United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

V.P., Appellant 

and 

DEPARTMENT OF THE ARMY, CORPUS 

CHRISTI ARMY DEPOT, Corpus Christi, TX, 

Employer 

__________________________________________ 

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Docket No. 16-0614 

Issued: May 18, 2016 

Appearances: Case Submitted on the Record

Glenda Turner, for the appellant

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On February 11, 2016 appellant, through her representative, filed a timely appeal from 

August 24, 2015 and February 1, 2016 merit decisions 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. 

ISSUE 

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

medical condition causally related to her March 7, 2012 employment injury. 

FACTUAL HISTORY 

On March 7, 2012 appellant, then a 47-year-old human resource specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on that date she injured her forehead when a 

dolly struck her head. She stopped work on March 8, 2012. OWCP accepted the claim for a 

 1

 5 U.S.C. § 8101 et seq. 
2

contusion of the face, scalp, and neck, concussion with loss of consciousness of 30 minutes or 

less, and postconcussion syndrome. 

In a progress report dated March 30, 2012, Dr. Juan E. Bahamon, a Board-certified 

neurologist, discussed his treatment of appellant for hormonal migraines. He related, “She 

suffered a very mild head injury on March 7, 2012. [Appellant] did not lose consciousness. She 

had a CAT [computerized axial tomography] scan of the head done at that time which showed no 

intracranial abnormalities.” Dr. Bahamon informed appellant that her head injury was not 

significant and that he did not expect “any long term consequences.” He released her to return to 

her usual employment on April 2, 2012. 

On October 25, 2013 Dr. Bahamon evaluated appellant for “frequent migraine headaches, 

mostly around her menstrual period.” He advised that she should continue with her medication. 

Dr. Praveen K. Thangada, a neurologist, evaluated appellant on September 3, 2014 for 

migraine headaches increasing in severity. He obtained a history of her headaches worsening 

after she struck her head on a dolly two years earlier. Dr. Thangada diagnosed “chronic 

recurrent migraine headaches with also complicated migraine, [and] occasional hemiplegic type 

of migraine.” He recommended medication and Botox injections to prevent headaches. 

Dr. Ninan T. Mathew, a neurologist, performed a Botox injection on May 1, 2015. He 

indicated that she had “an area of tenderness in the right frontal region where she sustained a hit 

on the head. It is probably some localized periostitis.” 

On June 9, 2015 appellant filed a recurrence of a medical condition (Form CA-2a) 

beginning on March 7, 2012, the date of injury. She indicated that she returned to work on 

April 7, 2012 following her injury. Appellant maintained that she continued to require medical 

treatment. She received Botox injections to help her headaches, which increased after her 

accident. 

By letter dated June 19, 2015, OWCP advised appellant of the medial evidence necessary 

to establish a recurrence of a medical condition. It requested that she complete an enclosed 

questionnaire describing the factual circumstances surrounding her alleged recurrence and a 

medical report from an attending physician addressing how her employment-related condition 

worsened such that she required additional treatment. 

A magnetic resonance imaging (MRI) scan study of appellant’s head, performed on 

May 13, 2015, yielded normal findings. 

 In a decision dated August 24, 2015, OWCP found that appellant had not established that 

she sustained a recurrence of a medical condition causally related to her March 7, 2012 work 

injury. It noted that she had not responded to its request for additional factual information. 

OWCP determined that appellant had not provided evidence supporting the need for further 

medical treatment due to a spontaneous worsening of her accepted conditions. 

On November 5, 2015 appellant requested reconsideration. In a statement dated 

November 2, 2015, she related that she experienced headaches due to her work injury that 

required treatment from a neurologist. 
3

With her reconsideration request, appellant submitted additional medical evidence. In a 

report dated August 24 2012, Dr. Bahamon evaluated her for menstrual migraines. 

Dr. Ryan Potter, a Board-certified anesthesiologist, evaluated appellant on September 17, 

2014 for a history of migraines since her teenage years. He diagnosed migraines without aura, 

intractable migraines, headaches, and extended use of medication. On October 10, 2014 

Dr. Potter diagnosed headache and provided an injection of botulinum toxin (Botox). 

On December 10, 2014 Dr. Thangada discussed appellant’s complaints of recurrent 

migraine headaches. He noted that Botox injections had not helped and referred her for 

treatment with Dr. Mathew. 

In an initial evaluation dated January 6, 2015, Dr. Mathew obtained a history of recurrent 

headaches that had “become more frequent and more severe, especially after [appellant] had a hit 

on the head with a concussion.” He diagnosed chronic migraine, obesity, depression, allodynia 

of the scalp, and cyclothymic. Dr. Mathew recommended additional Botox injections.2

By decision dated February 1, 2016, OWCP denied modification of its August 24, 2015 

decision. It found that the medical evidence did not support that appellant’s accepted conditions 

worsened such that she again required medical treatment. 

On appeal appellant argues that she has not reached maximum medical improvement and 

pays all of her treatment through her private insurance. She maintains that she still had 

headaches and a bump on her forehead from her injury. 

LEGAL PRECEDENT 

Appellant has the burden of proof to establish that she sustained a recurrence of a medical 

condition causally related to her accepted employment injury. To meet her burden, she must 

furnish medical evidence from a physician who, on the basis of a complete and accurate factual 

and medical history, concludes that the condition is causally related to the employment injury 

and supports that conclusion with sound medical rationale.3

 Where no such rationale is present, 

the medical evidence is of diminished probative value.4

 

OWCP regulations define a recurrence of medical condition as the documented need for 

further medical treatment after release from treatment of the accepted condition when there is no 

work stoppage. Continued treatment for the original condition is not considered a renewed need 

for medical care, nor is examination without treatment.5 

OWCP’s procedures provide that, after 90 days of release from medical care (based on 

the physician’s statement or instruction to return as needed or computed by the claims examiner 

 2

 On February 6, 2015 appellant received a Botox injection. 

3 Ronald A. Eldridge, 53 ECAB 218, 220 (2001). 

4 Mary A. Ceglia, 55 ECAB 626, 629 (2004); Albert C. Brown, 52 ECAB 152, 155 (2000). 

5

 20 C.F.R. § 10.5(y). 
4

from the date of last examination), a claimant is responsible for submitting an attending 

physician’s report which contains a description of the objective findings and supports causal 

relationship between the claimant’s current condition and the previously accepted work injury.6

 

ANALYSIS 

The Board finds that appellant has not established a recurrence of a medical condition. 

OWCP accepted that she sustained a contusion of the face, scalp, and neck, a concussion with 

loss of consciousness of 30 minutes or less, and postconcussion syndrome. Appellant alleged 

that she needed further medical treatment. She has not, however, submitted medical evidence 

sufficient to establish that she required further treatment because of her accepted employmentrelated conditions. 

Appellant’s attending physician, Dr. Bahamon, opined on March 30, 2012 that her head 

injury was mild and that objective testing was normal. He released her to resume her usual 

employment on April 2, 2012. 

Appellant submitted no further medical evidence for more than 90 days. Consequently, 

to establish the need for continued medical treatment, she must submit an attending physician’s 

report providing objective findings and supporting a causal relationship between any current 

conditions and the prior accepted work injury.7

On August 24, 2012 and October 25, 2013 Dr. Bahamon treated appellant for migraine 

headaches associated with her menstrual period. As he did not attribute her headaches to her 

accepted employment injury, his opinion is insufficient to meet her burden of proof. 

Dr. Thangada, in a report dated September 3, 2014, discussed appellant’s complaints of 

worsening migraine headaches after being hit in the head with a dolly two years ago. He 

diagnosed chronic, recurrent migraines headaches, and recommended Botox injections and 

medication. On December 10, 2014 Dr. Thangada noted that the Botox injections were not 

helpful. As he did not specifically attribute appellant’s need for medical treatment to her 

employment injury, his reports fail to establish causal relationship. 

In a report dated September 17, 2014, Dr. Potter noted appellant’s history of migraines 

since she was a teenager and diagnosed intractable migraines and migraines without aura. On 

October 10, 2014 he provided a Botox injection. Dr. Potter did not address causation. Medical 

evidence that does not offer an opinion regarding the cause of an employee’s condition is of 

diminished probative value on the issue of causal relationship.8

On January 6, 2015 Dr. Mathew reviewed appellant’s history of headaches that had 

increased in severity, particularly after she was hit on the head and sustained a concussion. On 

May 1, 2015 he administered a Botox injection and noted that she complained of tenderness 

where she was hit on the head. While Dr. Mathew discussed appellant’s history of begin struck 

 6

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4(b) (June 2013). 

7 Id. 

8 See T.Y., Docket No. 12-093 (issued August 3, 2012); A.D., 58 ECAB 124 (2006). 
5

on head, he did not relate her current condition and need for medical treatment to the accepted 

employment injury. Consequently, his reports are of little probative value and insufficient to 

establish a recurrence of a medical condition.9

 

On appeal appellant contends that she has continued headaches and residuals of her 

employment injury. She notes that she pays for her treatment through private insurance. As 

discussed, however, appellant has the burden to submit reasoned medical evidence supporting 

that she requires medical treatment as a result of her accepted employment.10 She did not 

provide such evidence and thus did not meet her burden of proof. 

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 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 a medical condition causally related to her March 7, 2012 employment injury. 

 9 See id. 

10 See supra note 3. 
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ORDER 

IT IS HEREBY ORDERED THAT the February 1, 2016 and August 24, 2015 

decisions of the Office of Workers’ Compensation Programs are affirmed. 

Issued: May 18, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board