United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.W., Appellant 

and 

DEPARTMENT OF AGRICULTURE, ANIMAL 

PLANT HEALTH INSPECTION SERVICE, 

Alpena, MI, Employer 

__________________________________________ 

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Docket No. 16-1013 

Issued: September 9, 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 April 12, 2016 appellant filed a timely appeal from a March 21, 2016 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 case. 

ISSUE 

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

medical condition as of February 23, 2015 causally related to the March 24, 2009 accepted 

employment injury. 

 

 1 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On March 24, 2009 appellant, then a 51-year-old veterinarian, filed a traumatic injury 

claim (Form CA-1) alleging that on that same date, while he was working with cattle doing a 

tuberculosis screening, he attempted to tag a cow and the cow hit him in the face causing him to 

fall backwards. OWCP accepted his claim for chin laceration and closed fracture of the right 

base of the skull without intracranial injury and no loss of consciousness. Appellant stopped 

worked intermittently after the injury and returned to full-time work on May 5, 2009. 

Medical evidence of record includes March 24, 2009 emergency room records from 

Dr. Dane Chapman, Board-certified in emergency medicine, who treated appellant for head 

trauma. Appellant reported being hit in the head by a cow when he was attempting to tag the 

animal. He noted a chin laceration. A head computerized tomography (CT) scan revealed a 

laceration through the temporal bone forming the anterior external auditory canal. Dr. Chapman 

diagnosed complex through and through laceration, eight centimeters left chin, right anterior 

temporal bone fracture with obstruction of the external auditory canal and closed head injury. 

Appellant submitted an authorization for examination and/or treatment (Form CA-16) prepared 

by Dr. Chapman dated March 24, 2009, who treated him for a chin and right face injury 

sustained when appellant was hit by a cow. He noted findings of a complete left chin laceration 

full thickness, blood in the right ear canal, and a head injury. Dr. Chapman repaired three 

lacerations on the chin and referred appellant to an otolaryngologist. A March 24, 2009 x-ray of 

the mandible was normal while a March 24, 2009 CT scan of the head revealed a fracture of the 

scull base of the anterior bony margin at the external auditory canal on the right. 

Appellant was treated by Dr. Richard C. Schultz, Jr., a Board-certified otolaryngologist, 

on April 16, 2009. Dr. Schultz performed otologic evaluation and audiometric testing. He 

reported that appellant had sustained facial injuries when he was struck in the face by a cow 

while trying to perform tuberculosis screening. A CT scan revealed a temporal bone fracture in 

the portion of the right temporal bone lateral to the tympanic membrane over the glenoid fossa. 

Dr. Schultz noted an oral examination was clear, dentition was in fine repair, and occlusion 

appeared normative, with no tenderness in the temporomandibular joint (TMJ) region. He 

diagnosed temporal bone fracture which was lateral to the glenoid fossa which may cause 

disability with mastication. Dr. Schultz performed audiometric testing and diagnosed 

sensorineural hearing loss. 

Appellant was treated by Dr. Michael J. Steber, a dentist, who reported, in an April 27, 

2009 report, that appellant’s lower jaw felt more forward and his bite was not aligned. Upon 

examination appellant’s bite looked normal, his second bite appeared more “end to end” with no 

popping or pain in the jaw area. Dr. Steber noted that appellant may have TMJ disorder. The 

initial evaluation and x-rays were performed on March 24, 2009 when appellant was swollen and 

in pain and he was instructed to return when his discomfort subsided. In a June 3, 2010 letter, 

the financial coordinator for Dr. Steber indicated that on December 22, 2009 Dr. Steber repaired 

teeth number 23, 24, and 25 which were chipped when he was kicked in the face by a cow. 

In a June 9, 2010 letter to Dr. Steber, OWCP denied authorization for the medical 

treatment of appellant’s teeth. It noted that there was no corresponding medical documentation 

to support that he sustained injuries to his teeth as alleged due to the work injury. OWCP noted 
3

that the original medical evidence from March 24, 2009 indicated that the teeth were intact and 

the mandible was nontender but there was no mention of a chipped tooth. It requested Dr. Steber 

to provide copies of the office visits that support that appellant sustained an injury to his number 

23, 24, and 25 teeth as a result of the work injury of March 24, 2009.2

On May 15, 2015 appellant filed a notice of recurrence (Form CA-2a) beginning 

February 23, 2015 causally related to the March 24, 2009 accepted work injury. He sought 

medical treatment only. Appellant noted that he returned to regular duty following the original 

injury and was not limited in performing his usual duties. He indicated that the recurrence was 

detected on routine x-rays by his dentist and the injured tooth from the March 24, 2009 work 

injury required a root canal. Appellant advised that his dentist warned him that his injured teeth 

may require further treatment. 

In an undated narrative statement, appellant indicated that his initial injury occurred on 

March 24, 2009 and he was treated in the emergency room for a laceration on his chin and a 

temporal bone fracture. On March 24, 2009 he was also seen by his dentist, Dr. Steber, for 

evaluation of several injured teeth. The lower anteriors were determined to be the injured teeth. 

Appellant noted being treated on October 15, 2009 for chips on his teeth which occurred on 

March 24, 2009. He stated that the dentist’s notes specifically mention number 23 IL and 

number 25 IL. Appellant was referred to an endodontist for a root canal on tooth number 23. He 

noted that Dr. Steber advised that he could develop future issues. 

In support of his claim, appellant submitted treatment records from Dr. Steber dated 

April 8, 2009 to October 18, 2011 who performed dental cleanings, crowns, and root canals. On 

March 24, 2009 he presented and reported that he had injured the lower anterior in an altercation 

with a cow. Appellant reported being treated in the emergency room. Dr. Steber instructed 

appellant to return when the pain and swelling had subsided. On April 27, 2009 appellant 

presented with complaints of lower jaw pain, his jaw felt more forward, and his bite was off. 

Dr. Steber noted findings that appellant’s bite looked good and his second bite was more end to 

end signaling a TMJ issue. He noted that there was no popping or pain in the jaw area and 

recommended Ibuprophen. Dr. Steber noted that appellant may need future care. On 

October 15, 2009 he stated that appellant presented with chips on tooth numbers 23 and 25 

noting these resulted from the previous injury. Dr. Steber noted that appellant was also grinding 

his teeth and recommended a bite splint. On December 22, 2009 he repaired teeth number 23 

and 25. 

Also submitted was a note from Dr. Geoffrey J. Carter, a dentist specializing in 

endodontics, dated February 23, 2015, which noted that appellant had a toothache at number 23 

and required evaluation. 

 2

 On October 20, 2010 appellant filed a notice of traumatic injury alleging that on October 19, 2010 he injured his 

left hand while testing a cow for tuberculosis when his left hand became pinned between the animal and a metal 

plate. Appellant submitted an x-ray of the left hand dated November 1, 2010 which was normal. An x-ray of the 

lumbosacral spine revealed degenerative disc disease at L2-3 and L3-4. The record does not indicate that OWCP 

further developed this matter and it is not before the Board on the present appeal. 
4

By letter dated August 26, 2015, OWCP advised appellant of the type of factual and 

medical evidence needed to establish his recurrence claim. It particularly requested that he 

submit a physician’s reasoned opinion addressing the relationship of his claimed condition and 

specific employment factors. OWCP allotted 30 days to submit the requested evidence. 

In a decision dated September 30, 2015, OWCP found that the evidence of record did not 

establish that appellant required additional medical treatment due to a worsening of his accepted 

work-related conditions. 

In a December 7, 2015 appeal request form, received by OWCP on December 23, 2015, 

appellant requested reconsideration. He completed an OWCP questionnaire regarding his 

recurrence claim and noted that on February 23, 2015 he attended his sixth-month dental 

checkup and was diagnosed with periapical abscess with fistula on tooth number 23. Appellant 

indicated that the dental records on the day of the injury showed injury to tooth number 23 and 

the dentist warned about possible future issues. He noted that his chipped teeth were repaired 

including tooth numbers 23 and 25 on December 22, 2009 and September 16, 2010. 

Appellant submitted a report from Dr. Steber dated October 12, 2015 who noted treating 

appellant on March 24, 2009 after a work-related altercation with a cow. He reported being 

treated for a laceration to the face, trauma to lower anterior and broken temporal bone. 

Dr. Steber noted that on the initial examination x-rays were taken on March 24, 2009 which 

revealed no obvious fractures, chipped teeth number 23 IL and 25 IL. He diagnosed periapical 

abscess with fistula. Dr. Steber noted that appellant was seen on April 27, 2009 for lower jaw 

pain and his bite felt off and more forward. He noted the restorative treatment on teeth 23 IL and 

25 IL was completed on December 22, 2009 and June 16, 2010. Dr. Steber noted teeth number 

21B, 22ML, 23 IDL, and 24 MLI were restored on October 18, 2011. He referred appellant to 

Dr. Carter, an endodontist, for tooth 23 IL due to an abscess resulting from getting hit in the 

mouth by a cow. 

In a decision dated March 21, 2016, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT 

A recurrence of medical condition refers to a documented need for further medical 

treatment after release from treatment for the accepted condition or injury when there is no 

accompanying work stoppage. Continuous treatment for the original treatment or injury is not 

considered a “need for further medical treatment after release from treatment,” nor is an 

examination without treatment.3

An employee who claims a recurrence of medical condition has the burden of proof to 

establish causal relationship by the weight of substantial, reliable, and probative evidence. This 

burden requires that an employee furnish medical evidence from a physician who, on the basis of 

a complete and accurate factual and medical history, concludes that the employee’s need for 

 3

 20 C.F.R. § 10.5(y).
5

additional medical care is causally related to the accepted injury and supports that conclusion 

with sound medical reasoning.4

ANALYSIS 

OWCP accepted appellant’s claim for chin laceration and closed fracture of the right base 

of the skull without intracranial injury and no loss of consciousness. Appellant worked 

intermittently thereafter. On May 15, 2015 he filed a claim for a recurrence of medical condition 

alleging that on February 23, 2015 his current tooth conditions were causally related to the 

March 24, 2009 work injury which was detected on routine dental x-rays and required a root 

canal. The Board finds that the medical record lacks a well-reasoned narrative from appellant’s 

physicians relating appellant’s claimed recurrent condition beginning February 23, 2015 to his 

accepted employment injury. 

Appellant submitted medical records from Dr. Steber. On March 24, 2009 Dr. Steber 

related that appellant presented and reported that he injured the lower anterior in an altercation 

with a cow. He instructed appellant to return when the pain and swelling had subsided. On 

April 27, 2009 appellant returned with complaints of lower jaw pain and his jaw felt misaligned 

and his bite was off. Dr. Steber noted that there was no sensitivity but just bite issues. He 

examined appellant and felt that he could have a TMJ issue. On October 15, 2009 Dr. Steber 

advised that appellant presented with chips on teeth numbers 23 and 25 as a result of his prior 

injury. However, he did not otherwise explain how these dental conditions were due to the 

employment injury. This is especially important where there is no mention of chipped teeth in 

earlier reports from Dr. Steber or in the initial emergency room records.5

In an October 12, 2015 report, Dr. Steber noted having treated appellant on March 24, 

2009 after a workplace incident with a cow. He noted that on the initial examination x-rays were 

taken on March 24, 2009 which showed no obvious fractures but did reflect chipped teeth 

numbers 23 IL and 25 IL which would need to be repaired at a future date. Dr. Steber diagnosed 

periapical abscess with fistula. He noted that appellant was seen on April 27, 2009 for lower jaw 

pain and for his bite. Dr. Steber indicated that restorative treatment on appellant’s teeth was later 

performed. OWCP has not accepted any chipped teeth as employment related.6

 Additionally, 

Dr. Steber has not provided medical reasoning explaining how any dental condition was caused 

or aggravated by the employment injury of March 24, 2009. The Board has found that vague 

and unrationalized medical opinions on causal relationship have little probative value.7

Also submitted was a note from Dr. Carter, dated February 23, 2015, which noted that 

appellant had a toothache at number 23 and required evaluation. However, this note is of limited 

 4 E.O., Docket No. 11-1099 (issued February 24, 2012); J.B., Docket No. 11-1410 (issued January 5, 2012). 

5 See S.S., 59 ECAB 315 (2008) (the Board has held that contemporaneous evidence is entitled to greater 

probative value than later evidence). 

6 See Jaja K. Asaramo, 55 ECAB 200 (2004) (where an employee claims that a condition not accepted or 

approved by OWCP was due to an employment injury, he bears the burden of proof to establish that the condition is 

causally related to the employment injury). 

7

 See Jimmie H. Duckett, 52 ECAB 332 (2001). 
6

probative value as Dr. Carter did not specifically address whether appellant had a condition 

causally related to the accepted employment condition.8 

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 appellant has not met his burden of proof in establishing a 

recurrence of a medical condition causally related to his accepted March 24, 2009 employment 

injury. 

ORDER 

IT IS HEREBY ORDERED THAT the March 21, 2016 decision of the Office of 

Workers’ Compensations Programs is affirmed. 

Issued: September 9, 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 

 8 See K.W., 59 ECAB 271 (2007) (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).