United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Youngstown, OH, Employer 

__________________________________________ 

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Docket No. 16-0390 

Issued: September 20, 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 December 29, 2015 appellant filed a timely appeal from a November 24, 2015 merit 

decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Act1

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.2

ISSUE 

The issue is whether OWCP met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits for her accepted right carpal tunnel syndrome, effective 

November 24, 2015. 

                                                             1

 5 U.S.C. § 8101 et seq. 

2

 Appellant submitted new evidence after OWCP rendered its November 24, 2015 decision. The Board’s 

jurisdiction is limited to reviewing the evidence that was before OWCP at the time of its final decision. Therefore, 

this additional evidence cannot be considered by the Board. 20 C.F.R. § 501.2(c)(1). 
2 

FACTUAL HISTORY 

On September 25, 2009 appellant, then a 49-year-old mail handler, injured her neck and 

left upper extremity in the performance of duty.3

 OWCP accepted her traumatic injury claim 

(Form CA-1) for left shoulder sprain and cervical sprain/strain under OWCP File No. 

xxxxxx454. Appellant had previously sustained work-related neck and upper extremity injuries 

on August 28 and September 30, 2008, which OWCP accepted for neck sprain/strain, left 

shoulder sprain, right carpal tunnel syndrome, and aggravation of preexisting cervical stenosis 

(OWCP File Nos. xxxxxx661 and xxxxxx009).4 Following her latest employment injury, she 

was able to work in a limited-duty capacity, but, as of September 21, 2010, the employing 

establishment was no longer able to accommodate appellant’s work restrictions. Therefore, 

OWCP paid appellant wage-loss compensation for temporary total disability.5

 Appellant 

returned to full-time, light-duty work on March 28, 2011. 

In August 2012, OWCP referred appellant to Dr. Manhal A. Ghanma, a Board-certified 

orthopedic surgeon, for a second opinion evaluation to determine the nature and extent of her 

employment-related conditions. In her September 20, 2012 report, Dr. Ghanma provided results 

on examination and reviewed the statement of accepted facts (SOAF), history of the injuries, and 

the medical evidence of record. He found that appellant’s accepted cervical conditions, left 

shoulder sprain/strain, and right carpal tunnel syndrome had resolved. Dr. Ghanma reported 

diagnostic findings of cervical degenerative disc disease and left acromioclavicular (AC) joint 

degenerative disease. However, he opined that neither condition was employment related. 

Dr. Ghanma also noted that appellant had right shoulder degenerative changes that affected her 

range of motion. This too was not employment related. Dr. Ghanma opined that based on 

appellant’s accepted conditions having resolved, she was capable of returning to full-duty work 

and no further treatment for her accepted conditions was necessary. 

On November 20, 2012 appellant began to lose intermittent work hours again and 

stopped work completely on February 8, 2013 due to nonemployment-related illness. She 

returned to work on April 26, 2013, but stopped again on April 27, 2013 because the employing 

establishment was unable to accommodate her medical restrictions. OWCP resumed payment of 

wage-loss compensation effective April 27, 2013.6

Subsequently, appellant submitted reports dated January 9, February 6, and March 6, 

2014 from Dr. Timothy J. Wagner, a Board-certified family practitioner, who diagnosed carpal 

tunnel syndrome, impingement syndrome of shoulder region, shoulder pain, neck pain, cervical 

sprain, and cervical spinal stenosis. Upon physical examination, Dr. Wagner found restriction of 

range of motion in the neck, back, upper back, and bilateral shoulders. He also found abnormal 

and decreased muscle strength in the upper extremities bilaterally due to pain. On April 2, 2014 

                                                             3

 Appellant was performing the job of cut-ups and rejects when she experienced pain in her left shoulder. 

4

 OWCP administratively combined the above-noted cervical and upper extremity injury claims and assigned File 

No. xxxxxx454 as the master file. 

5

 OWCP placed appellant on the periodic compensation rolls, effective February 13, 2011. 

6

 Effective December 15, 2013, OWCP returned appellant to the periodic compensation rolls. 
3 

Dr. Wagner found numbness in appellant’s right and left hands and tenderness in the left 

shoulder, neck, left upper arm, right shoulder, and right upper arm. On May 15, 2014 he 

reported that appellant complained of worsening pain in the right arm and numbness and tingling 

in both arms. 

OWCP found a conflict in medical opinion between Drs. Wagner and Ghanma and 

referred appellant to Dr. Robert C. Erickson, a Board-certified orthopedic surgeon, for an 

impartial medical examination to resolve the issue of whether she continued to have any 

disability or residuals as a result of the accepted employment conditions. In his May 29, 2014 

report, Dr. Erickson reviewed a statement of accepted facts and the medical evidence of record. 

He found that appellant’s left shoulder sprain and cervical sprain conditions had resolved. 

Dr. Erickson concluded that appellant had reached maximum medical improvement and was 

capable of working regular duty with medical restrictions that were unrelated to her accepted 

conditions. 

Appellant submitted reports dated June 11 through September 24, 2014. Dr. Wagner 

noted that appellant had been experiencing increased pain after physical therapy to the point 

where she was unable to complete exercises due to pain in the neck and left shoulder. On 

September 24, 2014 he reiterated his diagnoses and indicated that appellant’s diagnoses 

included: upper arm sprain, cervical spinal stenosis, cervical sprain, bilateral carpal tunnel 

syndrome, exacerbation of asthma, impingement syndrome of shoulder region, neck pain, 

bilateral shoulder pain, and sinusitis. 

In a July 30, 2015 memorandum to the file, OWCP acknowledged that Dr. Erickson’s 

impartial medical examination was insufficient to resolve the issue in the claim because he was 

not asked to address all of the accepted conditions in appellant’s combined cases. Therefore, his 

May 29, 2014 report could not be used to terminate her compensation benefits. OWCP further 

indicated that additional medical development was needed to address appellant’s residuals and 

work capabilities in regards to all of her accepted conditions. 

In an August 7, 2015 letter, OWCP requested that Dr. Wagner submit an updated report 

regarding appellant’s work-related conditions and capabilities, including any residuals of her 

cervical sprain and aggravation of cervical stenosis. Dr. Wagner did not respond. 

On August 11, 2015 OWCP referred appellant to Dr. Richard Deerhake, a Board-certified 

orthopedic surgeon, for a second opinion evaluation to determine the nature and extent of her 

accepted employment-related conditions. In his September 9, 2015 report, Dr. Deerhake 

reviewed the updated SOAF and appellant’s medical history.7

 On physical examination he found 

that appellant had approximately 80 percent range of motion in her neck. Appellant complained 

bitterly of pain when Dr. Deerhake touched her or moved her in certain directions in a 

nonorganic fashion. In ranging the shoulders, she had a lot of weakness, positive Waddell-type 

signs, and exaggerated pain with any attempts at motion of her shoulders. Dr. Deerhake found 

                                                             7

 The updated August 7, 2015 SOAF identified appellant’s accepted conditions under OWCP File Nos. 

xxxxxx661, xxxxxx009 and xxxxxx454. It also noted that appellant had the following nonwork-related medical 

diagnoses: degenerative joint and disc disease of the cervical spine; and degenerative joint disease of the bilateral 

AC joints. 
4 

that appellant’s shoulders could be moved through essentially a normal range of motion when 

she was distracted. Appellant had weakness in abduction, forward flexion, and internal and 

external rotation. She had normal reflexes, normal fine touch sensation, negative Tinel’s signs, 

and negative Phalen’s tests in both upper extremities. Dr. Deerhake found that appellant did 

have “a residual loss of motion of the cervical spine, and this could not be attributable to any of 

the specific injuries, but would relate to basically all three of them.” He opined that “she will 

have some permanence to the loss of motion of the cervical spine related to the degenerative 

changes and the cervical stenosis.” Regarding appellant’s left shoulder condition, Dr. Deerhake 

opined that she had a lot of exaggeration in her findings and that it would be impossible to tell if 

there were residuals remaining from her left shoulder sprain related to her employment injuries. 

He found that appellant had no symptoms or residuals related to carpal tunnel syndrome. 

Dr. Deerhake concluded that appellant was capable of her regular duties as a mail handler and 

released her to full-duty work without restrictions. 

By letter dated October 23, 2015, OWCP notified appellant that it proposed to terminate 

her wage-loss compensation. It advised appellant that her claim would remain open for 

conservative medical treatment of the cervical spine and left shoulder. OWCP further advised 

that the proposed action was based on Dr. Deerhake’s September 9, 2015 second opinion 

examination results. It explained that wage-loss compensation would be terminated with respect 

to all three claims (August 28 and September 30, 2008, and September 25, 2009), and that 

medical benefits would be terminated with respect to appellant’s accepted right carpal tunnel 

syndrome (September 30, 2008). OWCP afforded appellant 30 days to submit additional 

evidence or argument in disagreement with the proposed action. 

In response, appellant submitted a November 14, 2015 narrative statement arguing that 

Dr. Deerhake’s second opinion lacked probative value and should not be given the weight of the 

evidence in her case. 

By decision dated November 24, 2015, OWCP terminated appellant’s medical benefits 

for right carpal tunnel syndrome and also her wage-loss compensation benefits effective that day, 

noting that the claim would remain open for conservative medical treatment of her accepted 

cervical spine and left shoulder conditions. It found the weight of the medical evidence was 

represented by Dr. Deerhake. 

LEGAL PRECEDENT 

Once OWCP accepts a claim and pays compensation, it has the burden of justifying 

modification or termination of an employee’s benefits.8 After it has determined that an 

employee has disability causally related to his or her federal employment, OWCP may not 

terminate compensation without establishing that the disability has ceased or that it is no longer 

                                                             8 See S.F., 59 ECAB 642 (2008). 
5 

related to the employment.9 Its burden of proof includes the necessity of furnishing rationalized 

medical opinion evidence based on a proper factual and medical background.10 

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

entitlement for disability.11 To terminate authorization for medical treatment, OWCP must 

establish that appellant no longer has residuals of an employment-related condition, which would 

require further medical treatment.12 

FECA provides that if there is disagreement between an OWCP-designated physician and 

the employee’s physician, OWCP shall appoint a third physician who shall make an 

examination.13 For a conflict to arise the opposing physicians’ viewpoints must be of “virtually 

equal weight and rationale.”14 Where OWCP has referred the case to an impartial medical 

examiner to resolve a conflict in the medical evidence, the opinion of such a specialist, if 

sufficiently well reasoned and based upon a proper factual background, must be given special 

weight.15

ANALYSIS 

Appellant’s accepted conditions include neck/cervical sprain/strain, left shoulder sprain, 

right carpal tunnel syndrome, and aggravation of preexisting cervical stenosis (OWCP File Nos. 

xxxxxx454, xxxxxx661 and xxxxxx009). Effective November 24, 2015, OWCP terminated 

entitlement to wage-loss compensation under all three claims, and terminated medical benefits 

with respect to her previously accepted right carpal tunnel syndrome (OWCP File No. 

xxxxxx009).16 It based its decision to terminate compensation and medical benefits carpal tunnel 

syndrome only on the September 9, 2015 report of Dr. Deerhake, a Board-certified orthopedic 

surgeon and OWCP referral physician. 

OWCP referred appellant to Dr. Deerhake for a second opinion evaluation to determine 

the nature and extent of her accepted employment-related conditions. In his September 9, 2015 

report, Dr. Deerhake found that appellant had approximately 80 percent range of motion in her 

neck. In ranging the shoulders, appellant had a lot of weakness, positive Waddell-type signs, and 

exaggerated pain with any attempts at motion of her shoulders. Dr. Deerhake found that 

appellant’s shoulders could be moved through essentially a normal range of motion when she 

                                                             9 See I.J., 59 ECAB 524 (2008). 

10 See J.M., 58 ECAB 478 (2007). 

11 See T.P., 58 ECAB 524 (2007); Kathryn E. Demarsh, 56 ECAB 677 (2005). 

12 See James F. Weikel, 54 ECAB 660 (2003). 

13 5 U.S.C. § 8123(a); see 20 C.F.R. § 10.321; Shirley L. Steib, 46 ECAB 309, 317 (1994). 

14 Darlene R. Kennedy, 57 ECAB 414, 416 (2006). 

15 Gary R. Sieber, 46 ECAB 215, 225 (1994). 

16 Appellant remained eligible for medical benefits with respect to her accepted cervical/neck and left upper 

extremity employment injuries. 
6 

was distracted. Appellant had normal reflexes, normal fine touch sensation, negative Tinel’s 

signs, and negative Phalen’s tests in both upper extremities. Dr. Deerhake found that appellant 

had a residual loss of motion of the cervical spine, which could not be attributable to any of the 

specific injuries. Regarding appellant’s left shoulder condition, he opined that she had a lot of 

exaggeration in her findings and that it would be impossible to tell if there were residuals 

remaining from her left shoulder sprain related to her employment injuries. Dr. Deerhake found 

that appellant had no symptoms or residuals related to carpal tunnel syndrome. He concluded 

that appellant was capable of her regular duties as a mail handler and released her to full-duty 

work without restrictions. 

The Board finds that Dr. Deerhake’s report represented the weight of the medical 

evidence as of November 24, 2015. OWCP properly relied on his September 9, 2015 report in 

terminating appellant’s wage-loss compensation and medical benefits (CTS only). The Board 

finds that he had full knowledge of the relevant facts and evaluated the course of appellant’s 

condition. Dr. Deerhake’s opinion is based on a proper factual and medical history and his 

report contained a detailed summary of this history. He reviewed the medical records and made 

his own examination findings to reach a reasoned conclusion regarding appellant’s conditions.17 

At the time benefits were terminated, he found no basis on which to attribute any continued 

disability to appellant’s accepted conditions. Dr. Deerhake’s opinion as set forth in his 

September 9, 2015 report is found to be probative evidence and reliable. The Board finds that 

Dr. Deerhake’s opinion constitutes the weight of the medical evidence and is sufficient to justify 

OWCP’s termination of benefits for the accepted conditions. 

In his reports, Dr. Wagner diagnosed upper arm sprain, bilateral carpal tunnel syndrome, 

impingement syndrome of shoulder region, cervical sprain, and cervical spinal stenosis. Upon 

physical examination, he found restriction of range of motion in the neck, back, upper back, and 

bilateral shoulders. Dr. Wagner also found abnormal and decreased muscle strength in the upper 

extremities bilaterally due to pain. He asserted that appellant had been noticing increased pain 

after physical therapy to the point where she was unable to complete exercises due to pain in the 

neck and left shoulder. However, Dr. Wagner did not provide any medical rationale explaining 

how appellant’s conditions were causally related to her federal employment or her accepted 

conditions or why they rendered her disabled. Thus, his reports are of diminished probative 

value and insufficient to overcome the weight of Dr. Deerhake’s report or to create a medical 

conflict.18

Accordingly, the Board finds that Dr. Deerhake’s opinion continues to constitute the 

weight of the medical evidence and supports OWCP’s decision terminating appellant’s wageloss compensation and medical benefits (carpal tunnel only), effective November 24, 2015. 

                                                             17 See Michael S. Mina, 57 ECAB 379 (2006) (the opportunity for and thoroughness of examination, the accuracy 

and completeness of the physician’s knowledge of the facts and medical history, the care of analysis manifested, and 

the medical rationale expressed in support of the physician’s opinion are facts, which determine the weight to be 

given to each individual report). 

18 See S.S., Docket No. 15-1160 (issued January 11, 2016). 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. James Mack, 43 ECAB 321 (1991).
7 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

The Board finds that OWCP met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits for her accepted right carpal tunnel syndrome, effective 

November 24, 2015. 

ORDER 

IT IS HEREBY ORDERED THAT the November 24, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 20, 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