United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.D., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

WEST LOS ANGELES VA MEDICAL 

CENTER, Los Angeles, CA, Employer

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Docket No. 20-1623

Issued: July 29, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 13, 2020 appellant filed a timely appeal from a March 17, 2020 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 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 The Board notes that following the March 17, 2020 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

5 U.S.C. § 8101 et seq.
ISSUE

The issue is whether OWCP met its burden of proof to terminate appellant’s medical 

benefits, effective March 17, 2020.

FACTUAL HISTORY

On July 21, 2015 appellant, then a 53-year-old motor vehicle operator, filed a traumatic 

injury claim (Form CA-1) alleging that on July 7, 2015 he developed pain in his lower back and 

left leg when instructed to assist pushing a patient in a faulty wheelchair, weighing in excess of 

600 pounds, up a 45-degree ramp while in the performance of duty. He initially stopped work on 

July 8, 2015.3 On December 9, 2016 OWCP accepted strain of the muscle, fascia, and tendon of 

the lower back.

On March 12, 2018 appellant filed a notice of recurrence (Form CA-2a) alleging that he 

lost time from work due to his July 7, 2015 employment injury. He noted that he had returned to 

light-duty work on April 26, 2016 and again stopped work completely as of January 20, 2017.

In an April 26, 2018 development letter, OWCP informed appellant of the deficiencies in 

his recurrence claim. It advised him of the type of additional medical evidence needed and

provided him with a questionnaire for his completion. OWCP afforded appellant 30 days to 

respond.

Dr. Steve Huang, a Board-certified physiatrist, completed both narrative and form reports 

on May 8, 2018. He described appellant’s history of injury on July 7, 2015 and diagnosed lumbar 

muscle strain, lumbar radiculopathy, and acute low back pain. Dr. Huang provided work 

restrictions and on May 10, 2018 prescribed physical therapy.

Appellant underwent a lumbar magnetic resonance imaging (MRI) scan on May 14, 2018,

which demonstrated minimal disc bulging at multiple levels without focal disc herniation or highgrade central canal stenosis at any level. It further revealed facet degeneration at L4-5 and mild 

canal narrowing at L3-4 and L4-5.

On May 30, 2018 OWCP referred appellant, a statement of accepted facts (SOAF), and a 

series of questions for a second opinion examination with Dr. Frederic G. Nicola, a Board-certified 

orthopedic surgeon.

In his June 21, 2018 report, Dr. Nicola noted appellant’s accepted employment injury on 

July 7, 2015, resulting in lumbar sprain/strain. He reported that appellant sustained a nonindustrial brain hemorrhage on January 29, 2018 and stopped work on this date. Dr. Nicola 

reviewed his medical records and performed a physical examination. He found paraspinal 

musculature tenderness to palpation in the lumbosacral spine and diagnosed muscle strain. 

Dr. Nicola found that appellant had normal motor, reflex, and sensory changes of both lower 

extremities and that his MRI scans were not clinically substantiated for lumbar radiculopathy. He 

3 On November 7, 2017 appellant explained that he performed light-duty work following his accepted employment 

injury for nine months. He then experienced bilateral medial meniscal tears.
found that appellant continued to experience residuals of his accepted injury in the form of 

subjective complaints in his lumbar spine. Dr. Nicola noted that he did not exhibit spasm, 

guarding, or asymmetry of motion and had a normal neurologic examination. He found that no 

further treatment was necessary for the accepted employment injury and no work restrictions due 

to the accepted employment injury. Dr. Nicola found that appellant had significant residuals due 

to his non-industrial traumatic brain injury and still required medical treatment.

On July 13, 2018 OWCP proposed to terminate appellant’s medical benefits as a result of 

his July 7, 2015 employment injury. It provided him 30 days to submit additional evidence or 

argument if he disagreed with the proposed termination.

On July 26 and August 6, 2018 Dr. Huang continued to diagnose lumbar muscle strain, 

lumbar radiculopathy, and acute low back pain. He performed a physical examination and found 

limited range of motion, positive straight leg raising on the right, and tenderness bilaterally over 

the L3-5 paraspinal muscles. Dr. Huang attributed appellant’s current condition to the July 7, 2015 

employment injury.

In a letter dated August 11, 2018, appellant disagreed with the proposed termination of 

medical benefits and alleged that Dr. Nicola’s report was not based on a complete review of the 

medical records nor a complete physical examination.

By decision dated October 4, 2018, OWCP terminated appellant’s medical benefits,

effective that date. On October 26, 2018 appellant requested an oral hearing from a representative 

of OWCP’s Branch of Hearings and Review.

By decision dated January 15, 2019, OWCP’s hearing representative set aside the 

October 4, 2018 termination decision and remanded the case for further development of the 

medical evidence including a review by Dr. Nicola of the May 2018 MRI scan.

In a March 28, 2019 supplemental report, Dr. Nicola reviewed the May 14, 2018 MRIscan

and found that appellant’s lumbar spine was unchanged from the prior MRI scan of 

September 15, 2015. He noted that review of the May 14, 2018 MRI scan did not alter his opinion 

that appellant had no medical residuals of the accepted July 7, 2015 employment injury.

On April 15, 2019 OWCP proposed to terminate appellant’s medical benefits due to his 

accepted July 7, 2015 employment injury. It afforded him 30 days to respond.

In an April 30, 2019 report, Dr. Brie Romines, a family practitioner, examined appellant 

due to chronic low back pain with lumbar radiculopathy. She noted his history of injury on July 7, 

2015 and performed a physical examination, finding tenderness to palpation of the left sacroiliac 

joint and lumbar paraspinal muscles. Dr. Romines reported that appellant had symptoms of 

tingling in his right toes when bending forward. He requested an additional MRI scan.

On May 13, 2019 Dr. Cameron reviewed appellant’s May 7, 2019 MRI scan and found 

changes at L3-4 where there was mild central canal and mild left neural foraminal stenosis. She 

diagnosed chronic low back pain with lumbar radiculopathy. Dr. Cameron opined that there were 

no significant changes in the new MRI scan and that appellant’s right toe pain was possibly from 

metatarsal pressure.
By decision dated May 22, 2019, OWCPterminated appellant’s medical benefits, effective 

that date. On June 20, 2019 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review.

By decision dated September 5, 2019, OWCP’s hearing representative set aside OWCP’s 

May 22, 2019 decision and remanded the case for further development, finding that Dr. Nicola’s 

March 28, 2019 supplemental report was equivocal with regard to whether appellant continued to 

have a medical condition due to his July 7, 2015 employment injury.

In an October 11, 2019 supplemental report, Dr. Nicola found that appellant had no work 

restrictions due to his July 7, 2015 employment injury. He found that appellant was permanent 

and stationary with regard to his accepted condition of lumbar sprain/strain and “should be released 

for his lumbar spine to all activities.” Dr. Nicola further concluded that he had no objective 

findings to document lumbar radiculopathy.

On February 12, 2020 OWCP proposed to terminate appellant’s medical benefits due to 

his July 7, 2015 employment injury. It afforded him 30 days to respond.

By decision dated March 17, 2020, OWCP terminated appellant’s medical benefits 

effective that date.

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.4 The right to medical benefits for an 

accepted condition is not limited to the period of entitlement for disability compensation.5 To 

terminate authorization for medical treatment, OWCP must establish that appellant no longer has 

residuals of an employment-related condition which require further medical treatment.6 

ANALYSIS

The Board finds that OWCP has met its burden of proof to terminate appellant’s medical 

benefits, effective March 17, 2020.

OWCP relied upon the reports of Dr. Nicola, the second opinion physician, in finding that 

appellant had no continuing residuals in terminating his medical benefits. Dr. Nicola opined that 

appellant did not exhibit spasm, guarding, or asymmetry of motion and had a normal neurologic 

examination and concluded that appellant had no objective findings to document lumbar 

radiculopathy. He noted that a review of the September 15, 2015 and May 14, 2018 MRI scans

4

See R.P., Docket No. 17-1133 (issued January 18, 2018); S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 

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

5

See R.P., id.; T.P., 58 ECAB 524 (2007); Kathryn E. Demarsh, 56 ECAB 677 (2005); A.P.,Docket No. 08-1822 

(issued August 5, 2009). FurmanG. Peake, 41 ECAB 361, 364 (1990).

6

See R.P., supra note 4; James F. Weikel, 54 ECAB 660 (2003); PamelaK. Guesford, 53 ECAB 727 (2002); 

Furman G. Peake, supra note 5.
confirmed that appellant had no medical residuals of the accepted July 7, 2015 employment injury. 

Dr. Nicola further opined that no additional treatment was necessary for the accepted employment 

injury and that he had no work restrictions due to the accepted employment injury. He noted that 

appellant had significant residuals due to his non-industrial traumatic brain injury that required 

continued medical treatment. Dr. Nicola concluded that appellant was permanent and stationary 

with regard to his accepted condition of lumbar sprain/strain and “should be released for his lumbar 

spine to all activities.” He further concluded that he had no objective findings to document lumbar 

radiculopathy. The Board finds that his report constitutes the weight of the medical evidence and 

establishes that appellant has no residuals causally related to the accepted July 7, 2015 employment 

injury. 

Following OWCP’s proposed termination of medical benefits on July 26 and August 6, 

2018, Dr. Huang continued to diagnose lumbar muscle strain, lumbar radiculopathy, and acute low 

back pain based on his physical examination of appellant. Although he attributed appellant’s 

current condition to the July 7, 2015 employment injury, he provided no medical rationale. The 

Board has held that medical evidence that states a conclusion but does not offer a rationalized 

medical explanation regarding the cause of an employee’s condition is of limited probative value 

on the issue of causal relationship.7 Dr. Huang’s report is, therefore, insufficient to establish that 

appellant had residuals due to her accepted employment conditions.

Although Dr. Romines and Dr. Cameron diagnosed chronic low back pain with lumbar 

radiculopathy, neither physician provided an opinion on whether appellant still had residuals due 

to her accepted employment conditions.

8

 As such, these reports are also insufficient to establish 

continuing employment-related residuals.

The Board finds that the reports of Dr. Nicola, the second opinion physician, constitute the 

weight of the medical evidence and establish that appellant no longer had residuals causally related 

to the accepted July 7, 2015 employment injury. OWCP, therefore, has met its burden of proof to 

terminate appellant’s medical benefits.

CONCLUSION

The Board finds that OWCP has met its burden of proof to terminate appellant’s medical 

benefits, effective March 17, 2020.

7

S.S., Docket No. 21-1140 (issued June29, 2022); P.J., Docket No. 18-1738 (issued May 17, 2019); D.H., Docket 

No. 17-1913 (issued December 13, 2018).

8

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

IT IS HEREBY ORDERED THAT the March 17, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 29, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board