United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.S., Appellant

and

U.S. HOUSE OF REPRESENTATIVES, 

Washington, DC, Employer

__________________________________________

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Docket No. 19-1370

Issued: November 30, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On June 10, 2019 appellant filed a timely appeal from December 18, 2018 and April 19, 

2019 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.2

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the April 19, 2019 decision, OWCP received additional evidence. 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

ISSUE

The issue is whether appellant has met her burden of proof to establish that the acceptance 

of her claim should be expanded to include additional conditions as causally related to her accepted 

December 1, 2005 employment injury.

FACTUAL HISTORY

On December 9, 2005 appellant, then a 48-year-old photographer, filed a traumatic injury 

claim (Form CA-1) alleging that she sustained an injury on December 1, 2005 when moving boxes

while cleaning out storage rooms in the performance of duty. By decision dated March 15, 2006, 

OWCP accepted the claim for the conditions of cervical spondylosis with myelopathy and 

traumatic spondylopathy. It paid appellant wage-loss compensation on the periodic rolls effective 

May 14, 2006.3

In a series of reports dated April 16, 2008 through November 9, 2018, Dr. Zinon M. 

Pappas, a Board certified physiatrist, diagnosed lumbar radiculopathy, causing left leg weakness, 

foot drop, knee instability, and lumber disc herniation.

4

 In a report dated July 20, 2009, he

reiterated that appellant had bilateral lumbar radiculopathy with severe weakness in the left leg 

and a complete foot drop in the left leg requiring an ankle foot orthosis. Dr. Pappas subsequently

diagnosed the additional conditions of lumbar disc prolapse with radiculopathy, degeneration of 

lumbar or lumbosacral intervertebral disc, cervicalgia, cervical radiculopathy, lumbar spondylosis, 

displacement of lumbar intervertebral disc without myelopathy, thoracic or lumbosacral neuritis 

or radiculitis, brachial neuritis or radiculitis, osteoarthritis of knee, localized and primary 

osteoarthrosis in the lower leg, obesity, and persistent insomnia.

In reports dated August 15, 2014 and July 5, 2016, Dr. Pappas noted his treatment of

appellant since February 2006.5 He reiterated that she was injured at work in December 2005 after 

lifting heavy boxes, which resulted in immediate pain in her neck and the pain radiated down the 

left upper extremity. Dr. Pappas indicated that appellant subsequently developed persistent 

numbness and tingling in the left arm, increasingly severe lower back pain, pain radiating to both 

legs, and “drop foot” bilaterally. He indicated that this weakness had persisted and she needed to 

wear an ankle/foot orthosis to prevent her from having frequent falls because of her drop foot. 

Appellant also developed two meniscal tears in her right knee and required arthroscopic surgery 

in the summer of 2010 for her right knee. Dr. Pappas noted that, in the spring of 2013, her lumbar 

 

3 On February 1, 2007 Dr. Willie E. Thompson, a Board certified orthopedic surgeon serving as a district medical 

adviser (DMA), opined that there was no pathology at the C4-5 level that would require the need for any type of 

surgical procedure. Appellant subsequently underwent an unauthorized anterior cervical spine fusion on 

March 13, 2007.

4 A magnetic resonance imaging (MRI) scan of the lumbar spine dated July 17, 2008 demonstrated a mild disc 

bulge at L2-3, L3-4, and L4-5. At L4-5, it favored the left side with a slight impression on the left side of the thecal 

sac.

5 A cervical spine MRI scan dated April 23, 2014 showed a slight interval progression of a concentric disc bulge 

with mild-to-moderate narrowing of the right neural foramen and mild narrowing of the left neural foramen. A lumbar 

spine MRI scan dated August 25, 2014 revealed bilateral L4-5 facet arthropathy and a broad-based protrusion posterior 

on the left contributing to the left greater than the right L4-5 foraminal stenosis.
3

radicular pain was getting quite severe and debilitating and she underwent a series of three lumbar 

epidural corticosteroid injections noting mild improvement. He opined that appellant was totally 

disabled for work.

In a September 30, 2014 report, Dr. Jocelyn Idema, a Board certified orthopedic surgeon, 

diagnosed degeneration of the intervertebral disc, lumbar spondylosis, lumbar radiculopathy, and 

displacement of lumbar intervertebral disc without myelopathy.

On September 10, 2018 OWCP referred appellant to Dr. Robert F. Draper, a Board 

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

her employment-related conditions. In his October 18, 2018 report, Dr. Draper noted his review 

of the medical history and the SOAF and reported examination findings which included her

emotional presentation and crying. He noted that appellant exhibited exaggerated loss of range of 

motion in her lower extremities, but with circumferential sensory deficits in both lower extremities 

from the knees to toes. Appellant was noted to have left the examination with orthotic devices on 

her lower extremities and left upper extremity, and she ambulated with assistance of a walker. 

Dr. Draper diagnosed cervical spondylosis and low back pain syndrome. He determined that

appellant’s bilateral foot drop condition was not fully clinically explained by the MRI scan 

findings of record. Dr. Draper opined that the accepted cervical spine injury would not have 

caused her to have low back pain, a foot drop condition, and neurological deficits to the extent that 

she claimed in the lower extremities. He explained that, although appellant’s cervical conditions 

were related to the accepted employment injury, her lumbar spine issues could not be related to 

the December 1, 2005 work injury because the records showed that she had injured her neck and 

not her back initially and her lower back complaints did not start until 2008. Dr. Draper 

determined that appellant had reached maximum medical improvement (MMI) and opined that she 

was totally disabled for work solely due to her accepted cervical spine conditions due to the 

December 1, 2005 employment injury.

By decision dated December 18, 2018, OWCP denied appellant’s claim finding that

Dr. Draper’s October 18, 2018 second opinion report was well rationalized and supported a finding 

that the claim should not be expanded to include additional conditions.

On January 24, 2019 appellant requested reconsideration.

In support of her request, she submitted a February 8, 2019 report from Dr. Pappas who 

reiterated his diagnoses and indicated that she continued to have severe back pain radiating down 

both legs, as well as pain in her neck radiating to the left upper extremity. Appellant also submitted 

a March 27, 2019 report from Dr. Surmeet Chhina, a Board certified anesthesiologist, who 

diagnosed lumbar radiculitis, chronic pain syndrome, and cervical post laminectomy syndrome. 

Dr. Chhina indicated that appellant’s chief complaint was chronic pain, involving the L4-5 disc, 

which had resulted from an injury at work on December 1, 2005 and noted that this was a 

degenerative condition that had been present for years.

By decision dated April 19, 2019, OWCP denied modification of the December 18, 2018 

decision.
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LEGAL PRECEDENT

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

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

related to the employment injury.6 

To establish causal relationship between the condition as well as any additional conditions 

claimed and the employment injury, an employee must submit rationalized medical evidence.7 

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.8

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish that the 

acceptance of her claim should be expanded to include additional conditions as causally related to 

her accepted December 1, 2005 employment injury.

In support of her claim, appellant submitted a series of reports by Dr. Pappas who indicated 

that he had been treating her since February 2006. Dr. Pappas diagnosed several lumbar spine 

conditions. Although he opined that appellant’s conditions were a direct result of the December 1, 

2005 employment injury, his reports do not contain rationale explaining how or why additional 

lumbar conditions had developed approximately three years after the workplace injury. The Board 

has held that a medical opinion must provide an explanation as to how the accepted employment 

injury had physiologically caused or aggravated the additional diagnosed medical conditions.9 

While the opinion supporting causal relationship does not have to reduce the cause or etiology of 

a disease or a condition to an absolute certainty, the opinion must be one of reasonable medical 

certainty and not speculative or equivocal in character.10 As Dr. Pappas’s opinions regarding 

causal relationship between the accepted injury and the additional claimed conditions were 

conclusory and unrationalized, the Board finds that they are insufficient to meet appellant’s burden 

of proof to establish that the additional conditions should be accepted in her claim.

11

Appellant was also examined by Dr. Idema who diagnosed degeneration of the 

intervertebral disc, lumbar spondylosis, lumbar radiculopathy, and displacement of lumbar 

intervertebral disc without myelopathy on September 30, 2014. However, Dr. Idema did not 

 

6 M.M., Docket No. 19-0951 (issued October 24, 2019); Jaja K. Asaramo, 55 ECAB 200 (2004).

7 T.K., Docket No. 18-1239 (issued May 29, 2019); M.W., 57 ECAB 710 (2006); John D. Jackson, 55 ECAB 

465 (2004).

8 T.K., id.; I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).

9 A.H., Docket No. 19-0270 (issued June 25, 2019); M.W., Docket No. 18-1624 (issued April 3, 2019).

10 C.H., Docket No 19-0409 (issued August 5, 2019).

11 P.A., Docket No. 18-0559 (issued January 29, 2020).
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provide an opinion on the issue of causal relationship between the accepted December 1, 2005 

employment injury and the diagnosed lumbar conditions. Likewise, the February 1, 2007 report 

of Dr. Thompson also does not provide an opinion on the issue of causal relationship or discuss 

lumbar spine conditions. The Board has held that medical evidence that does not offer an opinion

regarding the cause of an employee’s condition is of no probative value on the issue of causal 

relationship.12 These reports, therefore, are insufficient to establish appellant’s request to expand 

the acceptance of her claim.

Appellant also submitted MRI scans and accompanying reports dated from July 17, 2008 

to August 25, 2014. The Board has long held that diagnostic studies, standing alone, are of limited

probative value on the issue of causal relationship as they do not address whether the employment 

injury caused any of the diagnosed conditions.13 These reports are, therefore, insufficient to 

establish appellant’s request to expand the acceptance of her claim.

OWCP properly referred appellant to Dr. Draper for a second opinion evaluation to 

determine the nature and extent of her employment-related conditions, including whether the 

acceptance of her claim should be expanded to include additional conditions as work related. In 

his October 18, 2018 report, Dr. Draper found that her bilateral foot drop was not clinically 

explained by the MRI scan findings of record. He opined that the accepted cervical spine injury 

would not have caused appellant to have low back pain, foot drop conditions, and neurological 

deficits in the lower extremities to the extent that she claimed. Dr. Draper explained that, although 

appellant’s cervical conditions were related to the accepted employment injury, her lumbar spine 

issues could not be related to the December 1, 2005 work injury because the records showed that 

she had injured only her neck and that her lower back complaints had not developed until 2008. 

The Board finds that Dr. Draper’s second opinion report is well rationalized and provides a 

supportive explanation in support of his finding that appellant’s claim should not be expanded to 

include additional conditions. Therefore, OWCP properly afforded him the weight of the 

evidence. Appellant has not submitted sufficient rationalized medical evidence to meet her burden 

of proof to establish causal relationship between her December 1, 2005 employment injury and 

her diagnosed medical conditions or to overcome the opinion of Dr. Draper. Thus, the Board finds 

that she has not met her burden of proof. 

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 has not met her burden of proof to establish that the 

acceptance of her claim should be expanded to include additional conditions as causally related to 

her accepted December 1, 2005 employment injury.

 

12 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

13 J.P., Docket No. 19-0216 (issued December 13, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
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ORDER

IT IS HEREBY ORDERED THAT the April 19, 2019 and December 18, 2018 decisions

of the Office of Workers’ Compensation Programs are affirmed.

Issued: November 30, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board