United States Department of Labor

Employees’ Compensation Appeals Board

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R.P., Appellant

and

DEPARTMENT OF JUSTICE, BUREAU OF 

PRISONS, Lexington, KY, Employer

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Docket No. 17-0428

Issued: April 19, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 19, 2016 appellant, through counsel, filed a timely appeal from an 

October 25, 2016 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

Pursuant to the Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 

501.3, the Board has jurisdiction over the merits of the claim.3

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq.

3 The record provided the Board includes evidence received after OWCP issued its October 25, 2016 decision. The 

Board’s review is limited to the evidence that was before OWCP at the time of its final decision. Therefore, the Board 

lacks jurisdiction to review this additional evidence for the first time on appeal. 20 C.F.R. § 501.2(c)(1).
2

ISSUE

The issue is whether OWCP properly denied authorization for sacroiliac joint arthrodesis. 

FACTUAL HISTORY

On March 10, 2010 appellant, then a 43-year-old correctional officer, filed a traumatic 

injury claim (Form CA-1) alleging injuries sustained to his back, left hip, and right shoulder as a 

result of slipping on a wet floor in the performance of duty. He stopped work on September 26, 

2010 and has not returned. OWCP accepted appellant’s claim for left hip contusion, right shoulder 

contusion, lumbar back sprain, acromioclavicular right shoulder strain, and left shoulder rotator 

cuff sprain. 

OWCP paid appellant wage-loss compensation benefits on the periodic rolls commencing 

October 24, 2010. Appellant underwent an August 10, 2011 authorized left shoulder surgery. 

Effective September 24, 2014, OWCP reduced appellant’s compensation benefits as he had 

the capacity to earn wages as a customer complaints clerk, Department of Labor, Dictionary of 

Occupational Titles, No. 241.367-014, at the rate of $504.40 per week. 

By decision dated December 18, 2014, OWCP denied modification of the loss of wageearning capacity determination.

On January 8, 2016 OWCP received a medical authorization request for arthrodesis (fusion 

surgery) of the left sacroiliac joint. In support of the request, appellant submitted diagnostic studies 

dated May 23, 2014 and June 8, 2015 of the lumbar spine and pelvis.

Multiple reports from Dr. Harry Lockstadt, an attending Board-certified orthopedic 

surgeon, dated April 22, 2015 through January 7, 2016 were received. He diagnosed right and left 

sacroiliac joint dysfunction and indicated that appellant required sacroiliac joint arthrodesis, first 

left side then right side. Dr. Lockstadt advised that appellant had failed all nonoperative treatment 

and a bilateral sacroiliac joint arthrodesis was the next logical course of treatment as alternative 

diagnoses had been ruled out. 

In his reports, Dr. Lockstadt provided an assessment of work-related traumatic right and 

left sacroiliac joint dysfunction with severe symptoms which occurred secondary to a twisting 

sensation through the lower spine. He indicated that appellant’s imaging studies were consistent 

with right and left sacroiliac joint dysfunction. Dr. Lockstadt noted that there was no evidence to 

indicate that appellant’s employment injury had returned to preinjury status. He advised that the 

accepted injury and related conditions were still present and disabling. 

In a November 2, 2015 report, Dr. Lockstadt advised that he had not found any evidence 

that the sacroiliac joint dysfunction preexisted the work injury. He noted that his records showed 

that appellant’s symptoms in his lower back were a consequence of his March 10, 2010 workrelated injury. 
3

In a January 20, 2016 letter, OWCP denied authorization for the arthrodesis sacroiliac joint 

procedure. It found that appellant’s sacroiliac dysfunction was a nonwork-related condition and 

preexisted his employment injury. 

On February 25, 2016 OWCP received a January 7, 2016 authorization request for 

arthrodesis sacroiliac joint. 

In a February 15, 2016 report, Dr. Melanie Ledford, a Board-certified physiatrist, provided 

an assessment of chronic pain, lumbar degenerative disc disease, lumbar spondylosis, lumbar facet 

arthropathy, and sacroiliac joint dysfunction. She noted that appellant’s low back pain radiated

into his bilateral hips, left greater than right, into his legs to the toes. 

In a development letter dated February 26, 2016, OWCP advised appellant of the evidence 

needed in order to expand his case to include sacroiliac dysfunction and authorize the requested 

medical treatment. Appellant was afforded 30 days to provide the necessary medical evidence.

In response, OWCP received a duplicate copy of Dr. Ledford’s February 15, 2016 report. 

It also received a request from appellant to have the acceptance of his case expanded to include 

injury to his right and left sacroiliac joints. 

On March 24, 2016 OWCP advised appellant that it previously reviewed the medical 

evidence and had found in a prior December 18, 2014 decision that the sacroiliac dysfunction was 

preexisting and not causally related to the March 10, 2016 work injury. Appellant was advised to 

follow his appeal rights if he disagreed with the December 18, 2014 decision. 

By decision dated March 31, 2016, OWCP denied appellant’s request for authorization of 

arthrodesis sacroiliac joint. It found that Dr. Ledford failed to provide the requisite medical 

rationale and an accurate and complete medical history as to what caused or aggravated the 

sacroiliac joint dysfunction. OWCP also referenced its prior decision which found that the 

sacroiliac dysfunction was preexisting and not causally related to the March 10, 2015 work injury. 

On July 7, 2016 appellant requested reconsideration. April 21 and June 16, 2016 hospital 

reports from Saint Joseph East Hospital were received accompanied by physical therapy notes 

dated June 21 through July 20, 2016. 

Medical reports from Dr. Lockstadt dated April 21 through September 15, 2016 were also 

received. In his May 5, 2016 report, he indicated that appellant had traumatic work-related 

sacroiliac arthropathy. Dr. Lockstadt also indicated that there was no evidence in the medical 

record of any preexisting sacroiliac joint dysfunction. He opined that appellant suffered a workrelated traumatic right and left sacroiliac joint dysfunction with severe symptoms which occurred 

secondary to a twisting sensation through the lower spine. Dr. Lockstadt indicated that appellant’s

claim had been accepted for a left hip contusion, which involved contusing the structures around 

the left hip including the supportive sacroiliac joint ligaments. He explained that, when a patient 

fell on his left side contusing the left hip, this caused a force to be transmitted through the left 

pelvis, left sacroiliac joint, and caused a ligamentous injury at the sacroiliac joint on the left side. 

Dr. Lockstadt also noted that the claim was accepted for lumbar back sprain. He advised that this 

included the ligaments that support the back and the sacroiliac. Dr. Lockstadt explained that, with 

a sprain, the ligamentous structures no longer provide the support necessary to support the 
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sacroiliac joint. He additionally noted that appellant’s left side was worse than his right side. 

Dr. Lockstadt also provided indicators as to why appellant was a good candidate for sacroiliac 

joint arthrodesis minimal invasive surgery. He concluded that the evidence-based medicine was 

overwhelming that appellant suffered a traumatic sacroiliac joint dysfunction. Dr. Lockstadt

reasoned that no evidence had been provided to him that this was a preexisting condition.

In an April 21, 2016 report, Dr. Ledford continued to provide assessments of chronic pain, 

lumbar degenerative disc disease, lumbar spondylosis, lumbar facet arthropathy, and sacroiliac 

joint dysfunction. 

Medical reports were received from Dr. James Oliver, a pain management specialist and 

anesthesiologist, dated April 21 through September 15, 2016. He noted the history of injury and 

provided assessments of lumbar disc disease, lumbar spinal stenosis, lumbar facet arthritis, and 

chronic S1 joint dysfunction.

On September 26, 2016 OWCP requested that its medical adviser review the medical 

reports and address whether the requested procedure was medically necessary for and causally 

related to the accepted conditions. 

In an October 17, 2016 report, OWCP’s medical adviser reviewed the provided statement 

of accepted facts (SOAF) and the medical record. He advised that OWCP had not accepted the 

condition of sacroiliac joint dysfunction. The medical adviser opined that the requested arthrodesis 

sacroiliac joint was not causally related to the accepted medical conditions, but rather was due to 

the degenerative changes noted on appellant’s computerized tomography (CT) scan. He indicated 

that appellant had an accepted condition of hip contusion and that the treatment for contusion was 

not sacroiliac joint fusion. Thus, the medical adviser advised that the proposed arthrodesis of the 

sacroiliac joint was not causally related to the accepted medical condition. He additionally 

indicated that, while appellant has met many of the criteria for sacroiliac joint fusion, he had not 

met all and that all the criteria must be documented completely before such surgery would be 

medically necessary. Therefore, the medical adviser concluded that the proposed arthrodesis of 

the sacroiliac joint was not medically necessary. 

By decision dated October 25, 2016, denied modification of its March 31, 2016 decision. 

It found that the weight of the medical evidence rested with its medical adviser who opined that 

the proposed arthrodesis of the sacroiliac joint was not causally related to the accepted medical 

conditions and was not medically necessary. 

LEGAL PRECEDENT

Section 8103 of FECA provides that the United States shall furnish to an employee who is 

injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree, or the period of disability, or aid in lessening the amount of monthly compensation.4 

While OWCP is obligated to pay for treatment of employment-related conditions, the employee 

 

4 5 U.S.C. § 8103; see Thomas W. Stevens, 50 ECAB 288 (1999).
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has the burden of proof to establish that the expenditure is incurred for treatment of the effects of 

an employment-related injury or condition.5

In interpreting this section of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided under section 8103, with the only limitation on OWCP’s 

authority being that of reasonableness.6 Abuse of discretion is generally shown through proof of 

manifest error, clearly unreasonable exercise of judgment, or actions taken which are contrary to 

both logic and probable deductions from established facts. It is not enough to merely show that 

the evidence could be construed so as to produce a contrary factual conclusion.7 To be entitled to 

reimbursement of medical expenses, a claimant has the burden of proof to establish that the 

expenditures were incurred for treatment of the effects of an employment-related injury or 

condition. Proof of causal relationship in a case such as this must include supporting rationalized 

medical evidence.8 In order for a surgical procedure to be authorized, a claimant must submit 

evidence to show that the surgery is for a condition causally related to an employment injury and 

that it is medically warranted. Both of these criteria must be met in order for OWCP to authorize 

payment.9

ANALYSIS

OWCP accepted appellant’s claim for left hip contusion, right shoulder contusion, lumbar 

back sprain, acromioclavicular right shoulder strain, and left shoulder rotator cuff sprain. On 

January 8, 2016 it received a medical authorization request for arthrodesis of the left sacroiliac 

joint. OWCP denied appellant’s request for authorization of surgery. 

The Board finds that the case is not in posture for decision as there is an unresolved conflict 

in medical opinion evidence as to whether the sacroiliac joint dysfunction is causally related to the 

employment injury.

In order for the proposed arthrodesis of the sacroiliac joint to be considered, it must first 

be determined whether a causal relationship exists between the accepted employment injury and

the condition of sacroiliac joint dysfunction. Dr. Lockstadt opined that appellant suffered a workrelated traumatic right and left sacroiliac joint dysfunction with severe symptoms which occurred 

secondary to a twisting sensation through the lower spine. He explained that appellant’s claim 

was accepted for a left hip contusion, which involved contusing the structures around the left hip 

including the supportive sacroiliac joint ligaments. Dr. Lockstadt explained that it was common 

that, when a patient falls on his left side contusing the left hip, this caused a force to be transmitted 

through the left pelvis, left sacroiliac joint, and causes a ligamentous injury at the sacroiliac joint 

on the left side. He also noted that the claim was accepted for lumbar back sprain, which included 

 

5 Kennett O. Collins, Jr., 55 ECAB 648 (2004).

6 See D.K., 59 ECAB 141 (2007).

7 Minnie B. Lewis, 53 ECAB 606 (2002).

8 M.B., 58 ECAB 588 (2007).

9 R.C., 58 ECAB 238 (2006).
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the ligaments that support the back and the sacroiliac. Dr. Lockstadt explained that, with a sprain,

the ligamentous structures no longer provided the support necessary to support the sacroiliac joint. 

OWCP’s medical adviser, however, opined that the proposed arthrodesis of the sacroiliac 

joint was not causally related to the accepted medical conditions. He indicated that appellant had 

an accepted hip contusion and explained that treatment for contusion did not include a sacroiliac 

joint fusion. The medical adviser explained that the sacroiliac joint dysfunction was due to 

degenerative changes noted on his CT scan. He did not discuss appellant’s accepted lumbar strain 

or address whether the work injury contributed to appellant’s degenerative changes of the 

sacroiliac joint dysfunction. 

If there is disagreement between OWCP’s referral physician and appellant’s physician, 

OWCP will appoint a third physician who shall make an examination.10 For a conflict to arise, the 

opposing physicians’ viewpoints must be of virtually equal weight and rationale.11 The Board 

finds that the medical opinions of Dr. Lockstadt and OWCP’s medical adviser are of equal weight. 

The dispute between these physicians centers on their opinions of whether the work injury caused 

or aggravated appellant’s sacroiliac joint dysfunction for there to be causal relationship between 

the accepted conditions and a need for surgery, which ostensibly supported their respective 

opinions of the proposed arthrodesis of the sacroiliac joint. Accordingly, there was an unresolved 

conflict in medical opinion regarding the causal relationship of his sacroiliac joint dysfunction. 

Because there is an unresolved conflict in medical opinion, pursuant to 5 U.S.C. § 8123(a), 

the case will be remanded to OWCP for referral of appellant, together with the medical record and 

an updated SOAF, to an appropriate Board-certified physician or specialist in the proper field of 

medicine for an impartial medical examination as to the causal relationship of appellant’s 

sacroiliac joint dysfunction and the proposed arthrodesis of the sacroiliac joint. After such further 

development as OWCP deems necessary, it shall issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

 

10 5 U.S.C. § 8123(a); see Y.A., 59 ECAB 701 (2008).

11 Darlene R. Kennedy, 57 ECAB 414 (2006).
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ORDER

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

Programs dated October 25, 2016 is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: April 19, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board