United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.Y., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

San Francisco, CA, Employer 

__________________________________________ 

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Docket No. 16-1555 

Issued: April 21, 2017 

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 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On July 26, 2016 appellant filed a timely appeal from a January 29, 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 this case. 

ISSUES 

The issues are: (1) whether OWCP met its burden of proof to justify termination of 

appellant’s wage-loss compensation and medical benefits, effective November 26, 2012, because 

her accepted conditions had resolved; and (2) whether appellant established any continuing 

residuals or employment-related disability after November 26, 2012. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

This case has previously been before the Board.2 The facts of the case as presented in the 

Board’s prior decision are incorporated herein by reference. The relevant facts are set forth 

below. 

On October 20, 2004 appellant, then a 50-year-old post office clerk, filed an occupational 

disease claim (Form CA-2) alleging that the repetitive motion of her daily work activity caused 

injury to her hands, wrists, forearms, and elbows. She continued to work light duty.3 OWCP 

accepted appellant’s claim for bilateral tenosynovitis of the hands and wrists and bilateral lateral 

epicondylitis. 

On August 17, 2007 appellant accepted a full-time limited-duty assignment as a manual 

distribution clerk. She stopped work on August 27, 2009 and filed a claim for wage-loss 

compensation (Form CA-7). On the back of the Form CA-7, the employing establishment 

indicated that there was no work available. OWCP paid wage-loss compensation benefits. 

Appellant was placed on the periodic rolls beginning September 26, 2009. 

Appellant was referred to Dr. Aubrey A. Swartz, a Board-certified orthopedic surgeon, on 

May 26, 2011 for a second opinion examination to determine whether she continued to suffer 

residuals and remained disabled due to her accepted conditions. OWCP referred appellant for a 

functional capacity evaluation (FCE) with Thomas Kowalski, an occupational therapist. In 

reports dated July 1 and August 5, 2011, Dr. Swartz reviewed appellant’s history and provided 

findings on physical examination. He reviewed the findings from the FCE and noted 

discrepancies and inconsistences in the Jamar grip testing, Cozen’s testing, provocative testing, 

and sensory testing. Dr. Swartz reported that upon examination he did not find objective 

evidence of residuals of appellant’s accepted bilateral upper extremity conditions. He related 

that examination findings and appellant’s complaints were symptoms of early degenerative 

arthritis, which was not an accepted condition. In a work capacity evaluation form, Dr. Swartz 

indicated that appellant was able to work her usual job full time, with restrictions of lifting up to 

20 pounds. 

In an August 30, 2011 report, Dr. Robert J. Harrison, Board-certified in internal and 

preventive medicine, he reviewed Dr. Swartz’ report and disagreed that appellant’s bilateral 

upper extremity conditions had resolved. He related that he had treated appellant since 

September 27, 2004 for bilateral tenosynovitis of the hand and wrist and lateral epicondylitis. 

Upon physical examination, Dr. Harrison observed swelling of appellant’s third digit of the right 

 2

 Docket No. 15-1510 (issued November 16, 2015). By decision dated November 16, 2015, the Board set aside 

OWCP’s decision dated March 18, 2015, which denied appellant’s February 23, 2015 reconsideration request as 

untimely filed, and remanded the case for OWCP to review appellant’s reconsideration request under the standard 

for a timely request. 

3

 In an attached statement, appellant explained that on February 2, 1987 she filed a claim for a work-related injury 

to her hands and arms and was placed on modified duty as a manual clerk. In June 2004 she was assigned to work 

as a machine mail processor. Appellant asserted that the pain in her hands and arms worsened. She sought 

treatment from her physician who diagnosed bilateral epicondylitis, bilateral wrist, tendinitis, and bilateral carpal 

tunnel syndrome. Appellant was returned to her light-duty position as a manual clerk. 
3

hand and pain over the dorsum of both hands with dorsiflexion. Tinel’s and Phalen’s sign were 

negative. Dr. Harrison reported that appellant continued to have objective residuals of her hand 

and wrist tenosynovitis. He explained that, although he acknowledged inconsistencies in the 

FCE, appellant had consistently reported bilateral wrist pain over many years of treatment. 

Dr. Harrison related that appellant could work with her usual restrictions. 

OWCP determined that a conflict in the medical evidence existed between Dr. Harrison, 

appellant’s treating physician, and Dr. Swartz, OWCP’s referral physician, with respect to her 

employment-related conditions and her disability. It referred appellant, along with a statement of 

accepted facts (SOAF) and the record, to Dr. Lin Ho, a Board-certified orthopedic surgeon, to 

resolve the conflict. 

In an April 30, 2012 report, Dr. Ho reviewed appellant’s history, including the SOAF, 

and related that appellant had work-related diagnoses of bilateral wrist tendinitis and bilateral 

lateral epicondylitis. He noted that appellant had not worked since August 28, 2009 because 

there was no limited duty available. Dr. Ho related appellant’s complaints of pain that was 

“moving around” and numbness over the entire left or right arm and weakness some of the time. 

He discussed appellant’s medical records and conducted an examination. Dr. Ho reported no 

crepitus or tenderness at either the flexor or extensor tendons of the forearms and no decrease in 

touch or temperature perception over the right and left hands. He also observed mild swelling of 

the right third proximal interphalangeal (PIP) joint but not crepitus in the fingers. Dr. Ho 

provided normal range of motion findings of the wrists and elbows. Tinel’s, Phalen’s, and 

Finklestein’s tests were negative bilaterally. He diagnosed resolved bilateral forearm pain. 

Dr. Ho opined that examination of appellant’s upper extremities revealed no objective 

findings except for swelling at the right third PIP. He related that a review of Dr. Harrison’s 

reports also showed no positive objective findings and explained that findings of tenderness were 

a subjective complaint. Dr. Ho also noted inconsistencies in the FCE with grip and cogwheel 

nonfunctional response to strength testing. He opined that appellant may have endogenous 

osteoarthritis of her right hand, which was nonindustrial. Dr. Ho concluded that appellant had no 

residuals of her accepted work-related conditions and was able to return to her original position 

as a mail clerk with no physical limitations due to her work-related disability. He provided a 

work capacity evaluation form, which indicated that appellant was capable of working eight 

hours per day with pushing, pulling, kneeling, squatting, climbing, and lifting up to 20 pounds. 

OWCP proposed to terminate appellant’s wage-loss and medical benefits in a decision 

dated October 24, 2012. It found that the weight of evidence rested with the opinion of the 

impartial medical examiner, Dr. Ho, who determined in an April 30, 2012 report that there were 

no objective findings to demonstrate continued residuals of her accepted bilateral tenosynovitis 

of the hands and bilateral lateral epicondylitis conditions. Appellant was advised that she had 30 

days to submit additional evidence or argument if she disagreed with the decision. 

On November 14, 2012 OWCP received appellant’s letter dated November 9, 2012. 

Appellant explained that she had been out of the country when OWCP’s October 24, 2012 

Notice of Proposed Termination was mailed and delivered. She noted that she had since 

scheduled another appointment with Dr. Harrison, but his earliest availability was on 
4

November 19, 2012. Appellant requested an extension to submit additional evidence or 

argument. 

In a decision dated November 26, 2012, OWCP finalized the termination of appellant’s 

wage-loss and medical benefits, effective that date. It determined that as appellant had not 

submitted any additional medical evidence or argument within 30 days of the proposed 

termination notice, the evidence of record was insufficient to alter the recommendation to 

terminate her medical and wage-loss compensation benefits. 

On December 4, 2012 OWCP received appellant’s November 30, 2012 request for 

hearing before an OWCP hearing representative. 

Dr. Harrison continued to treat appellant. In a December 2, 2012 report, he noted 

reviewing OWCP’s October 24, 2012 Notice of Proposed Termination and Dr. Ho’s April 30, 

2012 referee medical report. Dr. Harrison indicated that upon examination he observed 

tenderness over the flexor and extensor wrist compartments bilaterally, with positive Tinel’s sign 

on both the right and left side. He pointed out that Dr. Ho had not examined appellant’s wrist 

but merely reported pain over the forearm. Dr. Harrison reported that appellant clearly had 

objective findings with tenderness over the flexor and extensor wrist compartments on both sides 

and evidence of median nerve irritation based on the positive Tinel’s sign. 

A hearing was held on March 27, 2013. Appellant’s representative at the time argued 

that Dr. Ho’s April 30, 2012 referee medical report was very confusing because he found 

appellant capable of working full duty, but noted work restrictions of 20 pounds. He noted that 

appellant had a preexisting claim and returned to work with limitations, which carried over into 

the 2004 injury. Dr. Ho asserted that because the employing establishment was unable to 

accommodate these work restrictions, OWCP erred in terminating her wage-loss compensation 

benefits. On direct examination, appellant described in detail her work duties as a mail clerk. 

She related that she first sustained an injury in 1987 and was placed on limited duty. Appellant 

explained that in 2004 her condition worsened and she was in terrible pain at the end of each 

workday. She reported that she continued to work limited duty until 2009 when her supervisor 

informed her that there was no work available for her. 

Appellant also expressed her disagreement with OWCP’s referral physician’s 

examinations and findings. She clarified that she described to Dr. Ho how the repetitive 

movement of sorting mail caused her injury. Appellant’s representative further explained that 

appellant would submit medical documentation from her psychiatrist, which supported 

expansion of appellant’s claim to include a psychiatric condition. He asserted that both 

Dr. Swartz’s and Dr. Ho’s reports lacked medical rationale to support their conclusion that 

appellant did not suffer residuals of her accepted work conditions and was able to work. The 

representative noted that Dr. Harrison had treated appellant since her 1987 injury and he 

continued to opine that appellant still had residuals of her bilateral upper extremity condition and 

could work with limitations. He requested that appellant’s claim be expanded to include a 
5

psychiatric condition, that her claim be remanded for further development of the medical 

evidence, and that her medical and wage-loss compensation benefits be reinstated.4

Appellant was also treated by Dr. George Demetrius Karalis, a psychiatrist. In an 

April 20, 2013 report, he requested that appellant’s claim be expanded to include major 

depression. Dr. Karalis reviewed appellant’s employment history and the injuries she sustained 

at work. He provided findings on physical examination and psychological testing. Dr. Karalis 

diagnosed major depression and explained that her depression and anxiety was caused by 

appellant’s constant orthopedic pain and limited upper extremity range of motion. 

In a May 3, 2013 report, Dr. Vatche Cabayan, a Board-certified orthopedic hand surgeon, 

noted that appellant worked as a mail clerk and had an accepted claim for bilateral wrist 

tendinitis and epicondylitis laterally. He related that appellant also had a previous claim from 

1987 and had been working limited duty. Dr. Cabayan reported that appellant’s condition 

worsened in 2004, which caused her to seek medical treatment from Dr. Harrison again. He 

discussed the medical reports of Drs. Swartz, Ho, and Katalis and their findings. 

Dr. Cabayan further related in a May 6, 2013 report that he reviewed appellant’s medical 

records. He asserted that Dr. Swartz and Dr. Ho overlooked the issue of appellant’s limited 

capacity since 1987. Dr. Cabayan provided a detailed description of the history of her bilateral 

upper extremity condition and opined that in 2004 appellant experienced a worsening of her 

initial injury with no permanent improvement. He explained that Drs. Swartz and Ho determined 

that appellant had recovered from the injury in 2004, but they overlooked her first injury from 

which she never recovered with limitation of function. Upon examination, Dr. Cabayan 

observed tenderness along the carpal tunnel area on the left and tenderness along the medial and 

lateral epicondylar surfaces bilaterally. He also noted tenderness along the base of the thumb 

bilaterally and swelling along the PIP joint with no instability. Sensory function was normal 

throughout. Dr. Cabayan diagnosed discogenic cervical condition with radiculitis, rotator cuff 

involvement and bicipital tendinitis bilaterally, epicondylitis medially and laterally on the right 

and left, carpometacarpal (CMC) joint inflammation of the thumb bilaterally, and mild stenosis 

tenosynovitis along the A1 pulley of the thumb bilaterally and the index finger on the left. 

Dr. Cabayan reported: “it is clear that the patient never recovered from her condition and 

has had residuals from her condition and limitation with forceful activities precluded from her 

usual job.” He noted that even though appellant continued working limited duty, her efficiency 

was not as good. Dr. Cabayan related that appellant’s restrictions might have improved over the 

years, but because of overuse, appellant’s treating physician never released her to greater than 5 

pounds of lifting. He pointed out that even OWCP’s referral physicians, Dr. Swartz and Dr. Ho, 

gave appellant restrictions although they claimed she had fully recovered. Dr. Cabayan 

concluded that appellant continued to have permanent restrictions and could not work her usual 

job position. 

 4

 During the hearing, appellant’s representative submitted as evidence the job position for a distribution/window 

clerk and a sales, services, and distribution associate, a letter dated April 12, 2011 which requested that appellant 

submit medical documentation that she was physically capable of performing the duties of a sales, service, and 

distribution associate, an August 27, 2009 Employee Leave Information letter, appellant’s statement dated 

October 21, 2004, and Dr. Harrison’s August 31, 1987 medical report. 
6

In a May 13, 2013 statement, appellant’s representative provided excerpts from 

Dr. Cabayan’s May 6, 2013 report and Dr. Karalis’ April 20, 2013 report as evidence that 

appellant’s disabling condition had not ceased and that she still required medical restrictions in 

order to work. He asserted that because appellant had medical restrictions and the employing 

establishment had no work available, OWCP erred in terminating appellant’s compensation. 

Appellant’s representative also noted that appellant was not evaluated by a specialist for mental 

disability due to pain. He requested that OWCP reinstate appellant’s compensation benefits and 

pay her retroactively. 

By decision dated June 12, 2013, an OWCP hearing representative affirmed the 

November 26, 2012 decision terminating appellant’s wage-loss compensation and medical 

benefits. She found that OWCP properly relied on the medical opinion of Dr. Ho, the referee 

medical examiner, who determined that appellant’s accepted medical conditions had ceased. The 

hearing representative also noted that the medical evidence appellant submitted after Dr. Ho’s 

April 30, 2012 referee medical report did not provide a complete and accurate background or 

adequate explanation of how the medical findings suddenly changed and were related to her 

accepted condition. 

On October 24, 2013 OWCP received appellant’s request, through her representative, for 

reconsideration. The representative indicated that he was enclosing additional reports by 

Dr. Karalis and Dr. Cabayan, which substantiated that appellant suffered from a condition that 

was caused while in the performance of duty and continued until the present. He requested that 

OWCP reconsider its decision, reinstate appellant’s compensation, and grant compensation 

retroactively. 

In a supplemental report dated September 8, 2013, Dr. Karalis expressed disagreement 

with OWCP’s June 12, 2013 decision. He pointed out that in his report he repetitively referred 

to different parts of the March 27, 2013 transcript, which indicated that he reviewed them. 

Dr. Karalis reiterated that appellant suffered a job-caused major depression condition. 

Dr. Cabayan also noted his disagreement with OWCP’s June 12, 2013 decision. In an 

October 10, 2013 report, he clarified that he had extensively reviewed appellant’s records as 

outlined in his reports. Dr. Cabayan also asserted that OWCP failed to mention that appellant 

worked extensive overtime over the years. He pointed out that a proper medical diagnosis for 

appellant’s condition could only be provided by a Board-certified orthopedic surgeon and hand 

specialist. Dr. Cabayan noted that it was unclear whether OWCP’s referral physicians had a 

hand specialty. He further reported that Dr. Swartz and Dr. Ho’s opinions were contradictory 

because they opined that appellant had fully recovered, but provided work restrictions. 

Dr. Cabayan reported that the fact that appellant had not worked since 2009 did not mean that 

her hand condition had not progressed. He explained that cumulative trauma could present itself 

after a patient is off work and progress, particularly if the patient is not involved in any other 

activities to cause or worsen the cumulative trauma. Dr. Cabayan opined that the fact that a 

patient was not aware of a hand condition at the time she stopped work did not negate the fact 

that her hand condition could not result from the 30 years of work preceding her work stoppage. 

By decision dated February 21, 2014, OWCP denied modification of the June 12, 2013 

decision. It determined that the medical evidence submitted was of insufficient probative value 
7

to create a conflict in medical opinion as they were based on an inaccurate history and lacked 

sufficient medical rationale. OWCP further found that the evidence of record was insufficient to 

modify the decision dated June 12, 2013 because it did not establish that appellant continued to 

suffer residuals or have ongoing disability as a result of her accepted employment conditions. 

On February 23, 2015 OWCP received appellant’s appeal request form, which indicated 

that she was requesting reconsideration. In an attached statement, she explained that OWCP had 

earlier found that Dr. Cabayan had relied upon her recitation of history, but not upon OWCP’s 

statement of accepted facts. Appellant noted that she was attaching new evidence. 

Appellant resubmitted Dr. Harrison’s October 14, 2013 progress reports, along with a 

new progress report dated August 21, 2014. He indicated that he examined appellant for followup of bilateral hand tenosynovitis, chronic hand pain, and occasional numbness and tingling. 

Dr. Harrison reported that examination of appellant’s wrists and hands demonstrated no palpable 

masses, temperature abnormalities, tenderness, clicking or snapping, or joint effusion. 

Neurological examination revealed negative Tinel’s and Phalen’s sign. Dr. Harrison diagnosed 

other tenosynovitis of the finger and hand and lateral epicondylitis beginning from December 15, 

2011 to the present and carpal tunnel syndrome on both sides from August 21, 2014 to the 

present. 

Along with Dr. Harrison’s progress notes, appellant also submitted April 15, 2013 

hospital records, which indicated that appellant was treated in the emergency room by 

Dr. Michael Fredericson, Board-certified in physical medicine and rehabilitation, for right carpal 

tunnel syndrome. An electromyography (EMG) and nerve conduction velocity (NCV) lab result 

report by Dr. Yousik Eugene Roh, Board-certified in physical medicine and rehabilitation, 

demonstrated an abnormal electrodiagnostic examination with mild left median sensory 

mononeuropathy across the wrist (i.e., carpal tunnel syndrome) but no electrodiagnostic evidence 

of right median neuropathy or bilateral ulnar neuropathy. 

In a February 19, 2015 statement, appellant explained that she was submitting additional 

evidence of sufficient probative value to modify OWCP’s February 21, 2014 decision. She 

noted that OWCP questioned the number of overtime hours that appellant worked and related 

that she was enclosing evidence about her number of worked overtime hours from 2004 to 2008. 

Appellant provided a table, which demonstrated the number of overtime hours she worked by 

pay period from 2004 to 2008. 

Appellant submitted another statement dated March 19, 2015 and related that she was 

approved for disability retirement in 2014 for the same diagnosis made by Dr. Harrison. She 

provided a letter dated September 3, 2014 from the Office of Personnel Management (OPM), 

which approved her for disability retirement. Appellant resubmitted OWCP’s October 28, 2004 

decision accepting her claim and a September 27, 2004 medical report by Dr. Harrison, which 

noted diagnoses of bilateral epicondylitis, bilateral wrist tendinitis, and bilateral carpal tunnel 

syndrome. 

In a decision dated March 18, 2015, OWCP denied appellant’s reconsideration request as 

untimely filed and failing to establish clear evidence of error. Appellant appealed to the Board. 
8

By decision dated November 16, 2015, the Board set aside OWCP’s decision dated 

March 18, 2015, which denied appellant’s February 23, 2015 request for reconsideration as 

untimely filed, and remanded the case for OWCP to review appellant’s reconsideration request 

under the standard for a timely request because it was timely filed.5

Following the Board’s decision, OWCP conducted a merit review of appellant’s case. In 

a decision dated January 29, 2016, it denied modification of the February 21, 2014 decision. 

OWCP found that the medical evidence submitted did not provide any medical opinion 

substantiating that appellant continued to be disabled due to her accepted employment 

conditions. Accordingly, it determined that the special weight of medical evidence rested with 

Dr. Ho’s November 26, 2012 referee medical report. 

LEGAL PRECEDENT -- ISSUE 1 

According to FECA, once OWCP accepts a claim and pays compensation, it has the 

burden of justifying termination or modification of an employee’s benefits.6

 OWCP may not 

terminate compensation without establishing that the disability had ceased or that it was no 

longer related to the employment.7 Its burden of proof includes the necessity of furnishing 

rationalized medical opinion evidence based on a proper factual and medical background.8 

The right to medical benefits for an accepted condition is not limited to the period of 

entitlement for disability compensation.9 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.10 

ANALYSIS -- ISSUE 1 

OWCP determined that a conflict in medical opinion existed between Dr. Harrison, 

appellant’s treating physician, who continued to support appellant’s need for continued medical 

treatment for her accepted conditions, and Dr. Swartz, OWCP’s referral physician, who found 

that appellant no longer suffered residuals or disability as a result of her accepted work 

conditions. Appellant was referred to Dr. Ho for an impartial medical examination to resolve the 

conflict. 

 5

 Docket No. 15-1510 (issued November 16, 2015). 

6 S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 197 (2005); Paul L. Stewart, 54 ECAB 824 (2003). 

7 Jason C. Armstrong, 40 ECAB 907 (1989); Charles E. Minnis, 40 ECAB 708 (1989); Vivien L. Minor, 37 

ECAB 541 (1986). 

8 See Del K. Rykert, 40 ECAB 284, 295-96 (1988). 

9 T.P., 58 ECAB 524 (2007); Kathryn E. Demarsh, 56 ECAB 677 (2005); A.P., Docket No. 08-1822 (issued 

August 5, 2009). 

10 James F. Weikel, 54 ECAB 660 (2003); Pamela K. Guesford, 53 ECAB 727 (2002); A.P., id.
9

In an April 30, 2012 report, Dr. Ho reviewed appellant’s history, including the SOAF. 

Appellant’s claim had been accepted for bilateral wrist tendinitis and bilateral lateral 

epicondylitis. He related appellant’s complaints of pain, not confined to a specific area, 

numbness, and weakness in both arms. Upon physical examination, Dr. Ho reported no crepitus 

or tenderness at either the flexor or extensor tendons of the forearms, no decrease in touch and 

temperature perception over the hands, and normal range of motion of the wrists and elbows. 

Tinel’s, Phalen’s, and Finklestein’s tests were negative bilaterally. Examination of appellant’s 

hands revealed mild swelling of the right third PIP joint but not crepitus in the fingers. Dr. Ho 

opined that there were no objective findings of her upper extremities except for swelling at the 

right third PIP. He diagnosed resolved bilateral forearm pain and reported possible endogenous 

osteoarthritis of her right hand, which was nonindustrial. Dr. Ho concluded that appellant had no 

residuals of her accepted work-related conditions and was able to return to her position as a mail 

clerk with no physical limitations due to her work-related disability. He provided a work 

capacity evaluation form, which indicated that appellant was capable of working eight hours per 

day with pushing, pulling, kneeling, squatting, lifting, and climbing up to 20 pounds. 

The Board finds that Dr. Ho’s April 30, 2012 report was entitled to the special weight of 

the medical opinion evidence to establish that appellant no longer suffered residuals of her 

accepted bilateral upper extremity conditions and was able to work. Dr. Ho accurately described 

appellant’s history and reviewed her medical records. He performed a thorough, clinical 

examination and provided findings on examination. Dr. Ho opined that there were no objective 

findings to support that appellant still suffered residuals of her accepted conditions. He further 

noted that appellant’s subjective complaints were generalized and unspecific and the FCE 

revealed inconsistent findings. The Board finds that Dr. Ho’s opinion was based on a proper 

factual and medical history and he had thoroughly reviewed the relevant factual and medical 

evidence.11 Accordingly, the Board finds that Dr. Ho’s opinion is entitled to special weight as 

the impartial medical examiner and was sufficient for OWCP to justify the termination of 

appellant’s wage-loss and medical benefits effective November 20, 2012.12

On appeal, appellant continues to disagree with Dr. Ho’s medical opinion. She contends 

that Dr. Ho’s April 30, 2012 report was inconsistent as he authorized appellant to work her 

regular duty, but provided work restrictions of 20 pounds. The Board finds, however, that 

Dr. Ho explained in his report that appellant had no physical limitations due to her work-related 

conditions. He did not, however, disregard the fact that appellant may have work restrictions due 

to possible osteoarthritis of her right hand, which was not an accepted condition.13 

Appellant has not submitted any objective rationalized medical evidence to establish that 

she continued to suffer from or required medical treatment for conditions causally related to her 

 11 See Melvina Jackson, 38 ECAB 443 (1987). 

12 Barry Neutuch, 54 ECAB 313 (2003). 

13 See N.P., Docket No. 15-1580 (issued September 1, 2016) (finding that an impartial medical examiner’s report, 

which authorized the claimant to work with restrictions, was entitled to special weight and established that the 

claimant did not have any continuing disability causally related to her December 21, 2010 injury because the 

restrictions were due to a nonwork-related injury). 
10

accepted employment conditions. OWCP, therefore, properly terminated her compensation 

benefits on November 26, 2012.14

LEGAL PRECEDENT -- ISSUE 2 

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

November 20, 2012, the burden shifted to her to establish that she had any continuing disability 

causally related to the accepted conditions.15 Causal relationship is a medical issue. 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.16

ANALYSIS -- ISSUE 2 

The Board finds that the medical evidence submitted following the November 26, 2012 

termination is insufficient to establish disability due to her accepted conditions. 

Appellant continued to submit reports dated December 2, 2012 to August 21, 2014 by 

Dr. Harrison, appellant’s treating physician, who was on one side of the conflict resolved by 

Dr. Ho. The Board has held that reports from a physician who was on one side of a medical 

conflict are generally insufficient to overcome the weight accorded to the report of the impartial 

medical examiner, or to create a new conflict.17

Dr. Cabayan also examined appellant. In a May 3, 2013 report, he related that appellant 

had a previous claim from 1987 and a current claim accepted for bilateral wrist tendinitis and 

epicondylitis laterally. Dr. Cabayan further noted that Drs. Swartz and Ho had determined that 

appellant had recovered from the 2004 injury, but overlooked the issue of appellant’s continued 

limited capacity since the 1987 employment injury. He provided examination findings and 

diagnosed discogenic cervical condition with radiculitis, rotator cuff involvement and bicipital 

tendinitis bilaterally, epicondylitis medially and laterally on the right and left, CMC joint 

inflammation of the thumbs, and mild stenosis tenosynovitis along the A1 pulley of the thumbs 

and the index finger on the left. Dr. Cabayan reported that appellant was able to work with 

restrictions. 

The Board finds that Dr. Cabayan’s reports are of diminished probative value as they do 

not contain sound medical reasoning establishing that appellant was totally disabled after 

November 26, 2012 due to the accepted bilateral upper extremity conditions. On the contrary, 

Dr. Cabayan attributes appellant’s current limited capacity to the previous 1987 injury. He did 

not specifically explain how appellant’s inability to work her usual job was causally related to 

 14 Manuel Gill, 52 ECAB 282 (2001). 

15 See Joseph A. Brown, Jr., 55 ECAB 542 (2004). 

16 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 

17 I.J., 59 ECAB 408 (2008). 
11

her accepted employment conditions of bilateral tenosynovitis of the hands and wrists and 

bilateral lateral epicondylitis.18 The Board further notes that, in his May 6, 2013 report, 

Dr. Cabayan diagnosed several conditions, which have not been accepted by OWCP as 

employment related. As Dr. Cabayan failed to attribute appellant’s continued disability to her 

accepted conditions, his reports are insufficient to establish work-related disability due to the 

accepted conditions.19

Likewise, Dr. Karalis, in his April 20 and September 8, 2013 reports, also diagnosed 

major depression and anxiety as a result of his job. These conditions, however, were not 

accepted as employment related. The additional reports dated April 15, 2013, including 

Dr. Fredericson’s hospital records and Dr. Roh’s EMG/NCV lab result report, also note 

diagnoses for right carpal tunnel syndrome, which is not an accepted condition. 

On appeal, appellant alleges that the medical reports by Drs. Harrison, Cabayan, and 

Karalis provided sufficient evidence to establish that she continued to have residuals of her 

employment injury. As explained above, however, these are reports are of diminished probative 

value and fail to establish that appellant was unable to work due to her accepted bilateral upper 

extremity conditions. 

Appellant further asserts on appeal that OWCP summarily dismissed the reports by her 

physicians and put an unreasonable “almost beyond-a-reasonable-doubt” burden of proof on her 

to produce medical reports establishing industrial causation. The Board notes that appellant 

bears the burden of proof to establish a causal relationship between her continued need for work 

restrictions and her accepted bilateral upper extremity conditions. As OWCP met its burden of 

proof to establish termination of appellant’s compensation benefits dated November 26, 2012, 

the burden then shifted to appellant to establish continuing disability.20 Appellant has not, 

however, submitted medical evidence sufficient to demonstrate continuing disability causally 

related to her accepted conditions. 

 18 A medical report is of limited probative value on the issue of causal relationship if it contains a conclusion 

regarding causal relationship which is unsupported by medical rationale. 

19 R.A., Docket No. 14-1327 (issued October 10, 2014). 

20 Supra note 14. 
12

The Board finds that Dr. Ho provided a comprehensive, well-rationalized opinion in his 

April 30, 2012 impartial medical report, that appellant did not have any continuing disability 

causally related to her accepted employment conditions. 

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 

compensation and medical benefits, effective November 26, 2012, and that she has failed to 

establish continuing employment-related disability after that date causally related to her accepted 

conditions. 

ORDER 

IT IS HEREBY ORDERED THAT the January 29, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 21, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board