United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.N., Appellant

and

DEPARTMENT OF THE ARMY, NATIONAL 

MUSEUM OF HEALTH & MEDICINE,

Silver Spring, MD, Employer

__________________________________________

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Docket No. 19-0994

Issued: November 7, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 1, 2019 appellant filed a timely appeal from an October 18, 2018 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

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish a recurrence 

of disability, commencing on or after September 11, 2014, causally related to her accepted 

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that appellant submitted additional evidence on appeal. 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

February 28, 2014 employment injury; and (2) whether appellant has met her burden of proof to

establish that the acceptance of her claim should be expanded to include additional medical 

conditions causally related to her accepted February 28, 2014 employment injury.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances of the case 

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

are as follows.

On March 6, 2014 appellant, then a 53-year-old management analyst, filed a traumatic 

injury claim (Form CA-1) alleging that on February 28, 2014 she sustained injury to her right arm 

when lifting binders at work while in the performance of duty.

4

 OWCP accepted her claim for a 

sprain of her right shoulder and upper arm.5 Appellant began performing limited-duty work on a 

full-time basis on March 16, 2014, but she periodically stopped work for intermittent periods of 

disability thereafter. OWCP paid her wage-loss compensation benefits for intermittent periods of 

disability on the daily rolls beginning April 6, 2014. 

Appellant stopped work on September 11, 2014. On October 6, 2014 she filed a notice of 

recurrence (Form CA-2a) claiming a recurrence of total disability commencing September 11, 

2014 due to her accepted February 28, 2014 employment injury. 

By decisions dated December 11, 2014 and June 12, September 14, and December 24, 

2015, OWCP denied appellant’s recurrence claim because she did not submit sufficient medical 

evidence to establish a recurrence of total disability on or after September 11, 2014 causally related 

to her February 28, 2014 employment injury.

Appellant submitted several reports, dated between September 18, 2014 and April 2, 2015, 

from Dr. David L. Taragin, a Board-certified neurologist, who determined that she was totally 

disabled due to her February 28, 2014 employment injury. Dr. Taragin indicated that she had 

disability due to employment-related right upper extremity conditions of complex regional pain 

syndrome (CRPS) and brachial plexopathy. In reports dated between December 17, 2014 and 

May 6, 2015, Dr. Dexter W. Love, a Board-certified orthopedic surgeon, also determined that 

appellant was totally disabled due to her February 28, 2014 employment injury. He diagnosed 

such conditions as employment-related degenerative disc disease of the cervical spine, cervical 

radiculopathy, and anterior/inferior labrum tear of the right shoulder.

 

3 Docket No. 16-1279 (issued November 7, 2017).

4 OWCP assigned the claim OWCP File No. xxxxxx748. In reports dated beginning in March 2014, appellant 

clarified the nature of the February 28, 2014 employment incident to her attending physicians by reporting that, on 

that date, a group of binders fell on her right arm when she attempted to catch them.

5 Appellant previously filed a separate claim, OWCP File No. xxxxxx834, in which she alleged that on August 31, 

2011 she sustained a traumatic injury when she stepped into a hole of a loading dock floor with her left leg and fell to 

the floor. OWCP administratively handled the claim and paid a limited amount of medical benefits without formally 

considering the merits of the claim. Appellant also had a history of a nonindustrial cervical radiculopathy from 2008. 
3

In October 2014, OWCP had referred appellant to Dr. Robert A. Smith, a Board-certified 

orthopedic surgeon, for a second opinion examination. In a November 19, 2014 report, Dr. Smith 

determined that she ceased to have residuals of her February 28, 2014 employment injury. He also 

noted that appellant did not have clinical findings of brachial plexopathy or CRPS and that she did 

not sustain a condition other than right shoulder/upper arm sprain due to her February 28, 2014 

employment injury. By decision dated February 5, 2015, OWCP terminated her wage-loss 

compensation and medical benefits, effective February 2, 2015, based on Dr. Smith’s 

November 19, 2014 report.6

Appellant appealed the December 24, 2015 OWCP decision to the Board and, by decision 

dated November 7, 2017,7the Board set aside the December 24, 2015 decision and remanded the 

case to OWCP for further development. It found that the medical reports submitted by her were 

sufficient to require further development with respect to the question of whether she sustained a 

recurrence of disability on or after September 11, 2014 causally related to her accepted 

February 28, 2014 employment injury. The Board specified that such development should include 

consideration of whether appellant sustained a condition, other than a right shoulder/upper arm

sprain, causally related to the February 28, 2014 employment injury. 

On remand, OWCP requested that Dr. Smith provide a supplemental report addressing the 

questions of whether appellant had disability on or after September 11, 2014 causally related to 

her February 28, 2014 employment injury, and whether her claim should be expanded to include 

brachial plexopathy, CRPS, or any other medical condition causally related to her February 28, 

2014 employment injury. 

In a March 21, 2018 report, Dr. Smith advised that he had reviewed the medical evidence 

of record and indicated that, when he examined appellant in November 2014, she had no clinical 

findings of brachial plexopathy or CRPS. Moreover, the findings of her electromyogram and nerve 

conduction velocity testing, considered in conjunction with her normal examination findings, ruled

out the existence of brachial plexopathy. Dr. Smith also noted that there were no magnetic 

resonance imaging (MRI) scans, technetium bone scans, or x-rays to support the existence of 

CRPS. He advised that he had no reason to revise the conclusions of his November 19, 2014 report 

with respect to appellant’s claims for disability and expansion of the accepted conditions.

8

On April 30, 2018 OWCP found a conflict in the medical opinion evidence between

Dr. Smith and Dr. Taragin regarding whether appellant had disability on or after September 11, 

2014 causally related to her February 28, 2014 employment injury, and whether the acceptance of 

her claim should be expanded to include additional conditions causally related to her February 28, 

2014 employment injury. It referred appellant to Dr. Steven L. Friedman, a Board-certified 

orthopedic surgeon, for an impartial medical examination and an opinion on these matters. 

 

6 This termination action is not currently before the Board. 

7 Supra note 3.

8

In a March 21, 2018 work capacity evaluation form (OWCP-5c), Dr. Smith indicated that appellant could return 

to her regular work without restrictions. 
4

In a June 4, 2018 report, Dr. Friedman discussed appellant’s factual and medical history 

and reported the findings of his physical examination. He noted that examination of her right 

shoulder revealed no visible atrophy, deformity, warmth, or erythema. Appellant had diffuse 

tenderness involving the anterior, posterior, superior, and lateral aspects of the right shoulder, but 

tenderness was not well localized to any particular anatomic region.9 Dr. Friedman advised that 

she suffered a relatively minor trauma on February 28, 2014 when she was holding some binders 

in her right arm with her elbow flexed in a fixed position and some additional binders fell from a 

shelf onto her right arm. He also indicated that, as early as 2011, there was x-ray evidence of 

degenerative changes in appellant’s right shoulder. Dr. Friedman noted that her February 28, 2014 

employment injury in the form of a right shoulder/upper arm sprain did render her disabled from 

work at that time, but opined that she would have been totally disabled for approximately three 

weeks. Dr. Friedman advised that appellant then would have been able to return to work at least 

in a position that limited overhead reaching, pushing, pulling, and lifting for an additional three 

weeks. He further advised that, during his examination, appellant did not exhibit objective 

evidence of CRPS. Dr. Friedman noted that there was no cutaneous allodynia or abnormal pseudomotor activity. Skin temperature, texture, nail growth, hair distribution, and sweat patterns were 

bilaterally symmetric.

10

 

Dr. Friedman opined that when he conducted his physical examination there was no 

objective evidence of brachial plexopathy when electrodiagnostic testing was performed.

Dr. Friedman also advised that the diagnosis of degenerative disc disease of the cervical spine was 

not related to the February 28, 2014 employment injury. He maintained that there was no trauma 

to the cervical spine on February 28, 2014 and advised that there was convincing diagnostic 

evidence that degenerative disease of the cervical spine existed prior to February 28, 2014.

Dr. Friedman opined that the tear of the anterior/inferior glenoid labrum of appellant’s right 

shoulder was not caused by the February 28, 2014 employment injury. He explained that an MRI

scan taken in March 2014 showed a degenerative labral tear, and that the mechanism of the 

February 28, 2014 incident as described by her would not be consistent with a diagnosis of 

traumatic anterior/inferior glenoid labial tear. Dr. Friedman maintained that anterior/inferior 

glenoid labral tears occur when the arm is in a flexed, abducted, and externally rotated position, or 

when a violent force pushes the humerus anteriorly and inferiorly with respect to the glenoid 

labrum. Therefore, Dr. Friedman concluded that she would have been able to return to work 

without specific restrictions six weeks after February 28, 2014. 

By decision dated July 12, 2018, OWCP found that appellant did not meet her burden of 

proof to establish a recurrence of disability, commencing on or after September 11, 2014, causally 

related to her accepted February 28, 2014 employment injury. It further found that she did not 

meet her burden of proof to establish that the acceptance of her claim should be expanded to

include brachial plexopathy, CRPS or any other medical condition causally related to her accepted 

February 28, 2014 employment injury. 

 

9 Dr. Friedman also indicated that appellant had no significant motor weakness with respect to resisted internal or 

external rotation of the right shoulder. Appellant had pain with right shoulder impingement maneuvers and 

examination of the cervical spine revealed that cervical extension caused right trapezial pain.

10 Dr. Friedman indicated that, in reviewing the medical records, he did not see any evidence of CRPS in the past.
5

Appellant requested reconsideration of the July 12, 2018 decision and argued that she 

sustained more serious medical conditions related to her February 28, 2014 employment injury 

than had been accepted by OWCP. She submitted a July 17, 2018 report of Dr. Love who indicated 

that he had treated her since February 25, 2016. Dr. Love noted that appellant reported 

experiencing chronic right shoulder pain following an injury at work on February 28, 2014. He

advised that her right shoulder condition could benefit from further physical therapy, subacromial 

corticosteroid injection, and, if necessary, arthroscopic repair of the rotator cuff/biceps tendon and 

subacromial decompression. Dr. Love noted, “The shoulder procedures would more definitively 

treat the shoulder injury sustained February 2014.”

11

By decision dated October 18, 2018, OWCP denied modification of the July 12, 2018 

decision. 

LEGAL PRECEDENT -- ISSUES 1 & 2

An employee seeking benefits under FECA has the burden of establishing the essential 

elements of his or her claim including the fact that the individual is an employee of the United 

States within the meaning of FECA, that the claim was timely filed within the applicable time 

limitation period of FECA, that an injury was sustained in the performance of duty as alleged, and 

that any specific condition and/or disability for which compensation is claimed are causally related 

to the employment injury.12 These are the essential elements of each and every compensation 

claim, regardless of whether the claim is predicated upon a traumatic injury or an occupational 

disease.13

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 

compensable injury or illness and without an intervening injury or new exposure in the work 

environment.14 This term also means an inability to work because a light-duty assignment made 

specifically to accommodate an employee’s physical limitations, and which is necessary because 

of a work-related injury or illness, is withdrawn or altered so that the assignment exceeds the 

employee’s physical limitations. A recurrence does not occur when such withdrawal occurs for 

reasons of misconduct, nonperformance of job duties, or a reduction-in-force.15 OWCP’s 

procedures provide that a recurrence of disability includes a work stoppage caused by a 

spontaneous material change in the medical condition demonstrated by objective findings. That 

change must result from a previous injury or occupational illness rather than an intervening injury 

 

11 Appellant also submitted a number of medical reports already of record. 

12 J.F., Docket No. 09-1061 (issued November 17, 2009). See also J.T., Docket No. 17-0578 (issued 

December 6, 2017.

13 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Dolores C. Ellyett, 41 ECAB 992 (1990).

14 20 C.F.R. § 10.5(x); see J.D., Docket No. 18-1533 (issued February 27, 2019).

15 Id.
6

or new exposure to factors causing the original illness. It does not include a condition that results 

from a new injury, even if it involves the same part of the body previously injured.16

An employee who claims a recurrence of disability due to an accepted employment-related 

injury has the burden of proof to establish by the weight of the substantial, reliable, and probative 

evidence that the disability for which he or she claims compensation is causally related to the 

accepted injury. This burden of proof requires that a claimant furnish medical evidence from a 

physician who, on the basis of a complete and accurate factual and medical history, concludes that, 

for each period of disability claimed, the disabling condition is causally related to the employment 

injury, and supports that conclusion with medical reasoning.17 Where no such rationale is present, 

the medical evidence is of diminished probative value.18

Where 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.19 The medical evidence required to establish causal 

relationship between a claimed period of disability or specific condition and an employment injury 

is rationalized medical opinion evidence. 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.20

Section 8123(a) of FECA provides in pertinent part: “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.”

21

 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.22

ANALYSIS -- ISSUES 1 & 2

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

disability, commencing on or after September 11, 2014, causally related to her accepted 

 

16 Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.2b (June 2013); L.B., Docket 

No. 18-0533 (issued August 27, 2018).

17 J.D., Docket No. 18-0616 (issued January 11, 2019); see C.C., Docket No. 18-0719 (issued November 9, 2018).

18 H.T., Docket No. 17-0209 (issued February 8, 2018).

19 C.S., Docket No. 17-1686 (issued February 5, 2019); Jaja K. Asaramo, 55 ECAB 200, 204 (2004).

20 See E.J., Docket No. 09-1481 (issued February 19, 2010).

21 5 U.S.C. § 8123(a).

22 D.M., Docket No. 18-0746 (issued November 26, 2018); R.H., 59 ECAB 382 (2008); James P. Roberts, 31 ECAB 

1010 (1980).
7

February 28, 2014 employment injury. The Board further finds that she has not met her burden of 

proof to establish that the acceptance of her claim should be expanded to include additional 

medical conditions causally related to her accepted February 28, 2014 employment injury.

The Board finds that OWCP properly determined that a conflict existed in the medical 

opinion between Dr. Taragin, an attending physician, and Dr. Smith, an OWCP referral physician, 

regarding whether appellant sustained a recurrence of disability, commencing on or after 

September 11, 2014, causally related to her February 28, 2014 employment injury, and whether 

the acceptance of her claim should be expanded to include additional medical conditions causally 

related to her February 28, 2014 employment injury. In order to resolve the conflict, OWCP 

properly referred her, pursuant to section 8123(a) of FECA, to Dr. Friedman for an impartial 

medical examination and an opinion on the matter.23

The Board finds that the special weight of the medical opinion evidence regarding the 

above-noted issues is represented by the thorough, well-rationalized opinion of Dr. Friedman.24 

The June 4, 2018 report of Dr. Friedman establishes that appellant did not sustain disability on or 

after September 11, 2014 causally related to her February 28, 2014 employment injury and that 

she did not sustain any condition causally related to that injury other than the accepted right 

shoulder/upper arm sprain.

In his June 4, 2018 report, Dr. Friedman explained that the February 28, 2014 employment 

injury was relatively minor in nature and that it was the type of injury that would have fully 

resolved to the extent that appellant would have been able to return to work without specific 

restrictions six weeks after February 28, 2014. He further advised that he did not see objective 

evidence upon his own examination or in the medical documents of record that she ever exhibited

objective evidence of CRPS or brachial plexopathy. Dr. Friedman also opined that the diagnosis

of degenerative disc disease of the cervical spine was not related to the February 28, 2014 

employment injury as there was no trauma to the cervical spine on February 28, 2014 and there 

was convincing diagnostic evidence that appellant had degenerative disease of the cervical spine 

prior to February 28, 2014. He maintained that the tear of the anterior/inferior glenoid labrum of 

her right shoulder was not caused by the February 28, 2014 employment injury. Dr. Friedman 

explained that an MRI scan taken in March 2014 showed a degenerative labral tear, and that the 

mechanism of the February 28, 2014 incident as described by appellant would not be consistent 

with a diagnosis of traumatic anterior/inferior glenoid labial tear.

The Board finds that Dr. Friedman’s opinion has reliability, probative value, and 

convincing quality with respect to its conclusions regarding the relevant issues of the present case. 

Dr. Friedman provided a thorough factual and medical history, and he accurately summarized the 

relevant medical evidence. He provided medical rationale for his opinion by explaining that the 

findings of record did not support disability on or after September 11, 2014 causally related to the 

 

23 See id.

24 See id.
8

February 28, 2014 employment injury or that appellant sustained an injury other than a right 

shoulder/upper arm sprain causally related to that injury.

25

After OWCP denied appellant’s claims for recurrence of disability and expansion of 

accepted conditions based on Dr. Friedman’s opinion, she submitted a July 17, 2018 report of

Dr. Love who indicated that her right shoulder condition could benefit from further physical 

therapy, subacromial corticosteroid injection, and, if necessary, arthroscopic repair of the rotator 

cuff/biceps tendon and subacromial decompression. Dr. Love further indicated, “The shoulder 

procedures would more definitively treat the shoulder injury sustained February 2014.” By 

indicating that appellant might need surgery in the future to address her right shoulder condition 

related to her February 28, 2014 employment injury, Dr. Love suggested that she sustained right 

shoulder conditions related to that injury other than a right shoulder/upper arm sprain. However,

Dr. Love’s July 17, 2018 report does not establish her request to expand the accepted conditions 

in that he did not provide a rationalized medical explanation for his ostensible opinion that she

sustained a more serious right shoulder condition related to her February 28, 2014 employment 

injury than had already been accepted. The Board has held that a medical report is of limited 

probative value on the issue of causal relationship if it contains a conclusion regarding causal 

relationship which is unsupported by medical rationale.26

Accordingly, the Board finds that the special weight of the medical evidence is represented 

by the impartial medical examiner Dr. Friedman and establishes that appellant did not sustain a 

recurrence of disability commencing on or after September 11, 2014, causally related to her 

accepted February 28, 2014 employment injury and that the acceptance of her claim should not be 

expanded to include additional medical conditions causally related to the accepted February 28, 

2014 employment injury. As such, appellant 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 a recurrence of 

disability, commencing on or after September 11, 2014, causally related to her accepted 

February 28, 2014 employment injury. The Board further finds that she has not met her burden of 

proof to establish that the acceptance of her claim should be expanded to include additional 

medical conditions causally related to her accepted February 28, 2014 employment injury.

 

25 See W.C., Docket No. 18-1386 (issued January 22, 2019); Melvina Jackson, 38 ECAB 443 (1987) (regarding the 

importance, when assessing medical evidence, of such factors as a physician’s knowledge of the facts and medical 

history, and the care of analysis manifested and the medical rationale expressed in support of the physician’s opinion).

26 Y.D., Docket No. 16-1896 (issued February 10, 2017); C.M., Docket No. 14-0088 (issued April 18, 2014).
9

ORDER

IT IS HEREBY ORDERED THAT the October 18, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 7, 2019

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board