United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.P., Appellant

and

DEPARTMENT OF HEALTH & HUMAN 

SERVICES, JAMAICA TELESERVICE 

CENTER, Jamaica, NY, Employer

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Docket No. 20-0196

Issued: June 24, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On November 4, 2019 appellant filed a timely appeal from an October 22, 2019 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 to consider the merits of this case.

ISSUE

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

compensation and medical benefits, effective October 23, 2019, as she no longer had residuals or 

disability causally related to her accepted employment condition.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On January 13, 1994 appellant, then a 49-year-old teleservice representative, filed an 

occupational disease claim (Form CA-2) alleging that she developed bilateral carpal tunnel 

syndrome due to factors of her federal employment including performing repetitive work duties 

seven hours per day. She noted that she first became aware of her condition in November 1993

and of its relationship to her federal employment on November 13, 1994. On the reverse side of 

the claim form, the employing establishment indicated that appellant stopped work on 

January 12, 1994.

On July 12, 1994 OWCP accepted appellant’s claim for bilateral carpal tunnel syndrome

and paid her wage-loss compensation benefits on the daily rolls, commencing that date and on the 

periodic rolls commencing August 7, 1996. 

Following further development of the claim, OWCP subsequently received an August 11, 

2018 medical report by Dr. Jay S. Aaron, an attending Board-certified internist. Dr. Aaron noted 

that appellant had chronic low back pain secondary to degenerative joint disease. He also noted

that she ambulated poorly with a cane. Dr. Aaron included his August 8, 2018 report noting that 

diagnostic testing confirmed the presence of bilateral carpal tunnel syndrome. He concluded that 

appellant was unable to return to work.

On May 1, 2019 OWCP referred appellant to Dr. Leon Sultan, a Board-certified orthopedic 

surgeon, for a second opinion evaluation, to determine whether she continued to have residuals or 

disability related to her accepted employment injury. 

In a June 24, 2019 report, Dr. Sultan noted that he had reviewed appellant’s medical 

records and a statement of accepted facts. He noted her current complaints of being unable to 

move her fingers, experiencing numbness in both hands and feet, feeling pain traveling up her 

arms, and dropping objects. Dr. Sultan reported that his objective examination of both hands and 

wrists revealed no abnormal orthopedic or neurological findings. He noted that appellant’s 

subjective complaints did not correspond with his objective examination findings. Dr. Sultan 

reviewed May 11, 2011 electrodiagnostic test results, which revealed bilateral carpal tunnel 

syndrome; however, he indicated that this condition was not reflected on his examination. He

noted appellant’s prior diagnosis of bilateral carpal tunnel syndrome and maintained that his 

examination did not confirm residual right or left carpal tunnel syndrome. Dr. Sultan advised that 

her bilateral wrist condition was now in remission. He noted that bilateral Tinel’s and Phalen’s 

testing failed to confirm any underlying neurological signs of carpal tunnel syndrome. Dr. Sultan

indicated that appellant’s work injury or employment factors temporarily precipitated her 

condition which was now in remission. He concluded that, based on clinical presentation, she was 

currently able to return to her date-of-injury job as a contact representative at the employing 

establishment. Dr. Sultan explained that his opinion was based on the unremarkable bilateral hand 

 

2 S.P., Docket No. 98-1322 (issued September 14, 2000).
3

and wrist examination findings. He further concluded that no further medical treatment was 

indicated. In an accompanying work capacity evaluation (Form OWCP-5c), Dr. Sultan found that 

appellant could work full time without restrictions.

By notice dated July 25, 2019, OWCP advised appellant that it proposed to terminate her 

wage-loss compensation and medical benefits based on Dr. Sultan’s opinion that the accepted 

condition had ceased without residuals. It afforded her 30 days to submit additional evidence or

argument challenging the proposed action. 

OWCP subsequently received a July 24, 2019 attending physician’s report (Form CA-20) 

by Dr. Aaron, who noted a November 1, 1993 date of injury and diagnosed C4-5 herniated discs;

bilateral carpal tunnel syndrome; degenerative joint disease of the spine; 1991 left knee tear; 2001 

fibromyalgia; back, neck, and knee pain; and a leg fracture due to an October 2008 motor vehicle 

accident. Dr. Aaron indicated that appellant had not been advised to return to work. 

OWCP also received an August 16, 2019 report by Dr. Michael Nissenbaum, a Boardcertified neurologist, who indicated that he had performed an electromyogram and nerve 

conduction velocity (EMG/NCV) testing of appellant’s bilateral wrists, which was consistent with 

a bilateral advanced sensorimotor carpal tunnel syndrome, right worse than left, and right ulnar 

sensory neuropathy. 

In a letter dated September 4, 2019, OWCP requested that Dr. Sultan review

Dr. Nissenbaum’s August 16, 2019 EMG/NCV study and provide a well-rationalized opinion as 

to whether appellant had any employment-related residuals or disability. 

In an addendum report dated September 9, 2019, Dr. Sultan responded to OWCP’s 

September 4, 2019 letter. He noted that Dr. Nissenbaum’s August 16, 2019 EMG/NCV study, 

which revealed clinical signs of bilateral carpal tunnel syndrome, was not confirmed by his 

June 24, 2019 examination. Dr. Sultan reiterated his prior opinion that appellant’s work-related 

condition had clinically resolved and she could return to her date-of-injury position with no 

restrictions, and that no further medical treatment was indicated. 

OWCP, in a September 17, 2019 letter, requested that Dr. Sultan provide an additional 

report which provided medical rationale explaining why the EMG/NCV study results were not 

causally related to the accepted employment injury and a rationalized opinion as to whether 

appellant’s accepted condition had resolved in light of these objective findings. 

In a second addendum report dated September 25, 2019, Dr. Sultan noted that when he 

examined appellant on June 24, 2019 she claimed that at times she experienced numbness in both 

hands. He indicated that this was 26 years after she stopped performing work activities on 

November 1, 1993. Dr. Sultan noted that appellant made no specific claim of numbness involving 

the right or left first, second, third, and one-half of the fourth digits, but claimed that at times both 

hands felt numb. He again indicated that his June 24, 2019 examination confirmed intact sensation 

of both hands without intrinsic muscle atrophy and noted that provocative testing in both hands 

revealed negative Tinel’s and Phalen’s bilaterally. Dr. Sultan advised that, despite positive 

electrodiagnostic readings, he was unable to confirm “triple correlation” in regard to the 

underlying bilateral carpal tunnel syndrome. He noted that “triple correlation” would indicate 
4

positive electrical testing, positive symptoms, and positive examination findings. Dr. Sultan 

further noted that positive electrical findings may be present through the electrical test, but not 

depicted on clinical examination or on specific symptoms or claims. He maintained that these 

electrical test findings were not reflected in his examination or in a specific claim of carpal tunnel 

syndrome. Dr. Sultan explained that if appellant continued to have carpal tunnel syndrome for the 

past 26 years, one would expect to find positive examination findings, notably intrinsic muscle 

atrophy, impaired sensation, and positive provocative testing. He again opined that she no longer 

suffered from carpal tunnel syndrome and that the electrical tests were not reflected in her clinical

examination.

OWCP, by decision dated October 22, 2019, terminated appellant’s wage-loss 

compensation and medical benefits, effective October 23, 2019, finding that Dr. Sultan’s opinion 

was entitled to the weight of the medical evidence. 

LEGAL PRECEDENT

Once OWCP accepts a claim and pays compensation, it has the burden of proof to justify 

termination or modification of an employee’s benefits.3 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 related to 

the employment.4 OWCP’s burden of proof includes the necessity of furnishing rationalized 

medical opinion evidence based on a proper factual and medical background.5

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

entitlement for disability.6 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.7

ANALYSIS

The Board finds that OWCP has not met its burden of proof to terminate appellant’s wageloss compensation and medical benefits, effective October 23, 2019.

The evidence of record establishes that, as of October 23, 2019, the date OWCP terminated 

appellant’s wage-loss compensation and medical benefits, there was disagreement between

Dr. Sultan, OWCP’s second opinion physician, and Dr. Aaron, appellant’s treating physician, as 

to whether appellant had residuals and disability from her accepted employment injury and the 

 

3 D.G., Docket No. 19-1259 (issued January 29, 2020); S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 

197 (2005); Paul L. Stewart, 54 ECAB 824 (2003).

4 See R.P., Docket No. 17-1133 (issued January 18, 2018); Jason C. Armstrong, 40 ECAB 907 (1989); Charles E. 

Minnis, 40 ECAB 708 (1989); Vivien L. Minor, 37 ECAB 541 (1986).

5 M.C., Docket No. 18-1374 (issued April 23, 2019); Del K. Rykert, 40 ECAB 284, 295-96 (1988).

6

J.W., Docket No. 19-1014 (issued October 24, 2019); L.W., Docket No. 18-1372 (issued February 27, 2019).

7 L.S., Docket No. 19-0959 (issued September 24, 2019); R.P., Docket No. 18-0900 (issued February 5, 2019).
5

accepted condition of bilateral carpal tunnel syndrome. Further, the report of Dr. Sultan fails to 

give appropriate consideration to the diagnostic testing studies completed by Dr. Nissenbaum 

which demonstrated continuing bilateral advanced sensorimotor carpal tunnel syndrome, right 

worse than left, and right ulnar sensory neuropathy.

Dr. Aaron has consistently opined that appellant continues to exhibit findings of bilateral 

carpal tunnel syndrome and that she is unable to return to any employment position. He referred 

her to Dr. Nissenbaum for diagnostic testing. In his August 16, 2019 report, Dr. Nissenbaum 

indicated that he had performed EMG/NCV testing of appellant’s bilateral wrists, which was 

consistent with a bilateral advanced sensorimotor carpal tunnel syndrome, right worse than left, 

and right ulnar sensory neuropathy. Dr. Aaron cited to the findings of Dr. Nissenbaum in opining 

that appellant was unable to return to work. 

OWCP relied upon the second opinion findings of Dr. Sultan in finding that appellant had 

no continuing residuals or disability in terminating her wage-loss compensation and medical 

benefits. Dr. Sultan noted that his June 24, 2019 examination confirmed intact sensation of both 

of her hands without intrinsic muscle atrophy and noted that provocative testing in both hands 

revealed negative Tinel’s and Phalen’s bilaterally. He advised that, despite positive 

electrodiagnostic readings, he was unable to confirm “triple correlation” in regard to the 

underlying bilateral carpal tunnel syndrome. Dr. Sultan noted that “triple correlation” would 

indicate positive electrical testing, positive symptoms, and positive examination findings. He

acknowledged Dr. Nissenbaum’s testing, but indicated that positive electrical findings may be 

present through the electrical test, but not depicted on clinical examination or on specific symptoms 

or claims. Dr. Sultan maintained that these electrical test findings were “not reflected” in his 

examination. He explained that if appellant continued to have carpal tunnel syndrome for the past 

26 years, one would expect to find positive examination findings, notably intrinsic muscle atrophy, 

impaired sensation, and positive provocative testing. Dr. Sultan concluded, therefore, that she no 

longer suffered from carpal tunnel syndrome and that the electrical tests were not reflected in her 

clinical examination. The Board finds that his report is insufficient for OWCP to meet its burden 

of proof to establish that appellant has no residuals of disability due to her accepted condition. 

First, Dr. Sultan’s opinion is contradicted by the physical findings of Dr. Aaron and

Dr. Nissenbaum and by the opinion of Dr. Aaron who finds her unable to return to any 

employment.8 Second, Dr. Sultan’s opinion is based upon his requirement of a “triple correlation”

standard which is not reflective of appellant’s current physical examination findings and diagnostic 

testing results, but is instead a requirement of general application and are not determinative as they 

are not based directly upon her current presentation.9 The Board therefore finds that OWCP 

improperly relied upon the opinion of him as the basis for terminating her continuing compensation 

benefits. 

 

8 5 U.S.C. § 8123(a). See also R.C., Docket No. 18-0463 (issued February 7, 2020); G.B., Docket No. 16-0996 

(issued September 14, 2016) (where the Board held that OWCP improperly terminated the claimant’s wage-loss 

compensation and medical benefits as there was an unresolved conflict of medical opinion between her treating 

physician and a second opinion specialist).

9 L.C., Docket No. 17-1811 (issued March 23, 2018); N.B., Docket No. 14-1702 (issued December 29, 2014); S.A.,

Docket No. 13-1551 (issued December 17, 2013); Gloria J. McPherson, 51 ECAB 441 (2000).
6

Thus, the Board finds that OWCP has not met its burden of proof to terminate appellant

wage-loss compensation and medical benefits, effective October 23, 2019.

CONCLUSION

The Board finds that OWCP has not met its burden of proof to terminate appellant’s wageloss compensation and medical benefits, effective October 23, 2019.

ORDER

IT IS HEREBY ORDERED THAT the October 22, 2019 decision of the Office of 

Workers’ Compensation Programs is reversed.

Issued: June 24, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board