United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.D., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, ROBINS 

AIR FORCE BASE, GA, Employer 

__________________________________________ 

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Docket No. 16-1854 

Issued: March 3, 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 September 19, 2016 appellant filed a timely appeal from June 21 and August 30, 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 has established that his claim should be expanded to 

include additional back conditions, including chronic degenerative lumbar disc disease, lumbar 

spondylosis, lumbar stenosis, and neuritis/radiculopathy as causally related to his January 27, 

2014 employment injury. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On February 10, 2014 appellant, then a 61-year-old electroplater, filed a traumatic injury 

claim (Form CA-1) alleging that on January 27, 2014 he strained his lower back when lifting a 

C-130 propeller barrel. He stopped work on January 27, 2014 and returned to restricted work on 

January 28, 2014. OWCP accepted the claim for lumbar strain.2

 

Appellant received treatment from an employing establishment clinic after his injury. In 

a March 20, 2014 report, Dr. Anna Abrigo, a pediatrician, and Dr. Michael G. Rappa, an 

internist, both employing establishment physicians, reviewed his workers’ compensation claim. 

The physicians noted that appellant had a prior history of low back pain as based on a 

December 2012 computerized tomography (CT) scan showing disc protrusions at L4-5 and L5-

S1 and severe canal narrowing due to facet hypertrophy. Dr. Abrigo and Dr. Rappa reviewed an 

October 28, 2013 medical report diagnosing degenerative disc disease, facet arthropathy at L4-5 

and L5-S1, disc protrusions and stenosis particularly at L4-5, osteoarthritis of the sacroiliac 

joints, bilateral hamstring tightness, and myofascial pain syndrome. The physicians related: 

“[Appellant] has an underlying back pain which is actively being treated by the 

[Veterans Administration] with a history of significant spinal stenosis. 

Understandably, [he] would have experienced low back pain with moving of the 

barrel and it could have exacerbated or brought out his symptoms more. Merely 

lifting the barrel did not cause or aggravate [the] condition for which he is now 

experiencing pain.” 

An April 25, 2014 CT scan showed degenerative disc disease and facet changes similar to 

that in a previous study and grade 1 anterolisthesis at L3-4. 

 On May 13, 2014 Dr. K. Scott Malone, a Board-certified physiatrist, noted that he had 

experienced low back pain for around five months after a January 2014 injury at work lifting a 

part. In a progress report dated June 3, 2014, he obtained a history of appellant sustaining an 

injury on January 27, 2014 causing back pain radiating into the left lower extremity after he 

lifted a barrel at work. Dr. Malone advised that he “consider[ed] the reported injury to be the 

cause of the injured workers’ problem.” In progress reports dated May 13 to October 22, 2014, 

he treated appellant for lumbar strain/sprain. 

A November 13, 2014 CT scan revealed advanced degenerative disc disease 

superimposed on a congenitally narrow canal, severe L3-4 and L4-5 spinal stenosis, mild 

stenosis at L2-3, and multilevel lateral recess and foraminal narrowing. 

Dr. Malone, on November 18, 2014, requested that OWCP update the injury-related 

diagnosis to include chronic degenerative lumbar disc disease. In an accompanying progress 

report, he discussed appellant’s symptoms of low back pain and diagnosed lumbar sprain and 

lumbar degenerative disc disease. 

 2

 In a March 25, 2014 decision, OWCP denied appellant’s traumatic injury claim as the medical evidence was 

insufficient to show causally relationship. In a decision dated May 13, 2014, it vacated the March 25, 2014 decision 

and accepted the claim for lumbar strain. 
3

On November 19, 2014 Dr. Daxes M. Banit, a Board-certified orthopedic surgeon, saw 

appellant for back pain radiating to the left leg for the past 11 months after bending to pick up a 

part at work in January 2014. He advised that the injury was “work related.” Dr. Banit 

diagnosed lumbar degenerative disc disease, lumbar spondylosis with myelopathy, lumbar 

stenosis, neuritis/radiculopathy, lumbar spondylosis without myelopathy, and foraminal stenosis. 

On December 3, 2014 he diagnosed lumbar sprain and lumbar degenerative disc disease. 

Dr. Banit indicated that the date of injury was January 27, 2014 and found “the reported injury to 

be the cause of the injured worker’s problem.” On December 4, 2014 he requested authorization 

for lumbar spinal injections. 

On January 8, 2015 Dr. Malone requested that OWCP update the accepted conditions to 

include chronic lumbar degenerative disc disease, lumbar spondylosis with myelopathy, lumbar 

stenosis, neuritis/radiculopathy, and spondylosis of the lumbar spine without myelopathy. 

By letter dated January 8, 2015, OWCP advised appellant that it could not authorize the 

requested treatment as it did not appear to be due to his January 27, 2014 work injury. It 

requested that he submit a reasoned report from his attending physician addressing why he 

believed the claimed condition was caused or aggravated by the employment injury. 

In a report dated January 29, 2015, Dr. Banit discussed appellant’s complaints of back 

pain affecting his activities of daily living. He provided examination findings of a positive 

straight leg raise. Dr. Banit diagnosed neuritis/radiculopathy, lumbar degenerative disc disease, 

and lumbar spondylosis without myelopathy. 

By decision dated March 3, 2015, OWCP denied appellant’s request to expand 

acceptance of his claim to include the additional conditions of chronic lumbar degenerative disc 

disease, lumbar spondylosis with and without myelopathy, lumbar stenosis, and neuritis/ 

radiculopathy. It found that he had not submitted a report from a physician explaining how the 

diagnosed conditions were causally related to the accepted January 27, 2014 work injury. 

In a report dated March 3, 2015, received by OWCP on March 11, 2015, Dr. Banit 

discussed his treatment of appellant for an employment injury on January 27, 2014 after he lifted 

a C-130 airplane barrel. He noted that his symptoms worsened with time and that he could not 

get authorization for treatment. Dr. Banit requested expansion of appellant’s claim to include the 

additional requested conditions.3

Dr. Banit, on March 16, 2015, noted that OWCP denied expansion of the additional 

conditions as they were preexisting. He related: 

“[I]t is my professional medical opinion that [appellant] was able to work without 

restrictions up until the date he injured his back lifting a C-130 propeller barrel. 

With that said, if these conditions are considered to be preexisting, they were 

certainly aggravated by this incident, within a reasonable degree of medical 

certainty.” 

 3

 Dr. Banit continued to provide progress reports describing his treatment of appellant. 
4

On April 30, 2015 appellant requested reconsideration.4 He maintained that his physician 

found that his claim should be expanded. 

By decision dated July 31, 2015, OWCP denied modification of the March 3, 3015 

decision. It found that Dr. Banit’s opinion was insufficiently rationalized to establish that lifting 

on January 27, 2014 caused or aggravated by diagnosed conditions. 

In a progress report dated August 13, 2015, Dr. Banit noted that appellant’s symptoms 

had not changed and that OWCP had not expanded acceptance of his conditions.5

 He diagnosed 

lumbar degenerative disc disease, lumbar spondylosis without myelopathy, and thoracic/lumbar 

neuritis and radiculitis. Dr. Banit again requested that OWCP update its acceptance to include 

additional conditions. 

In a September 8, 2015 report, Dr. George S. Stefanis, a Board-certified neurosurgeon, 

related that appellant had low back pain radiating into the legs after lifting parts at work on 

January 27, 2014. He reviewed the results of objective studies showing retrolisthesis at L4-5, 

anterior listhesis at L3-4, and degenerative disc disease at L4-5 and L5-S1.6

 On September 22, 

2015 Dr. Stefanis requested that OWCP update the accepted conditions to include herniated discs 

at L4-5 and L5-S1, lumbar spinal stenosis at L4-5 and L5-S1, lumbar spondylolisthesis at L3-4, 

and lumbar degenerative disc disease from L3 to S1. In an accompanying chart note, he advised 

that a September 17, 2015 myelogram showed L4-5 and L5-S1 disc herniations. Dr. Stefanis 

recommended surgery and work restrictions. 

Dr. Stefanis, on October 3, 2015, noted that appellant provided a history of a lifting 

injury at work on January 27, 2014. He related, “At that time, he developed pain in his back 

radiating into the back and the legs down into the hips and into the thighs.” Dr. Stefanis advised 

that objective testing showed impingement of the L4-5 and L5-S1 nerve roots bilaterally, or 

“pressure on the nerve roots on both sides with physical pressure as well as swelling of the 

nerves that can cause pain in the back, hip, and legs.” He noted that appellant also had instability 

at L3-4 and anticipated that he would require surgery. 

Appellant, on October 14, 2015, requested reconsideration. In a chart note dated 

October 20, 2015, Dr. Stefanis recommended a spinal fusion. He found that appellant could 

continue working modified duty. In an attached November 2, 2015 cover letter, Dr. Stefanis 

requested that OWCP expand acceptance of the claim to include additional conditions. 

 4

 In a statement dated April 27, 2015, appellant described the January 27, 2015 work incident. 

5

 Dr. Banit and Dr. Malone continued to provide progress reports. In an August 18, 2015 report, Dr. Malone 

provided examination findings and diagnosed chronic lumbar disc degeneration and lumbar sprain/strain. He noted 

that OWCP had not authorized epidural injections and that a “causation statement was provided in his initial note on 

December 3, 2014.” 

6

 In a progress report dated September 10, 2015, Dr. Banit diagnosed lumbar degenerative disc disease, lumbar 

spondylosis without myelopathy, and neuritis/radiculitis of the thoracic and lumbar spine. 
5

By decision dated January 12, 2016, OWCP denied modification of the July 31, 2015 

decision. It found that Dr. Stefanis did not provide rationale for his opinion that the current 

conditions resulted from the January 27, 2014 work injury. 

Dr. Stefanis submitted chart notes dated March and April 2016. On March 9, 2016 he 

noted that OWCP accepted only that appellant sustained a lumbar sprain. Dr. Stefanis opined 

that the results of the September 17, 2015 myelogram were “totally different than a lumbar 

strain.” He indicated that appellant had not been evaluated by a neurosurgeon at the time of the 

diagnosis. Dr. Stefanis found that based on the history of injury and the results of the 

myelogram, appellant had “a very significant problem causing nerve root compression.” 

On April 12, 2016 Dr. Stefanis noted seeking approval for surgery from OWCP. He 

discussed appellant’s history of a January 27, 2014 work injury and his radiating pain symptoms 

since that time. Dr. Stefanis noted that physicians originally diagnosed a lumbar strain but that a 

September 17, 2015 myelogram showed a significant disc herniation at L5-S1 and nerve root 

problems at L4-5 and L5-S1. He related, “I feel that the disc herniation was caused by the 

incident [appellant] described to me. [Appellant] does have degenerative changes, but [he] was 

working and continues to work even though it is light duty, but he is having pain radiating into 

both hips and both legs.” Dr. Stefanis opined, “My feeling is that he does have a disc herniation 

extend[ing] into the left neural foramen at L4-5 as well as a large central herniation at L5-S1. 

There are degenerative changes, but these [he] was working with before the injury occurred. I 

feel that his symptoms are due to the injury that he described to me.” 

In an April 13, 2016 report, Dr. Stefanis advised that appellant had degenerative disc 

disease before his work injury but it “did not inhibit his ability to perform his full time, regularduty work activities which required him lifting 75 [pound] aircraft parts.” He further did not 

have radiculopathy prior to lifting the aircraft part on January 27, 2014. Dr. Stefanis related that 

appellant’s accepted conditions should be expanded to include a herniated disc at L4-5 and L5-

S1, spinal stenosis at L4-5 and L5-S1, spondylolisthesis at L3-4, and degenerative disc disease at 

L3-4, L4-5, and L5-S1. He advised that a sprain would have long since resolved. 

On April 18, 2016 appellant requested reconsideration.7

 

In a decision dated June 21, 2016, OWCP denied modification of its January 12, 2016 

decision. It found that the medical evidence did not contain a rationalized opinion that the work 

incident resulted in the diagnosed conditions. 

Dr. Stefanis, in an August 9, 2016 report, indicated that a 2015 myelography showed L4-

5 and L5-S1 disc problems. He related that based on appellant’s history and the myelogram 

appellant had experienced “an aggravation of his preexisting problem.”8

 Dr. Stefanis advised 

that appellant could work light duty and would at some point require surgery. 

 7

 In chart notes dated May 3 and June 7, 2016, Dr. Stefanis provided physical findings and opined that appellant 

could work with restrictions. 

8

 Dr. Stefanis also provided a chart note dated July 29, 2016. 
6

On August 18, 2016 appellant requested reconsideration. By decision dated August 30, 

2016, OWCP denied modification of its June 21, 2016 decision. 

LEGAL PRECEDENT 

Where an employee claims that a condition not accepted or approved by OWCP was due 

to an employment injury, he bears the burden of proof to establish that the condition is causally 

related to the employment injury.9

 To establish a causal relationship between the condition, as 

well as any attendant disability claimed and the employment event or incident, the employee 

must submit rationalized medical opinion evidence based on a complete factual and medical 

background, supporting such a causal relationship.10 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.11 The weight of medical evidence is determined by its reliability, its probative 

value, its convincing quality, the care of analysis manifested and the medical rationale expressed 

in support of the physician’s opinion.12 

OWCP’s procedures provide: 

“In any case where a preexisting condition involving the same part of the body is 

present and the issue of causal relationship therefore involves aggravation, 

acceleration or precipitation, the physician must provide rationalized medical 

opinion which differentiates between the effects of the work-related injury or 

disease and the pre-existing condition. Such evidence will permit the proper kind 

of acceptance (e.g., temporary vs. permanent aggravation).”13

ANALYSIS 

OWCP accepted that appellant sustained lumbar strain due to a January 27, 2014 

employment injury. Appellant returned to modified duty following his injury. He requested that 

OWCP accept additional back conditions as work related. The Board finds, however, that 

appellant did not submit sufficient reasoned medical evidence on causal relationship to establish 

additional employment-related conditions. 

Appellant received treatment from physicians at the employing establishment from 

January to April 2014. A CT scan obtained April 25, 2014 revealed degenerative disc disease 

and facet changes similar to that in a previous study and grade 1 anterolisthesis at L3-4. In a 

 9 See V.B., Docket No. 12-599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200 (2004). 

10 See M.W., 57 ECAB 710 (2006); John D. Jackson, 55 ECAB 465 (2004). 

11 See John W. Montoya, 54 ECAB 306 (2003). 

12 See H.H., Docket No. 16-0897 (issued September 21, 2016); James Mack, 43 ECAB 321 (1991). 

13 Federal (FECA) Procedure Manual, Part 2 -- Claims, Casual Relationship, Chapter 2.805.3(e) (January 2013). 
7

report dated October 28, 2014, Dr. Abrigo and Dr. Rappa discussed appellant’s history of 

preexisting low back pain and CT scan findings from 2012 of L4-5 and L5-S1 disc protrusions 

and facet hypertrophy. The physicians found that appellant’s January 27, 2014 injury could have 

increased his symptoms but did not cause or aggravate his current condition. 

Dr. Malone began treating appellant in May 2014 for lumbar strain/sprain. He obtained a 

November 13, 2014 CT scan showing advanced degenerative disc disease superimposed on a 

congenitally narrow canal, severe L3-4 and L4-5 spinal stenosis, mild stenosis at L2-3, and 

multilevel lateral recess and foraminal narrowing. Dr. Malone provided a history of appellant’s 

January 2014 work injury. On November 18, 2014 he requested that OWCP expand acceptance 

of appellant’s claim to include chronic lumbar degenerative disc disease. On January 8, 2015 

Dr. Malone recommended that OWCP accept chronic lumbar degenerative disc disease, lumbar 

spondylosis with and without myelopathy, lumbar stenosis, and neuritis/radiculopathy as 

employment-related conditions. However, he did not provide any rationale supporting his 

conclusion that the additional conditions were due to the accepted work injury. Medical 

conclusions unsupported by rationale are of diminished probative value.14

Dr. Banit, on November 19, 2014, discussed appellant’s complaints of radiating back 

pain after picking up a part at work in January 2014. He indicated that the injury was related to 

his work. Dr. Banit diagnosed lumbar degenerative disc disease, lumbar spondylosis with 

myelopathy, lumbar stenosis, neuritis/radiculopathy, lumbar spondylosis without myelopathy, 

and foraminal stenosis. On December 3, 2014 he diagnosed lumbar sprain and degenerative disc 

disease and advised that appellant’s January 27, 2014 injury caused his problem. In a March 3, 

2015 progress report, Dr. Banit noted that appellant sustained a work injury on January 27, 2014 

lifting a barrel for a C-130 airplane and requested claim expansion to include the previously 

requested conditions. He did not, however, support his causation finding with medical rationale 

explaining how the January 27, 2014 work incident caused or aggravated the diagnosed 

conditions.15 Such rationale is particularly important given appellant’s history of preexisting 

back conditions.16 

On March 16, 2015 Dr. Banit reviewed OWCP’s denial of the expansion of appellant’s 

claim to include additional conditions. He noted that he had worked without any restrictions 

until lifting the C-130 propeller barrel and advised that the lifting injury aggravated his 

preexisting back condition. In a progress report dated August 13, 2015, Dr. Banit again 

requested that OWCP update its acceptance to include lumbar degenerative disc disease, lumbar 

spondylosis without myelopathy, and thoracic/lumbar neuritis and radiculitis. However, he did 

not explain how the lifting injury caused an aggravation of appellant’s underlying back 

condition. The Board notes that, with respect to an opinion on aggravation or exacerbation, the 

opinion must differentiate between the effects of the work-related injury and the preexisting 

 14 See Jacquelyn L. Oliver, 48 ECAB 232 (1996). 

15 See K.W., Docket No. 10-0098 (issued September 10, 2010). 

16 See P.H., Docket No. 16-0654 (issued July 21, 2016); S.R., Docket No. 16-0657 (issued July 13, 2016). 
8

condition.17 Dr. Banit did not explain how the lifting incident affected an underlying condition 

and thus his report is insufficient to meet appellant’s burden of proof. 

Dr. Stefanis, on September 8, 2015, discussed appellant’s complaints of low back pain 

radiating into his legs after lifting parts on January 27, 2014 at work. He noted that diagnostic 

studies showed L4-5 retrolisthesis, L3-4 anterior listhesis, and L4-5 and L5-S1 degenerative disc 

disease. On September 22, 2015 Dr. Stefanis requested that OWCP expand acceptance of 

appellant’s claim to include herniated discs at L4-5 and L5-S1, lumbar spinal stenosis at L4-5 

and L5-S1, lumbar spondylolisthesis at L3-4, and lumbar degenerative disc disease from L3 to 

S1. He provided additional reports on October 3 and 20, 2015 describing the findings on 

objective studies and requesting claim explanation. On March 9, 2016 Dr. Stefanis advised that 

the results of the September 2015 myelogram were different than the accepted lumbar sprain 

condition. He found that the injury and objective testing showed a back problem with nerve root 

compression. Dr. Stefanis did not, however, provide any rationale for his causation finding or 

explain how any additional conditions resulted from the January 2014 lifting incident. A mere 

conclusion without the necessary rationale explaining how and why the physician believes that a 

claimant’s accepted exposure could result in a diagnosed condition is not sufficient to meet a 

claimant’s burden of proof.18 Again, as noted, such rationale is particularly necessary given the 

history of preexisting back conditions.19

Dr. Stefanis, in a report dated April 12, 2016, indicated that while physicians originally 

diagnosed appellant’s condition as lumbar sprain, testing showed a disc herniation. He attributed 

the L5-S1 disc herniation and nerve root problems at L4-5 and L5-S1 to the work injury, noting 

that while he had preexisting degenerative changes he was able to perform his usual employment 

prior to the injury. On April 13, 2016 Dr. Stefanis again noted that appellant’s preexisting 

degenerative disc disease did not prevent him from preforming his usual employment prior to his 

January 27, 2014 lifting incident. He further advised that he did not have radiculopathy before 

that date and requested claim expansion. A medical opinion that a condition is causally related 

to an employment injury because the employee was asymptomatic before the injury but 

symptomatic after it is insufficient, without supporting rationale, to establish causal 

relationship.20 Dr. Stefanis did not explain, with reference to the specific mechanism of injury, 

how lifting on January 27, 2014 aggravated a preexisting condition and thus his report is of little 

probative value.21

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. 

 17 See supra note 13; see also J.R., Docket No. 16-0327 (issued July 6, 2016). 

18 See Beverly A. Spencer, 55 ECAB 501 (2004). 

19 See supra note 16. 

20 Cleopatra McDougal-Saddler, 47 ECAB 480 (1996). 

21 The Board notes that other medical reports, including Dr. Stefanis’ August 9, 2016 report, are of limited 

probative value as they did not provide an opinion on causation. See Jaja K. Asaramo, supra note 9. 
9

CONCLUSION 

The Board finds that appellant has not established that his claim should be expanded to 

include additional back conditions, including chronic degenerative lumbar disc disease, lumbar 

spondylosis, lumbar stenosis, and neuritis/radiculopathy as causally related to his January 27, 

2014 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the August 30 and June 21, 2016 decisions of the 

Office of Workers’ Compensation Programs are affirmed. 

Issued: March 3, 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