United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.T., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

U.S. CITIZENSHIP & IMMIGRATION 

SERVICES, Washington, DC, Employer

__________________________________________

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Docket No. 21-0906

Issued: September 2, 2022

Appearances: Case Submitted on the Record

Michael D. Overman, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On May 26, 2021 appellant, through counsel, filed a timely appeal of a December 3, 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.3

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.

3 The Board notes that, following the issuance of the December 3, 2020 decision, OWCP received additional 

evidence. However, the Board’s Rules of Procedureprovides: “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

ISSUES

The issues are: (1) whether appellant has met her burden of proof to expand the acceptance 

of her claim to include additional medical conditions causally related to the accepted October 24, 

2019 employment injury; and (2) whether appellant has met her burden of proof to establish 

disability from work for the period commencing January 6, 2020 causally related to her accepted 

employment injury.

FACTUAL HISTORY

On October 29, 2019 appellant, then a 49-year-old supervisory economist, filed a traumatic 

injury claim (Form CA-1) alleging that on October 24, 2019 she experienced abdominal pain as 

she lifted and moved 20 case file bundles while in the performance of duty. She noted that she 

had undergone an umbilical hernia repair on September 18, 2019 and had been following her 

physician’s order not to lift more than 20 pounds at the time of injury.

OWCP subsequently received medical evidence. An October 29, 2019 work note from

Dr. Alan Ansher, Board-certified in gastroenterology and internal medicine, indicated a history of 

appellant’s September 18, 2019 open umbilical hernia repair and her current complaint of 

abdominal muscle strain. He noted that she had no recurrent hernia. 

In medical reports dated October 30, 2019, Dr. Irene Odigie, Board-certified in emergency 

medicine, noted a history of appellant’s injury on October 24, 2019. She diagnosed strain of 

muscle, fascia, and tendon of the abdomen, initial encounter. Dr. Odigie provided appellant’s 

light-duty restrictions commencing October 30, 2019 and indicated that her anticipated full-duty 

release date was November 4, 2019.

Dr. Nino Gelenidze, a Board-certified family practitioner, in a November 4, 2019 report,

noted a history of the October 24, 2019 incident. He diagnosed strain of muscle, fascia, and tendon 

of the abdomen, subsequent encounter. Dr. Gelenidze provided appellant’s light-duty restrictions 

commencing November 5, 2019 and indicated that her anticipated full-duty release date was 

November 11, 2019.

In a November 15, 2019 diagnostic addendum, Catherine Cameron, a physician assistant, 

related lumbar spine x-ray findings. 

A November 21, 2019 lumbar spine magnetic resonance imaging (MRI) scan interpreted 

by Dr. Oluwatoyin T. Idowu, a Board-certified diagnostic radiologist and neuroradiologist, was

normal.

In a November 25, 2019 thoracic spine MRI scan report, Dr. Brian Choi, a Board-certified 

diagnostic radiologist and neuroradiologist, provided impressions of normal cord signal and no 

significant disc bulge or protrusion, and was otherwise unremarkable.

OWCP, in a November 21, 2019 development letter, informed appellant of the factual and 

medical evidence necessary to establish her claim and provided a questionnaire for her completion. 

OWCP afforded appellant 30 days to submit the necessary evidence.
3

In response to OWCP’s development letter, Dr. Ehsan Jazini, an attending orthopedic 

surgeon, submitted a letter and report dated November 26, 2019. He noted a history of the claimed 

October 24, 2019 incident and provided findings on physical examination and diagnostic test 

results. Dr. Jazini diagnosed lumbar intervertebral disc disorders (annular tears), sacroiliitis, not 

elsewhere classified, greater trochanteric bursitis of the left hip, myalgia, unspecified site, and left 

groin and abdominal pain. He noted appellant’s previous medical treatment and advised that she 

could work with restrictions, four hours per day, five days per week. In the November 26, 2019 

letter, Dr. Jazini opined that repetitive lifting of multiple files over several hours directly led to her

lumbar symptoms, which included pain in the low back, lower extremity, left groin, thoracic spine, 

and abdomen. He advised that appellant’s symptoms were consistent with pain/sacroiliac

dysfunction and sacroiliitis, left greater trochanteric bursitis, lumbar paraspinal musculature, and 

lumbar discs. Dr. Jazini noted that there may be some involvement of the intraarticular structures 

of the left hip and recommended further imaging to address this condition.

In a report of even date, Tracey Perkins, a physician assistant, provided assessments of 

other intervertebral disc disorders, lumbar region, sacroiliitis, not elsewhere classified, greater 

trochanteric bursitis of the left hip, myalgia, unspecified site, abdominal pain, unspecified 

abdominal location, and left groin pain.

Dr. Thomas T. Nguyen, an anesthesiologist, in a December 3, 2019 report, provided 

assessments of sacroiliitis and other bursitis, not elsewhere classified, low back pain, and 

segmental and somatic dysfunction of sacral region. He performed injections in the left SI joint 

and left greater trochanter bursa.

OWCP, by decision dated December 19, 2019, accepted appellant’s claim for strain of 

muscle, fascia, and tendon of the abdomen. However, it denied expansion of the acceptance of the 

claim, finding that the medical evidence of record was insufficient to establish that her diagnosed 

conditions of other specified dorsopathies, radiculopathy, myalgia, and other intervertebral disc 

disorders of the lumbar region were causally related to the accepted October 24, 2019 employment 

injury.

OWCP subsequently received additional reports dated December 10, 2019 from

Dr. Nguyen who continued to provide examination findings. Dr. Nguyen provided assessments of 

other spondylosis and other specified dorsopathies of the lumbar region. He advised that appellant 

sustained a work-related injury. Dr. Nguyen performed injections in the lumbar/sacral levels.

In reports dated November 15, 2019 through January 14, 2020, Dr. Jazini reiterated his 

prior diagnosis of abdominal and left groin pain, greater trochanteric bursitis of the left hip, other 

intervertebral disc disorders of the lumbar region, and myalgia. He further diagnosed other 

specified dorsopathies, radiculopathy, and other spondylosis of the lumbar region, myalgia, 

unspecified site, and left groin pain.

In a January 6, 2020 letter, Vincenta Tran, a physician assistant, noted that appellant could 

work with temporary restrictions three to four hours per day, five days per weeks, due to her current 

symptomatology.

Dr. Sommer Gbdlahad, a neurologist and pain management specialist, reported that an 

electromyogram/nerve conduction velocity study performed on January 8, 2020 was normal. He 

noted that there was no electrodiagnostic evidence of a lumbosacral radiculopathy, lumbosacral
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plexopathy, focal neuropathy, diffuse polyneuropathy, or myopathy affecting the lower 

extremities. In a report of even date, Dr. Gbdlahad provided an assessment of spondylosis, lumbar 

region.

In a January 15, 2019 letter, Ms. Cameron indicated that appellant could work with 

temporary restrictions, three to four hours per day, five days per week, due to her current 

symptomatology.

In a November 7, 2019 report, Tara C. Villano, a physician assistant, diagnosed the 

accepted conditions of strain of muscle, fascia, and tendon of abdomen, subsequent encounter. 

She also diagnosed unspecified abdominal pain.

On January 17, 2020 appellant filed a claim for compensation (Form CA-7) for disability 

from work for the period January 6 through 17, 2020. In a time analysis form (Form CA-7a), she 

claimed one hour of leave without pay (LWOP) on January 6, 9, 13, and 15, 2020 and two hours 

of LWOP on January 8, 2020 due to a physician visit under the Family and Medical Leave Act 

(FMLA), totaling six hours.

Appellant also submitted a January 14, 2020 letter from Dr. Jazini who noted that, in 

addition to the accepted condition of strain of muscle, fascia, and tendon of the abdomen, she had

other specified dorsopathies, radiculopathy, and other intervertebral disc disorders of the lumbar 

region, myalgia, sacroiliitis, not elsewhere classified, left groin pain, and greater trochanteric 

bursitis of the left hip. Dr. Jazini related that the diagnosed conditions were based on her history 

and physical examination findings. He further related that the objective findings included 

tenderness over the lumbar facet joints, sacroiliac joint, paraspinal musculature, and left greater 

trochanter, limited lumbar range of motion with pain in extension (facet loading), and weakness 

of the left gastric with repetitive calf raise motor testing. Dr. Jazini maintained that these clinical 

findings supported the diagnosed conditions despite normal-appearing anatomy on lumbar x-ray 

and MRI scan test results. He recommended further testing, including lumbar discography 

arthrograms, or other testing to obtain further information. Additionally, Dr. Jazini maintained 

that improvement of appellant’s symptoms with steroid lidocaine injections at the left L4-5 and

L5-S1 facet joints and separately at the left S1 joint and left greater trochanter were also objective 

findings to support these areas as generators of pain and inflammation. He requested that OWCP 

expand the acceptance of her claim to include the above-noted diagnoses. Dr. Jazini indicated that 

appellant was unable to perform full-duty work. He placed her on limited-duty status with a work 

schedule that included one day in the office and four days of telework due to her ongoing pain and 

dysfunction related to her lumbar conditions. Dr. Jazini maintained that appellant’s conditions 

were separate from her abdominal symptoms that may be associated with her previous umbilical 

hernia repair. He further maintained that her abdominal condition would not cause the symptoms 

in her low back and legs. Dr. Jazini related that appellant had no lumbar problems prior to the 

accepted employment injury according to his review of her medical records.

In a November 7, 2019 report, Dr. Gelenidze reiterated his prior diagnosis of the accepted 

condition strain of muscle, fascia, and tendon of the abdomen, subsequent encounter. He also 

diagnosed unspecified abdominal pain. Dr. Gelenidze anticipated appellant’s release to full-duty 

work on November 15, 2019.
5

In a November 13, 2020 report, Dr. Faiqa Mahmud, a Board-certified family practitioner, 

diagnosed the accepted condition strain of muscle, fascia, and tendon of the abdomen, subsequent 

encounter.

In a January 23, 2020 report, Dr. Mingilanti Tjahjana, a Board-certified internist, 

confirmed that appellant had no reported symptom or any abnormal physical finding related to 

abdominal or back/lumbar/spine.

OWCP, by decision dated January 29, 2020, denied the expansion of the acceptance of 

appellant’s claim, finding that the medical evidence of record was insufficient to establish that the 

additional claimed medical conditions of left groin pain, other intervertebral disc disorders,

spondylosis, and radiculopathy, lumbar region, sacroiliitis, not elsewhere; myalgia, greater 

trochanteric bursitis of the left hip, segmental and somatic dysfunction of the sacral region, other 

bursitis of the left hip, not elsewhere classified, and other specified dorsopathies, lumbar region,

were causally related to the accepted employment injury.

In a development letter of even date, OWCP advised appellant that her claim had only been 

accepted for strain of muscle, fascia, and tendon of the abdomen. It further advised her of the 

deficiencies of her wage-loss compensation claim. OWCP also explained that it will only 

reimburse up to four hours for medical appointments and advised her of the type of medical 

evidence necessary to establish her claim. It afforded appellant 30 days to submit the requested 

evidence.

OWCP subsequently received a January 21, 2020 letter from Dr. Jazini who reiterated his 

prior diagnoses and advised that appellant could work six hours per day, one to two days in the 

office and three to four days of telework per week. Dr. Jazini provided her work restrictions.

On January 30, 2020 appellant filed an additional Form CA-7 requesting wage-loss 

compensation for the period January 19 through February 1, 2020. In an accompanying Form 

CA-7a, she noted that she used 18 hours of LWOP during the period January 21 through 31, 2020

due to a physician visit under the FMLA.

In a February 6, 2020 report, Dr. Nguyen reiterated his prior assessments of low back pain

and other specified dorsopathies, lumbar region. He also provided assessments of bilateral 

sacroiliitis. Dr. Nguyen again indicated that appellant sustained a work-related injury.

OWCP, by decision dated March 20, 2020, denied appellant’s claim for disability from 

work during the period January 6 through 17, 2020 and continuing, finding that the medical 

evidence of record was insufficient to establish disability during the claimed period due to the 

accepted employment injury.

On May 22, 2020 OWCP referred appellant, together with the medical record, a statement 

of accepted facts (SOAF), and a set of questions, Dr. D. Burke Haskins, a Board-certified 

orthopedic surgeon,for a second opinion to determine whether the accepted condition had resolved 

or worsened and whether appellant had ongoing disability and any additional conditions caused 

by her accepted employment injury.

In a July 7, 2020 report, Dr. Haskins reviewed the SOAF and medical record. He noted 

the history of appellant’s employment injury and her complaints of pain in her back, left buttock, 
6

and lateral hip area, and similar pain on the right, but not as bad. Dr. Haskins reported normal 

findings on examination of appellant’s gait, pelvis, and shoulders. He found pain in the 

lumbosacral region, sacroiliitis region, bilaterally, and both greater trochanters. Range of motion 

of the lumbar spine was full in flexion and extension with complaints of pain. Assessments of heel 

and toe when walking were normal. Strength was normal in both lower extremities. There was 

decreased sensation using a pinwheel on the lateral aspect of the left leg, posterior left calf, and 

plantar surface and dorsum of the left foot. Manual strength test was normal bilaterally. A Faber’s 

sign and straight leg raising test were negative. A Lasegue’s sign was negative bilaterally. 

Dr. Haskins diagnosed a history of lumbar strain, trochanteric bursitis, and resolved abdominal 

complaints. He noted that appellant’s subjective complaints of numbness and complaints of 

decreased sensation in the left leg were not supported by the clinical studies of a normal lumbar 

spine MRI scan and normal nerve conduction studies. Dr. Haskins further noted that, although 

there was a history of lumbar strain, clinical studies did not support an ongoing condition. The 

lumbar strain was related by direct cause. Dr. Haskins indicated that he was unaware of a 

preexisting back condition. He advised that the diagnosed condition of trochanteric bursitis was 

active and based on history and was work related. Appellant had not reached maximum medical 

improvement regarding this condition. Dr. Haskins opined that she could return to her date-ofinjury position as a supervisory economist on a full-time basis with restrictions due to her 

trochanteric bursitis work injury. He further advised that there was no need for further medical 

treatment. Dr. Haskins found that Dr. Jazini’s diagnoses of other dorsopathies, radiculopathy, and 

other intervertebral disc disorder of the lumbar region were not causally related to the accepted 

employment injury. He explained that there was no evidence of dorsopathy of the lumbar region. 

RegardingDr. Jazini’s diagnosis of left hip trochanteric bursitis, Dr. Haskins again noted that there 

was left hip trochanteric bursitis based on physical examination findings. He also explained that 

there was no evidence of radiculopathy based on a normal lumbar spine MRI scan and 

neurodiagnostic studies. Additionally, there was no supplied evidence of intervertebral disc 

disorder. Based on history, the abdominal muscle strain had resolved. Dr. Haskins noted that the 

umbilical hernia condition was outside his professional expertise. In a July 14, 2020 work capacity 

evaluation (Form OWCP-5c), he reiterated that appellant was unable to perform her usual job 

without restriction due to pain and loss of function and that she could work eight hours per day.

Dr. Haskins noted that the work restrictions would apply for six months.

On August 12, 2020 OWCP requested that Dr. Haskins explain how trochanteric bursitis

was related to the accepted employment-related abdominal injury, why he provided work 

restrictions due to trochanteric bursitis, a condition which had not been accepted as work related,

and how a history of lumbar strain was related by direct cause.

In a response letter dated August 27, 2020, Dr. Haskins explained that his diagnoses of 

trochanteric bursitis and lumbar strain were causally related to the accepted employment injury 

based on examination findings and appellant’s history. He indicated that if OWCP did not accept 

these conditions as work related, then she could return to full-time unrestricted work.

OWCP, by decision dated September 25, 2020, expanded the acceptance of appellant’s 

claim to include trochanteric bursitis of the left hip.

OWCP subsequently received a July 13, 2020 progress note and July 22, 2020 report from

Dr. Steven Papuchis, an osteopath specializing in pain management, provided assessments of 

tendinopathy of right and left gluteus medius, sacroiliac joint dysfunction of the left side, 
7

spondylosis of the lumbar region without myelopathy or radiculopathy, and degenerative labral 

tear of the hip.

On October 15, 2020 appellant, through counsel, requested reconsideration of the 

January 29 and March 20, 2020 decisions.

In a September 27, 2019 work note, Dr. Ansher noted appellant’s 20-pound lifting 

restriction until October 30, 2019.

By decision dated December 3, 2020, OWCP denied modification of the January 29 and 

March 20, 2020 decisions.

LEGAL PRECEDENT -- ISSUE 1

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 

causally 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 a causal relationship 

between the diagnosed condition and the accepted employment injury must be based on a complete 

factual 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, 

explaining the nature of the relationship between the diagnosed condition and appellant’s 

employment injury.7

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

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

shall appoint a third physician (known as a referee physician or impartial medical examiner (IME)) 

who shall make an examination.8 OWCP will select a physician who is qualified in the appropriate 

specialty and who has no prior connection with the case.9

ANALYSIS -- ISSUE 1

The Board finds that this case is not in posture for decision regarding whether appellant 

has met her burden of proof to expand the acceptance of her claim to include additional medical 

conditions causally related to the accepted October 24, 2019 employment injury. 

4 R.J., Docket No. 17-1365 (issued May 8, 2019); Jaja K. Asaramo, 55 ECAB 200, 204 (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.

8

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

9

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

In reports dated November 15, 2019 through January 14, 2020 and a November 26, 2019 

letter, Dr. Jazini diagnosed abdominal and left groin pain, other intervertebral disc disorders of the 

lumbar region, sacroiliitis, not elsewhere classified, myalgia, unspecified site, and other specified 

dorsopathies, radiculopathy, and other spondylosis of the lumbar region. In the November 26, 

2019 letter, he explained that repetitive lifting of multiple files over several hours directly caused 

appellant’s lumbar intervertebral disc disorder, sacroiliitis, myalgia, and left groin and abdominal 

pain. Dr. Jazinimaintained that despite normal-appearing anatomy on lumbar x-ray and MRI scan 

test results, his opinion was supported by her history and objective findings, which included 

tenderness over the lumbar facet joints, sacroiliac joint, paraspinal musculature, and left greater 

trochanter, limited lumbar range of motion with pain in extension (facet loading), and weakness 

of the left gastroc with repetitive calf raise motor testing. 

OWCP referred appellant to Dr. Haskins for a second opinion examination. In an 

October 7, 2020 report, Dr. Haskins found that Dr. Jazini may have diagnosed other dorsopathies, 

radiculopathy, and other intervertebral disc disorder of the lumbar region, but he observed no such 

findings on physical examination or diagnostic testing. He related that appellant had sustained an 

employment-related lumbar sprain, that her lumbar sprain had resolved. Dr. Haskins found that 

the additional conditions Dr. Jazini diagnosed were not employment related. Additionally, He

noted that the accepted abdominal muscle strain had resolved.

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

referral physician, OWCP will appoint an IME who shall make an examination. 10 Dr. Haskins and

Dr. Jazini both diagnosed lumbar conditions, which they related were related to appellant’s 

accepted employment injury. However, they disagreed regarding the exact diagnosis, and whether 

she had continuing findings of a lumbar condition. The Board, therefore, finds that a conflict exists 

between Dr. Jazini and Dr. Haskins regarding expansion of the acceptance of appellant’s claim to 

include additional conditions causally related to the accepted employment injury.

On remand, OWCP shall refer appellant to an IME, pursuant to 5 U.S.C. § 8123(a), to 

determine whether the acceptance of her claim should be expanded to include the additional 

diagnosed conditions.11 Following this and other such further development as deemed necessary, 

OWCP shall issue a de novo decision.12

CONCLUSION

The Board finds that the case is not posture for decision regarding whether appellant has 

met her burden of proof to expand the acceptance of her claim to include additional medical 

conditions causally related to the accepted October 24, 2019 employment injury. 

10 See M.R., Docket No. 21-0219 (issued May25, 2022); S.S., Docket No. 19-1658 (issued November 12, 2020);

C.S., Docket No. 19-0731 (issued August22, 2019).

11 See M.R., id.; L.C., Docket No. 20-0866 (issued February 26, 2021); S.N., Docket No. 19-1050 (issued July 31, 

2020); P.S., Docket No. 17-0802 (issued August18, 2017).

12 In light of the Board’s dispositionregardingIssue 1,Issue2 is rendered moot.
9

ORDER

IT IS HEREBY ORDERED THAT the December 3, 2020 decision of the Office of 

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

consistent with this decision of the Board.

Issued: September 2, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board