United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.R., Appellant

and

U.S. POSTAL SERVICE, PARKVILLE POST 

OFFICE, Baltimore, MD, Employer

__________________________________________

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Docket No. 18-0188

Issued: September 6, 2018

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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 3, 2017 appellant, through counsel, filed a timely appeal from an August 16, 

2017 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of the claim.

 

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

ISSUE

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

disability commencing January 1, 2013 causally related to her accepted October 15, 2005 

employment injury. 

FACTUAL HISTORY

On October 15, 2005 appellant, then a 35-year-old full-time letter carrier, filed a traumatic 

injury claim (Form CA-1) alleging that on that date a dog charged at her as she was delivering 

mail. She explained that she sustained injuries to her right arm and wrist when she stepped 

backwards and fell over a brick wall. On November 18, 2005 OWCP accepted appellant’s claim 

for fracture of right distal radius.

On November 23, 2005 Dr. W. Hugh Baugher, a Board-certified orthopedic surgeon,

performed an OWCP-approved open reduction internal fixation of appellant’s wrist. Appellant 

received continuation of pay until November 29, 2005. OWCP paid disability compensation on 

the supplemental rolls from November 29, 2005 to January 21, 2006 and on the periodic rolls from 

January 22 through May 13, 2006. On May 13, 2006 appellant returned to work full time with 

restrictions and her wage-loss compensation on the periodic rolls ended. However, she still 

received intermittent supplemental compensation. 

On March 13, 2007 appellant filed claims for compensation (Form CA-7) for the period 

October 14, 2006 to January 19, 2007 due to de Quervain’s tendinitis, which was not an accepted 

condition.

In a medical report dated January 31, 2007, Dr. Baugher noted that appellant was postinjection for de Quervain’s tendinitis. He provided her restrictions indicating that she could 

frequently lift only 5 to 10 pounds, she could lift occasionally up to 20 pounds with both hands, 

and the maximum that she could occasionally carry with the right hand was 12 pounds.

Dr. Baugher opined that these restrictions would be permanent and were the direct result of her 

employment injury. He noted that appellant had been unable to work starting October 22, 2006 

due to her de Quervain’s tendinitis. Dr. Baugher noted that, after her injections, she was able to 

return to work on January 15, 2007. He discharged her and advised her to return as necessary.

By decision dated March 26, 2007, OWCP determined that appellant sustained a 

recurrence as of October 23, 2006. It expanded acceptance of the claim to include de Quervain’s 

tendinitis.

In a May 15, and June 5 and 29, 2007 reports, Dr. Baugher noted that appellant had prior 

injections for her de Quervain’s tendinitis and that it still was bothersome. He recommended a 

first dorsal compartmental release. Dr. Baugher noted that he was awaiting authorization.

On June 20, 2007 OWCP approved surgery for the removal of appellant’s right support 

implant and right incision of tendon sheath. On August 2, 2007 Dr. Baugher noted that appellant 

had recovered from her July 11, 2007 surgical procedure. He recommended that appellant remain 

on light duty.
3

On January 22, 2008 appellant accepted an offer of limited-duty employment from the 

employing establishment. In a March 4, 2008 report, Dr. Baugher indicated that he saw no reason 

that appellant could not continue to work light duty.

On June 17, 2013 Dr. Ibrahim Elsamanoudi, a Board-certified anesthesiologist, noted that 

appellant had a flare up of sympathetic mediated pain, and that he performed a right stellate 

ganglion block for appellant’s complex regional pain syndrome of her right upper limb. He noted 

that appellant will follow up with a hand surgeon for evaluation of the recent onset of pain at the 

carpometacarpal joint. In the meantime, Dr. Elsamanoudi recommended that appellant continue 

with the same limitations set by Dr. Baugher. Appellant had previously received multiple

injections from Dr. Elsamanoudi, including those administered on April 19, May 17, June 1 

and 15, 2006, April 7, 2009, and September 27, 2011.

On July 11, 2013 appellant underwent a magnetic resonance imaging (MRI) scan of her 

right wrist. Dr. Robert VanBesien, a Board-certified radiologist, found deformity of the distal 

radial metaphysis with irregularity of the articular surface which was consistent with an old healed 

fracture. He also noted a narrowing of the radiocarpal joint consistent with secondary degenerative 

change. Dr. VanBesien noted no avascular necrosis of the scaphoid or lunate, and no bone marrow 

edema to suggest acute fracture. He also noted mild degeneration of the triangular fibrocartilage 

complex without definite tear, distal radioulnar joint intact, and no definite tear of the scapholunate 

or lunotriquetral ligament.

On July 21, 2014 appellant filed a notice of recurrence (Form CA-2a) dated July 10, 2014. 

She alleged that the recurrence occurred on January 1, 2013, but that she had been in pain since 

the original injury and that this pain was becoming more frequent and severe.

By development letter dated August 27, 2014, OWCP informed appellant that further 

medical evidence was necessary to support her recurrence claim. It afforded her 30 days to submit 

the necessary evidence.

In a statement received by OWCP on October 8, 2014, appellant alleged that her symptoms 

had “come and gone,” but that they have been more frequent over the last two years. In further 

response, she submitted copies of medical evidence from periods prior to the alleged recurrence. 

Appellant also submitted reports of physicians already in the record and submitted reports relating

that she had multiple right stellate ganglion blocks. 

In reports dated from January 20 through September 29, 2014, Dr. Brian Janz, a Boardcertified plastic surgeon specializing in hand surgery, noted that appellant had a complicated 

history involving her right wrist. He indicated that she had an open reduction and internal fixation

of a distal radius facture followed by hardware removal and what sounded like de Quervain’s

release. Dr. Janz noted that appellant was then followed by Drs. Fisher and Baugher, who treated

her for continued wrist pain with conservative treatment, light duty, and anti-inflammatories. He 

noted that despite the fact that appellant had been placed on long-term light duty a number of years 

ago, her pain involving the upper extremity had worsened. Dr. Janz conducted a physical 

examination and noted appellant’s range of motion findings. He noted that appellant did have pain 

with manipulation of the radiocarpal joint. Dr. Janz concluded that appellant has radiocarpal 

arthritis which was inhibiting her function. He noted that appellant had, by her account, received 
4

over 10 injections with little relief, and that she would like to proceed with a wrist fusion to 

decrease the pain. Dr. Janz further noted that appellant’s MRI scan showed radiocarpal arthritis. 

He indicated that appellant did not have a dorsal or volar intercolated segment deformity on the 

MRI scan, but that the radiocarpal arthritis was fairly significant, and that appellant’s x-rays 

showed mild-to-moderate radiocarpal arthritis. In a September 29, 2014 report, Dr. Janz noted 

that appellant’s radiocarpal arthritis had progressed and was symptomatic. He opined that 

appellant was a candidate for a wrist fusion, which he believed was her best option.

By decision dated May 15, 2015, OWCP denied appellant’s claim for a recurrence. It

determined that she failed to establish that she was further disabled due to a material change or 

worsening of her accepted condition. OWCP noted that there was no medical evidence provided 

to bridge the gap of medical treatment from September 27, 2011 to July 11, 2013.

On April 18, 2016 appellant requested reconsideration.

In a July 8, 2013 report, Dr. Stephen N. Fisher, an orthopedic surgeon, noted that he had 

given appellant a right wrist corticosteroid injection. In a September 26, 2013 report, he noted that 

appellant came in for a follow up, and that the corticosteroid injection had given her very brief 

relief of symptoms. Dr. Fisher noted that appellant’s right wrist had ongoing significant limitation 

in motion. In a July 29, 2013 report, he noted that appellant’s MRI scan was reviewed, and that 

there was a scapholunate diastasis. Dr. Fisher noted severe degenerative changes between the 

lunate and radius with cystic changes. He also noted that there appeared to be some volar 

subluxation of the lunate with volar intercalated segment instability. The distal radial ulnar joint, 

otherwise, appeared intact. In a January 23, 2014 report, Dr. Fisher noted that he saw appellant 

for a follow up, and that she was experiencing tingling over the dorsum of the right hand and pain 

over the radial aspect of the wrist extending into the thumb. On physical examination he noted 

that appellant had a positive Finkelstein’s test on the right side, and tenderness over the first 

extensor compartment. Dr. Fisher noted no extensor subluxation. He further noted a positive 

Tinel’s over the radial sensory nerve near the prior right wrist de Quervain’s release incision. In 

an August 1, 2014 report, Dr. Fisher noted that appellant had radiocarpal arthritis which was 

inhibiting her function. He noted that appellant was scheduled for a wrist fusion, and will follow 

up as needed for either injections or conservative management until she had surgery. Dr. Fisher

noted that appellant’s multiple injections had not helped her pain.

In a January 20, 2015 report, Dr. Janz noted that appellant was still having pain involving 

the radiocarpal joint and also had some generalized pain involving the upper extremity in that area 

of the dorsal mid-forearm and also along the ulnar aspect. He noted that the vast majority of 

appellant’s pain was in the area of the radiocarpal joint with manipulation and that appellant was 

currently waiting for approval of a wrist fusion.

By decision dated May 15, 2015, OWCP denied appellant’s claim for a recurrence. It

determined that the evidence did not establish that she had a return or increase of disability due to 

a change/worsening of her accepted work-related conditions because she did not submit medical 

evidence addressing her gap in treatment, and there was no medical evidence as to how her work 

injury of October 5, 2005 caused her alleged recurrence in 2013.
5

In a July 9, 2015 report, Dr. Janz noted that appellant had symptomatic radiocarpal arthritis 

and had a long course of conservative management, light duty, and the use of anti-inflammatories. 

In a November 4, 2015 report, he noted that she was doing well and improving and could return 

to work light duty. Dr. Janz noted that, if appellant continued to have pain and discomfort about 

the upper extremity beyond the acute injury with the sprain, then he would proceed with a right 

wrist MRI scan.

In a March 21, 2016 report, Dr. Janz noted that appellant had an acute-on-chronic injury 

involving the wrist with MRI scan showing arthrosis and irregularities involving the radius with 

loss of cartilage, that appellant was symptomatic on a daily basis, and that she would benefit from 

a wrist fusion. He noted that she would lose some extension and flexion, but that she did not have 

great extension and flexion at this point. Dr. Janz opined that appellant would be able to do her 

daily activities and return to normal activity with regard to her job without restrictions. He noted 

that he would schedule a wrist fusion.

On April 18, 2016 appellant requested reconsideration. In an accompanying letter, she

stated that, since her initial injury, her doctor had related that the damage was irreversible and that 

she could either live with the pain or get a fusion. Appellant noted that she decided to live with 

pain. She noted that she tried a second opinion and Dr. Fisher recommended a “wrist 

replacement.”

By decision dated May 13, 2016, OWCP denied modification. It determined that the 

medical evidence of record did not explain how specific activities of appellant’s employment on 

October 15, 2005 caused her condition of radiocarpal arthritis, which was not an accepted

condition.

On May 31, 2016 appellant requested reconsideration. She attached a copy of her letter, 

previously received by OWCP on April 18, 2016. Appellant attached a copy of a previously 

unreviewed October 15, 2015 report wherein Dr. Janz noted that she had a history of radiocarpal 

arthritis and recently had a fall involving the wrist. Dr. Janz also noted that appellant would be off 

work for several weeks while she recovered from the fall.

By decision dated June 14, 2016, OWCP determined that appellant’s reconsideration 

request neither raised a substantive legal question nor included new and relevant evidence and 

was, therefore, insufficient to warrant review of the May 13, 2016 decision.

On May 11, 2017 appellant, through counsel, requested reconsideration. In support 

thereof, he submitted a May 10, 2017 report wherein Dr. Janz related that appellant’s postoperative 

arthritis in her wrist was directly related to her employment injury of October 15, 2005. Counsel

noted that appellant objectively underwent a right wrist MRI scan on February 2, 2016 which 

showed a deformity and prior surgery of the distal radius with narrowing of the radial carpal joint. 

He noted that there were signs of osteoarthritis involving the joint shown on the MRI scan. 

Dr. Janz noted that biomechanically appellant had arthrosis from the irregularities involving the 

joint from the joint fracture, which led to irregularities in the radial carpal joint which caused 

appellant pain and discomfort. He noted that these fractures could have arisen from the 

employment injury of October 15, 2005 as this was an intra-articular fracture. Dr. Janz indicated 

that it did not appear that other medical problems that she had or other injuries had contributed to 
6

her injury in October 2005. He noted that biomechanically the irregularities of the joint wore down 

the cartilage within the radial carpal joint, causing the arthritis and the advancement of the 

discomfort and pain that appellant was currently experiencing. Dr. Janz opined that the objective 

changes seen on appellant’s MRI scan were directly related to appellant’s injuries. He concluded 

that in the setting of no other injuries occurring to the wrist with regard to fractures, or dislocations, 

the irregularities and advancement of the arthritis were directly related to appellant’s employment 

injury which occurred on October 15, 2005. In a May 10, 2017 follow up, Dr. Janz again opined 

that appellant’s postoperative arthritis involving her wrist was directly related to appellant’s

October 15, 2005 employment injury. 

In a handwritten note received by OWCP on May 18, 2017, appellant requested 

reconsideration. She contended that OWCP was ignoring the medical opinions of three different 

doctors.

By decision dated August 16, 2017, OWCP determined that the evidence of record was 

insufficient to modify the decision dated May 13, 2016 because the medical evidence of record 

did not support that appellant sustained a recurrence of disability as a result of a spontaneous 

change or worsening of the accepted condition. The decision noted that the evidence reviewed in 

support of the reconsideration request included medical reports from Dr. Janz dated May 10, 2017 

and October 15, 2015, a letter from counsel dated May 11, 2017, a letter from appellant dated 

May 18, 2017, and medical restriction notes dated March 21 and June 17, 2016.

LEGAL PRECEDENT

A recurrence of disability means an inability to work after an employee has returned to 

work caused by a spontaneous change in a medical condition which resulted from a previous injury 

or illness without an intervening injury or new exposure to the work environment that caused the 

illness.3 Recurrence of disability also means an inability to work that takes place when a lightduty assignment made specifically to accommodate an employee’s physical limitations due to his 

or her work-related injury or illness is withdrawn or when the physical requirements of such an 

assignment are altered so that they exceed his or her established physical limitations.4 

Absent a change or withdrawal of a light duty-assignment, a recurrence of disability 

following a return to light duty may be established by showing a change in the nature and extent 

of the injury-related condition such that the employee could no longer perform the light-duty 

assignment.5

It is an accepted principle of workers’ compensation law that, when the primary injury is 

shown to have arisen out of and in the course of employment, every natural consequence that flows 

from the injury is deemed to arise out of the employment, unless it is the result of an independent 

 

3 20 C.F.R. § 10.5(x). 

4

Id.

5 Theresa L Andrews, 55 ECAB 719, 722 (2004); see also C.S., Docket No. 17-1345 (issued May 24, 2018). 
7

intervening cause which is attributable to the employee’s own intentional conduct.6 In discussing 

the range of compensable consequences, once the primary injury is causally connected with the 

employment, then 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.7

When an employee claims a recurrence of disability due to an accepted employmentrelated injury, he or she has the burden of establishing that the recurrence is causally related to the 

original injury.8 This burden includes the necessity of furnishing evidence from a qualified 

physician who concludes that the condition is causally related to the employment injury.9 The 

physician’s opinion must be based on a complete and accurate factual and medical history and 

supported by sound medical reasoning.10

ANALYSIS

The Board finds that this case is not in posture for decision. 

On November 18, 2005 OWCP accepted appellant’s claim for a fracture of the right distal 

radius as a result of an October 15, 2005 employment incident. Appellant underwent an open 

reduction internal fixation of the wrist on November 23, 2005. On March 26, 2007 OWCP 

accepted her claim for a recurrence as of October 23, 2006. At that time, it expanded acceptance 

of appellant’s claim to include the condition of de Quervain’s tendinitis. On July 11, 2007 

appellant underwent surgery by Dr. Baugher for the removal of her right support implant and right 

incision of the tendon sheath. On January 22, 2008 she accepted an offer of limited-duty 

employment from the employing establishment. 

Appellant filed a notice of a recurrence as of January 1, 2013, alleging that her accepted 

injury had caused continued pain and limitation of her right wrist. Essentially, she claimed that 

she developed right wrist radiocarpal arthritis as a consequence of the accepted injury.

There are notes indicating that Dr. Elsamanoudi administered numerous injections for the 

treatment of appellant’s right wrist conditions from April 19, 2006 through June 17, 2013. In his 

June 17, 2013 report, Dr. Elsamanoudi recommended that she follow up with a hand surgeon due 

to pain in the carpometacarpal joint. He also recommended that appellant continue with the same 

work limitations as set by Dr. Baugher. Dr. Fisher also provided injections for appellant starting 

July 8, 2013. On July 11, 2013 Dr. VanBesien reviewed appellant’s right wrist MRI scan and 

found deformity of the distal radial metaphysis with irregularity of the articular surface consistent 

with old healed fracture. He also noted a narrowing of the radiocarpal joint consistent with 

secondary degenerative change. In an August 1, 2014 report, Dr. Fisher noted that appellant had 

 

6 Albert F. Ranieri, 55 ECAB 598, 602 (2004); A Larson, The Law of Workers’ Compensation § 10.01 (2000).

7 Charles W. Downey, 54 ECAB 421, 422-23 (2003).

8 20 C.F.R. § 10.104(b); see Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.5 

and Chapter 2.1500.6 (June 2013). 

9 See S.S., 59 ECAB 315, 318-19 (2008). 

10 Id. at 319. 
8

radiocarpal arthritis which was inhibiting her function. There is therefore objective medical 

evidence of record that appellant’s right wrist condition worsened.11 

Dr. Janz started treating appellant on January 20, 2014. In an October 15, 2015 report, he

noted that she had a history of radiocarpal arthritis. In a March 21, 2016 report, Dr. Janz noted 

that appellant had an acute-on-chronic injury involving the wrist with a right wrist MRI scan 

showing arthrosis and irregularities involving the radius with loss of cartilage, that appellant was 

symptomatic on a daily basis, and that she would benefit from a wrist fusion. In a May 10, 2017 

report, he opined that appellant’s arthritis in her wrist was directly related to the injury of 

October 15, 2005. Dr. Janz noted that appellant’s February 2, 2016 MRI scan showed a deformity 

and prior surgery of the distal radius with narrowing of the radial carpal joint. He noted that there 

were signs of osteoarthritis involving the joint shown on the MRI scan. Dr. Janz noted that 

biomechanically the irregularities of the joint wore down the cartilage within the radial carpal joint, 

causing the arthritis and the advancement of the discomfort and pain that appellant was currently 

having. He opined that the objective changes seen on appellant’s MRI scan were directly related 

to appellant’s injury, and noted that there were no other injuries occurring to the wrist with regard 

to fractures or dislocations. 

By decision dated August 16, 2017, OWCP denied modification of its denial of her 

recurrence claim. It noted in its decision that appellant had submitted a May 10, 2017 medical 

report from Dr. Janz, amongst other items, in support of her claimed recurrence. OWCP cited to 

the specific findings of Dr. Janz as to the progression of her medical condition, noting his opinion 

that “biomechanically the irregularities of the joint then wear down the cartilage within the radial 

carpal joint, causing the arthritis and the advancement of the discomfort and pain that the patient 

is currently having” and that “the irregularities and advancement of the arthritis are directly related 

to the patient’s injury which occurred on October 15, 2005.” The Board finds that the decision 

dated August 16, 2017 failed to explain why the medical opinion of Dr. Janz, as set forth in detail 

in the decision, was deficient in it reasoning. OWCP’s regulations direct that decisions shall 

contain findings of fact and a statement of reasons.12 The Board has held that the reasoning behind 

OWCP’s evaluation should be clear enough for the reader to understand the precise defect of the 

claim and the kind of evidence which would overcome it.13 Herein, OWCP did not explain why 

the opinion of Dr. Janz was insufficiently rationalized or what further medical evidence was 

required of appellant to establish her claim for recurrence of disability. 

On remand OWCP shall make findings of fact and provide a detailed evaluation of the 

sufficiency of the May 20, 2017 report of Dr. Janz. If it finds that the report of Dr. Janz is 

insufficiently well rationalized to establish the claimed recurrence of disability, it shall set forth 

such reasons in a manner that is clear enough for appellant to understand the precise defect of the 

claim and the kind of evidence which would overcome it. 

 

11 Supra note 5. 

12 20 C.F.R. § 10.126. See O.R., 59 ECAB 432 (2008); Teresa A. Ripley, 56 ECAB 528 (2005); Tonja R. Hiebert, 

55 ECAB 706 (2004) (it is a well-established principle that OWCP must make proper findings of fact and a statement 

of reasons in its final decisions).

13 C.W., Docket No. 14-0693 (issued January 12, 2016).
9

After this and such further development as may be deemed necessary, OWCP shall issue a 

de novo decision on appellant’s claim. 

CONCLUSION

The Board finds that this case is not in posture for decision. 

ORDER

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

Programs dated August 16, 2017 is set aside and this case is remanded for further proceedings 

consistent with this opinion.

Issued: September 6, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board