United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.P., Appellant

and

DEPARTMENT OF JUSTICE, FEDERAL 

BUREAU OF PRISONS, Florence, CO, Employer

__________________________________________

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Docket No. 20-0820

Issued: July 12, 2022

Appearances: Case Submitted on the Record

Lonnie Boylan, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 3, 2020 appellant, through her representative, filed a timely appeal from a 

September 24, 2019 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 her burden of proof to expand the acceptance of the 

claim to include additional conditions as causally related to her accepted July 31, 2017 

employment injury.

FACTUAL HISTORY

On August 1, 2017 appellant, then a 37-year-old education specialist, filed a traumatic 

injury claim (Form CA-1) alleging that on July 31, 2017 she injured her groin and hip when she 

was running in response to an institutional emergency and slipped on uneven ground while in the 

performance of duty. She explained that she experienced pain and soreness in her left hip and 

interior left groin and that she could hear her hip clicking when she walked. Appellant noted that 

the incident “felt like a bolt of lightning went through her hip and it instantly felt weak.” She 

stopped work on August 1, 2017 and returned to work four hours a day on October 2, 2017.

In an August 2, 2017 development letter, OWCP advised appellant of the deficiencies of 

her claim. It requested additional factual and medical evidence and provided a questionnaire for 

her completion. OWCP afforded appellant 30 days to respond.

In an August 25, 2017 response to OWCP’s development questionnaire, appellant 

explained that on July 31, 2017 she was running, when she caught her foot in the mud, and that 

“[her] leg tweaked slightly in an awkward position and [she] stumbled slightly.” She instantly felt 

a sharp pain in her left hip and weakness in her upper thigh and hip. Shortly thereafter appellant 

began to hear a clicking noise in her hip as she walked, and it felt as though her hip and pelvis 

bones were rubbing against each other. Her groin was also very sore. Appellant alleged that her 

upper back began to spasm due to her limp. She also asserted that she had to ice her lower back.

Appellant submitted additional evidence in support of her claim. On August 8, 2017

Dr. Cynthia A. Schafer, a Board-certified family practitioner, recounted appellant’s injury while 

running at work and diagnosed left hip sprain. She noted that she had a history of a left hip labral 

tear approximately one year earlier. Dr. Schafer listed appellant’s symptoms as arthralgias, back 

pain, gait problem, myalgias, neck pain, and neck stiffness. On physical examination, she had 

decreased range of motion (ROM) in her left hip, as well as decreased strength, and tenderness. 

Appellant further exhibited tenderness in her cervical, thoracic, lumbar back and was found to 

have a very antalgic gait. Dr. Schafer reviewed hip x-rays which were unremarkable.

On August 28, 2017 OWCP accepted the claim for left hip sprain.

OWCP subsequently received additional evidence, including an August 1, 2017

authorization for examination and/or treatment (Form CA-16).

A September 11, 2017 magnetic resonance imaging (MRI) scan demonstrated a contusion 

of the anterior greater trochanter at the insertion site of the gluteus minimus muscle, mild 

insertional tendinopathy changes of the gluteus minimus at the greater trochanter, and L5-S1 disc 

degenerative changes.
3

In September 11 and 25, 2017 notes, Dr. Schafer found tenderness in appellant’s 

paraspinous and glutes in the lumbar back, but no bony tenderness, swelling or spasm. On 

September 25, 2017 she also diagnosed sacroiliitis in addition to left hip sprain. Dr. Schafer 

explained that appellant’s method of injury was running when her left foot caught in mud, and she 

twisted her hip. She opined that there was 50 percent probability for causation.

In an October 10, 2017 note, Dr. Schafer found that appellant exhibited decreased ROM in 

the left hip and lumbar spine. She noted that appellant did not exhibit swelling or spasm.

Dr. Schafer described the method of injury as appellant running when her left foot caught in mud,

and she twisted her hip. She again opined that there was 50 percent probability for causation.

In an October 25, 2017 note, Dr. James P. Duffey, a Board-certified orthopedic surgeon, 

listed appellant’s symptoms of low back pain radiating to both legs, left hip sprain, and sacroiliitis. 

He opined that her symptoms and physical findings were much more consistent with lumbar spine 

pathology than with intra-articular hip pathology. Dr. Duffey found that appellant’s MRI scan

suggested the presence of significant L5-S1 disc pathology. He recommended a lumbar MRIscan.

On November 7, 2017 appellant underwent a lumbar MRI scan, which demonstrated an 

annular bulge with a tear at L4-5 and L5-S1 broad-based protrusion with annular tear. Dr. Schafer

examined her on November 9, 2017 and recommended an electromyogram (EMG). A 

December 13, 2017 EMG and nerve conduction velocity (NCV) study demonstrated mild irritation 

in the left low lumbar paraspinals. There was no specific myotomal acute or chronic irritation.

The results noted that these findings could be supportive of left lumbar radiculopathy or lumbar 

spinal stenosis.

In a December 13, 2017 note, Dr. Gregory Ales, an osteopath, diagnosed left lumbar 

radiculitis and left leg numbness and pain.

On December 14, 2017 Dr. Roger Sung, a Board-certified orthopedic surgeon, examined 

appellant due to back and bilateral leg pain. He described her history of injury on July 31, 2017. 

Dr. Sung found tenderness in the lower back and buttocks as well as pain with ROM and loss of 

ROM. He reviewed appellant’s MRI scan and reported low back pain, intervertebral disc disorders 

with lumbar radiculopathy, and lumbar disc degeneration. Dr. Sung noted that appellant sustained 

a work-related twisting injury on July 31, 2017 and diagnosed L4-5, L5-S1 annular tear with disc 

bulging, and back and bilateral leg pain.

On December 15, 2017 Dr. Schafer diagnosed left lumbar radiculitis, left hip sprain, and 

sacroiliac sprain. She reviewed appellant’s lumbar MRI scan and noted an L4-5 bulge with an 

annular tear and an L5-S1 broad-based disc protrusion with annular tear and moderate left 

foraminal narrowing. Dr. Schafer described the method of injury as running when her left foot 

became caught in mud, and she twisted her hip. She opined that there was 50 percent probability 

for causation.

In the January 18, 2018 notes, Dr. Michael Sparr, a Board-certified physiatrist, noted 

appellant’s history of a work injury on July 31, 2017. He diagnosed a substantial L5-S1 disc 

herniation and left L5 radiculopathy. Dr. Sparr found weakness as well as numbness and tingling 
4

in the L5 dermatome, mild bilateral sacroiliitis, and moderate bilateral trochanteric bursitis. He 

prescribed a lumbar epidural steroid injection (ESI).

On January 25, 2018 Dr. Schafer diagnosed left lumbar radiculitis, left hip sprain, 

sacroiliac sprain and left L5-S1 herniated disc with annular tear. She recounted the history of 

injury and reiterated her opinion.

Appellant underwent ESI on February 16, 2018. Dr. Schafer examined her on February 20, 

2018 and noted that she experienced little improvement from the ESI. She repeated her previous 

diagnoses and conclusions. Appellant underwent a second ESI on March 23, 2018.

On April 5, 2018 appellant underwent additional EMG/NCV studies, which were normal 

and demonstrated no evidence of lumbosacral radiculopathy, sciatic, or generalized peripheral 

neuropathy.

Dr. Sparr examined appellant on April 5 and 16, 2018 and reviewed her EMG/NCV 

studies. He found that these studies and her reaction to ESI argued against significant 

radiculopathy. Dr. Sparr noted that the diffuse nature of appellant’s pain was not easily explained. 

She underwent a third ESI on May 4, 2018.

On May 17, 2018 Dr. Sparr noted that appellant underwent bilateral trochanteric bursa 

injections, which she found extremely beneficial. He diagnosed lumbago. Dr. Sparr found that 

she had ongoing diffuse lumbosacral and lower extremity pain with minimal objective findings. 

He determined that there was no evidence of radiculopathy based on electrodiagnostic studies and 

ESI. Dr. Sparr opined that appellant may have sacroiliitis and advised that she was nearing 

maximum medical improvement.

In May 15, June 12, and 26, 2018 notes, Dr. Schafer diagnosed sacroiliac sprain, left 

lumbar radiculitis, and intervertebral disc disorder with radiculopathy of the lumbosacral region. 

Appellant reported that she had to wear a 25-pound duty belt at work and suggested that this belt 

could be part of the prolongation of her symptoms. Dr. Schafer noted on June 12 and 26, 2018 

that she suspected that the 25-pound duty belt was contributing to the persistence of her symptoms. 

On June 26, 2018 she noted that appellant was experiencing treatment delays as her lumbar 

conditions were the issue, not a hip sprain as originally believed and coded.

On June 1, 2018 appellant sought treatment from Dr. Nicholas Kurz, an osteopath. 

Dr. Kurz diagnosed left hip and lumbar muscle strain with exacerbation of preexisting 

degenerative disc disease. He opined that appellant could return to full-duty work.

In a letter dated July 11, 2018, appellant requested that OWCP expand acceptance of her 

claim to include additional conditions of left lumbar radiculitis, sacroiliac sprain, intervertebral 

disc disorder with lumbar radiculopathy, and degeneration of lumbar disc. She again described 

her July 31, 2017 employment incident and reviewed her medical history. Appellant asserted that 

Drs. Schafer and Duffy had opined that the initial diagnosis of hip sprain was premature and not 

complete.

Dr. Schafer completed a note on July 10, 2018 and opined that the November 7, 2017 MRI 

scan demonstrated disc herniations and that this scan confirmed that appellant’s symptoms 
5

originated in her back rather than her hip. She requested that OWCP expand the acceptance of her 

claim to include lumbar sprain with herniated disc causally related to the July 31, 2017 

employment injury.

In July 10 and August 14, 2018 treatment notes, Dr. Schafer diagnosed sacroiliac sprain, 

subsequent encounter, degeneration of lumbosacral intervertebral disc, and left lumbar radiculitis. 

She noted that appellant did not have any leg radiation until October 10, 2017. Dr. Schafer opined 

that her radiculitis was not related to the original injury, but began three months later.

On February 15, 2019 the employing establishment informed OWCP that appellant had 

undergone back surgery.

On February 25, 2019 OWCP referred appellant, a statement of accepted facts (SOAF), 

and a series of questions to Dr. John Douthit, an osteopath and Board-certified family practitioner, 

for a second opinion evaluation.

In his March 20, 2019 report, Dr. Douthit described appellant’s July 31, 2017 employment 

incident of running, catching her foot and twisting. He reviewed appellant’s medical history and 

found that Dr. Sung had performed a lumbosacral fusion from L4 through S1 on October 9, 2018.

3

 

Dr. Douthit reviewed treatment notes dated August 8, 23, and September 27, 2018 from Dr. Sung,

which reported bilateral leg pain and diagnosed degenerative disc disease L4-5 and L5-S1 with 

retrolisthesis and chronic pain with extremity radiculopathy. He examined appellant’s MRI scan 

and found bulging discs at L4-5 and L5-S1, but no herniation or nerve root compression. 

Dr. Douthit noted that she reported foot drop and severe weakness of the leg, but that these 

symptoms were not included in the medical record. In response to OWCP’s questions, Dr. Douthit 

reported that it was unclear what was appellant’s actual injury and the source of her pain. He 

found that the medical evidence did not support Dr. Sung’s diagnoses of degenerative disease of 

the lumbar spine. Dr. Douthit opined that appellant’s spine surgery was not causally related to the 

July 31, 2017 employment injury and advised that she could return to work without restrictions.

In an April 17, 2019 development letter, OWCP requested that appellant submit additional 

medical evidence supporting that the alleged back conditions were causally related to her July 31, 

2017 employment injury. It afforded her 30 days to respond.

Appellant’s representative responded on May 15, 2019 and asserted that the SOAF was 

vague. He specifically objected to the statements that while running she slightly slipped and 

tweaked her groin and hip. Appellant’s representative further asserted that there was an unresolved 

conflict of medical opinion between Drs. Sung and Douthit regarding whether appellant’s 

diagnosed back conditions were related to the July 31, 2017 employment incident.

By decision dated June 5, 2019, OWCP denied appellant’s request to expand the 

acceptance of her claim to include diagnosed back conditions. It noted that she had not submitted 

medical evidence in support of her additional claimed conditions.

3 The Board notes that Dr.Douthit referenced reports from Dr.Sung that are not present in the record before the 

Board.
6

On July 1, 2019 appellant, through her representative, requested a review of the written 

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

Dr. Schafer’s May 15, 2018 treatment note. Appellant’s representative also provided a July 8, 

2019 brief in which he again alleged that the SOAF was vague and that there was a conflict of 

medical opinion between Drs. Sung and Douthit.

By decision dated September 24, 2019, OWCP’s hearing representative affirmed OWCP’s 

June 5, 2019 decision, noting that Dr. Douthit’s opinion was entitled to the weight of the medical 

opinion evidence.

LEGAL PRECEDENT

When 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 ca usally 

related to the employment injury.4

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.5 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and an accepted injury must be based on a complete f actual and 

medical background.6 Additionally, the physician’s opinion must be expressed in terms of a 

reasonable degree of medical certainty and must be supported by medical rationale, which, 

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

employment injury.7

ANALYSIS

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of her claim to include additional conditions as causally related to the accepted July 31, 2017 

employment injury.

In his March 20, 2019 report, Dr. Douthit described her July 31, 2017 employment incident 

of running, catching her foot and twisting. He reviewed her medical history and noted that while 

she was alleging foot drop and severe weakness of the leg, these symptoms were not previously 

included in the medical record. Further, Dr. Douthit did not find medical evidence to support

Dr. Sung’s diagnoses of degenerative disease of the lumbar spine noting that a review of her MRI 

scan demonstrated only bulging discs at L4-5 and L5-S1. He opined that appellant’s spine surgery 

was not causally related to the July 31, 2017 employment injury and that she could return to work 

with no restrictions. The Board finds that Dr. Douthit’s report has reliability, probative value, and 

convincing quality with respect to its conclusions regarding appellant’s claim for additional back 

4 A.A.,Docket No. 19-1165 (issued December 16, 2019); M.B., Docket No. 19-0485 (issued August22, 2019); R.J.,

Docket No. 17-1365 (issued May 8, 2019); JajaK. Asaramo, 55 ECAB 200 (2004).

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

6 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

7

Id.
7

conditions related to her July 31, 2017 employment injury. Dr. Douthit provided a thorough 

factual and medical history and accurately summarized the relevant medical evidence with medical 

rationale for his opinion that appellant had no objective findings of an employment-related back 

condition. As Dr. Douthit’s report is sufficiently rationalized and based on an accurate factual 

history, his opinion constitutes the weight of the medical evidence. 8

Appellant submitted July 10 and August 14, 2018 treatment notes, wherein Dr. Schafer 

diagnosed sacroiliac sprain, subsequent encounter, degeneration of lumbosacral intervertebral 

disc, and left lumbar radiculitis. She noted that appellant did not have any leg radiation until 

October 10, 2017. Dr. Schafer opined that her radiculitis was not related to the original injury, but 

began three months later. These notes negate causal relationship between appellant’s back 

conditions and her accepted employment injury. The Board has held that medical evidence that 

negates causal relationship is of no probative value.9 As such, this evidence is insufficient to 

establish expansion of the claim

On May 17, 2018 Dr. Sparr diagnosed lumbago. He found that appellant had ongoing 

diffuse lumbosacral and lower extremity pain with minimal objective findings. Dr. Sparr

determined that there was no evidence of radiculopathy based on electrodiagnostic studies and 

ESI. He also noted that appellant may have sacroiliitis. However, Dr. Sparr did not provide an 

opinion regarding his most recent diagnoses and appellant’s July 31, 2017 employment injury. 

The Board has held that a medical report is of no probative value on the issue causal relationship 

if it does not offer an opinion as to whether the accepted employment incident caused or aggravated 

the claimed condition.10 As such, this report is insufficient to establish expansion of the claim. 

Similarly, on December 14, 2017 Dr. Sung recounted that appellant sustained a workrelated twisting injury on July 31, 2017 and diagnosed L4-5, L5-S1 annular tear with disc bulging, 

and back and bilateral leg pain. However, he merely repeated the history of injury as reported by 

appellant without providing his own opinion regarding whether his diagnosed conditions were 

work related. As noted, the Board has held that a medical report lacking an opinion on causal 

relationship is of no probative value.

11

 As such, this report is also insufficient to establish the 

claim.

As the medical evidence of record is insufficient to establish that the diagnosed back 

conditions are causally related to the accepted July 31, 2017 employment injury, the Board finds 

that appellant has not met her burden of proof to establish expansion of the claim.

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.

8

S.B., Docket No. 20-0643 (issued January 27, 2021); R.J., Docket No. 17-1365 (issued May 8, 2019).

9 T.W.,Docket No. 19-0677 (issued August16, 2019). 

10 E.T., Docket No. 19-0948 (issued July 27, 2020); A.R.,Docket No. 19-1560 (issued March 2, 2020).

11 Id.
8

CONCLUSION

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of the claim to include additional conditions as causally related to her accepted July 31, 2017 

employment injury.

ORDER

IT IS HEREBY ORDERED THAT the September 24, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 12, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board