2002 and reported on 

March 2, 2015 that she continued to perform various modified jobs with restrictions. Her claim 

alleged that her medical condition deteriorated on January 27, 2015 requiring further treatment. 

Appellant has the burden of establishing by the weight of the substantial, reliable, and 

probative evidence, a causal relationship between the recurrence of her medical condition and 

need for further medical treatment on January 27, 2015 and her July 23, 2001 employment 

injury.10 Although the record does include medical evidence submitted prior to January 27, 

2015, the date her disability allegedly began, she has submitted no medical evidence in support 

of a change in the nature and extent of her injury-related condition or the need for further 

medical treatment to support this current claim. 

The Board finds that the evidence submitted by appellant is not sufficient to establish a 

causal connection between the alleged recurrence of her medical conditions and the accepted 

employment injury. Appellant has 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. 

On appeal appellant notes her frustration with OWCP’s decision to close her claim and 

her desire to reopen her claim to receive further medical treatment. As noted, OWCP denied 

appellant’s recurrence claim as there was no medical evidence establishing a causal connection 

between the alleged recurrence of her medical condition and the accepted employment injury. 

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

8 A.D., 58 ECAB 149 (2006). 

9 D.T., and Mary A. Ceglia, supra note 5. 

10 Dominic M. DeScala, 37 ECAB 369, 372 (1986); Bobby Melton, 33 ECAB 1305, 1308-09 (1982). 
5

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 as of January 27, 2015 causally related to her 2001 accepted lumbar 

strain. 

ORDER 

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

Workers’ Compensation Programs is affirmed. 

Issued: June 6, 2016 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board