United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.B., Appellant

and

U.S. POSTAL SERVICE, INTERNATIONAL 

SERVICE CENTER, Los Angeles, CA, Employer

__________________________________________

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Docket No. 19-0081

Issued: April 23, 2019

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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 15, 2018 appellant filed a timely appeal from an August 24, 2018 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 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 this case.

ISSUE

The issue is whether OWCP met its burden of proof to terminate appellant’s medical 

benefits, effective August 24, 2018.

 

1 The Board notes that appellant submitted additional evidence on appeal and OWCP also received additional 

evidence subsequent to tis August 24, 2018 decision. However, the Board’s Rules of Procedure provides: “The 

Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final 

decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. 

§ 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id.

2 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On June 21, 2017 appellant, then a 59-year-old clerk, filed an occupational disease claim 

(Form CA-2) alleging that she experienced pain in her low back, left shoulder, and the left side of 

her neck causally related to factors of her federal employment. She did not stop work. The 

employing establishment indicated that appellant was last exposed to the work factors alleged to 

have caused her condition on April 17, 2017. OWCP accepted the claim for impingement 

syndrome of the left shoulder, lumbar intervertebral disc degeneration, and lumbar spinal stenosis. 

OWCP noted that it had previously accepted that appellant sustained contusions of the right 

hand and wrist on November 11, 2016. It assigned OWCP File No. xxxxxx822. OWCP indicated 

that appellant had performed modified employment beginning November 6, 2014 due to her right 

hand and wrist condition. 

On September 22, 2017 OWCP referred appellant to Dr. Richard A. Rogachefsky, a 

Board-certified orthopedic surgeon, for a second opinion examination. 

In a report dated September 28, 2017, Dr. James T. Tran, a Board-certified internist, 

discussed appellant’s history of injury and her current complaints of back pain radiating into her 

left thigh. He diagnosed lumbar spinal stenosis and lumbar intervertebral disc degeneration that 

had failed conservative treatment. Dr. Tran requested authorization for a lumbar laminectomy and 

foraminotomy at L3-4 and L4-5. 

In a report dated October 5, 2017, Dr. Rogachefsky reviewed appellant’s history of injuries

to her right wrist on November 11, 2016 and to her left shoulder and spine moving mail and sorting 

parcels in April 2017. On examination he found a positive left shoulder impingement test and 

noted that x-rays of the right wrist showed Kienbock’s disease and degenerative arthritis at the 

distal radial ulnar nerve. Dr. Rogachefsky opined, “The conditions of the left and right hand, 

lumbosacral spine, and left shoulder are resolved with regards to the work injuries of 

November 2016 and April 2017.” He found that appellant could resumed her usual employment 

and required no further medical treatment. 

OWCP determined that a conflict existed between Dr. Tran and Dr. Rogachefsky regarding 

whether the accepted conditions had resolved. It noted that Dr. Tran had found that appellant 

required lumbar surgery due to her employment injury.

On May 10, 2018 OWCP referred appellant to Dr. Charles Sadler, a Board-certified 

orthopedic surgeon, for an impartial medical examination. It provided Dr. Sadler with the medical 

record along with a statement of accepted facts (SOAF) indicating that it had accepted the claim 

for left shoulder impingement syndrome, lumbar intervertebral disc degeneration, and lumbar 

spinal stenosis.

In a report dated June 18, 2018, Dr. Sadler reviewed appellant’s history of injury and the 

medical evidence of record, including the results of diagnostic testing. He disagreed with OWCP’s 

acceptance of left shoulder impingement syndrome, asserting that the June 21, 2017 magnetic 

resonance imaging (MRI) scan showed tenosynovitis without impingement. Dr. Sadler proposed 

instead a diagnosis of left shoulder biceps tenosynovitis. He found that diagnostic testing 
3

established the diagnoses provided in the SOAF of lumbar spinal stenosis and lumbar disc 

degeneration but opined that these conditions were unrelated to the accepted employment. 

Dr. Sadler determined that none of the diagnosed conditions set forth in the SOAF were causally 

related to the accepted employment injury. He advised that appellant had no need for further 

medical treatment and no employment-related disability.

On July 23, 2018 OWCP notified appellant of its proposed termination of her entitlement 

to medical benefits as the evidence established that she had no residuals of her accepted left 

shoulder impingement syndrome, intervertebral disc degeneration, and lumbar spinal stenosis. 

Thereafter, appellant submitted a July 16, 2018 progress report from Dr. Christopher P. 

DeCarlo, an attending physiatrist, who evaluated her for continued left shoulder and low back pain. 

Dr. DeCarlo diagnosed degenerative disc disease of the lumbar spine, facet arthropathy, neural 

foraminal stenosis, and tenosynovitis and impingement syndrome of the left shoulder.

By decision dated August 24, 2018, OWCP terminated appellant’s medical benefits,

effective that date. It found that the opinion of Dr. Sadler represented the weight of the evidence 

and established that she had no need for further medical treatment due to her accepted employment 

injury.

LEGAL PRECEDENT

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

modification or termination of an employee’s benefits.3 The right to medical benefits for an 

accepted condition is not limited to the period of entitlement for disability.4 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.5

Section 8123(a) of FECA provides that, if there is disagreement between the physician 

making the examination for the United States and the physician of the employee, the Secretary 

shall appoint a third physician who shall make an examination.6 In situations where there exist 

opposing medical reports of virtually equal weight and rationale and the case is referred to an 

impartial medical specialist for the purpose of resolving the conflict, the opinion of such specialist, 

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

weight.7

 

3 M.M., Docket No. 17-1264 (issued December 3, 2018).

4 S.M., Docket No. 18-0673 (issued January 25, 2019).

5 D.M., Docket No. 17-1052 (issued January 24, 2019).

6 5 U.S.C. § 8123(a); L.T., Docket No. 18-0797 (issued March 14, 2019).

7 D.W., Docket No. 18-0123 (issued October 4, 2018).
4

OWCP’s procedures provide as follows: 

“The [claims examiner] is responsible for ensuring that the SOAF is correct, 

complete, unequivocal, and specific. When the [medical adviser], second opinion 

specialist or referee physician renders a medical opinion based on a SOAF which 

is incomplete or inaccurate or does not use the SOAF as the framework in forming 

his or her opinion, the probative value of the opinion is seriously diminished or 

negated altogether.”

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ANALYSIS

The Board finds that OWCP has not met its burden of proof to terminate appellant’s 

medical benefits, effective August 24, 2018.

OWCP properly found a conflict existed between Dr. Tran, appellant’s treating physician, 

and Dr. Rogachefsky, an OWCP referral physician, regarding whether she had continued residuals 

of her employment injury, accepted for left shoulder impingement syndrome, lumbar intervertebral 

disc degeneration, and lumbar spinal stenosis. It referred her to Dr. Sadler, a Board-certified 

orthopedic surgeon, for an impartial medical examination, pursuant to 5 U.S.C. § 8123(a).

When there exists a conflict in medical opinion and the case is referred to an impartial 

medical examiner (IME) for the purpose of resolving the conflict, the opinion of such specialist, if 

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

weight.9 

OWCP provided Dr. Sadler with a SOAF advising that it had accepted left shoulder 

impingement syndrome, lumbar intervertebral disc degeneration, and lumbar spinal stenosis as 

employment related. In a report dated June 18, 2018, Dr. Sadler found that appellant had not 

sustained left shoulder impingement syndrome. He further determined that she had lumbar disc 

degeneration and lumbar spinal stenosis but that the conditions were unrelated to the accepted

employment injury. 

The Board finds that the opinion of Dr. Sadler is not entitled to the special weight afforded 

an IME as it is outside of the SOAF.

10

 While he reviewed the medical evidence in detail, Dr. Sadler

did not accept the facts as presented in the SOAF in rendering his medical opinion. It is OWCP’s 

responsibility to provide a complete and proper framework for a physician by preparing a SOAF.11 

OWCP procedures and Board precedent dictate that, when an OWCP medical adviser, second 

opinion specialist, or referee physician renders a medical opinion based on a SOAF which is 

 

8 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990); see also R.P., Docket No. 18-0900 (issued February 5, 2019).

9 M.S., Docket No. 18-1228 (issued March 8, 2019).

10 M.D., Docket No. 18-0468 (issued September 4, 2018).

11 D.E., Docket No. 17-1794 (issued April 13, 2018).
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incomplete or inaccurate or does not use the SOAF as the framework in forming his or her opinion, 

the probative value of the opinion is seriously diminished or negated altogether.

12

Dr. Sadler indicated that he had reviewed the SOAF and concluded that none of the 

accepted conditions were employment related. The Board has explained that the report of an IME 

who disregards a critical element(s) of the SOAF and disagrees with the medical basis for 

acceptance of a condition is defective and insufficient to resolve the existing conflict of medical 

opinion evidence.13 Dr. Sadler’s report is of diminished probative value as his opinion did not rely 

on the SOAF and contradicted critical elements of the SOAF. The Board notes that it is the 

function of a medical expert to give an opinion only on medical questions, not to find facts.14 

Dr. Sadler did not rely on the SOAF and as such his report is not based on an accurate history of 

injury. His report is therefore insufficient to meet OWCP’s burden of proof to terminate medical 

benefits.15

Accordingly, OWCP improperly terminated appellant’s medical benefits, effective 

August 24, 2018.

CONCLUSION

The Board finds that OWCP has not met its burden of proof to terminate appellant’s 

medical benefits, effective August 24, 2018.

 

12 Supra note 9.

13 J.S., Docket No. 17-0626 (issued January 22, 2019).

14 R.P., Docket No. 18-0900 (issued February 5, 2019).

15 B.B., Docket No. 18-1121 (issued January 8, 2019).
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ORDER

IT IS HEREBY ORDERED THAT the August 24, 2018 decision of the Office of 

Workers’ Compensation Programs is reversed.

Issued: April 23, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy 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