United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.N., Appellant 

and 

U.S. POSTAL SERVICE, ASTRODOME 

STATION, Houston, TX, Employer 

__________________________________________ 

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Docket No. 16-1439 

Issued: May 3, 2017 

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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On July 5, 2016 appellant, through counsel, filed a timely appeal from a February 12, 

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 case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish that she sustained 

bilateral brachial plexus impingement; reflex spasm in the neck, back, shoulder girdle, and 

 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

buttocks; bilateral sciatic nerve impingement; deranged disc in the back, and bilateral L5-S1 

impingement causally related to the accepted October 5, 2007 employment injury. 

On appeal counsel asserts that the February 12, 2016 decision is contrary to fact and law. 

FACTUAL HISTORY 

On October 5, 2007 appellant, then a 33-year-old letter carrier, injured her back on 

October 5, 2007 when she was pulling mail for her route. She began modified duty. On 

November 21, 2007 OWCP accepted sprain of back, thoracic region. The claim was 

subsequently expanded to include thoracic disc displacement. 

In October 10 and 16, 2007 reports, Dr. Asaf R. Qadeer, Board-certified in family 

medicine, noted that on October 5, 2007 appellant injured her back between the shoulder blades 

while pulling mail. He diagnosed acute back sprain with muscle spasm. October 10, 2007 

thoracic spine x-rays were normal.3

 Dr. Richard Francis, a Board-certified orthopedic surgeon, 

provided medical care commencing June 28, 2008. 

In reports dated September 22, 2008, Dr. Ulysses W. Watkins Jr., a family physician, 

noted a history that appellant had been in a motor vehicle accident. Following physical 

examination, he diagnosed upper and lower back pain, headaches, chest pain, cervical pain, and 

left shoulder pain. A skull x-ray that day was negative. 

Appellant stopped her modified-duty work on September 23, 2008 and filed a claim for 

compensation (Form CA-7). She received wage-loss compensation effective that date, and was 

placed on the periodic compensation rolls. 

On September 29, 2008 appellant began pain management with Dr. Alan Moore, Boardcertified in anesthesiology and pain medicine. Dr. Moore diagnosed displacement of thoracic 

intervertebral disc without myelopathy and scheduled steroid injections at T8-9. 

Dr. M. Athari, a Board-certified neurologist, saw appellant on October 2, 2008 and 

diagnosed chronic back pain, post-traumatic myofascitis, possible thoracic herniated disc, and 

possible fibromyalgia. November 20, 2008 lower extremity electrodiagnostic testing showed 

evidence of T8-9 nerve root irritation on the left. On January 29, 2009 OWCP accepted 

displacement of the thoracic spine at T8-9. 

Appellant continued treatment with Drs. Moore, Francis, and Athari. Dr. Moore 

additionally diagnosed thoracolumbar myofascial pain syndrome. In a March 19, 2009 report, 

Dr. Francis also noted appellant’s report that she had a low back injury at work in 2001, but had 

recovered from this. An April 10, 2009 thoracic spine magnetic resonance imaging (MRI) scan, 

showed posterior bulging discs at T8-9 and T11-12. 

 3

 The record also includes a June 1, 2007 x-ray of the thoracic spine that demonstrated minimal left lower thoracic 

scoliosis, and a lumbar x-ray that day demonstrated no abnormality. 
3

On April 30, 2009 Dr. Stephen I. Esses, a Board-certified orthopedic surgeon, noted his 

review of the MRI scan revealed no spinal cord or nerve root compression. 

OWCP referred appellant to Dr. Gary C. Freeman, a Board-certified orthopedist, for a 

second opinion evaluation. In a May 5, 2009 report, he related that on October 5, 2007 

appellant, who was on light duty at the time, felt pain in her back after pulling a table, and now 

her entire back hurt. Dr. Freeman reviewed the medical record including MRI scans and 

performed physical examination. He advised that physical examination demonstrated symptom 

magnification, no positive findings, and that appellant had age-appropriate degenerative bulging 

at T8-9 and T10-11 and no displacement of thoracic intervertebral disc. Dr. Freeman found no 

indication of a herniated disc, fibromyalgia, or chronic myofasciitis, and diagnosed chronic midthoracic pain. He concluded that the October 5, 2007 employment injury had resolved without 

residuals and that appellant could return to her usual job duties.4

OWCP found that a conflict in medical opinion was created regarding appellant’s work 

abilities, and in October 2009 referred her to Dr. Frank L. Barnes, a Board-certified orthopedic 

surgeon, for an impartial medical evaluation. In a November 19, 2009 report, Dr. Barnes noted 

his medical record review5

 and appellant’s complaint of back pain. He noted the history of 

injury, the 2008 motor vehicle accident, and appellant’s November 2008 lap-band procedure. 

Following examination and review of the MRI scans, Dr. Barnes diagnosed cervical, thoracic, 

and lumbar spine degenerative disc disease, and T8 nerve irritation. He opined that appellant 

had no objective findings of the work injury based on his examination, but that there was 

radiology evidence of a bulging T8-9 disc and electromyogram/nerve conduction velocity 

(EMG/NCV) evidence. Dr. Barnes concluded that appellant could perform modified duty for 

eight hours daily.6 

In an April 5, 2010 addendum, Dr. Barnes acknowledged that appellant had a bulging 

thoracic T8-9 disc. He advised, however, that there was no evidence on examination of any 

 4

 A May 5, 2009 cervical spine MRI scan showed mild disc protrusions at C4-5, C5-6, and C6-7 that mildly 

impressed the thecal sac. A lumbar MRI scan of the same date showed mild protrusion at L4-5 which mildly 

impressed the thecal sac, a mild bulge at L5-S1 that mildly impressed the thecal sac. Loss of lumbar lordosis, 

bilateral facet arthrosis, and mild bilateral neural foraminal narrowing was seen. A May 7, 2009 thoracic MRI scan 

showed moderate thoracic hyperkyphosis, a moderate protrusion at T8-9 that moderately impressed the thecal sac 

and appeared to contact the cord, and mild disc protrusions at T5-6 and T11-12 that mildly impressed the thecal sac. 

A June 25, 2009 FCE was invalid due to excessive magnified symptoms. On July 16, 2009 the employing 

establishment offered appellant a modified job that she declined. 

5

 Dr. Barnes indicated that he could not review the OIG surveillance video as it was password-protected. 

6

 On December 10, 2009 OWCP proposed to terminate appellant’s compensation based on Dr. Barnes’ impartial 

medical opinion. Appellant disagreed and asserted that Dr. Barnes did not properly review the medical record, that 

stress from her claim made her condition worse, and that the medical evidence established continuing disability. On 

January 12, 2010 OWCP terminated appellant’s wage-loss and medical benefits, effective January 17, 2010. It 

found that the weight of the medical evidence rested with the opinion of Dr. Barnes. Appellant requested a hearing. 

In a March 16, 2010 decision, an OWCP hearing representative reversed the January 12, 2010 decision. She found 

that the opinion of Dr. Freeman, who performed the second opinion evaluation, was of no probative value as he did 

not base his medical conclusions on the statement of accepted facts. Appellant was returned to the periodic 

compensation rolls with retroactive compensation. In April 2010 the employing establishment offered appellant a 

modified letter carrier position which she declined. 
4

neurologic loss of function that was consistent with a thoracic spine problem. Dr. Barnes 

specifically noted that appellant had four indicators of probable symptom magnification: lumbar 

pain with axial compression, inconsistent straight leg raising signs, pain with pelvic 

compression, and simulated rotation experienced in her lower back. He concluded that, although 

appellant had a bulging thoracic disc at T8-9 that could have occurred at the time of injury, this 

could not be demonstrated to be causing her pain which, she indicated was in her neck, 

shoulders, and upper thoracic spine, which were above the area of the bulging disc. 

On April 26, 2010 Dr. John W. Ellis, a Board-certified family physician, reported the 

history of the October 5, 2007 work injury, and that appellant had been in motor vehicle 

accidents in 2005 and 2008. Current complaints included severe pain between her shoulders, the 

base of her neck, and buttocks as well as sacroiliac pain and headaches. Dr. Ellis noted review 

of medical evidence and described findings. He diagnosed work-related muscle tendon unit 

strain of the thoracic spine, deranged disc at T8-9, reflex spasm of the neck and shoulder girdles 

causing bilateral brachial plexus impingement and reflex spasm in the back causing tightness of 

the back, buttocks, and sacroiliac ligaments with bilateral sciatic nerve impingement.7

Appellant continued pain management with Dr. Moore. On May 12, 2010 he additionally 

diagnosed displacement of cervical and lumbar intervertebral disc without myelopathy, thoracic 

spinal pain, thoracic spondylosis without myelopathy, thoracolumbar myofascial pain syndrome, 

and lumbar radiculitis. Dr. Moore advised that her condition was worsening. A June 25, 2010 

MRI scan of the lumbar spine demonstrated mild disc bulges at L3-4, L4-5, and L5-S1 mild 

impressing on the thecal sac. 

On July 6, 2010 appellant began treatment with Dr. James D. Key, a Board-certified 

orthopedic surgeon. He noted a history that lifting cases of mail caused a thoracic herniated disc. 

Findings included decreased thoracic and lumbar spine range of motion, altered gait and balance 

secondary to low back pain, and tenderness on spinal examination. Dr. Key diagnosed brachial 

neuritis or radiculitis; lumbar neuritis/radiculitis/radiculopathy; lumbar herniated disc; status 

postlaminectomy syndrome; spinal instability L4 and L5-S1; failed back surgery syndrome; 

muscle spasm and myofascial pain syndrome of paraspinal musculature; muscle weakness, 

general, traumatic, antalgic; neck, thoracic spine, low back, sacroiliac joint, shoulder, elbow, 

wrist, hip, knee, and ankle/foot pain; nonallopathic lesion articular dysfunction/biomechanical 

lesion pelvic region (joint); internal derangement of knee; and chronic pain. He recommended 

MRI scans of both shoulders. 

OWCP found that a conflict in the medical evidence was created between Dr. Barnes and 

Dr. Athari regarding appellant’s work-related disability and referred her to Dr. Grant McKeever, 

a Board-certified orthopedic surgeon. In a July 23, 2010 report, Dr. McKeever diagnosed 

psychophysiologic spine pain and advised that the October 5, 2007 spine strain would have 

resolved within a few weeks of her injury. He opined that appellant could return to her usual 

letter carrier job. On September 15, 2010 OWCP proposed to terminate appellant’s wage-loss 

compensation, based on Dr. McKeever’s opinion. It finalized the termination on October 15, 

2010, effective October 24, 2010. Counsel requested a hearing. In a December 9, 2010 report, 

 7

 Dr. Ellis also assessed appellant’s permanent impairment for schedule award purposes. Matters pertaining to a 

schedule award are not before the Board on the present appeal. 
5

Dr. Ellis advised that appellant’s condition had worsened since he last saw her on April 26, 2010. 

He advised that she had significant limitations and was permanently and totally disabled. In a 

second December 9, 2010 report, Dr. Ellis repeated the history of injury and appellant’s current 

complaints that were in his April 26, 2010 report, and noted that she continued to receive pain 

management from Dr. Moore. He noted his review of medical evidence and provided 

examination findings, noting decreased sensation of the T7 and T8 nerve roots bilaterally, point 

tenderness of thoracic interspinous ligaments with palpable spasm of the paraspinous muscles in 

the mid and lower thoracic regions, mild spasm of the cervical and supper thoracic regions, and 

moderate spasm of the lumbar paraspinous muscles. Dr. Ellis further found tightness of the 

shoulder girdle muscles, tenderness over the iliolumbar and sacroiliac ligaments with diminished 

two-point discrimination and positive straight leg raising. He indicated that the accepted 

conditions were muscle tendon unit strain of the thoracic spine, derangement disc at T8-T9, and 

bilateral T8 and T9 spinal nerve root impingement. Dr. Ellis advised that additional conditions 

should be accepted: reflex spasm in the neck and shoulder girdles; bilateral brachial plexus 

impingement due to spasms of the shoulder girdle muscles; reflex spasm in the back and 

buttocks; bilateral sciatic nerve impingement; deranged discs in the back due to continued 

tightness of the back; and bilateral L5 and S1 spinal nerve impingement. He opined that these 

conditions were causally related to the work injury because appellant had an acute injury to the 

T8-9 thoracic disc which caused the paraspinous muscles in the thoracic and neck areas to 

become very tight and this caused brachial plexus impingement due to the tight muscles in the 

thoracic, cervical, and shoulder girdle area. Dr. Ellis maintained that continued pain in the spinal 

nerves caused the lower back to stay in spasm which caused tightness in the iliolumbar and 

sacroiliac ligaments and the buttocks muscles which led to bilateral sciatic nerve impingement, 

and that the continued tightness in her back caused increased pressure on the lumbar discs which 

caused the discs to impinge upon the bilateral L5 and S1 spinal nerve roots leading to 

impairment of the L5 and S1 spinal nerve roots bilaterally. He also provided an impairment 

evaluation. 

Counsel requested a hearing before an OWCP hearing representative and submitted a 

May 3, 2010 note in which Dr. Ellis advised that appellant was totally disabled and needed 

further treatment. A hearing was held on February 9, 2011. 

In a March 31, 2011 decision, a hearing representative reversed the termination of wageloss compensation benefits.8

 He found the opinion of Dr. McKeever, the referee physician, 

insufficient to resolve the medical conflict because he did not address whether the accepted 

displaced disc at T8-9 had resolved or address appellant’s cervical, shoulder, brachial plexus, and 

lower back conditions. On remand OWCP was also to determine whether additional conditions 

should be accepted. The hearing representative found that Dr. McKeever was a second opinion 

physician with respect to whether additional conditions should be accepted. OWCP reinstated 

benefits retroactive to the date of termination and appellant was returned to the periodic 

compensation rolls. 

In a May 31, 2011 report, Dr. Dan K. Eidman, an attending Board-certified orthopedic 

surgeon, noted the history of injury and appellant’s complaints of back pain, anxiety, depression, 

 8 See id.
6

and poor sleep. He noted tenderness in the cervical, thoracic, and lumbar spines with positive 

straight leg raise testing and decreased range of motion. Dr. Eidman diagnosed thoracic disc 

displacement, chronic pain syndrome, depressive disorder, and sleep disturbance. 

On June 7, 2011 OWCP asked its medical adviser to comment on whether the conditions 

of reflex spasm in the neck and shoulder girdles, bilateral brachial plexus impingement due to 

spasms of the shoulder girdle muscles and ligaments, reflex spasm in the back, reflex spasm in 

the buttocks, bilateral sciatic nerve impingement, deranged discs in the back due to continued 

tightness of the back, and bilateral L5 and S1 spinal nerve impingement were consequential to 

the October 5, 2007 employment injury. 

In a June 13, 2011 report, Dr. Michael M. Katz, a Board-certified orthopedic surgeon and 

OWCP medical adviser, described the history of injury. He listed the accepted conditions of 

sprain of back, thoracic region, and displacement of thoracic intervertebral disc without 

myelopathy and noted his review of the medical record, including Dr. Ellis’ opinion. Dr. Katz 

advised that the mechanism for the consequential nature for additional conditions proposed by 

Dr. Ellis was unlikely and implausible given the accepted conditions, and the objective evidence 

available in the form of EMG/NCV testing. He further indicated that reports submitted by 

OWCP referral physicians Dr. Freeman and Dr. Sofia M. Weigel, a Board-certified physiatrist, 

did not support the physical findings reported by Dr. Ellis. Dr. Katz concluded that no additional 

conditions should be accepted. He also opined that the question of whether appellant could 

perform her regular job duties should be based on the opinion of examining physicians. 

On August 4, 2011 Dr. Rafi Bidros, Board-certified in general and a plastic surgery, 

indicated that appellant had been treated for a medically necessary procedure on July 12, 2011 

which rendered her temporarily totally disabled.9

In an August 18, 2011 decision, OWCP found that appellant did not establish that the 

additional claimed conditions were due to the October 5, 2007 employment injury. Appellant, 

through counsel, timely requested a hearing. 

Appellant continued pain management with Dr. Moore. Dr. Moore described complaints, 

provided findings, and reiterated diagnoses. 

In an October 28, 2011 decision, a hearing representative set aside the August 18, 2011 

OWCP decision denying appellant’s claim for additional employment-related conditions. The 

hearing representative remanded the case to obtain an additional report from Dr. McKeever to be 

followed by a de novo decision. 

In a November 14, 2011 report, Dr. Ellis noted appellant’s continued complaints and 

described examination findings. He reiterated his conclusions regarding the additional claimed 

conditions, noting that appellant did not think she had any residuals from the September 2008 

 9

 On July 11, 2011 OWCP had referred appellant to Dr. McKeever for a repeat impartial evaluation. Appellant 

did not keep the appointment due to the unrelated plastic surgery procedure. OWCP recommended that, because 

appellant’s condition had changed since the last second opinion evaluation, a new second opinion evaluation was 

appropriate. 
7

motor vehicle accident. Dr. Ellis concluded that she had been totally disabled due to the 

employment injury from September 22, 2008 until October 20, 2010. He also provided lower 

extremity impairment evaluations. 

On November 21, 2011 Dr. Key noted appellant’s complaints of mid and low back pain 

and depression, described physical examination findings, and diagnosed thoracic disc 

displacement, chronic pain syndrome, depressive disorder, and sleep disturbance. A 

December 7, 2011 lower extremity EMG/NCV study was unremarkable for lumbar 

radiculopathy and/or peripheral entrapment syndromes. 

In accordance with the October 28, 2011 hearing representative decision, OWCP notified 

appellant in December 2011 that a conflict in medical evidence was created regarding her work 

capabilities and again referred her to Dr. McKeever for an impairment evaluation. 

Dr. McKeever was also specifically asked to address whether the following conditions were 

caused or aggravated by the October 5, 2007 employment injury: reflex spasm in the neck and 

shoulder girdles, bilateral brachial plexus impingement due to spasm of the shoulder girdle, 

muscles, and ligaments, reflex spasm in the back, reflex spasm in the buttocks, bilateral sciatic 

nerve impingement, deranged discs in the back due to continued tightness of the back, and 

bilateral L5 and S1 nerve root impingement. 

A January 27, 2012 MRI scan of the thoracic spine demonstrated a mild disc protrusions 

at T2-3 and T3-4 which mildly impressed the thecal sac, a mild central disc protrusion at T7-8 

which mildly impressed the thecal sac and appeared to contact the cord, and a mild 

circumferential disc bulge at T10-11 which mildly impressed the thecal sac. 

In a treatment note dated February 1, 2012, Dr. Moore noted appellant’s complaint of 

radiating lumbar spine pain with additional complaints of muscle pain, spasms, spasticity, 

stiffness, weakness, and myalgias. He described physical examination findings, noting 

tenderness on palpation of the spine, full upper and lower strength, and normal bilateral passive 

straight leg raise. Dr. Moore diagnosed unspecified myalgia and myositis, unspecified 

lumbosacral neuritis, pain in the thoracic spine, thoracic disc displacement, cervical disc 

displacement, thoracic spondylosis, and lumbar disc displacement. 

On February 6, 2012 appellant was evaluated by Dr. Yusuf Mosuro, Board-certified in 

anesthesiology and pain medicine. He described the work injury, appellant’s complaint of mid 

and lower back pain, and physical examination findings. Dr. Mosuro diagnosed thoracic disc 

displacement and chronic pain syndrome, and recommended physical therapy and medication. 

On March 5, 2012 he advised that, because a lumbar spine MRI scan showed an L5-S1 disc 

protrusion, he asked that this be accepted. 

In a March 12, 2012 report, Dr. McKeever noted his review of the statement of accepted 

facts, the medical record including diagnostic studies, and the history of injury. He noted that 

examination showed complaints of pain with very light pressure over the dorsal and lumbar spine 

and head. Dr. McKeever again diagnosed psychophysiologic spine pain with symptom 

magnification. He advised that appellant had no residuals of the accepted thoracic sprain and 

displaced intervertebral disc. Dr. McKeever noted that, per a functional capacity evaluation 
8

(FCE), she was limited to sedentary work and recommended work hardening. A February 9, 

2012 FCE, ordered by Dr. McKeever, showed that appellant functioned in a sedentary category. 

A March 13, 2012 EMG/NCV study of the lower extremities demonstrated mild chronic 

and ongoing bilateral L5-S1 radiculopathy with no evidence of tibial or peroneal 

mononeuropathies. An April 5, 2012 cervical spine MRI scan demonstrated a subtle disc bulge 

at C5-6. 

In an April 27, 2012 decision, OWCP found that appellant had not established that reflex 

spasm in the neck and shoulder girdles; bilateral brachial plexus impingement due to spasms of 

the shoulder girdle, muscles and ligaments; reflex spasm in the back; reflex spasm in the 

buttocks; bilateral sciatic nerve impingement; deranged discs in the back due to continued 

tightness of the back; and bilateral L5 and S1 nerve root impingement were consequential to the 

October 5, 2007 employment injury. Appellant, through counsel, timely requested a hearing. 

Subsequently submitted medical evidence included an April 12, 2012 evaluation by 

Dr. Key who noted the history of injury. Physical examination demonstrated tenderness to 

palpation of the mid and lower back, decreased sensation and strength of the lower extremities, 

and a positive straight leg raising test bilaterally. Dr. Key diagnosed thoracic disc displacement 

and chronic pain. Dr. Moore and Dr. Key continued to submit monthly pain management 

reports. 

On July 16, 2012 Dr. Suzanne M. Manzi, a Board-certified physiatrist and associate of 

Dr. Moore, noted seeing appellant for pain management. Findings included lumbar and thoracic 

spine tenderness to palpation with painful lumbar and thoracic range of motion. Sensory 

examination in the arms and legs was grossly intact. Dr. Manzi diagnosed unspecified 

lumbosacral neuritis; lumbar disc displacement; thoracic spine pain; cervical disc displacement; 

thoracic spondylosis; unspecified myalgia and myositis; and thoracic disc displacement.10 

A hearing was held on August 7, 2012. Counsel noted that appellant continued to receive 

wage-loss compensation. Appellant testified that when she stopped work in September 2008 she 

was not restricted to a 40-hour workweek and was not working outside her restrictions. She 

stated that her condition worsened causing unbearable upper and lower back pain and migraine 

headaches. 

Appellant thereafter submitted a May 15, 2012 report in which Dr. Key noted decreased 

sensation in both lower extremities with a positive straight leg raising test. Dr. Key advised that, 

following his evaluation and examination, and as evidenced by the May 5, 2009 lumbar MRI 

scan and March 13, 2012 EMG/NCV, appellant’s work injury was not limited to thoracic disc 

displacement and chronic pain. He requested that her accepted conditions be upgraded to 

include lumbar disc displacement. In treatment notes dated August 13 and October 8, 2012, 

Dr. Manzi described appellant’s pain management. 

 10 Dr. Moore’s last treatment note was dated June 15, 2012. His associate Dr. Manzi thereafter provided pain 

management. 
9

By decision dated October 15, 2012, an OWCP hearing representative found, while the 

medical evidence submitted was insufficient to establish the additional claimed conditions, 

OWCP had failed to completely develop the case prior to its denial. The hearing representative 

remanded the case to OWCP to seek an addendum report from Dr. McKeever, to be followed by 

a de novo decision on the claimed consequential conditions. He also indicated that OWCP 

should consider whether the allowed conditions remained symptomatic and disabling. 

Dr. Manzi continued to submit monthly treatment notes in which she described 

appellant’s pain management. On December 3, 2012 she reported that an EMG/NCV was done 

that day.11 In reports dated November 26, 2012 and January 14, 2013, Dr. Mosuro described 

physical examination findings and diagnosed sprain thoracic region, thoracic disc displacement, 

and chronic pain syndrome. He advised that appellant could not work, indicating that she was 

retired. 

In December 2012 OWCP again referred appellant to Dr. McKeever. In a February 4, 

2013 report, Dr. McKeever noted reviewing the medical record including diagnostic studies and 

the history of injury. He described findings, noting appellant’s complaint of neck pain that 

radiated down her left arm into the finger. Dr. McKeever found full range of motion of the right 

arm and intermittent motion on the left, with full range of motion of the elbows, hands, and 

wrists, and 5/5 strength in both shoulders. He noted spine tenderness at the bra strap level and in 

the lower lumbar musculature. Dr. McKeever diagnosed resolved acute dorsal muscular strain; 

resolved acute lumbosacral strain; and psychophysiologic left-sided body pain with symptom 

magnification. He advised that the conditions of reflex spasm in the neck and shoulder girdles, 

bilateral brachial plexus impingement due to spasm of the shoulder girdle, muscles, and 

ligaments, reflex spasm in the back, reflex spasm in the buttocks, bilateral sciatic nerve 

impingement, deranged discs in the back due to continued tightness of the back, and bilateral L5 

and S1 nerve root impingement were not a result of the October 5, 2007 work injury. 

Dr. McKeever opined that the October 5, 2007 injury caused mild dorsal and lumbar muscular 

strains which would be expected to resolve in six to eight weeks from the injury date. He 

indicated that his opinion was supported by x-ray findings, Dr. Francis’ June 2008 opinion that 

diagnosed chronic mid-thoracic spine pain, cervical, thoracic, and lumbar spine MRI scans 

which were consistent with chronic, long-standing degenerative spine disease not related to the 

October 5, 2007 work injury, an invalid June 2009 FCE, and Dr. Barnes November 19, 2009 

evaluation which showed no evidence of work-related residuals and no objective finding to 

explain appellant’s spine, arm, or leg pain. Dr. McKeever based his opinion on his clinical 

assessment, examination, and record documentation. 

 11 A report of the study is not found in the case record. 
10

By decision dated March 4, 2013, OWCP denied appellant’s claim for additional 

conditions causally related to the October 5, 2007 employment injury. Appellant, through 

counsel, timely requested a hearing from the March 4, 2013 decision.12 

In January 29 through June 17, 2013 treatment notes, Dr. Manzi described examination 

findings and appellant’s pain management regimen. She reiterated diagnoses of unspecified 

lumbosacral neuritis, lumbar disc displacement, thoracic spondylosis, thoracic disc displacement, 

cervical disc displacement, unspecified myalgia and myositis, and additionally diagnosed pain in 

thoracic spine, chronic pain syndrome, unspecified brachial neuritis, skin sensation disturbance, 

lumbosacral disc degeneration, cervicalgia, and gait abnormality. Dr. Manzi advised that, based 

on her review of the history, physical examination, and relevant imaging, appellant’s complaints 

“may be” attributed in part to the listed diagnoses. A February 25, 2013 MRI scan of the lumbar 

spine demonstrated disc bulges at T11-12, L3-4, L4-5, and L5-S1 which mildly impressed the 

thecal sac. Dr. Manzi continued submitted status reports which reiterated her findings and 

conclusions. 

At the hearing, held on July 12, 2013, appellant testified that she was not working due to 

severe back and leg pain which affected her activities of daily living. She stated that she had 

been in an automobile accident, but could not remember when. The hearing representative 

requested that she submit additional medical and factual information.13

In a September 25, 2013 decision, an OWCP hearing representative vacated the March 4, 

2013 decision regarding appellant’s claim for additional employment-related conditions. He 

found that Dr. McKeever did not discuss Dr. Ellis’ December 9, 2010 report. The hearing 

representative remanded the case to OWCP to obtain a new second opinion evaluation on the 

issue of whether appellant developed additional medical conditions as a consequence of the 

October 5, 2007 employment injury. 

In October 2013 OWCP referred appellant to Dr. Robert D. Harper, a Board-certified 

orthopedic surgeon, for a second opinion. The statement of accepted facts listed the accepted 

conditions of thoracic sprain, displacement of thoracic intervertebral disc without myelopathy, 

and chronic pain syndrome. Dr. Harper was asked to address whether the conditions specified as 

consequential injuries by Dr. Ellis were related to the October 5, 2007 work injury. 

 12 On June 13, 2013 OWCP proposed to terminate appellant’s wage loss and medical benefits. It found that the 

special weight of the medical opinion evidence rested with Dr. McKeever, the referee physician, who submitted 

July 23, 2010, March 12, 2012, and February 4, 2013 reports and advised that the accepted conditions had resolved. 

Appellant disagreed with the proposed termination, maintaining that the medical evidence established continuing 

disability. Additional medical evidence submitted included unsigned emergency department discharge instructions 

dated November 28, 2012 which diagnosed cervical radiculopathy. On January 29 to May 20, 2013 questionnaires 

completed by appellant, she described her pain. 

13 In a July 26, 2013 decision, OWCP terminated appellant’s wage-loss and medical benefits, effective 

July 28, 2013. It found that the weight of the medical evidence rested with Dr. McKeever. Counsel timely 

requested a hearing. In a December 12, 2013 decision, a hearing representative reversed the July 26, 2013 decision. 

He found that it was premature to terminate benefits until active development of appellant’s claim for consequential 

conditions had been concluded. Appellant’s medical and monetary benefits were restored, retroactive to the date of 

termination. 
11

In an October 24, 2013 report, Dr. Harper noted the history of injury and his review of 

the medical record. He related her pain complaints throughout the back, neck, left leg, left 

foot/toe, left knee, left hip, left arm, and left buttock along with tingling, numbness, and burning. 

Activities made the pain worse. Appellant ambulated into the examination room with a slow, 

guarded and broad-based gait. On examination, she performed heel and toe walk without 

difficulty. Appellant was tender to palpation along the cervical, thoracic, and lumbar spines. No 

muscle spasms were noted. Rib compression tests were positive for mid thoracic pain. Sitting 

and supine straight leg raises were positive. Additional tests in the upper and lower extremities 

were negative. Dr. Harper also performed extensive sensation and muscle strength testing, 

finding normal results in all upper and lower extremities. He diagnosed thoracic sprain/strain 

and thoracic disc disorder. Dr. Harper noted his review of and disagreement with Dr. Ellis 

December 9, 2010 report, opining that the conclusions presented by Dr. Ellis had not previously 

been described in medical orthopedic literature, indicating that, while on the surface the 

mechanism of injury described by Dr. Ellis sounded plausible, it was simply not known to 

happen. Dr. Harper noted that commonly, muscle spasms are the result of spinal problems, and 

did not produce spinal problems as posited by Dr. Ellis. He advised that he found no reflex 

spasms in the neck, shoulder girdles, back, or buttocks, no bilateral brachial plexus impingement 

or sciatic nerve impingement in his examination, and he concluded that any muscle spasms were 

the result of the known underlying cervical and lumbar problems seen on MRI scans. Dr. Harper 

concluded that, after careful review of the record, none of the conditions found by Dr. Ellis were 

caused by the October 5, 2007 employment injury. 

Dr. Manzi continued submitting monthly status reports from January 29 to 

August 13, 2014. She noted findings, reiterated diagnoses, and continued advising that 

appellant’s complaints could be attributed to her diagnoses. 

In October 2014, OWCP referred appellant, along with a statement of accepted facts, the 

medical record, and a set of questions to Dr. James Hood, Board-certified in orthopedic surgery, 

for a second opinion examination. Dr. Hood was asked to review Dr. Ellis’ December 9, 2010 

report and opine as to whether the following were causally related to the October 5, 2007 

employment injury: reflex spasm in the neck and shoulder girdles; bilateral brachial plexus 

impingement due to spasm of the shoulder girdle, muscles, and ligaments; reflex spasm in the 

back; reflex spasm in the buttocks; bilateral sciatic nerve impingement; deranged discs in the 

back due to continued tightness of the back; and bilateral L5 and 51 nerve root impingement. 

An October 28, 2014 upper and lower extremity EMG/NCV study was interpreted as 

normal by Dr. Goran A. Jezic, a Board-certified physiatrist. Dr. Jezic advised that there was no 

electrodiagnostic evidence of acute or chronic peripheral nerve or muscle pathology affecting the 

upper or lower extremities, specifically noting no evidence of radiculopathy, plexopathy, or focal 

peripheral neuropathy affecting any extremity. A November 5, 2014 lumbar MRI scan 

demonstrated disc bulges at L3-4, L4-5, and L5-S1 which mildly impressed the thecal sac with 

mild foraminal narrowing. 

Dr. Hood provided an October 21, 2014 report in which he described the history of 

injury, reviewed the medical record including Dr. Ellis’ December 9, 2010 report, and noted 

appellant’s complaints. He related that appellant had been examined by numerous physicians 

and that, over the span of seven years, not one physician had noted any significant pathology that 
12

would require any additional treatment and all indicated that as a result of the work event she had 

a thoracic sprain that in reasonable medical probability had resolved. Dr. Hood described 

findings from his October 21, 2014 examination, noting no palpable cervical spasm, no trigger 

points in the trapezial or rhomboid region, and normal arm reflexes and muscle strength 

bilaterally including deltoid, triceps, biceps, wrist extensors, thenar muscles and intrinsics. 

Lumbar examination demonstrated no palpable muscle spasm, no scoliosis, and normal lumbar 

lordosis but with limited range of motion. Lower extremity strength was normal in the hip 

flexors, quadriceps, hamstrings, and extensor hallucis longus with normal reflexes and no 

scapular winging. Dr. Hood noted the findings of the October 28, 2014 EMG/NCV examination. 

He opined that appellant’s case should have been closed years earlier and, with regard to the 

October 5, 2007 injury, she could return to full duty without restrictions. 

On February 22, 2015 OWCP forwarded Dr. Hood’s report and the October 28, 2014 

EMG/NCV study to Dr. Manzi for comment. In an April 1, 2015 treatment note, Dr. Manzi 

related appellant’s complaint of worsening back pain. Physical examination demonstrated an 

antalgic gait and back pain with range of motion. Dr. Manzi diagnosed pain in the thoracic 

spine, unspecified myalgia and myositis, thoracic disc displacement, thoracic spondylosis, and 

chronic pain syndrome. She advised that, “based on careful review of the history, physical 

examination, and relevant imaging, I believe [appellant’s] complaints may be attributed in part to 

the above listed diagnoses.” 

By decision dated April 27, 2015, OWCP denied appellant’s claim for additional 

conditions due to the October 5, 2007 employment injury. Appellant, through counsel, timely 

requested a hearing. 

Dr. Manzi continued to submit monthly pain management reports in which she reiterated 

her findings and conclusions.14

A hearing was held on December 16, 2015 regarding whether appellant had established 

consequential conditions. Counsel argued that the April 27, 2015 decision denying 

consequential conditions was premature, maintaining that it should have been held in abeyance 

until the issue of termination of accepted conditions was resolved. He suggested that the issues 

be combined with one referral physician rendering an opinion. 

 14 OWCP also continued to develop the issue of whether the accepted thoracic sprain, displacement of thoracic 

intervertebral disc without myelopathy, and chronic pain syndrome had resolved. It found that a conflict in medical 

evidence was created between Drs. Hood and Manzi regarding appellant’s condition, work status, and treatment 

options related to the October 5, 2007 work injury. In June 2015, OWCP referred appellant to Dr. Larry L. Likover, 

a Board-certified orthopedic surgeon, for an impartial evaluation on the issue of whether the accepted conditions had 

resolved. In a June 25, 2015 report, Dr. Likover noted his review of the record and described examination findings. 

He reported that appellant was a very healthy-appearing 41-year-old female and opined that her case had been 

mismanaged from the very beginning. Dr. Likover advised that he was unable to identify any significant injury due 

to the October 5, 2007 work injury, opining that there was no justification for her to be managed and continue taking 

addictive narcotics. He found no sign of a surgical problem or evidence of permanent impairment. Dr. Likover 

concurred with Dr. Hood’s assessment that appellant’s work related conditions have resolved and that she required 

no further treatment, no further medication, and was capable of returning to work without restrictions. On 

November 17, 2015 OWCP proposed to terminate appellant’s wage-loss and medical benefits, based on the opinion 

of Dr. Likover. Appellant disagreed with the proposed termination and continued to assert that she had additional 

injuries. 
13

By decision dated December 22, 2015, OWCP terminated appellant’s wage-loss 

compensation and medical benefits. It found that the weight of the medical evidence rested with 

the opinion of Dr. Likover who performed the impartial medical evaluation. Appellant, through 

counsel, timely requested a hearing from the December 22, 2015 termination decision. 

A pain management treatment note from Dr. Manzi, dated November 3, 2015, was 

submitted on January 11, 2016 in which she reiterated her findings and conclusions. 

By decision dated February 12, 2016, an OWCP hearing representative affirmed the 

April 27, 2015 decision regarding consequential conditions. She noted that OWCP had 

repeatedly addressed whether the conditions of reflex spasm of the neck and shoulder girdles, 

bilateral brachial plexus impingement, reflex spasm in the back, shoulder girdles, and buttocks, 

bilateral sciatic nerve impingement, deranged disc in the back, and bilateral L5-S1 impingement 

were consequential to the October 5, 2007 work injury. The hearing representative noted that 

only Dr. Ellis supported the relationship while OWCP’s referral physicians did not support the 

relationship. She concluded that appellant did not meet her burden of proof to establish 

additional conditions causally related to the October 5, 2007 work injury. 

LEGAL PRECEDENT 

In discussing the range of compensable consequences, once the primary injury is causally 

connected with the employment, Larson notes that, when the question is whether compensability 

should be extended to a subsequent injury or aggravation related in some way to the primary 

injury, the rules that come into play are essentially based upon the concepts of direct and natural 

results and of claimant’s own conduct as an independent intervening cause. The basic rule is that 

a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is 

compensable if it is the direct and natural result of a compensable primary injury.15 

A claimant bears the burden of proof to establish a claim for a consequential injury. As 

part of this burden, he or she must present rationalized medical opinion evidence, based on a 

complete factual and medical background, showing causal relationship. The opinion must be 

one of reasonable medical certainty and must be supported by medical rationale explaining the 

nature of the relationship of the diagnosed condition and the specific employment factors or 

employment injury.16

Causal relationship is a medical issue, and the medical evidence required to establish a 

causal relationship is rationalized medical evidence.17 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 

 15 Lex K. Larson, The Law of Workers’ Compensation § 3.05 (2014); see Charles W. Downey, 54 ECAB 

421 (2003). 

16 Charles W. Downey, id. 

17 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 
14

the employee.18 Neither the mere fact that a disease or condition manifests itself during a period 

of employment nor the belief that the disease or condition was caused or aggravated by 

employment factors or incidents is sufficient to establish causal relationship.19

ANALYSIS 

OWCP accepted that appellant sprained her back, thoracic region, on October 5, 2007 

when she was pulling a table of mail. It later expanded the acceptance of the claim to include 

displacement of thoracic intervertebral disc without myelopathy and chronic pain syndrome. 

Dr. Ellis, an attending physician, opined that additional conditions of reflex spasm in the neck 

and shoulder girdles; bilateral brachial plexus impingement due to spasms of the shoulder girdle 

muscles; reflex spasm in the back and buttocks; bilateral sciatic nerve impingement; deranged 

discs in the back due to continued tightness of the back; and bilateral L5 and S1 spinal nerve 

impingement should be accepted. On February 12, 2016 an OWCP hearing representative 

affirmed an April 27, 2015 OWCP decision denying the claim for additional or consequential 

conditions. The Board finds that the record does not support that additional conditions should be 

accepted. 

In April 26 and December 9, 2010, and November 14, 2011 reports, Dr. Ellis opined that 

the October 5, 2007 work injury caused consequential injuries. He noted the history of injury 

and also that appellant had been in motor vehicle accidents in 2005 and 2008. Dr. Ellis 

described current complaints and indicated that appellant’s conditions worsened over time such 

that she was permanently and totally disabled. He maintained that appellant had an acute injury 

to the T8-9 thoracic disc on October 5, 2007, and this caused the paraspinous muscles in the 

thoracic and neck areas to become very tight which caused brachial plexus impingement due to 

the tight muscles in the thoracic, cervical, and shoulder girdle area; that continued pain in the 

spinal nerves caused the lower back to stay in spasm which caused tightness in the iliolumbar 

and sacroiliac ligaments, and in the buttocks muscles, and this led to bilateral sciatic nerve 

impingement. Dr. Ellis maintained that the continued tightness in her back caused increased 

pressure on the lumbar discs which caused the discs to impinge upon the bilateral L5 and S1 

spinal nerve roots leading to impairment of the L5 and S1 spinal nerve roots bilaterally. 

Dr. Ellis first saw appellant on April 26, 2010, two and a half years after the October 5, 

2007 work injury. He did not discuss the impact of the 2008 motor vehicle accident that 

occurred shortly before appellant stopped work in September 2008 other than to say that 

appellant did not think she had any residuals of this accident. The record before the Board 

contains scant medical evidence regarding this accident, merely a brief note by Dr. Watkins 

dated September 22, 2008, the day before appellant stopped work. He noted that appellant had 

been in a motor vehicle accident and diagnosed upper and lower back pain, headaches, chest 

pain, cervical pain, and left shoulder pain. 

The Board finds that Dr. Ellis’ explanation of the mechanics of why the additional 

conditions should be accepted has insufficient rationale to meet appellant’s burden of proof. He 

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

19 Dennis M. Mascarenas, 49 ECAB 215 (1997). 
15

did not discuss the impact of disc protrusions found on a May 5, 2009 MRI scan of cervical 

spine, MRI scan findings of the lumbar spine demonstrating a mild disc protrusion at L4-5 and a 

mild disc bulge at L5-S1, or the December 7, 2011 lower extremity EMG/NCV that did not 

demonstrate lumbar radiculopathy and/or peripheral entrapment syndromes. While Dr. Ellis 

provided some explanation of why he believed the accepted thoracic conditions caused 

additional conditions, he exhibited limited knowledge of appellant’s condition prior to the 

October 5, 2007 injury and did not explain with sufficient rationale how this work incident 

caused or aggravated additional conditions. As his reports did not contain sufficient rationale on 

causal relationship, they are of diminished probative value and are insufficient to meet 

appellant’s burden of proof to establish additional conditions due to October 5, 2007 

employment injury.20

Dr. Mosuro, a pain management specialist, treated appellant from February 6, 2012 to 

January 14, 2013. He advised on March 12, 2012 that, because a lumbar spine MRI scan 

demonstrated a disc protrusion at L5-S1 and he would ask that this be accepted. Similarly, on 

May 15, 2012, Dr. Key advised that, following his evaluation and examination, and as evidenced 

by the May 5, 2009 lumbar MRI scan and March 13, 2012 EMG/NCV, appellant’s work injury 

was not limited to thoracic disc displacement and chronic pain. He requested that her accepted 

conditions include lumbar disc displacement. Neither Dr. Mosuro nor Dr. Key, however, 

provided an explanation of how the October 5, 2007 work injury caused the subsequent findings 

on the diagnostic studies. A physician’s opinion on causal relationship between a claimant’s 

disability and an employment injury is not conclusive simply because it is rendered by a 

physician. To be of probative value, the physician must provide rationale for the opinion 

reached. Where, as here, no such rationale is present, the medical opinion is of diminished 

probative value.21 

Dr. Manzi began pain management in July 2012 and also diagnosed additional conditions 

of unspecified lumbosacral neuritis, lumbar and cervical disc displacement, unspecified myalgia 

and myositis, unspecified brachial neuritis, skin sensation disturbance, lumbosacral disc 

degeneration, cervicalgia, and abnormality of gait. While she advised that based on her review 

of the history, physical examination, and relevant imaging, appellant’s complaints “may be” 

attributed in part to her listed diagnoses, which included the accepted condition, she failed to 

explain how the October 5, 2007 employment injury caused the additional diagnoses. Moreover, 

the equivocal aspect of her opinion diminishes its probative value.22

Other medical evidence provided by appellant did not specifically address whether any 

additional diagnosed medical conditions were causally related to the October 5, 2007 work 

injury. Thus, this evidence is of limited probative value on the issue of causal relationship.23 For 

example, reports from Dr. Athari, Dr. Moore, and Dr. Eidman did not specifically address how 

any additional conditions were causally related to the accepted work injury. 

 20 See D.U., Docket No. 10-144 (issued July 27, 2010). 

21 T.M., Docket No. 08-975 (issued February 6, 2009). 

22 See D.D., 57 ECAB 734 (2006). 

23 Willie M. Miller, 53 ECAB 697 (2002). 
16

Furthermore, the record contains reports from several OWCP physicians which do not 

support that any additional conditions were casually related to the October 5, 2007 work injury. 

Dr. Barnes, who provided an impartial medical evaluation regarding appellant’s ability to work, 

opined on April 5, 2010 that appellant exhibited symptom magnification. On June 13, 2011 

Dr. Katz, an OWCP medical adviser, opined that the mechanism for the consequential nature for 

additional conditions proposed by Dr. Ellis was unlikely and implausible given the accepted 

conditions and the objective evidence from diagnostic studies. OWCP’s medical adviser 

referenced reports from other examining physicians that did not support the physical findings 

reported by Dr. Ellis. 

In a February 4, 2013 report Dr. McKeever, an independent medical examining 

physician, described physical examination findings and diagnosed resolved acute dorsal 

muscular strain; resolved acute lumbosacral strain; and left-sided psychophysiologic body pain 

with symptom magnification. Dr. McKeever specifically advised that the conditions of reflex 

spasm in the neck and shoulder girdles, bilateral brachial plexus impingement due to spasm of 

the shoulder girdle, muscles, and ligaments, reflex spasm in the back, reflex spasm in the 

buttocks, bilateral sciatic nerve impingement, deranged discs in the back due to continued 

tightness of the back, and bilateral L5 and S1 nerve root impingement were not due to the 

October 5, 2007 work injury. He opined that the October 5, 2007 injury caused mild dorsal and 

lumbar muscular strains which would have resolved within six to eight weeks after the injury. 

Dr. McKeever indicated that his opinion was supported by reports in the record as well as x-ray 

and MRI scan findings which were consistent with chronic, long-standing degenerative spine 

disease not related to the October 5, 2007 work injury. 

In an October 24, 2013 report, Dr. Harper, an OWCP referral physician, reviewed the 

record, described examination findings and diagnosed thoracic sprain/strain and thoracic disc 

disorder. He disagreed with Dr. Ellis’ December 9, 2010 report, opining that the conclusions 

presented by Dr. Ellis had not previously been described in medical orthopedic literature. 

Dr. Harper indicated that, while on the surface the mechanism of injury described by Dr. Ellis 

sounded plausible, it was simply not known to happen. He maintained that muscle spasms were 

commonly the result of spinal problems, but would not produce the spinal problems noted by 

Dr. Ellis. Dr. Harper advised that on examination, he found no reflex spasms in appellant’s 

neck, shoulder girdles, back, or buttocks, and no bilateral brachial plexus impingement or sciatic 

nerve impingement. He concluded that any muscle spasms were the result of the known 

underlying cervical and lumbar problems seen on MRI scans. As such, none of the 

consequential conditions found by Dr. Ellis were due to the October 5, 2007 work injury. 

Dr. Hood, also an OWCP referral physician, provided an October 21, 2014 report in 

which he related appellant’s examination by numerous physicians had not indicated any 

significant pathology that would require any additional treatment. He described essentially 

normal examination findings and concluded that appellant’s case should have been closed years 

earlier. Likewise, on June 25, 2015, Dr. Likover who examined appellant with regard to whether 

the accepted conditions had resolved, found no basis on which to attribute any continuing 

condition or impairment to the October 5, 2007 employment injury. 
17

The Board finds that appellant has submitted insufficient rationalized medical evidence 

supporting causal relationship between any of the claimed additional conditions and the 

October 5, 2007 employment injury. 

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 did not meet her burden of proof to establish that she 

sustained bilateral brachial plexus impingement; reflex spasm in the neck, back, shoulder girdles, 

and buttocks, bilateral sciatic nerve impingement, deranged disc in the back, and bilateral L5-S1 

impingement causally related to the October 5, 2007 employment injury. 

ORDER 

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

Compensation Programs dated February 12, 2016 is affirmed. 

Issued: May 3, 2017 

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