United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.C., Appellant

and

U.S. POSTAL SERVICE, HIGH POINT POST 

OFFICE, High Point, NC, Employer

__________________________________________

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Docket No. 20-1618

Issued: October, 8, 2021

Appearances: Case Submitted on the Record

Joanne Wright, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On September 4, 2020 appellant, through his representative, filed a timely appeal from a 

July 9, 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. 

ISSUES

The issues are: (1) whether OWCP properly terminated appellant’s wage-loss 

compensation and medical benefits, effective May 16, 2019, as he no longer had residuals or 

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

disability causally related to his accepted employment injury; and (2) whether appellant has met 

his burden of proof to establish continuing employment-related disability or residuals on or after 

May 16, 2019 due to his accepted employment injury. 

FACTUAL HISTORY

On November 15, 2013 appellant, then a 61-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on November 8, 2013 he broke his rib, fractured his upper jaw, 

lost teeth, and injured his back and neck when involved in a head-on motor vehicle accident 

(MVA) while in the performance of duty. He stopped work on November 8, 2013. OWCP 

accepted the claim for a broken tooth. It subsequently expanded acceptance of the claim to include 

an open wound of the lip without complications, an abrasion or friction burn of the left elbow, 

forearm, and wrist, without infection, an abrasion or friction burn of the left leg except the foot 

without infection, an abrasion or friction burn of the left fingers without infection, thoracic sprain, 

a closed fracture of a rib, and post-concussion syndrome. OWCP paid appellant wage-loss 

compensation for total disability on the supplemental rolls, effective December 28, 2013, and on 

the periodic rolls, effective January 12, 2014.

In a report dated January 29, 2014, Dr. Amit Hiralal Patel, a physiatrist, evaluated appellant 

for back and leg pain as a result of a November 8, 2013 MVA. He noted that, subsequent to the 

injury, appellant had “difficulty with attention and memory, gait difficulty associated with multiple 

falls, and occasional slurring of speech.” Dr. Patel diagnosed neck, back, and shoulder pain.

A February 12, 2014 magnetic resonance imaging (MRI) scan of the lumbar spine revealed 

degenerative changes at multiple levels and severe central spinal stenosis at L3-4. A February 12, 

2014 MRI scan of the thoracic spine was unremarkable. A cervical MRI scan of even date showed 

spinal and foraminal stenosis from C3 to C7.

On February 18, 2014 Dr. Benjamin R. Graves, a Board-certified orthopedic surgeon, 

discussed appellant’s history of a head-on collision in November 2013 when a driver fell asleep 

and veered into his lane at a “high rate of speed, resulting in significant facial trauma and a 

significant head injury....”

3

 H noted that his wife advised that he had been normal before the 

collision, but that subsequently had become “increasingly confused, has difficulty speaking, has 

gait abnormalities, and balance issues that cause him to fall frequently.” Dr. Graves discussed 

appellant’s complaints of shoulder pain and stiffness throughout his bilateral shoulders, elbow, 

wrists, fingers, hips, knees, and ankles. He related, “I would venture to say that this is somehow 

related to his gait disturbance, confusion, and personality change after the motor vehicle collision.” 

An MRI scan of the brain obtained on March 11, 2014 demonstrated no acute abnormality 

and nonspecific areas of high signal likely showing microvascular ischemic disease which appears 

advanced for age, with other etiologies including remote trauma/inflammation, demyelination, or 

chronic ischemia.

3

In a February 10, 2014 report, Dr.Chason Hayes, a Board-certified orthopedic surgeon, diagnosed cervical and 

lumbar spondylosis aggravated by a MVA and left rotator cuff syndrome.
3

In an April 8, 2014 report, Dr. Herman Schmid, a physician specializing in family 

medicine, advised that he had treated appellant since 1996. He discussed his history of a severe 

MVA on November 8, 2013 and subsequent treatment at the emergency department for “multiple 

injuries including the loss of two teeth, fractured ribs, and damage to his cervical and lumbar 

spine.” Dr. Schmid noted that appellant had an “ataxic gait secondary to progressive muscle 

weakness and poor muscle coordination since the accident.” He opined that appellant was 

permanently disabled from all work due to the MVA.

On July 16, 2014 Dr. Paul Fredrick Meyer, Board-certified in family practice, discussed 

appellant’s history of a November 2013 MVA and current complaints of stiffness, somnolence, 

personality change, ataxia, and problems walking. He diagnosed post-concussive syndrome, 

diabetes mellitus, hypertension, a traumatic brain injury, and post-traumatic stress disorder 

(PTSD).

On August 19, 2014 Dr. Meyer requested that OWCP expand the acceptance of appellant’s 

claim to include a traumatic brain injury, PTSD, neck pain, hypertension, dysphonia, and diabetes. 

He advised that the diagnosed conditions were either caused or aggravated by the employment 

based on his examination and medical studies.

On June 10, 2015 Dr. Meyer opined that appellant’s employment injury had aggravated or 

accelerated hypertension, chronic kidney disease, degenerative joint disease, and diabetes. He 

further found that he had sustained an acute injury to his brain and PTSD “as a consequence of the 

events of the collision and his injuries, and he has developed traumatic Parkinson’s disease as a 

consequence of his injuries.” Dr. Meyer advised that appellant required continued lifelong medical 

treatment as a result of the collision. He asserted that medical literature supported that traumatic 

head injuries could cause traumatic Parkinson’s disease and PTSD and that he had based his 

conclusion on his examination of appellant and a review of treatment notes. Dr. Meyer further 

opined that medical literature supported that head and musculoskeletal injuries sustained in a 

collusion could activate or accelerated underlying hypertension and diabetes. He found that 

appellant was permanently disabled from employment and required continued treatment.

On June 17, 2015 OWCP referred appellant to Dr. Shervin Eshraghi, a Board-certified 

neurologist, for a second opinion examination. It requested that he address whether appellant had 

sustained a traumatic brain injury as a result of the accepted employment injury.

In a report dated July 1, 2015, Dr. Eshraghi discussed appellant’s history of a November 8, 

2013 head-on MVA. He found that the accepted conditions had resolved except for some 

symptoms of tenderness and stiffness in the thoracic region. Dr. Eshraghi asserted that appellant 

had sustained a traumatic brain injury as a result of his employment injury. He related:

“His history is consistent with post-concussive syndrome. His neurologic 

exam[ination] and low score on cognitive testing is consistent with cognitive 

impairment, which may be seen after a traumatic brain injury as well. Furthermore, 

his neurological exam[ination] shows evidence of Parkinsonism. Although 

pugilistic Parkinsonism from repeated brain trauma is a well-known phenomenon, 

it is unusual for it to occur with one injury event. Nevertheless, it is within the 

realm of possibility.” 
4

Dr. Eshraghi related that appellant had significant disability both from the accident-related 

traumatic brain injury and from Parkinsonism that “may have potentially predated the accident.” 

He opined that appellant was disabled from his usual employment.

On January 21, 2016 OWCP expanded the acceptance of appellant’s claim to include postconcussion syndrome.

In a report dated April 6, 2016, Dr. Meyer opined that appellant had “developed traumatic 

Parkinson’s disease as a consequence of his injuries.” He further opined that he suffered a 

permanent aggravation or acceleration of hypertension, diabetes, chronic kidney disease, 

degenerative joint disease, and PTSD due to his employment injury. Dr. Meyer related that 

medical literature supported that traumatic head and musculoskeletal injuries caused an elevation 

of blood sugar levels and hypertension, and could lead to neurological and psychiatric conditions, 

including traumatic Parkinson’s disease and PTSD. He advised that he had based his conclusion 

that appellant was permanently disabled from employment on his examination and review of the 

medical evidence. 

In a note dated July 24, 2017, Dr. Meyer advised that appellant’s condition had not changed 

and referenced his June 10, 2015 letter.4 He indicated that he did not anticipate his condition 

improving. 

On August 9, 2018 Dr. Miranda Jocelyn Turner, Board-certified in family medicine, 

indicated that appellant’s condition remained unchanged.

On February 4, 2019 OWCP again referred appellant to Dr. Eshraghi for a second opinion 

examination regarding whether he had continued residuals and disability due to his accepted 

employment injury.

In a report dated February 18, 2019, Dr. Eshraghi determined that appellant’s cognitive 

function had significantly worsened since his prior evaluation. On examination he found 

moderate-to-severe bradykinesia of the extremities and moderate rigidity. Dr. Eshraghi advised 

that testing showed low cognitive function and signs of moderate-to-severe Parkinsonism. He

opined that the cognitive impairment and Parkinsonism were unrelated to the accepted 

employment injury. Dr. Eshraghi related:

“Post-concussive syndrome improves with time and either stabilizes or totally 

resolves. [Appellant’s] cognitive dysfunction has progressively gotten worse, 

which is not the pattern expected as part of a post-concussive syndrome. His history 

and examination are most consistent with probable Lewy body dementia and this 

cannot be caused by a traumatic brain injury. This condition is comprised of 

dementia and Parkinsonism within one year of onset of each other and is a 

4

In a progress report dated March 6, 2017, Dr.Meyer noted that appellant had a medical history that included a 

November 18, 2013 closed-head injury. He diagnosed essential hypertension, cervical stiffness, and PTSD. 

Dr. Meyer advised that appellant was on medication for Parkinson’s disease. 
5

progressive neurodegenerative condition as evidence by his history and 

examination. All the other accepted conditions have resolved.” 

Dr. Eshraghi found that appellant was totally disabled from his usual employment, but that 

his disability was “not a direct result of the accepted work-related conditions.”

On March 27, 2019 OWCP notified appellant of its proposed termination of his 

compensation and medical benefits as the weight of the evidence established that he no longer had 

any employment-related residuals or disability due to his accepted November 8, 2013 employment 

injury. It afforded him 30 days to submit additional evidence or argument if he disagreed with the 

proposed termination. 

By decision dated May 15, 2019, OWCP terminated appellant’s wage-loss compensation 

and medical benefits, effective May 16, 2019. It found thatDr. Eshraghi’s opinion represented the 

weight of the evidence and established that he had no further disability or residuals of his accepted 

employment injury. 

Thereafter, OWCP received a December 3, 2018 report from Dr. John G. Malone, a Boardcertified neurologist and neurophysiologist. Dr. Malone diagnosed Parkinsonism, a history of a 

traumatic brain injury, diabetes mellitus, proximal muscular weakness, dyslipidemia, chronic 

kidney disease, PTSD, muscular weakness, and memory loss.

In a report dated June 7, 2019, Dr. Malone advised that he had treated appellantsince 2014 

as a result of a November 2013 MVA. He diagnosed a traumatic brain injury, concussion, and 

post-concussion syndrome. Dr. Malone indicated that brain imaging obtained March 11, 2014 

showed signal abnormalities that could be due to “remote trauma, microvascular ischemia, 

inflammation, or demyelination.” He noted that appellant had Parkinson’s disease, which could 

“certainly be caused or aggravated by severe closed-head injuries.” Dr. Malone opined that 

appellant’s 2013 traumatic brain injury at least partially caused his “ongoing demise and poor 

functional status.”

On October 31, 2019 appellant requested reconsideration. He argued that Dr. Malone’s 

June 7, 2019 report created a conflict in medical opinion.

By decision dated January 17, 2020, OWCP denied modification of its May 5, 2019 

decision.

On April 2, 2020 Dr. Malone advised that appellant’s 2013 traumatic brain injury was “felt 

to be causal, at least in part, to his progressive physical and mental decline associated with 

Parkinsonism.”

On April 10, 2020 appellant requested reconsideration. He again argued that a conflict in 

medical opinion existed.

By decision dated July 9, 2020, OWCP denied modification of its January 17, 2020 

decision. It further found that Dr. Malone’s opinion was insufficient to show that appellant had 

sustained Parkinson’s disease caused or aggravated by the accepted employment injury.
6

LEGAL PRECEDENT -- ISSUE 1

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

modification or termination of an employee’s benefits.5 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.6 Its burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background.7

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

entitlement for disability.8 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.9

Section 8123(a) 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.10

ANALYSIS -- ISSUE 1

The Board finds that OWCP improperly terminated appellant’s wage-loss compensation 

and medical benefits, effective May 16, 2019, as he no longer had residuals or disability causally 

related to his accepted employment injury.

The Board finds that OWCP has not resolved the issue of whether acceptance of appellant’s 

claim should be expanded to include additional conditions and, thus, has not met its burden of 

proof to terminate his wage-loss compensation and medical benefits.11

In reports dated June 10, 2015 and April 6, 2016, Dr. Meyer found that, based on his 

examination findings, review of the evidence, and medical literature, appellant had developed 

traumatic Parkinson’s disease as a result of the accepted employment injury. He further found that 

the MVA had aggravated or accelerated his hypertension, chronic kidney disease, degenerative 

joint disease, and diabetes and caused PTSD.

5 R.H., Docket No. 19-1064 (issued October 9, 2020); M.M., Docket No. 17-1264 (issued December 3, 2018).

6 A.T., Docket No. 20-0334 (issued October 8, 2020); E.B., Docket No. 18-1060 (issued November 1, 2018).

7 C.R., Docket No. 19-1132 (issued October 1, 2020); G.H., Docket No. 18-0414 (issued November 14, 2018).

8 E.J., Docket No. 20-0013 (issued November 19, 2020); L.W., Docket No. 18-1372 (issued February 27, 2019).

9 A.J., Docket No. 18-1230 (issued June 8, 20200); R.P., Docket No. 18-0900 (issued February 5, 2019).

10 5 U.S.C. § 8123(a); L.T.,Docket No. 18-0797 (issued March14, 2019); Shirley L. Steib, 46 ECAB 309, 

317 (1994).

11 See T.M., Docket No. 19-1068 (issued March 30, 2021).
7

OWCP referred appellant to Dr. Eshraghi for an opinion regarding whether appellant had 

sustained a traumatic brain injury due to the accepted employment injury. In a report dated July 1, 

2015, Dr. Eshraghi diagnosed post-concussive syndrome and noted that his scores on cognitive 

testing showed an impairment consistent with a traumatic brain injury. He advised that a 

neurological examination showed Parkinsonism. Dr. Eshraghi indicated that it was unusual, but 

possible, for pugilistic Parkinson disease to develop from one event.

After receipt of Dr. Eshraghi’s July 1, 2015 report, OWCP accepted post-concussive 

syndrome, but did not determine whether it should expand acceptance of his claim to include a 

traumatic brain injury or Parkinsonism as due to the accepted employment injury. 12

On February 4, 2019 OWCP again referred appellant to Dr. Eshraghi. In a February 18, 

2019 report, Dr. Eshraghi opined that appellant’s Parkinsonism and cognitive impairment were 

unrelated to the accepted employment injury. He diagnosed probable Lewy body dementia 

unrelated to appellant’s traumatic brain injury and post-concussive syndrome. Dr. Eshraghi

explained that post-concussive syndrome stabilized or improved with time while appellant’s 

condition had worsened. He concluded that appellant’s disability was not a direct result of his 

accepted employment injury.

Once OWCP undertakes development of the medical evidence, it has the responsibility to 

do so in a manner that will resolve the relevant issues in the case.13 The Board finds that a conflict 

exists between Dr. Meyer, appellant’s physician, and Dr. Eshraghi, an OWCP referral physician, 

regarding whether he sustained Parkinson’s disease causally related to the accepted employment 

injury. Prior to its termination decision, OWCP failed to fully develop the issue of claim expansion 

to determine whether it should expand acceptance of the claim to include additional co nditions 

diagnosed by Dr. Meyer. It further failed to resolve the conflict in medical opinion between

Dr. Meyer and Dr. Eshraghi regarding whether his claim should be expanded to include 

Parkinson’s disease and whether, if established, the additional conditions resulted in continuing 

disability from employment or the need for medical treatment.14

For the above-stated reasons, OWCP has not resolved the issue of whether the acceptance 

of appellant’s claim should be expanded to include additional conditions and, thus, it has not met 

its burden of proof to terminate appellant’s wage-loss compensation and medical benefits.15

12 The Board notes that the International Classification of Diseases (ICD)-10 code for post-concussion syndrome is 

different from the code for a traumatic brain injury.

13 See B.W., Docket No. 20-1033 (issued November 30, 2020); R.B. Docket No. 20-0109 (issued June25, 2020).

14 B.W., id.; J.T., Docket No. 19-1723 (issued August24, 2020).

15 T.M., supra note 11.
8

CONCLUSION

The Board finds that OWCP improperly terminated appellant’s wage-loss compensation 

and medical benefits, effective May 16, 2019, as he no longer had residuals or disability causally 

related to his accepted employment injury.16 

ORDER

IT IS HEREBY ORDERED THAT the July 9, 2020 decision of the Office of Workers’

Compensation Programs is reversed.

Issued: October, 8, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

16 In view of the Board’s disposition of Issue 1, Issue 2 is moot.