United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Milwaukee, Wl, Employer

__________________________________________

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Docket No. 17-1878

Issued: March 7, 2018

Appearances: Case Submitted on the Record

David A. Teegarden, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 5, 2017 appellant, through her representative, filed a timely appeal from an 

April 7, 2017 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 this case.

ISSUE

The issue is whether appellant has established an injury causally related to the accepted 

factors of her federal employment.

 

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.
2

FACTUAL HISTORY

On October 10, 2015 appellant, then a 55-year-old city mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that she sustained left forearm pain from her elbow to hand, 

with tingling of fingers and palm, right arm weakness, and tightness in both thighs as a result of 

her federal employment duties. In an attached narrative statement, she alleged that on August 11 

or 12, 2015 she noticed a “jelly like” feeling in both thighs and felt that her thighs were so heavy 

that she could not pick up her feet. Appellant noted that on or around September 14, 2015 she 

began having left arm pain, from her elbow to hand, extending to her fingers. She described the 

duties of her federal employment, which included retrieving mail and standing while placing 

mail in case. Appellant noted that, as she was 4’10”, she was given a stool to reach upper 

shelves, but she still had to reach over her shoulder and head. She explained that she would load 

trays and tubs of mail into a vehicle, and she would then deliver the mail, which involved 

carrying up to 35 pounds. Appellant noted that twisting, turning, and bending were required in

the performance of her duties. She stopped work on September 14, 2015. 

The employing establishment controverted appellant’s claim, noting that she had not 

established fact of injury or causal relationship.

By development letter dated December 14, 2015, OWCP informed appellant that further

medical evidence was necessary to establish her claim. Appellant was afforded 30 days to 

submit the necessary evidence. 

Appellant was treated by Dr. Shekhar A. Dagam, a Board-certified neurosurgeon. On 

December 15, 2015 Dr. Dagam performed a T8-11 laminectomy for resection of thoracic 

intraspinal extradural calcification and decompression of spinal cord.

In a December 16, 2015 report of a computerized tomography of the thoracic spine,

Dr. Matthew R. Brewer, a Board-certified radiologist, found: (1) interval posterior 

decompression from T8-10 with no residual central canal stenosis at these levels; (2) persistent 

multilevel foraminal stenosis secondary to hypertrophic facet arthropathy; (3) stable calcified 

disc protrusions at T8-9 and T9-10; and (4) nonobstructing left renal stone and stable left adrenal 

adenoma. 

A magnetic resonance imaging scan of appellant’s thoracic spine taken on December 17, 

2015 was interpreted as showing: (1) postsurgical change from TI-10 laminectomy; (2) interval 

development of ill-defined 12 millimeter (mm) longitudinal intramedullary hyperintense T2 cord 

signal without enhancement concerning for edema; (3) stable focal 4 mm intramedullary 

hyperintense T2 nonenhancing intramedullary cord signal C5-6 level; (4) and multilevel mild 

disc degenerative changes and scattered facet arthropathy, stable foraminal stenosis T7-8, T9-10, 

and T10-11 levels. 

In a January 12, 2016 report, Dr. Dagman noted that he had treated appellant on multiple 

occasions since September 30, 2015. He noted her complaints and discussed results of

diagnostic testing. Dr. Dagman diagnosed lumbar spinal stenosis, lumbar degenerative disc 

disease, thoracic degenerative disc disease, thoracic myelopathy, thoracic spinal stenosis, 

thoracic spondylosis, thoracic myelomalacia, and weakness of the lower extremities. He 
3

described appellant’s 25-year work experience at the employing establishment. Dr. Dagman

opined that the combination of the repetitive movements of lifting, bending, and twisting 

provided stress on the spine which overtime led to degenerative disc disease, and that the 

progression of degenerative disc disease ultimately may lead to canal stenosis and foraminal 

narrowing, which he believed that were contributors to her symptoms. He noted that appellant 

had radiographic evidence of calcified disc protrusions which were likely a result of repetitive

movements and overuse related to a high work demand. Dr. Dagam opined that her fall on ice 

may have been exacerbated her symptoms, but the underlying spinal changes were the result of 

repetitive, strenuous activities related to her position as a mail carrier for over 25 years. 

By memorandum dated February 11, 2016, OWCP referred appellant’s case to an OWCP

medical adviser. In a March 9, 2016 response, OWCP’s medical adviser noted that there was no 

diagnostic evidence of lumbar disease and no description of employment factors causative of 

lumbar injury or disease. Accordingly, he recommended that appellant’s lumbar conditions not 

be accepted.

By letter to Dr. Dagam dated April 19, 2016, OWCP requested that he provide diagnostic 

evidence and reasoned medical opinion describing how employment factors aggravated the 

diagnosed conditions in his January 12, 2016 report. In a response dated May 2, 2016,

Dr. Dagam described appellant’s employment duties and opined that her work environment 

caused progressive degenerative disease in her thoracic spine with disc herniation at T9-10 as 

well as T10-11 which caused compression of the spinal cord and myelopathic symptoms. He 

believed that the repetitive heavy lifting, bending, twisting, carrying, and multiple falls were the 

cause of her degenerative disc disease and ultimate disc herniation with compression of the 

spinal cord. Dr. Dagam related that, while appellant would have some improvement of her right 

lower extremity paresthesia and weakness, she would have a permanent deficit.

By memorandum dated May 20, 2016, OWCP asked its medical adviser to discuss the 

relationship of appellant’s diagnosed conditions to her employment duties. In a May 23, 2016 

response, the medical adviser opined that, based on a review of the file, the weight of the medical 

evidence did not support a causal relationship between her diagnosed condition and her work 

activities. He noted that appellant’s thoracic canal stenosis and associated calcification in all 

likelihood represented degenerative changes due to her age without any causal relationship to her 

work activities. In a supplemental report dated June 8, 2016, the medical adviser reviewed 

additional records and determined that, from review of the entire case file, it appeared that her

problems with the thoracic spine resulted from degenerative joint/degenerative disc disease of 

the thoracic spine with extradural calcification resulting in spinal cord compression. He related 

that the weight of the medical evidence did not support causal relationship between this

condition and appellant’s work activities or her falls which occurred at work. The medical 

adviser noted that, although the claimant did have documented falls at work, it appeared that 

these were secondary to weakness in the lower extremities and there was no documentation that 

any of these falls resulted in injury to her thoracic spine. In addition, he noted that, although

Dr. Dagam was of the opinion that appellant developed disc herniation as a result of work 

activities, the operative report did not demonstrate any obvious thoracic disc herniation. The 

medical adviser further found that the evidence did not support that her work activities resulted 

in the development of thoracic spinal stenosis and extradural calcification which was the cause of 

her problem. 
4

By letter dated July 8, 2016, OWCP referred appellant to Dr. Mysore S. Shivaram, a

Board-certified orthopedic surgeon, for a second opinion. In a July 27, 2016 report,

Dr. Shivaram diagnosed her with: (1) degenerative disc disease of the thoracic spine; (2) spinal 

stenosis at T9, T10, and T11 secondary to degenerative disc disease of the thoracic spine; and 

(3) cord compression at T9, T10, and T11 level. He opined that the conditions of degenerative 

changes of the thoracic spine and disc herniations at T9-10 and T10-11 were not related to 

claimant’s employment. Dr. Shivaram opined that appellant’s diagnosis had no relationship to

her work activities and her falls at work were secondary to weakness in both lower extremities 

from cord compression. He also opined that the condition of degenerative disc disease and 

consequent spinal stenosis were degenerative conditions and not medically related to the factors 

of her federal employment. Dr. Shivaram noted that appellant had progressively worsening 

degenerative conditions of the thoracic spine, which ultimately resulted in her current condition, 

and was the result of degenerative arthritis of the thoracic spine, spinal stenosis, and calcified 

discs at this level. 

On June 8, 2016 OWCP’s medical adviser again reviewed the case file. He noted that 

appellant did have problems with the thoracic spine that resulted from degenerative 

joint/degenerative disc disease of the thoracic spine with extradural calcification resulting in 

spinal cord compression. The medical adviser determined that the weight of the medical 

evidence did not support any causal relationship between her condition and her work activities.

He noted that, although appellant did have documented falls at work, it appeared that these were 

secondary.

By decision dated August 25, 2016, OWCP denied appellant’s claim as it determined that 

the medical evidence of record was insufficient to demonstrate that her claimed condition was 

related to the established work-related factors. 

On December 19, 2016 appellant requested reconsideration. In support thereof, she 

submitted a November 3, 2016 report wherein Dr. Dagam opined that her thoracic spine findings 

were associated with a prolonged period of work-related exposure to strenuous and repetitive

activities. Dr. Dagam noted that repetitive twisting and turning could induce motion upon the 

spine which over time, could contribute to breakdown of cartilage between joints, disc bulging 

and degeneration, as well as bone spur formation, and that this in turn could lead to spondylosis 

and spinal stenosis. Within a reasonable degree of medical certainty, he opined that appellant’s 

employment, which she performed for well over two decades, contributed to a permanent 

acceleration of a degenerative thoracic condition beyond the means of normal progression, which 

ultimately led to the presentation of spinal myelopathy and symptoms of weakness in the lower 

extremities that required surgical intervention. 

OWCP determined that a conflict in medical opinion existed between appellant’s treating 

physician, Dr. Dagam, and the second opinion medical examiner, Dr. Shivaram, as to whether

her progressive degenerative disc disease of her thoracic spine with disc herniation at T9-10 as 

well as T10-11, with myelopathic symptoms, was causally related to her employment as a letter 

carrier. Accordingly, by letter dated February 22, 2017, it referred her to Dr. Jonathan Citow, a 

Board-certified neurosurgeon, for an impartial medical evaluation. 
5

In an April 6, 2017 report, Dr. Citow noted that appellant appeared to have an 

inflammatory condition unrelated to actual pressure on her cervical or thoracic spine, as well as 

chronic spondylosis and some element of stenosis in the cervical, thoracic, and lumbar spine. He 

believed that her symptoms were not at all related to her work environment. Dr. Citow opined 

that appellant had normal, age-appropriate spondylitic changes, and these were likely causing the 

symptoms she was having. He noted that her acute deterioration and imaging studies with the

signal changes at levels that were not significantly stenotic, suggested an inflammatory 

myelopathy such as transverse myelitis, and this was not related to her work duties which 

required lifting and retrieving mail.

By decision dated April 7, 2017, OWCP denied modification of its prior decision, finding

that the evidence submitted was not of sufficient probative value to alter the August 25, 2016

decision. It determined that the special weight of the medical evidence rested with the opinion of 

the impartial medical examiner, Dr. Citow, who provided a well-reasoned and unequivocal 

medical opinion that was based on a complete, accurate, and consistent history covering both the 

factual and medical aspects of this claim. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including the fact that the individual is an “employee of 

the United States” within the meaning of FECA, that the claim was filed within the applicable 

time limitation, that the injury was sustained while in the performance of duty as alleged, and 

that any disability or specific condition for which compensation is claimed is causally related to 

the employment injury.4 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.5 

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence 

or occurrence of the disease or condition; and (3) medical evidence establishing that the 

employment factors identified by the claimant were the proximate cause of the condition for 

which compensation is claimed, or stated differently, medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the claimant. 

The medical evidence must include a physician’s rationalized 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 

 

3 Supra note 2.

4

Joe D. Cameron, 41 ECAB 153 (1989). 

5 See Irene St. John, 50 ECAB 521 (1999).
6

supported by medical rationale explaining the nature of the relationship between the diagnosed 

condition and the specific employment factors identified by the claimant.6

Section 8123(a) provides that, if there is a disagreement between the physician making 

the examination for the United States and the physician of the employee, the Secretary shall 

appoint a third physician who shall make an examination.7 The implementing regulations state 

that, if a conflict exists between the medical opinion of the employee’s physician and the medical 

opinion of either a second opinion physician or an OWCP medical adviser, OWCP shall appoint 

a third physician to make an examination. This is called a referee examination and OWCP will 

select a physician who is qualified in the appropriate specialty and who has no prior connection 

with the case.8 In situations where there exist opposing medical reports of virtually equal weight 

and rationale and the case is referred to an impartial medical specialist for the purpose of 

resolving the conflict, the opinion of such specialist, if sufficiently well-rationalized and based 

upon a proper factual background, must be given special weight.9

ANALYSIS

The Board finds that appellant has not established that her diagnosed medical conditions 

were causally related to her accepted factors of her federal employment.

Dr. Dagam, appellant’s treating physician, determined that appellant’s duties of 

employment, which she performed for well over two decades, contributed to a permanent 

acceleration of her degenerative thoracic condition, and that this ultimately led to the 

presentation of spinal myelopathy and symptoms of weakness in the lower extremities that 

required surgical intervention. He supported his opinion with multiple medical reports that,

discussed her diagnostic studies, her physical findings, and her employment duties. OWCP 

referred appellant for a second opinion with Dr. Shivaram who opined that the degenerative 

changes of the thoracic spine and disc herniations at T9-10 and T10-11 were not related to her

employment. Dr. Shivaram opined that her diagnosis had no bearing on her work activities and 

the incidents of falls at work were secondary to weakness in both lower extremities from cord 

compression. He also found that the degenerative disc disease and consequent spinal stenosis 

was a degenerative condition and not medically connected to the factors of appellant’s federal 

employment. The Board finds that the reports of Drs. Dagam and Shivaram are in equipoise as 

to whether her diagnosed conditions were causally related to the duties of her federal 

employment.10 Accordingly, OWCP properly referred the case to Dr. Citow for an impartial 

medical examination.11

 

6

Id.

7 R.C., Docket No. 12-0437 (issued October 23, 2012).

8 20 C.F.R. § 10.321.

9 F.C., Docket No. 14-0560 (issued November 12, 2015). 

10 See L.B., Docket No. 17-0597 (issued September 1, 2017).

11 Id.
7

In an April 6, 2017 report, Dr. Citow reviewed appellant’s medical history and conducted 

a physical examination. He explained that she appeared to have an inflammatory condition 

unrelated to the actual pressure on her spine, as well a chronic spondylosis and some element of 

stenosis in the cervical, thoracic, and lumbar spine. Dr. Citow opined that these symptoms were 

not related to appellant’s work environment, noting that she had normal, age-appropriate 

spondylitic changes. He also noted that the acute deterioration and imaging studies were not 

significantly stenotic and suggested an inflammatory myelopathy such as transverse myelitis

which was not related to lifting and retrieving mail at the employing establishment. 

The Board finds that the special weight of the medical evidence rests with the wellreasoned report of Dr. Citow. As noted above, the opinion of an impartial specialist, if 

sufficiently well rationalized and based on a proper factual and medical background, must be 

given special weight.12 The Board finds that Dr. Citow provided a comprehensive report that 

resolved the conflict, and his opinion represents the special weight of the medical evidence.13 

Appellant therefore has not met her burden of proof to establish that her medical diagnoses were 

related to her accepted factors of federal employment. 

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 established an injury causally related to the 

accepted factors of her federal employment.

 

12 C.L., Docket No. 17-0949 (issued September 19, 2017). 

13 Id.
8

ORDER

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

Compensation Programs dated April 7, 2017 is affirmed. 

Issued: March 7, 2018

Washington, DC

Patricia H. Fitzgerald, Deputy 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