United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.K., Appellant

and

U.S. POSTAL SERVICE, ELEPHANT BUTTE 

POST OFFICE, Elephant Butte, NM, Employer

__________________________________________

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Docket No. 20-0443

Issued: August 8, 2023

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

JANICE B. ASKIN, Judge

JURISDICTION

On December 18, 2019 appellant filed a timely appeal from July 26 and November 18, 

2019 merit decisions and a November 29, 2019 nonmerit 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 OWCP properly denied claims for travel reimbursement for 

medical treatment on September 10 and 17, and December 3, 2018; (2) whether OWCP properly 

denied appellant’s November 22, 2019 request for reconsideration of the merits of her claim 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the November 29, 2019 decision, appellant submitted evidence to OWCP and 

with her appeal to the Board. 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).
2

pursuant to 5 U.S.C. § 8128(a); (3) whether OWCP has met its burden of proof to terminate 

appellant’s wage-loss compensation and medical benefits, effective July 17, 2019, as she no longer 

had disability or residuals causally related to her accepted March 31, 2015 employment injury;3

and (4) whether appellant has met her burden of proof to establish continuing disability or residuals 

on or after July 17, 2019 causally related to the accepted March 31, 2015 employment injury.

FACTUAL HISTORY

This case has previously been before the Board.4 The facts and circumstances as presented 

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

follows.

On April 6, 2015 appellant, then a 45-year-old sales and service distribution associate, filed 

a notice of traumatic injury (Form CA-1) alleging that she injured both shoulders on March 31, 

2015 when she was struck by a falling gate, while in the performance of duty. On January 22, 

2016 OWCP accepted the claim for concussion without loss of consciousness and sprain of the 

ligaments of the cervical and lumbar spine. It subsequently expanded the acceptance of appellant’s 

claim to include cervical disc displacement, occipito-atlanto-axial region, intervertebral disc 

displacement of the lumbosacral region, and cervical and lumbar disc protrusions. Appellant 

stopped work on March 31, 2015.

On August 31, 2017 OWCP referred appellant to Dr. Gary D. Barham, a Board-certified 

orthopedic surgeon, for a second opinion evaluation to determine if appellant continued to have 

residuals of the accepted work-related injury. In a September 19, 2017 report, Dr. Barham 

discussed appellant’s work history. He noted findings on examination of walking without an 

antalgic gait, ability to stand on toes and go up on heels, negative straight leg raises, negative 

Lasegue test, equal reflexes in upper and lower extremities, and normal Babinski test. 

Dr. Barham reviewed x-rays and x-ray reports and noted no evidence of boney injury in the 

cervical, thoracic or lumbosacral spine, and no spondylosis. He noted that in performing the 

physical examination there were questionable parts of validity and opined that there was anxiety, 

hysteria and psychic overlay that was affecting the testing. Dr. Barham advised that from an 

orthopedic standpoint appellant could return to work. He noted that the current diagnosed 

conditions that were causally related to her work injury were lumbosacral sprain and cervical 

vertebral muscle strain. Dr. Barham advised that the right hip was not related to the accepted 

March 31, 2015 employment injury because appellant had preexisting osteoarthritis. He noted 

that appellant reached maximum medical improvement (MMI) with regard to her orthopedic 

injuries six weeks after the injury. Dr. Barham advised that there was no need for surgical 

intervention or further treatment of the neck and back and indicated that appellant could return 

to the same position held prior to the date of injury.5

3 The termination of benefits relates only to the accepted conditions of sprain of the cervical spine, sprain of the 

lumbar spine, other cervical disc displacement occipito-atlanto-axial region, other intervertebral disc displacement 

lumbosacral region, and sprain of the right hip.

4 Docket No. 18-1183 (issued May 12, 2020); Docket No. 17-1393 (issued March 20, 2018).

5 On March 20, 2018 OWCP authorized spinal neck fusion and fixation.
3

On October 13, 2017 OWCP requested clarification of Dr. Barham’s September 19, 2017 

report. It specifically requested that he address whether the right shoulder or right hip conditions 

were aggravated, precipitated, or accelerated by the March 31, 2015 employment injury, and if 

not, to provide well-reasoned medical rationale in support of his opinion, and to identify if any of 

appellant’s accepted conditions have resolved.

In a supplemental report dated October 18, 2017, Dr. Barham noted that the March 31, 

2015 employment injury did not markedly aggravate, precipitate, or accelerate any preexisting 

underlying condition. He noted there was no major muscular, skeletal pathology of significance 

to be aggravated by the trauma experienced on March 31, 2015 and there were no supporting

radiographic or clinical signs in the record. Dr. Barham advised that soft tissue injuries such as 

contusions and bruises resolve within 7 to 10 days. He further noted that concussion without loss 

of consciousness, sprain of the ligaments of the lumbar and cervical spine, cervical displacement, 

occipito-atlanto-axial region, and other intervertebral disc displacement of the lumbosacral region 

were resolved.

On December 4, 2017 OWCP determined that there was a conflict in medical opinion 

between appellant’s treating physicians, Dr. Keith R. Johnson, a Board-certified orthopedist and

Dr. Bassam Al-Homsi, a Board-certified internist, and OWCP’s second opinion physician,

Dr. Barham. Drs. Johnson and Al-Homsi both opined that appellant continued to have residuals 

from her work-related injuries and that the right hip and right shoulder conditions were related to 

the accepted March 31, 2015 employment injury. Dr. Barham opined that appellant’s work-related 

injuries had resolved and the right shoulder and right hip were preexisting conditions that were not 

related to the March 31, 2015 work injury.

On December 12, 2017 OWCP expanded the acceptance of appellant’s claim to include 

postconcussion syndrome, migraine not intractable and post-traumatic seizures. 

On February 16, 2018 OWCP scheduled an impartial medical examination with Dr. Daniel 

Romanelli, a Board-certified orthopedic surgeon. It provided Dr. Romanelli with a statement of 

accepted facts (SOAF) and a series of questions. 

In a March 2, 2018 report, Dr. Romanelli noted his review of the SOAF, the medical 

record, and appellant’s complaints of extreme hip, lumbar spine, shoulder and neck pain. He

provided detailed examination findings. Dr. Romanelli diagnosed work-related cervical 

sprain/strain, lumbar sprain/strain, right shoulder sprain/strain, right hip sprain/strain, 

nonphysiologic, nonanatomic nonorganic subjective complaints of global pain consistent with 

behavioral illness, no evidence of concussion. He indicated that sprains and strains usually resolve 

within 6 to 12 weeks. Dr. Romanelli opined that appellant was at MMI for the cervical 

sprain/strain, lumbar spine sprain/strain, right shoulder and right hip sprain/strain to a reasonable 

degree of medical probability by June 31, 2015, and that further medical treatment was not 

necessary or medically appropriate for these conditions. He reviewed extensive diagnostic studies 

and advised that x-rays showed mild degenerative changes consistent with her age, and the natural 

progression of degenerative changes not related to the March 31, 2015 employment injury. 

Dr. Romanelli additionally noted that the examination was extremely inconsistent with 

nonphysiologic complaints consistent with behavioral illness. He opined that there was no further 

medical treatment necessary or medically appropriate for the work-related injuries. Dr. Romanelli
4

asserted that she had no temporary, permanent, or preventative restrictions, and that she could 

return to full duty in the same position held prior to the date of injury. He concluded that, to a 

reasonable degree of medical probability and certainty, the accident of March 31, 2015 did not 

aggravate, precipitate, or accelerate any preexisting or underlying condition.

On March 13, 2018 OWCP expanded the acceptance of appellant’s claim to include strain 

of the muscle, fascia, and tendon of the right hip.

Appellant submitted a request for travel reimbursement for medical appointments on 

September 5, 10, and 17, October 4, 15, and 19, and December 3, 18, and 31, 2018 and

January 26, 2019.

On September 5, 2018 appellant attended a medical appointment and noted traveling 290 

miles. On September 10 and 17, 2018 she reported attending appointments with Dr. Reymundo A. 

Molina, a licensed counselor and school psychologist, and noted traveling 160 miles on each date. 

Appellant submitted restaurant receipts dated September 5, 2018 for $26.47, September 10, 2018 

for $5.39, and September 17, 2018 for $3.66. 

Appellant attended physical therapy treatment on October 15, 2018. 

In a letter dated April 2, 2019, OWCP noted that it had received appellant’s request for 

travel reimbursement on the above dates, but that she had not provided verification that she 

obtained medical treatment on the dates requested. It advised her to submit the necessary 

documentation within 30 days.

OWCP received additional evidence. On January 15, 2019 Dr. Johnson performed 

arthroscopy of the right hip with acetabuloplasty of the pincer lesion, arthroscopic femoroplasty 

of the right hip Cam lesion, manipulation of the right hip under anesthesia, arthroscopy with 

synovectomy of the right hip, arthroscopic surgical debridement of the articular cartilage, and 

debridement and resection of the labrum. He diagnosed right hip labral tear, hip impingement, 

pincer and Cam lesion, labral tear, and synovitis of the right hip.

In a letter to OWCP dated April 9, 2019, appellant asserted that her travel expenses were

improperly denied for failure to submit proof of visitation. She further asserted that Dr. Molina 

billed OWCP for these visits, and the bills served as proof of her treatment on those dates.

Appellant submitted a Form OWCP-957 dated April 9, 2019 for appointments on 

September 10 and 17, 2018. She noted attending appointments with Dr. Molina on both days,

traveling 160 miles for each appointment. Appellant submitted a receipt noting a date of service 

of September 10, 2018, bill status, billed amount, and bill type. The receipt did not identify a 

specific health care provider. On the bottom of the receipt, appellant noted that date of service 

was the date of her appointment and the bill status reflected “paid,” which proved that she was 

treated for her March 31, 2015 employment injury by Dr. Molina on that date. 

By decision dated May 6, 2019, OWCP denied authorization for travel reimbursement for 

medical treatment for September 10, 17, October 15, December 3, 2018 and January 26, 2019. It 
5

found no evidence to support that appellant received medical treatment for her accepted conditions 

on those dates.

OWCP received reports dated August 29 and September 27, 2018 from Dr. Johnson who

treated appellant for right shoulder and right hip pain, which began after a gate fell on her at work 

on March 31, 2015. Dr. Johnson diagnosed right acetabular labrum tear, hip pain, and right 

shoulder sprain. He treated appellant from January 22 through July 10, 2019 for orthopedic 

aftercare from a right hip arthroscopy labral repair on January 15, 2019 and diagnosed right 

sacroiliac joint pain, other sprain of the right hip, femoral acetabular impingement, hip pain, and 

acetabular labrum tear.

In an initial consultation on December 3, 2018, Dr. Daniel C. Bonis, a Board-certified 

anesthesiologist, evaluated appellant for low back pain, which began in 2015 when a commercial 

gate fell on her. He diagnosed sacroiliitis, low back pain, hypothyroidism, anxiety disorder, 

depressive episodes, and long-term opiate use.

Appellant was treated by Dr. Jessie D. Coleman, a Board-certified anesthesiologist, on 

December 31, 2018 for low back pain radiating into the bilateral lower extremities, which began 

in 2015 after a commercial gate fell on her back. Dr. Coleman diagnosed sacroiliitis, low back 

pain, hypothyroidism, anxiety disorder, depressive episodes, allergic rhinitis, and long-term opiate 

use. He performed intra-articular injections on December 31, 2018 and January 26, 2019 and 

diagnosed sacroiliitis and intractable hip pain.

In a letter dated April 2, 2019, appellant noted that she was treated by Dr. Molina on 

September 10, 17, and October 15, 2018, and by Dr. Bonis on December 3, 2018. She asserted 

that the bills were paid by OWCP, which substantiate that she was treated on those dates. 

On May 14, 2019 appellant requested reconsideration of the May 6, 2019 decision. She 

submitted a receipt, noting various dates of service, bill status, billed amount, and bill type. The 

receipt did not identify a specific health care provider. 

On June 24, 2019 OWCP proposed to terminate appellant’s wage-loss compensation and 

medical benefits for sprain of the cervical spine, sprain of the lumbar spine, other cervical disc 

displacement occipito-atlanto-axial region, other intervertebral disc displacement lumbosacral 

region, and sprain of the right hip because her March 31, 2015 employment injury had resolved. 

It found that the special weight of medical evidence rested with the March 2, 2018 medical report 

of Dr. Romanelli, OWCP’s impartial medical examiner (IME), who found that appellant no longer 

had any disability or residuals causally related to her accepted March 31, 2015employment injury. 

OWCP afforded appellant 30 days to submit additional evidence or argument, in writing, if she 

disagreed with the proposed termination.

Appellant submitted a May 10, 2018 report from Dr. Johnson who diagnosed internal 

derangement of the right knee, right hip labral tear, right shoulder rotator cuff tear, and cervical 

sprain. Dr. Johnson opined that these injuries occurred on March 31, 2015 when a gate crashed 

down on her head. He recommended a right hip arthroplasty with femoroplasty and 

acetebuloplasty. 
6

On January 10, 2019 Dr. Helson Pacheco-Serrant, a Board-certified neurosurgeon, noted 

appellant was status post anterior cervical discectomy with fusion at levels C4-5, C5-6 performed 

on April 18, 2018 and she remained totally disabled. 

On January 26, 2019 Dr. Coleman treated appellant for sacroiliitis and intractable hip pain 

beginning in 2015 when a commercial gate fell on her at work. He performed an intra-articular 

injection.

Appellant submitted work capacity evaluations (Form OWCP-5c) from Dr. Al-Homsi 

dated March 14, April 24, May 14, July 11, and July 14, 2019, who noted that appellant had a 

cervical fusion on April 18, 2018, arthroscopy on January 15, 2019, and intra-articular injections 

on January 26, 2019, and was totally disabled from work. In an undated optometric and 

ophthalmologist report, Dr. Al-Homsi diagnosed visual impairment associated with traumatic 

brain injury, visual processing and visual motor dysfunction, hyperopia, and presbyopia.

On March 20, 2019 Dr. Bonis diagnosed sacroiliitis and intractable hip pain and performed 

an intra-articular joint injection. On April 17, 2019 he diagnosed sacroiliitis, other spondylosis 

with myelopathy of the lumbar region and low back pain and performed radiofrequency ablation 

at right S1-S4. 

By decision dated July 17, 2019, OWCP denied modification of the May 6, 2019 decision.

By decision dated July 26, 2019, OWCP finalized the termination of appellant’s wage-loss 

compensation and medical benefits, effective July 17, 2019 with regard to sprain of the cervical 

spine, sprain of the lumbar spine, other cervical disc displacement occipito-atlanto-axial region, 

other intervertebral disc displacement lumbosacral region, and sprain of the right hip. It found that 

the special weight of medical evidence rested with Dr. Romanelli, the IME.

OWCP received additional evidence. On July 23, 2019 Dr. Javed Iqbal, a Board-certified 

neurologist, treated appellant for a history of a head injury and diagnosed seizures, migraine 

headaches, and memory loss impairment.

Appellant also submitted OWCP-5c forms from Dr. Al-Homsi dated August 2,

September 23, and October 10, 2019 who noted that appellant had a cervical fusion, hip 

arthroscopy, and S1 joint injections and continued to suffer from seizures and dizziness and was 

totally disabled. In a report dated August 9, 2019, Dr. Al-Homsi noted that appellant was 

asymptomatic prior to the March 31, 2015 employment injury when she was struck by a large 

commercial gate and opined that all of her treatment related to the injuries sustained on 

March 31, 2015.

In an August 5, 2019 statement, appellant indicated that she attended medical appointments 

with Dr. Molina and Las Cruces Pain Center, and the bills for the office visits were paid by OWCP. 

With regard to providing proof that she was treated by Dr. Molina on September 10, 17, and 

October 15, 2018 she suggested OWCP contact his office for the notes and bills. 

On August 5, 2019 appellant requested reconsideration of the July 17, 2019 decision.
7

By decision dated August 14, 2019, OWCP affirmed the July 17, 2019 decision in part and 

vacated in part. It found that the medical evidence substantiated that she was medically seen for 

treatment of her employmentinjury on October 15, 2018 and January 26, 2019; however,itdenied 

appellant’s travel reimbursement requests for September 10, 17, and December 3, 2018 as the 

evidence was insufficient to support treatment in relation to her work injury for those dates. 

On August 22, 2019 appellant requested reconsideration. She submitted an August 21, 

2019 work note from Dr. Johnson, who diagnosed anterior superior quadrant chondral labral tear 

by MRI scan. Dr. Johnson performed surgery on January 15, 2019 and opined that the labral tear 

was caused by the traumatic event of the gate falling on appellant.

Appellant submitted a medical travel refund request dated September 6, 2019 for an 

appointment on December 3, 2018. She noted attending an appointment at the Las Cruces Pain 

Center on this date and noted traveling 290 miles for the appointment. Appellant submitted a 

receipt noting a date of service of December 3, 2018, bill status as “paid,” billed amount, and bill 

type. The receipt did not identify a specific health care provider. Appellant attached a restaurant 

receipt dated December 3, 2018 for $25.21.

By decision dated November 18, 2019, OWCP denied modification of the prior decision.

OWCP received a Form OWCP-5c dated November 18, 2019, wherein Dr. Al-Homsi

noted that appellant had a cervical fusion, hip arthroscopy, and S1 joint injections and continued 

to suffer from seizures and dizziness and was totally disabled.

On November 22, 2019 appellant requested reconsideration. She submitted a copy of the 

November 18, 2019 decision with handwritten notes indicating that she attended physical therapy 

treatment on October 1, 8, and 22, November 7, 14, 21, and 28, and December 10, 2018. Appellant

also submitted copies of correspondence from to her to her providers. By decision dated 

November 29, 2019, OWCP denied appellant’s request for reconsideration of the merits of her 

claim under 5 U.S.C. § 8128(a).

LEGAL PRECEDENT -- ISSUE 1

OWCP’s regulations provide that the employee is entitled to reimbursement of reasonable 

and necessary expenses, including transportation needed to obtain authorized medical services, 

appliances, or supplies.6 To determine a reasonable travel distance, it will consider the availability 

of services, the employee’s condition, and the means of transportation. Effective August 29, 2011, 

the most recent regulations provide that a round-trip distance of up to 100 miles is considered a 

reasonable distance to travel.7If round-trip travel of more than 100 miles is contemplated, or air 

transportation or overnight accommodations will be needed, the employee must submit a written 

request to OWCP for prior authorization with information describing the circumstances and 

necessity for such travel expenses. OWCP will approve the request if it determines that the travel 

6

20 C.F.R. § 10.315(a).

7

Id.
8

expenses are reasonable and necessary and are related to obtaining authorized medical services, 

appliances, or supplies.8

Pursuant to FECA Bulletin No. 14-02, when a claimant submits a travel reimbursement in 

excess of 100 miles for a single date of service, the bill will automatically be suspended, and the 

Central Bill Processing provider will send notification to OWCP’s claims examiner.9 FECA 

Bulletin No. 14-02 notes that in some limited circumstances it may be necessary for a claimant to 

travel more than 100 miles on a regular basis, such as when the claimant lives in a remote area. 10

In interpreting this section, the Board has recognized that OWCP has broad discretion in 

approving services provided under FECA.11 The only limitation on OWCP’s authority is that of 

reasonableness. OWCP may authorize medical treatment, but determine that the travel expense 

incurred for such authorized treatment was unreasonable or unnecessary.12

ANALYSIS -- ISSUE 1

The Board finds that OWCP properly denied appellant’s claims for travel reimbursement. 

Appellant submitted a request for travel reimbursement for medical appointments on 

September 10 and 17, and December 3, 2018. 

OWCP’s regulations provide that the employee is entitled to reimbursement of reasonable 

and necessary expenses, including transportation needed to obtain authorized medical services, 

appliances, or supplies.13 OWCP will approve the request if it determines that the travel expenses 

are reasonable and necessary and are related to obtaining authorized medical services, appliances, 

or supplies.14

Appellant submitted documentation of medical treatment on various dates; however, the 

evidence of record does not establish that she received medical treatment for her March 31, 2015 

employment injury on September 10 and 17, and December 3, 2018. As noted above, the Board 

has recognized that OWCP has broad discretion in approving services provided under FECA. 15 

The only limitation on OWCP’s authority is that of reasonableness. Although OWCP had 

8

Id. at § 10.315(b).

9 FECA Bulletin No. 14-02 (issued January 29, 2014).

10 Id.

11 G.C., Docket No. 19-0298 (issued June 24, 2019).

12 Id.

13 Supra note 8.

14 Supra note 10.

15 Supra note 13.
9

authorized travel expenses for appellant to attend medical appointments with the same providers 

in the past, this does not establish a right to continuing authorization.16 

As the medical evidence of record does not establish that appellant received medical 

treatment on the claimed dates, the Board finds that OWCP properly denied appellant’s request 

for travel reimbursement.

LEGAL PRECEDENT -- ISSUE 2

Section 8128(a) of FECA vests OWCP with discretionary authority to determine whether 

to review an award for or against compensation. The Secretary of Labor may review an award for 

or against compensation at any time on his own motion or on application. 17

To require OWCP to reopen a case for merit review pursuant to FECA, the claimant must 

provide evidence or an argument which: (1) shows that OWCP erroneously applied or interpreted 

a specific point of law; (2) advances a relevant legal argument not previously considered by 

OWCP; or (3) constitutes relevant and pertinent new evidence not previously considered by 

OWCP.18

A request for reconsideration must be received by OWCP within one year of the date of 

OWCP’s decision for which review is sought.19 If it chooses to grant reconsideration, it reopens 

and reviews the case on its merits.20 If the request is timely, but fails to meet at least one of the 

requirements for reconsideration, OWCP will deny the request for reconsideration without 

reopening the case for review on the merits.21

ANALYSIS -- ISSUE 2

The Board finds that OWCP properly denied appellant’s request for reconsideration of the 

merits of her claim pursuant to 5 U.S.C. § 8128(a).

16 See W.H., Docket No. 14-1662 (issued February 3, 2015).

17 5 U.S.C. § 8128(a); see M.S., Docket No. 19-1001 (issued December 9, 2019); L.D., Docket No. 18-1468 (issued 

February11, 2019); see also V.P., Docket No. 17-1287 (issued October 10, 2017); W.C., 59 ECAB 372 (2008).

18 20 C.F.R. § 10.606(b)(3); see also E.W., Docket No. 19-1393 (issued January 29, 2020); L.D., id.; B.W., Docket 

No. 18-1259 (issued January 25, 2019).

19 Id. at § 10.607(a). The one-year period begins on the next day after the date of the original contested decision. 

Federal (FECA) Procedure Manual, Part 2 -- Claims, Reconsiderations, Chapter 2.1602.4 (September 2020). 

Timeliness is determined by the document receipt date of the request for reconsideration as indicated by the received 

date in the Integrated Federal Employees’ Compensation System (iFECS). Id. at Chapter 2.1602.4b.

20 Id. at § 10.608(a); see also Y.H., Docket No. 18-1618 (issued January 21, 2020); R.W., Docket No. 18-1324 

(issued January 21, 2020); M.S., 59 ECAB 231 (2007).

21 Id. at § 10.608(b); D.C., Docket No. 19-0873 (issued January 27, 2020); M.S., Docket No. 19-0291 (issued 

June 21, 2019).
10

The Board finds that appellant has not alleged or demonstrated that OWCP erroneously 

applied or interpreted a specific point of law. Moreover, appellant has not advanced a relevant 

legal argument not previously considered. Consequently, she is not entitled to a review of the 

merits of her claim based on the first and second above-noted requirements under 20 C.F.R. 

§ 10.606(b)(3).22

The Board further finds that appellant has not provided relevant and pertinent new evidence 

in support of her request for reconsideration. With the November 22, 2019 reconsideration 

request, appellant provided a report from Dr. Al-Homsi dated November 18, 2019. This report, 

however, fails to address the underlying merit issue of whether appellant was entitled to travel 

reimbursement for the remaining claimed dates. Appellant also submitted a copy of the 

November 18, 2019 decision with handwritten notes indicating that she attended physical therapy 

treatment on October 1, 8, and 22, November 7, 14, 21, and 28, and December 10, 2018. Appellant 

also submitted copies of correspondence from her to her providers. However, this evidence is 

irrelevant to the underlying issue as it does not corroborate that appellant attended appointments 

on the dates in question. The submission of evidence or argument, which does not address the 

particular issue involved does not constitute a basis for reopening a case. 23 As appellant did not 

provide relevant and pertinent new evidence, she is not entitled to a merit review based on the third 

requirement under 20 C.F.R. § 10.606(b)(3).24

The Board, accordingly, finds that appellant has not met any of the requirements of 20 

C.F.R. § 10.606(b)(3). Pursuant to 20 C.F.R. § 10.608(b), OWCP properly denied appellant’s

request for reconsideration of the merits of the claim.

25

LEGAL PRECEDENT -- ISSUE 3

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

termination or modification of an employee’s benefits.26 After it has determined that an employee 

has disability causally related to his or her federal employment, it may not terminate compensation 

without establishing that the disability has ceased or that it is no longer related to the 

22 M.O., Docket No. 19-1677 (issued February 25, 2020); C.B., Docket No. 18-1108 (issued January 22, 2019).

23 M.B.,Docket No. 17-1980 (issued May 14, 2019); E.G., Docket No. 18-0270 (issued August 24, 2018); 

Eugene F. Butler, 36 ECAB 393, 398 (1984).

24 20 C.F.R. § 10.606(b)(3)(iii); T.W., Docket No. 18-0821 (issued January 13, 2020).

25 D.G., Docket No. 19-1348 (issued December 2, 2019).

26 See D.B., Docket No. 19-0663 (issued August 27, 2020); D.G.,Docket No. 19-1259 (issued January 29, 2020); 

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).
11

employment.27 OWCP’s burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background. 28

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

entitlement for disability compensation.29 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.30

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

making the examination for the United States and the physician of an employee, the Secretary shall 

appoint a third physician (known as a referee physician or IME) who shall make an examination. 31 

This is called an impartial medical examination and OWCP will select a physician who is qualified 

in the appropriate specialty and who has no prior connection with the case. 32 When there exist 

opposing medical reports of virtually equal weight and rationale and the case is referred to an IME 

for the purpose of resolving the conflict, the opinion of such specialist, if sufficiently wellrationalized and based upon a proper factual background, must be given special weight. 33

ANALYSIS -- ISSUE 3

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

compensation and medical benefits for sprain of the cervical spine, sprain of the lumbar spine, 

other cervical disc displacement occipito-atlanto-axial region, other intervertebral disc 

displacement lumbosacral region, and sprain of the right hip, effective July 17, 2019, as she no 

longer had disability or residuals causally related to her accepted March 31, 2015 employment 

injury.

OWCP properly determined that a conflict in medical opinion existed betweenDr. Johnson 

and Dr. Al-Homsi, appellant’s treating physicians, who continued to opine that appellant still 

suffered residuals and work restrictions due to her March 31, 2015 employment injury, and

Dr. Barham, OWCP’s second opinion physician, who found that appellant no longer suffered 

27 See D.G., id.; R.P., id.; JasonC. Armstrong, 40 ECAB 907 (1989); Charles E. Minnis, 40 ECAB 708 (1989); 

Vivien L. Minor, 37 ECAB 541 (1986).

28 K.W.,Docket No. 19-1224 (issued November 15, 2019); see M.C.,Docket No. 18-1374 (issued April23, 2019); 

Del K. Rykert, 40 ECAB 284, 295-96 (1988).

29 A.G., Docket No. 19-0220 (issued August 1, 2019); A.P.,Docket No. 08-1822 (issued August5, 2009); T.P., 58 

ECAB 524 (2007); Kathryn E. Demarsh, 56 ECAB 677 (2005); Furman G. Peake, 41 ECAB 361, 364 (1990).

30 K.W., supra note 28; see A.G., id.; James F. Weikel, 54 ECAB 660 (2003); PamelaK. Guesford, 53 ECAB 727 

(2002); Furman G. Peake, id.

31 5 U.S.C. § 8123(a); see R.S., Docket No. 10-1704 (issued May 13, 2011); S.T., Docket No. 08-1675 (issued 

May 4, 2009).

32 20 C.F.R. § 10.321.

33 Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. Godfrey, 52 ECAB 486 (2001).
12

residuals or work restrictions due to her March 31, 2015 employment injury. Appellant was 

referred to Dr. Romanelli for an impartial medical examination to resolve the conflict in medical 

evidence regarding whether she continued to have residuals or work restrictions causally related 

to the March 31, 2015 employment injury.

In a March 2, 2018 report, Dr. Romanelli noted appellant’s history, reviewed the medical 

record, and noted examination findings. He noted that diagnostic studies of the cervical spine, 

lumbar spine, pelvis and right hip show preexisting degenerative changes. Dr. Romanelli 

diagnosed work-related cervical sprain/strain, lumbar sprain/strain, right shoulder sprain/strain, 

right hip sprain/strain, nonphysiologic, nonanatomic nonorganic subjective complaints of global 

pain consistent with behavioral illness, no evidence of concussion. He indicated that sprains and 

strains usually resolve within 6 to 12 weeks. Dr. Romanelli noted multiple inconsistencies in the 

examination that was suggestive of behavioral illness. He advised that appellant reached MMI for 

sprain of the cervical spine, sprain of the lumbar spine, other cervical disc displacement occipitoatlanto-axial region, other intervertebral disc displacement lumbosacral region, and sprain of the 

right hip to a reasonable degree of medical probability by June 31, 2015. Dr. Romanelli indicated 

that any ongoing complaints would be more likely related to appellant’s degenerative condition 

than to a traumatic injury on March 31, 2015. He noted that no further treatment was indicated in 

relation to the accepted sprain of the cervical spine, sprain of the lumbar spine, other cervical disc 

displacement occipito-atlanto-axial region, other intervertebral disc displacement lumbosacral 

region, and sprain of the right hip. Dr. Romanelli also reported that appellant had no ongoing work 

restrictions due to the above accepted conditions. 

The Board finds thatDr. Romanelli’s March 2, 2018 report is entitled to the special weight 

of the medical opinion evidence and establishes that appellant no longer had disability or residuals 

causally related to the accepted conditions of sprain of the cervical spine, sprain of the lumbar 

spine, other cervical disc displacement occipito-atlanto-axial region, other intervertebral disc 

displacement lumbosacral region, and sprain of the right hip due to her March 31, 2015

employment injury. Dr. Romanelli provided an accurate history of the March 31, 2015

employment injury, reviewed her medical records, performed a thorough clinical examination and 

provided findings on examination. He noted that appellant’s subjective complaints were due to 

her degenerative conditions and behavioral illness, and not as a result of the March 31, 2015

employment injury. Dr. Romanelli opined that appellant’s accepted sprain of the cervical spine, 

sprain of the lumbar spine, other cervical disc displacement occipito-atlanto-axial region, other 

intervertebral disc displacement lumbosacral region, and sprain of the right hip had resolved and 

that she no longer had work restrictions due to these accepted conditions. The Board finds that

Dr. Romanelli provided a well-rationalized opinion based on a complete factual background, 

SOAF, a review of the medical record, and physical examination findings. Accordingly,

Dr. Romanelli’s medical opinion was sufficient for OWCP to justify the termination of appellant’s 

wage-loss compensation and medical benefits, effective July 17, 2019, as she no longer had 

disability or residuals causally related to her accepted employment injury.34

34 See D.G., Docket No. 19-1259 (issued January 29, 2020);see also D.T., Docket No. 10-2258 (issued August 1, 

2011); Gloria J. Godfrey, 52 ECAB 486 (2001).
13

After receiving OWCP’s notice of proposed termination, appellant submitted additional 

reports from Dr. Johnson dated May 10, 2018 through June 12, 2019 and Dr. Al-Homsi dated 

March 14 through July 14, 2019. However, Drs. Johnson and Al-Homsi were on one side of the 

conflict, which Dr. Romanelli had resolved. The Board has held that reports from a physician who 

was on one side of a medical conflict are insufficient to overcome the special weight accorded to 

the IME, or to create a new conflict.35

Appellant also submitted reports from Dr. Bonis, Dr. Coleman, and Dr. Pacheco-Serrant,

who diagnosed sacroiliitis and noted that appellant was disabled, and required continued medical 

treatment. These physicians, however, did not explain how this condition was disabling and 

causally related to the accepted employment injury.36 Accordingly, these reports are insufficient 

to overcome the special weight of the medical evidence accorded to Dr. Romanelli.37

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

wage-loss compensation and medical benefits for the conditions of sprain of the cervical spine, 

sprain of the lumbar spine, other cervical disc displacement occipito-atlanto-axial region, other 

intervertebral disc displacement lumbosacral region, and sprain of the right hip, effective 

July 17, 2019, as she no longer had disability or residuals causally related to her accepted 

March 31, 2015 employment injury.

LEGAL PRECEDENT -- ISSUE 4

When OWCP properly terminates appellant’s wage-loss compensation and medical 

benefits, the burden of proof shifts to her to establish continuing disability or residuals, on or after 

that date, causally related to the accepted employment injury.38 To establish causal relationship 

between the condition as well as any attendant disability claimed and the employment injury, an 

employee must submit rationalized medical evidence based on a complete medical and factual 

background, supporting such a causal relationship.39 Causal relationship is a medical issue and 

the medical evidence required to establish causal relationship is rationalized medical evidence.

ANALYSIS -- ISSUE 4

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

employment-related disability or residuals for the conditions of sprain of the cervical spine, sprain 

of the lumbar spine, other cervical disc displacement occipito-atlanto-axial region, other 

35 See C.L., Docket No. 18-1379 (issued February 5, 2019); I.J., 59 ECAB 408 (2008).

36 R.P., id.

37 Id.

38 C.C., Docket No. 19-1062 (issued February 6, 2020).

39 T.C., Docket No. 19-1383 (issued March 2, 2020);see N.G.,Docket No. 18-1340 (issued March 6, 2019); A.F., 

Docket No. 16-0393 (issued June 24, 2016).
14

intervertebral disc displacement lumbosacral region, and sprain of the right hip, on or after July 17, 

2019, causally related to the accepted March 31, 2015 employment injury.

Following the termination of her wage-loss compensation and medical benefits, appellant 

submitted reports from Dr. Al-Homsi dated August 2 through November 18, 2019 who diagnosed 

cervical fusion, hip arthroscopy, and S1 joint injections and advised that appellant continued to 

suffer from seizures and dizziness and was totally disabled. While he concluded that appellant 

was totally disabled, he did not provide rationale to explain why her continuing disability was 

causally related to her accepted conditions. The Board has held that a mere conclusion without 

the necessary rationale as to whether a period of disability is due to an accepted employment 

condition is insufficient to meet a claimant’s burden of proof.40 Dr. Al-Homsi’s reports are,

therefore, of diminished probative value and insufficient to meet appellant’s burden of proof.41

In an August 21, 2019 work note, Dr. Johnson diagnosed anterior superior quadrant 

chondral labral tear by MRI scan. He noted that he performed surgery on January 15, 2019 and 

opined that the labral tear was caused by the traumatic event of the gate falling on appellant. As

Dr. Johnson was on one side of the conflict, his report, without more by way of medical rationale, 

is insufficient to create a new conflict in medical opinion to overcome the special weight properly 

accorded to Dr. Romanelli.42

The record contains a July 23, 2019 report from Dr. Iqbal who treated appellant for a 

history of a head injury and diagnosed seizures, migraine headaches, and memory loss impairment.

Dr. Iqbal did not, however, address the relevant issue of whether appellant was disabled from work 

or required further medical treatment due to her accepted employment-related medical conditions, 

and thus his opinion is of limited probative value.43

Appellant has not submitted sufficiently-rationalized medical evidence establishing 

employment-related disability or residuals for the conditions of sprain of the cervical spine, sprain 

of the lumbar spine, other cervical disc displacement occipito-atlanto-axial region, other 

intervertebral disc displacement lumbosacral region, and sprain of the right hip, on or after July 17, 

2019, due to the accepted employment injury. As such, the Board finds that she has not met her 

burden of proof.44

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.

40 A.T., Docket No. 19-0410 (issued August 13, 2019); E.L., Docket No. 17-1632 (issued January 3, 2018).

41 L.S., Docket No. 19-0959 (issued September 24, 2019).

42 See J.M., Docket No. 11-1257 (issued January 18, 2012); Dorothy Sidwell, 41 ECAB 857 (1990).

43 R.R., Docket No. 19-0173 (issued May 2, 2019).

44 T.C., Docket No. 19-1383 (issued March 2, 2020);see N.G., Docket No. 18-1340 (issued March 6, 2019); A.F., 

Docket No. 16-0393 (issued June 24, 2016).
15

CONCLUSION

The Board finds that OWCP properly denied appellant’s requests for travel reimbursement 

for medical treatment. The Board further finds that OWCP properly denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a). The Board also finds 

that OWCP has met its burden of proof to terminate appellant’s wage-loss compensation and 

medical benefits for sprain of the cervical spine, sprain of the lumbar spine, other cervical disc 

displacement occipito-atlanto-axial region, other intervertebral disc displacement lumbosacral 

region, and sprain of the right hip, effective July 17, 2019, as she no longer had disability or 

residuals causally related to her accepted March 31, 2015 employment injury. The Board further 

finds that she has not met her burden of proof to establish continuing employment-related residuals 

or disability on or after July 17, 2019, causally related to her accepted March 31, 2015 employment 

injury.

ORDER

IT IS HEREBY ORDERED THAT the July 26, November 18, and November 29, 2019 

decisions of the Office of Workers’ Compensation Programs are affirmed.

Issued: August 8, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board