United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.B., Appellant

and

U.S. POSTAL SERVICE, HOWELL POST 

OFFICE, Howell, NJ, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 21-0398

Issued: October 15, 2021

Appearances: Case Submitted on the Record

Robert D. Campbell, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 28, 2021 appellant, through counsel, filed a timely appeal from a December 7, 

2020 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 this case.

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 his burden of proof to establish that the acceptance 

of his claim be expanded to include additional conditions causally related to his January 9, 2018 

accepted employment injury. 

FACTUAL HISTORY

On January 9, 2018 appellant, then a 45-year-old rural carrier associate, filed a traumatic 

injury claim (Form CA-1) alleging that on that date he injured his wrist and lower back when he 

slipped and fell while in the performance of duty. OWCP accepted the claim for a left wrist 

contusion. It subsequently expanded acceptance of the claim to include a left wrist triquetral 

fracture, a partial tear of the left scapholunate ligament, a contusion of the left back wall of the 

thorax, a sprain of the left wrist and hand, and a traumatic rupture of the left wrist ligament.3 

Appellant stopped work on January 9, 2018 and returned to his date-of-injury job on 

April 16, 2018. OWCP paid appellant wage-loss compensation on the supplemental rolls from 

February 24 to April 13, 2018.

In an emergency department report dated January 9, 2018, Dr. Bruce Bonanno, who 

specializes in emergency medicine, obtained a history of appellant injuring his left wrist and left 

side of back when he fell on ice while delivering mail. He diagnosed a sprain of the left wrist, left 

hand, and left shoulder.

On January 11, 2018 Dr. Teddy L. Atik, a Board-certified orthopedic surgeon, evaluated 

appellant for a hand injury sustained when he slipped and fell on ice while delivering mail at work. 

He discussed his complaints of left wrist pain with numbness and burning in the fingers. On 

examination Dr. Atik found a positive Tinel’s sign and Phalen’s test. He diagnosed acute carpal 

tunnel syndrome of the left wrist and a contusion of the left wrist. Dr. Atik submitted a progress 

report on February 1, 2018. 

A magnetic resonance imaging (MRI) scan of the left shoulder, obtained on February 7, 

2018, showed mild tendinosis of the distal infraspinatus tendon and early mild osteoarthritis of the 

acromioclavicular joint. A February 9, 2018 lumbar MRI scan revealed postsurgical changes at 

L5-S1 with a decompressed spinal canal, but no recurrent disc herniation. 

In a report dated February 22, 2018, Dr. Nasser Ani, a Board-certified orthopedic surgeon, 

advised that he had evaluated appellant on January 15, 2018 and had diagnosed a left rotator cuff 

tear, impingement syndrome, a herniated cervical disc, cervical radiculopathy, a herniated lumbar 

disc with radiculopathy, and a lumbar spine fusion. He opined that the diagnoses were “directly 

caused by [appellant’s] traumatic injury that occurred while he was delivering mail and he slipped 

on black ice landing on his left side.” Dr. Ani related that the mechanism of injury and symptoms 

were consistent with a rotator cuff tear, which commonly occurred with “a jerking motion or high 

impact trauma.” He further indicated that the mechanism of injury was consistent with the 

3 Appellant alleged that he sustained an injury to his strains to his rib and neck, and a shoulder contusion under 

OWCP File No. xxxxxx623 and a thoracolumbar sprain on May 1, 2012 under OWCP File No. xxxxxx167. 
3

diagnosis of a disc herniation, noting that appellant’s spine had jerked when he slipped on black 

ice and fell, causing the inner portion of the disc to move outward causing pain. 

On March 14, 2018 appellant requested that OWCP expand the acceptance of his claim to 

include his left shoulder, left wrist, neck, and low back conditions. 

By decision dated March 14, 2018, OWCP denied appellant’s request to expand the 

acceptance of his claim to include additional left wrist conditions and lumbar, cervical, and left 

shoulder conditions.

Thereafter, OWCP received a March 22, 2018 letter from Dr. Atik.4 Dr. Atik clarified that 

appellant had sustained an injury on January 9, 2018 when he slipped and fell on ice, landing on 

his outstretched left wrist. He advised that an MRI scan had revealed a chip fracture and partial 

tear of the scapholunate ligament of the left wrist. Dr. Atik asserted that a fracture could cause 

bruising of the median nerve and acute carpal tunnel syndrome and opined, “I believe with a 

reasonable degree of medical certainty that the accident that happened while at work when he was

delivering the mail on January 9, 2018 when he had a slip and fall on his outstretched left wrist 

was causally related to him developing acute left carpal tunnel syndrome and a fracture of the left 

triquetrum and a contusion of the wrist and a partial scapholunate ligament tear.”

In a report dated March 27, 2018, Dr. Ani diagnosed left shoulder impingement, tenopathy, 

and a rotator cuff tear, a lumbar spinal fusion at L5-S1 with multiple disc bulges, lumbar and 

cervical radiculopathy, and disc bulges at C3-4 and C5-6. He explained how the mechanism of 

injury was consistent with the diagnosed conditions. Dr. Ani advised that his review of the MRI 

scan showed a partially torn rotator cuff, “contrary to the radiology report.” He further asserted 

that appellant’s fall had aggravated a preexisting lumbar condition, noting that the MRI scan of 

the lumbar spine had shown “bulges at multiple levels above the level of the fusion, which are 

directly and causally related to the injury he sustained on January 9, 2018.”

On March 28, 2018 appellant requested a review of the written record of the March 14, 

2018 decision by a representative of OWCP’s Branch of Hearings and Review. 

Thereafter, appellant submitted an operative report regarding his July 19, 2011 lumbar 

fusion at L5-S1 and medical reports describing his treatment in 2011 and 2012. 

By decision dated June 1, 2018, OWCP denied appellant’s claim for wage-loss 

compensation beginning February 24, 2018. 

On June 21, 2018 appellant requested a review of the written record by a representative of 

OWCP’s Branch of Hearings and Review regarding the June 1, 2018 decision. 

Following a preliminary review, by decision dated June 21, 2018, OWCP’s hearing 

representative found the case not in posture for decision and vacated the March 14, 2018 decision. 

She found that the opinions of Dr. Atik and Dr. Ani were sufficient to warrant further development 

of the evidence. The hearing representative instructed OWCP to obtain information regarding 

4 Dr. Atik also submitted a progress report on April12, 2018. 
4

appellant’s preexisting conditions and to refer him for a second opinion examination to determine 

whether the acceptance of his claim should be expanded to include additional conditions caused 

or aggravated by the January 9, 2018 employment injury and, if so, any periods of employmentrelated disability.

In a June 27, 2018 development letter, OWCP requested that appellant provide medical 

records describing his preexisting lumbar fusion and any surgical and hospital records. It advised 

that, following receipt of the requested information, it would refer him for a second opinion 

examination. OWCP afforded appellant 30 days to respond to its request.

Following a preliminary review, OWCP’s hearing representative, in an August 30, 2018 

decision, found the case not in posture for decision and vacated the June 1, 2018 decision pending 

further development of the issue of claim expansion. 

By decision dated September 12, 2018, OWCP denied appellant’s request to expand the 

acceptance of his clam to include additional conditions. It noted that he had not responded to its 

request for information regarding his preexisting lumbar condition.

In a report dated September 17, 2018, Dr. Ani repeated the same diagnoses as his prior 

reports and explained his belief that the conditions were causally related to the accepted 

employment injury. He recommended surgery to repair the rotator cuff tear.

On September 27, 2018 appellant, through counsel, requested a review of the written 

record by a representative of OWCP’s Branch of Hearings and Review. 

Thereafter, OWCP received an April 3, 2018 electromyogram (EMG) and nerve 

conduction velocity (NCV) study showing left elbow ulnar neuropathy, mild median neuropathy 

at the wrist and no evidence of cervical radiculopathy or brachial plexopathy. 

Following a preliminary review, by decision dated December 18, 2018, OWCP’s hearing 

representative found the case not in posture for decision and vacated the September 12, 2018 

decision. The hearing representative found that appellant had submitted evidence from 2011 

relevant to his preexisting spinal condition and instructed OWCP, on remand, to refer him to a 

second opinion examination. The hearing representative noted that he had two prior claims that 

had been administratively handled for medical care. 

On January 29, 2019 OWCP referred appellant, along with the medical record, a statement 

of accepted facts (SOAF), and a series of questions to Dr. Paul Teja, an osteopath, for a second 

opinion examination. 

On February 26, 2019 Dr. Teja discussed appellant’s history of injury on January 9, 2018 

and provided his review of the medical evidence. He provided range of motion measurements for 

the cervical and lumbar spine, and noted that he had complained of a loss of sensation in the left 

thigh down to the left foot. Dr. Teja found a negative straight leg raise bilaterally and full strength 

with no instability or loss of sensation and a negative impingement test for the left shoulder. For 

the left wrist, he found tenderness to palpation of the ulnar styloid with no instability, swelling, 

effusion, or loss of strength. Dr. Teja found a positive Tinel’s sign on the left and a negative 

Phalen’s test. He diagnosed a left wrist triquetral fracture, a contusion to the distal radius, and a 
5

partial tear of the scapholunate ligament. Dr. Teja found that the accepted conditions had resolved. 

He opined that the evidence failed to support appellant’s “continued complaints of pain in the 

cervical spine, lumbar spine, or left shoulder.” Dr. Teja noted that a lumbar MRI scan had shown 

no recurrent disc herniation and that an MRI scan of the left shoulder had revealed minimal 

findings and no rotator cuff tear. 

On March 12, 2019 OWCP expanded acceptance of appellant’s claim to include a left wrist 

triquetral fracture and a partial tear of the left scapholunate ligament. 

By decision dated March 20, 2019, OWCP denied appellant’s request to expand acceptance 

of his claim to include a lumbar and lumbosacral fusion, left shoulder sprain, a cervical disc bulge 

with protrusion, lumbar and cervical radiculopathy, postsurgical lumbar changes, lumbar and 

cervical intervertebral disc displacement, lumbar herniation and disc bulge, tendinopathy with 

degeneration of the left rotator cuff, carpal tunnel syndrome, left shoulder impingement, other left 

shoulder legions, left wrist sprain, a contusion of the left thorax back wall, and a traumatic left 

wrist rupture. 

On March 20, 2019 OWCP updated the accepted conditions, noting that appellant’s left 

wrist triquetral fracture and a partial tear of the left scapholunate ligament had resolved. 

On April 2, 2019 appellant, through counsel, requested a review of the written record by a 

representative of OWCP’s Branch of Hearings and Review.5

In a report dated May 30, 2019, Dr. Ani again diagnosed left shoulder impingement, a 

rotator cuff tear, and tenopathy, multiple lumbar disc bulges and L5-S1 fusion, lumbar and cervical 

radiculopathy, and cervical disc bulges at C3-4 and C5-6 causally related to the accepted 

employment injury. He explained that the mechanism of injury was consistent with the diagnosed 

conditions.

On June 4, 2019 counsel asserted that Dr. Teja had failed to provide any rationalized 

medical opinion supporting his causation finding. He maintained that the opinions of Dr. Atik and

Dr. Ani were sufficient to meet appellant’s burden of proof to establish a left shoulder, cervical 

spine, and left wrist conditions, ulnar neuropathy, and left carpal tunnel syndrome causally related 

to his January 9, 2018 employment injury.

Following a preliminary review, by decision dated July 1, 2019, OWCP’s hearing 

representative vacated the March 20, 2019 decision. The hearing representative found that 

appellant had submitted sufficient evidence contemporaneous with his injury to establish a left 

thorax back wall contusion, left wrist/hand sprain, and a traumatic rupture of the left wrist 

ligament. OWCP’s hearing representative noted thatDr. Teja had not addressed whether appellant 

sustained left carpal tunnel syndrome, a left shoulder condition, or cervical and lumbar conditions 

causally related to the accepted employment injury. The hearing representative instructed OWCP, 

on remand, to update the SOAF to include all accepted conditions and to request that Dr. Teja 

5 On May 3, 2019 OWCP advised that it had superseded the March 12, 2019 decision and advised that it had 

accepted the conditions of left wrist triquetral fracture and a partial tear of the left scapholunate ligament as resolved. 
6

provide a reasoned opinion of whether appellant sustained a cervical lumbar, or left shoulder 

condition, or left carpal tunnel syndrome, due to his January 9, 2018 employment injury. 

On July 16, 2019 OWCP expanded acceptance of appellant’s claim to include a left wrist 

sprain, a contusion of the left back wall of the thorax, and a traumatic rupture of the left wrist 

ligament. 

In a supplemental report dated July 25, 2019, Dr. Teja reviewed the updated SOAF. He 

related that at the time of his examination appellant had no objective evidence of difficulties with 

his cervical spine, lumbar spine, or left shoulder, and no clinical evidence of carpal tunnel 

syndrome. Dr. Teja advised thatDr. Ani had not diagnosed carpal tunnel syndrome in his May 30, 

2019 report, and opined that “causality for this diagnosis cannot be established as it relates to the 

incident on January 9, 2018.” He related, “In conclusion, based upon my review of the provided 

records, I am unable to determine that the January 9, 2018 injury contributed to the claimant’s left 

carpal tunnel syndrome, left shoulder, cervical, and lumbar conditions either directly or by 

precipitation, acceleration, or aggravation.”

On August 28, 2019 OWCP amended the SOAF to accurately reflect the current accepted 

conditions. 

In a September 11, 2019 addendum, Dr. Teja reviewed the amended SOAF and advised 

that his opinion remained unchanged. 

By decision dated September 18, 2019, OWCP denied appellant’s request to expand 

acceptance of his claim to include additional conditions causally related to his January 9, 2018 

employment injury. 

On October 3, 2019 appellant, through counsel, requested a review of the written record 

before a representative of OWCP’s Branch of Hearings and Review. 

By decision dated December 7, 2020, OWCP’s hearing representative affirmed the 

September 18, 2019 decision. 

LEGAL PRECEDENT

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.6

Causal relationship is a medical question that requires medical opinion evidence to resolve 

the issue.7 The opinion of the physician must be based on a complete factual and medical 

background, must be one of reasonable certainty, and must be supported by medical rationale 

6 K.T., Docket No. 19-1718 (issued April7, 2020); JajaK. Asaramo, 55 ECAB 200 (2004).

7 E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. Morris, 48 ECAB 238 (1996).
7

explaining the nature of the relationship between the diagnosed condition and the accepted 

employment injury.8

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

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

shall appoint a third physician (known as a referee physician or impartial medical specialist) who 

shall make an examination.9 This is called a referee examination and OWCP will select a physician 

who is qualified in the appropriate specialty and who has no prior connection with the case. 10

ANALYSIS

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

OWCP accepted that appellant sustained a left wrist contusion, a triquetral fracture of the 

left wrist, a partial tear of the left scapholunate ligament, a contusion of the left back wall o f the 

thorax, a sprain of the left wrist and hand, and a traumatic rupture of the left wrist ligament due to 

his January 9, 2018 employment injury.

On February 22, 2018 Dr. Ani diagnosed left rotator cuff syndrome, impingement 

syndrome, herniated lumbar and cervical discs with radiculopathy, and a history of a lumbar spinal 

fusion. He attributed the diagnosed conditions to appellant slipping on black ice while delivering 

mail and landing on his left side. Dr. Ani advised that the mechanism of injury, a jerking motion 

as he fell, was consistent with the diagnoses. In a March 27, 2018 report, he interpreted an MRI 

scan as showing a partially torn rotator cuff contrary to the radiologist’s findings. Dr. Ani advised 

that appellant’s fall had aggravated a preexisting lumbar condition and attributed bulging discs 

above and below the lumbar fusion as causally related to the January 9, 2018 employment injury. 

On September 17, 2018 he diagnosed same conditions as due to the accepted work injury and 

recommended rotator cuff surgery.

Dr. Atik, on March 22, 2018, discussed appellant’s history of slipping on January 9, 2018 

and landing on his outstretched left wrist. He indicated that an MRI scan had demonstrated a left 

wrist fracture and partial tear of the scapholunate ligament. Dr. Atik noted that injuries such as a 

fracture could result in bruising of the median nerve and acute carpal tunnel syndrome. He 

diagnosed acute left carpal tunnel syndrome causally related to appellant’s January 9, 2018 work 

injury.

OWCP referred appellant to Dr. Teja for a second opinion examination. In a February 26, 

2019 report, Dr. Teja found that the accepted conditions of a left wrist triquetral fracture, a 

contusion to the distal radius, and a partial tear of the scapholunate ligament had resolved and that 

there was no evidence supporting appellant’s complaints of cervical, lumbar, or left shoulder pain. 

On July 25, 2019 he advised that appellant had no objective evidence of a cervical, lumbar, or left 

shoulder condition or of carpal tunnel syndrome. Dr. Teja found that the January 9, 2018 

8

Id.

9

5 U.S.C. § 8123(a); L.S., Docket No. 19-1730 (issued August26, 2020); M.S., 58 ECAB 328 (2007).

10 20 C.F.R. § 10.321; P.B., Docket No. 20-0984 (issued November 25, 2020); R.C., 58 ECAB 238 (2006).
8

employment injury had not caused or aggravated his left carpal tunnel syndrome or a left shoulder, 

cervical, or lumbar condition. He reviewed an updated SOAF on September 11, 2019 and advised 

that his condition remained unchanged.

As noted above, if there is a disagreement between an employee’s physician and an OWCP 

referral physician, OWCP will appoint a referee physician or impartial medical specialist who shall 

make an examination.11 The Board finds that a conflict in medical opinion exists between Dr. Ani,

Dr. Atik and Dr. Teja regarding whether the acceptance of appellant’s claim should be expanded 

to include additional conditions causally related to the accepted January 9, 2018 employment 

injury.12 

The Board, therefore, will remand the case for OWCP to refer appellant to an impartial 

medical examiner for resolution of the conflict in medical opinion evidence in accordance with 

5 U.S.C. § 8123(a).13 After this and other such further development as OWCP deems necessary, 

it shall issue a de novo decision.

CONCLUSION

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

11 See S.S., Docket No. 19-1658 (issued November 12, 2020); C.S., Docket No. 19-0731 (issued August22, 2019).

12 S.M., Docket No. 19-0397 (issued August 7, 2019).

13 V.B., Docket No. 19-1745 (issued February 25, 2021).
9

ORDER

IT IS HEREBY ORDERED THAT the December 7, 2020 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: October 15, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board