United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.B., Appellant

and

SOCIAL SECURITY ADMINISTRATION, 

DISTRICT OFFICE, Brooklyn, NY, Employer

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Docket No. 21-0894

Issued: February 8, 2023

Appearances: Case Submitted on the Record

Paul Kalker, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 3, 2021 appellant, through counsel, filed a timely appeal from a March 30, 2021 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.

ISSUES

The issues are: (1) whether OWCP has met its burden of proof to terminate appellant’s 

wage-loss compensation and medical benefits, effective July 25, 2020, as she no longer had 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq.
2

disability or residuals causally related to her June 26, 2008 employment injury; and (2) whether 

appellant has met her burden of proof to establish continuing disability or residuals on or after 

July 25, 2020 causally related to her accepted June 26, 2008 employment injury.

FACTUAL HISTORY

This case has previously been before the Board on a different issue.3 The facts and 

circumstances as set forth in the Board’s prior decision are incorporated herein by reference. The 

relevant facts are as follows.

On June 30, 2008 appellant, then a 50-year-old claims representative, filed a traumatic 

injury claim (Form CA-1) alleging that, on June 26, 2008, she injured her left knee, right elbow, 

upper back, and neck when she attempted to sit down in her chair which slid backward and caused

her to fall and hit the side of a desk while in the performance of duty. She stopped work on June 27, 

2008 and returned to part-time work at the employing establishment on September 9, 2008. 

OWCP initially accepted appellant’s claim for sprains of the neck; back, lumbar region; right 

shoulder and upper arm; and unspecified sites of the left knee and leg. It later expanded the 

acceptance of the claim to include derangement of the left medial meniscus. By decision dated 

June 17, 2009, OWCP accepted that appellant sustained a recurrence of disability on June 3, 2009 

based on her OWCP-authorized left knee surgery. It paid her wage-loss compensation on the 

periodic rolls commencing June 7, 2009.

4

By decision dated May 6, 2011, OWCP terminated appellant’s wage-loss compensation 

and entitlement to a schedule award, effective May 8, 2011, as she had refused an offer of suitable 

work pursuant to 5 U.S.C. § 8106(c)(2). Appellant appealed to the Board and by decision dated 

January 9, 2012, the Board reversed the May 6, 2011 termination decision, finding that the reports

of Dr. Robert Meyerson, a Board-certified orthopedic surgeon and an impartial medical specialist, 

were insufficient to establish that appellant’s accepted employment conditions no longer caused 

disability.5

OWCP received an October 8, 2019 medical report and doctor’s progress report from

Dr. Stephen Horowitz, an attending Board-certified physiatrist and pain medicine physician. 

Dr. Horowitz noted appellant’s history on June 26, 2008 and her current complaint of low back 

pain. He discussed examination findings and diagnosed lumbar radiculopathy, lumbar spondylosis 

without myelopathy or radiculopathy, and lumbar myositis, unspecified site. Dr. Horowitz opined 

3 Docket No. 11-1384 (issued January 9, 2012).

4 By decision dated May 6, 2011, OWCP terminated appellant’s wage-loss compensation and entitlement to a 

schedule award, effective May 8, 2011, as she had refused an offer of suitable work pursuant to 5 U.S.C. § 8106(c)(2). 

Appellant appealed to the Board and by decision dated January 9, 2012, the Board reversed the May 6, 2011 

termination decision, finding that the reports of Dr. Robert Meyerson, a Board-certified orthopedic surgeon and an 

impartial medical specialist, were insufficient to establish that appellant’s accepted employment conditions no longer 

caused disability. Id.

5

Id.
3

that the diagnosed conditions were caused by the June 26, 2008 employment injury. He further 

opined that appellant was unable to return to work due to pain.

On December 23, 2019 OWCP referred appellant, together with a statement of accepted 

facts (SOAF), the medical record, and a series of questions, to Dr. Leon Sultan, a Board-certified 

orthopedic surgeon, for a second-opinion evaluation regarding the status of her June 26, 2008 

employment injury. 

In a February 12, 2020 medical report, Dr. Sultan noted his review of the SOAF and the 

medical record. He described the June 26, 2008 employment injury and noted appellant’s current 

complaints of intermittent low back pain that traveled down to her right calf. Examination of the 

cervical spine revealed a head that was normally centered on level shoulders. The cervical 

curvature was well preserved. There was no active paracervical muscle spasm and no trigger 

points on palpation over the right and left trapezius musculature. Dr. Sultan provided normal range 

of motion (ROM) measurements for the cervical spine. Sensory testing of both upper extremities 

was intact. Grip strength was strong on both sides and pinch mechanism was firm bilaterally. 

Biceps and triceps reflexes and radial reflexes were symmetrically dull. An axial compression test 

was negative. 

Examination of appellant’s right shoulder, by Dr. Sultan, revealed no evidence of any 

localized swelling, deformity, or discoloration. There were no complaints on palpation over the 

acromioclavicular joint or long head of the biceps tendon. Dr. Sultan detected no deltoid muscle

atrophy when compared to the opposite side. He reported normal ROM measurements for the 

right and left shoulders. Impingement, drop arm, and Hawkins’ test results were negative.

Upon examination of appellant’s thoracolumbar spine, Dr. Sultan noted that it was 

normally aligned. The pelvis was not tilted and lordotic curvature was maintained. There was no 

active parathoracic or paralumbar muscle spasm. Sacroiliac joints were nontender to palpation. 

Heel and toe standing was unimpaired and a Trendelenburg test was negative on both sides. ROM 

measurements were normal. In the supine position, a straight leg raising test was negative

bilaterally. Sensory testing of both lower extremities was intact. Big toe extension was strong

bilaterally. A Patrick test was negative bilaterally. Knee jerk and ankle reflexes were 

symmetrically dull. Plantar reflexes were down going. 

Examination of appellant’s left knee revealed no localized swelling, deformity, or 

discoloration. The left knee anterior arthroscopic puncture scars were barely visible. The left knee 

patella was mobile. Stress testing of the right knee revealed intact collateral and cruciate 

ligaments. A patellofemoral compression test was negative and there was no abnormal

patellofemoral crepitus during motion testing. The ROM measurement for the left knee extension 

was normal and flexion was normal with limitations secondary to appellant’s size. There were 

equal ROM findings on the right side. Spring and McMurray tests were negative. Appellant had

no complaints on palpation over the medial or lateral joint line. The left knee measured 17 inches 

in circumference with equal findings noted on the right side. The left distal thigh measured 21

inches in circumference with equal findings noted on the right side. Dr. Sultan observed 

ambulating without external support and a steady walking pattern without any visible signs of 

antalgia.
4

Dr. Sultan opined that appellant no longer suffered from any of her accepted employment 

conditions or disability due to these conditions based on his examination findings. He advised that 

the accepted conditions had healed sufficiently such that she could resume full-time full-duty 

work. Dr. Sultan noted that appellant had a thoracolumbar spine sprain/strain that had resolved. 

He related that this condition should be accepted as causally related to her June 26, 2008 

employment injury. Dr. Sultan noted that the medical record and his examination findings did not 

support that appellant had a preexisting condition. There was no clinical evidence that she suffered 

an aggravation, precipitation, or acceleration of a preexisting condition. Dr. Sultan maintained 

that appellant’s prognosis was favorable and opined that no further medical treatment was needed. 

He concluded that she had reached maximum medical improvement.

In an April 1, 2020 letter, OWCP noted Dr. Horowitz’ diagnoses of lumbar radiculopathy, 

lumbar spondylosis, and myositis and requested that Dr. Sultan explain whether his examination 

findings supported these diagnoses and the expansion of the acceptance of appellant’s claim. 

In response, Dr. Sultan submitted an addendum report dated May 22, 2020 in which he 

opined that the acceptance of appellant’s claim should be expanded to include the diagnoses of 

lumbar radiculopathy, lumbar spondylolysis, and myositis. He noted that these diagnosed 

conditions may have been temporarily aggravated by the June 26, 2008 employment injury.

Dr. Sultan noted, however, that these conditions were in remission and no longer active. He 

reiterated his prior opinion that appellant was no longer disabled or required further medical 

treatment due to her accepted employment injury.

On June 2, 2020 OWCP again expanded acceptance of appellant’s claim to include 

temporary aggravation of lumbar radiculopathy and temporary aggravation of lumbar spondylosis 

with myelopathy and myositis.

By notice dated June 10, 2020, OWCP advised appellant that it proposed to terminate her 

wage-loss compensation and medical benefits based on Dr. Sultan’s opinion that the accepted 

conditions had ceased without residuals or disability. It afforded her 30 days to submit additional 

evidence or argument challenging the proposed termination.

In a June 15, 2020 response to OWCP’s notice, appellant, through counsel, disagreed with 

the proposed termination.

OWCP subsequently received a June 16, 2020 report by Dr. Katherine Migliore, an 

orthopedic surgeon. Dr. Migliore noted a history of the June 26, 2008 employment injury and 

appellant’s current complaint of low back pain. She provided examination findings and diagnosed 

lumbar radiculopathy, lumbar spondylosis with myelopathy, and myositis.

By decision dated July 24, 2020, OWCP finalized the proposed notice of termination of

appellant’s wage-loss compensation and medical benefits, effective July 25, 2020, finding that the 

medical evidence submitted was insufficient to outweigh Dr. Sultan’s second opinion.

OWCP, thereafter, received an August 12, 2020 left knee x-ray report by Dr. Michael 

Green, a Board-certified diagnostic radiologist. Dr. Green provided an impression of mild 

osteoarthritis that was most prominent within the medial and patellofemoral compartments.
5

OWCP also received additional reports by Dr. Horowitz. In a September 4, 2020 report,

Dr. Horowitz reiterated appellant’s history of injury and her complaint of low back pain. He 

reported examination findings and reiterated his prior diagnoses of the accepted lumbar conditions. 

Dr. Horowitz advised that appellant’s injuries, current disability, and need for treatment were 

causally related to her June 2008 employment injury.

In a November 20, 2020 procedure note, Dr. Horowitz indicated that appellant underwent 

epidural steroid and trigger point injections to treat her accepted diagnosis of lumbar radiculopathy

and additional diagnosis of myofascial pain. 

On January 4, 2021 appellant, through counsel, requested reconsideration of the July 24, 

2020 termination decision and submitted an additional report dated August 11, 2020 from

Dr. Horowitz. Dr. Horowitz restated a history of appellant’s injury and his own treatment of 

appellant. He noted a review of medical records, including Dr. Sultan’s reports. Dr. Horowitz 

discussed examination findings and provided assessments of lumbago, lumbar disc bulge at L4-5, 

and lumbar disc herniation at L3-4, and L5-S1. He disagreed with Dr. Sultan’s normal physical 

examination findings. Dr. Horowitz indicated that his examination revealed positive findings, 

including a positive facet loading and positive straight leg raising along with decreased and 

restricted ROM, which indicated real, organic anatomical dysfunction. He maintained that these 

findings were consistent with lumbar spine MRI scan findings. Dr. Horowitz opined that the 

June 26, 2008 employment injury was responsible for appellant’s lumbar pain. He explained that 

the stress that occurred to her spinal column at the time of the fall resulted in the vertebrae to shift 

out of normal alignment causing multilevel disc bulge in her lumbar spine. The physical trauma 

appellant suffered during the accident caused the disc to rupture and impinge on the spinal nerve 

causing her current radicular pain. Dr. Horowitz noted her treatment plan. He advised that 

appellant was permanently partially disabled due to her continued lumbar pain and significant loss 

of ROM. Dr. Horowitz restated his prior opinion that her injuries, disability, and need for further 

treatment were causally related to June 26, 2008 employment injury. 

OWCP, by decision dated March 30, 2021, denied modification of its July 24, 2020 

termination decision.

LEGAL PRECEDENT -- ISSUE 1

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

termination or modification of an employee’s benefits.6 After it has determined that an employee 

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

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

6 See 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).
6

the employment.7 Its burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background.8

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

entitlement for disability.9 To terminate authorization for medical treatment, OWCP must 

establish that appellant no longer has residuals of an employment-related condition, which would 

require further medical treatment.10

ANALYSIS -- ISSUE 1

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

compensation and medical benefits, effective July 25, 2020, as she no longer had disability or 

residuals causally related to her June 26, 2008 employment injury.

OWCP referred appellant to Dr. Sultan for a second-opinion evaluation to determine the 

status of her accepted conditions and work capacity. In his February 12 and May 22, 2020 reports,

Dr. Sultan indicated that appellant’s physical examination revealed no objective findings of the 

accepted conditions. He opined that the accepted work-related conditions had resolved, that 

appellant could return to full-time full-duty work, and that there was no need for further medical 

treatment.

The Board finds that OWCP properly accorded the weight of the medical evidence to

Dr. Sultan. Dr. Sultan based his opinion on a proper factual and medical history and physical 

examination findings and provided medical rationale for his opinion. He provided a wellrationalized opinion based on medical evidence regarding the accepted conditions causally related 

to appellant’s June 26, 2008 employment injury. Accordingly, OWCP properly relied on

Dr. Sultan’s second-opinion report in terminating her wage-loss compensation and medical 

benefits.11

The remaining evidence submitted prior to OWCP’s termination of appellant’s 

compensation is insufficient to overcome the weight afforded to Dr. Sultan as the second-opinion 

physician. 

Appellant submitted an October 8, 2019 doctor’s progress report from Dr. Horowitz

describing the accepted June 26, 2008 employment injury and providing examination findings. 

7 See R.P., id.; Jason C. Armstrong, 40 ECAB 907 (1989); Charles E. Minnis, 40 ECAB 708 (1989); Vivien L. 

Minor, 37 ECAB 541 (1986).

8 K.W., Docket No. 19-1224 (issued November 15, 2019); see M.C., Docket No. 18-1374 (issued April 23, 2019); 

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

9

J.W., Docket No. 19-1014 (issued October 24, 2019); L.W., Docket No. 18-1372 (issued February 27, 2019).

10 L.S., Docket No. 19-0959 (issued September 24, 2019); R.P., Docket No. 18-0900 (issued February 5, 2019).

11 See E.S., Docket No. 20-0673 (issued January 11, 2021); K.W., supra note 8; N.G., Docket No. 18-1340 (issued 

March 6, 2019); A.F., Docket No. 16-0393 (issued June 24, 2016).
7

Dr. Horowitz diagnosed the accepted conditions of lumbar radiculopathy, lumbar spondylosis 

without myelopathy or radiculopathy, and lumbar myositis. Additionally, he opined that appellant 

was unable to return to work due to pain. However, Dr. Horowitz failed to offer an opinion 

addressing why appellant continued to have residuals or disability for work due to the accepted 

conditions from the June 26, 2008 employment injury. The Board finds that his conclusory 

opinion was insufficient to establish that appellant continued to have disability and/or residuals 

causally related to her accepted employment injury.12

Similarly, Dr. Migliore’s June 16, 2020 report, in which she described the June 26, 2008 

employment injury, provided examination findings, and diagnosed the accepted conditions of 

lumbar radiculopathy, lumbar spondylosis with myelopathy, and lumbar myositis, did not offer an 

opinion addressing why appellant continued to have residuals or disability causally related to the 

June 26, 2008 employment injury. Thus, her report is insufficient overcome the weight afforded 

to Dr. Sultan’s opinion.13

The Board finds, therefore, that OWCP properly terminated appellant’s wage-loss 

compensation and medical benefits, effective July 25, 2020.

LEGAL PRECEDENT -- ISSUE 2

Once OWCP properly terminates a claimant’s compensation benefits, the burden shifts to 

appellant to establish continuing disability or residuals after that date causally related to the 

accepted injury.14 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 causal 

relationship.15

ANALYSIS -- ISSUE 2

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

disability or residuals on or after July 25, 2020, causally related to her accepted June 26, 2008 

employment injury.

Subsequent to the termination of her wage-loss compensation and medical benefits, 

appellant submitted additional reports from Dr. Horowitz. In a September 4, 2020 report,

Dr. Horowitz diagnosed the accepted conditions of lumbar radiculopathy, lumbar spondylosis 

without myelopathy or radiculopathy, and other myositis in an unspecified site, and found that 

appellant’s continuing disability and need for further medical treatment were causally related to 

the June 26, 2008 employment injury. However, he did not provide medical rationale explaining 

12 See V.W., Docket No. 20-0693 (issued June 2, 2021); E.S., id.

13 Id.

14 See V.W., supra note 12; D.G., Docket No. 19-1259 (issued January 29, 2020); S.M., Docket No. 18-0673 (issued 

January 25, 2019); J.R., Docket No. 17-1352 (issued August 13, 2018).

15 Id.
8

the basis of his conclusory opinion and therefore his opinion is of diminished probative value.16 

Thus, the Board finds that Dr. Horowitz’s report is insufficient to establish appellant’s burden of 

proof. 

In an August 11, 2020 report, Dr. Horowitz restated a history of appellant’s injury and his 

own treatment of appellant. He reviewed medical records, including Dr. Sultan’s reports. 

Dr. Horowitz reported examination findings and provided assessments of lumbago, lumbar disc 

bulge at L4-5, and lumbar disc herniation at L3-4, and L5-S1. He opined that the June 26, 2008

employment injury was responsible for appellant’s lumbar pain, permanent partial disability, and 

need for further medical treatment. Dr. Horowitz also disagreed with Dr. Sultan’s normal physical 

examination findings as his physical examination revealed positive findings of a positive facet 

loading and positive straight leg raising along with decreased and restricted ROM, which indicated 

real, organic anatomical dysfunction. While Dr. Horowitz explained how appellant’s lumbar pain 

was caused by the June 26, 2008 employment injury, the Board notes that pain does not constitute 

the basis for payment of compensation, as pain is a symptom rather than a specific medical 

diagnosis.17 Moreover, OWCP has only accepted appellant’s claim for sprains of the neck, back, 

lumbar region, right shoulder and upper arm, unspecified site, and left knee and leg, unspecified 

sites; derangement of the left medial meniscus; temporary aggravation of lumbar radiculopathy, 

lumbar spondylosis with myelopathy; and myositis. Dr. Horowitz did not specifically address how 

any continuing disability was causally related to the accepted employment-related conditions.18 

Thus, for these reasons his opinion is insufficient to meet appellant’s burden of proof.

Although Dr. Horowitz’ remaining November 20, 2020 procedure note indicated that he 

treated appellant’s accepted diagnosis of lumbar radiculopathy with epidural steroid and trigger 

point injections, he did not explain how the reported treatment was medically necessary for 

treatment of the effects of an employment-related condition.19

Appellant also submitted an August 12, 2020 x-ray report from Dr. Green which addressed 

her left knee conditions. The Board has held that diagnostic studies, standing alone, lack probative 

value as they do not address causal relationship.20 For this reason, this evidence is not sufficient 

to meet her burden of proof.

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

disability or residuals due to her accepted employment conditions.

16 See supra note 12.

17 L.G., Docket No. 19-0142 (issued August 8, 2019).

18 See M.L., Docket No. 20-1682 (issued June 24, 2021); K.E., Docket No. 17-1216 (issued February 22, 2018).

19 E.U., Docket No. 13-1853 (issued January 16, 2014).

20 See J.O., Docket No. 19-0850 (issued October 22, 2020); L.K., Docket No. 19-0313 (issued January 15, 2020);

O.W., Docket No. 19-0316 (issued June 25, 2019); J.F., Docket No. 17-1716 (issued March 1, 2018); G.G., Docket 

No. 17-0537 (issued July 20, 2017).
9

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 and 20 C.F.R. 

§§ 10.605 through 10.607.

CONCLUSION

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

compensation and medical benefits, effective July 25, 2020, as she no longer had disability or 

residuals causally related to her accepted June 26, 2008 employment injury. The Board further 

finds that appellant has not met her burden of proof to establish continuing disability or residuals 

on or after July 25, 2020, causally related to her accepted June 26, 2008 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the March 30, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 8, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board