United States Department of Labor

Employees’ Compensation Appeals Board

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D.B., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

HEALTH SERVICES COMMAND, U.S. ARMY 

DENTAL ACTIVITY, Fort Benning, GA, 

Employer

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Docket No. 23-0949

Issued: November 30, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 29, 2023 appellant filed a timely appeal from a June 1, 2023 merit 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

1

5 U.S.C. § 8101 et seq.

2 The Board notes that following the June 1, 2023 decision, appellant submitted additional evidence on appeal and 

to OWCP. 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

ISSUE

The issue is whether OWCP properly denied authorization for Butalbital-AcetaminophenCaffeine-Codeine (BUT/APAP/CAF CAP CODEINE) for treatment of appellant’s accepted 

employment-related conditions.

FACTUAL HISTORY

On November 24, 1998 appellant, then a 42-year-old dental assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on November 17, 1998 she sustained a low back injury 

when she fell to the floor after her chair rolled out from under her while in the performance of 

duty. She stopped work on November 17, 1998 and returned on November 20, 1998. OWCP 

accepted the claim for lumbar strain, thoracic/lumbosacral neuritis, and nerve root and plexus 

disorder.

In letters dated May 20, August 18, and October 4, 2022, OWCP informed appellant and

Dr. Kenneth Barngrover, an osteopath and Board-certified anesthesiologist, that it had contracted 

with Optum to serve as FECA’s Pharmacy Benefit Manager (PMB) for patients cover by FECA. 

It advised them that the medication, BUT/APAP/CAF CAP CODEINE, did not appear to be related 

to the accepted conditions of nerve root and plexus disorder, lumbosacral sprain, and thoracic or 

lumbosacral neuritis or radiculitis. OWCP requested that Dr. Barngrover provide a reasoned 

medical opinion explaining why the medication prescribed was required for appellant’s accepted 

conditions. Or if the medication was prescribed for a condition not currently accepted,

Dr. Barngrover was asked to explain the diagnosis of consequential condition and how this 

condition was causally related to appellant’s November 17, 1998 employment injury. 

OWCP subsequently received reports dated November 9 and December 9, 2022, 

January 10, February 9, March 13, April 12, and May 12, 2023 from Dr. Barngrover who noted 

appellant’s continued pain complaints, her medical course, and provided examination findings. 

Diagnoses included lower back sprain, nerve root and plexus disorder, lumbar neuritis, 

lumbosacral neuritis, lumbosacral intervertebral disc, chronic pain, sacroiliitis, and long-term use 

of opiate analgesic.

In a January 10, 2023 letter, Optum advised Dr. Barngrover that it spoke with a nurse in 

his office on January 9, 2023 regarding the associated risks with concurrent meperdine, 

BUT/APAP/CAF CAP CODEINE, and carisoprodol including the need to taper one or more of 

these medications. It also discussed the use of nonformulary meperidine and BUT/APAP/CAF 

CAP CODEINE and the need to transition to a preferred formulary alternative such as morphine 

IR, tramadol IR, or hydrocodone-acetaminophen.

On April 14, 2023 Dr. Barngrover noted his disagreement with Optum’s guidance in the 

January 10, 2023 letter. He noted that only #10 (ten) tablets of meperidine per mouth was 

prescribed and soma was used mainly at bedtime.

By decision dated June 1, 2023, OWCP denied authorization for BUT/APAP/CAF CAP 

CODEINE, finding that evidence was insufficient to establish that medication was medically 

necessary for the effects of the accepted employment injuries. 
3

LEGAL PRECEDENT

Section 8103(a) of FECA3 provides that the United States shall furnish to an employee who 

is injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree, or the period of disability, or aid in lessening the amount of monthly compensation. 4 

While OWCP is obligated to pay for treatment of employment-related conditions, the employee 

has the burden of proof to establish that the expenditure is incurred for treatment of the effects of 

an employment-related injury or condition.5

In interpreting section 8103 of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided, with the only limitation on OWCP’s authority being that 

of reasonableness.6 OWCP has the general objective of ensuring that an employee recovers from 

his or her injury to the fullest extent possible, in the shortest amount of time. It, therefore, has 

broad administrative discretion in choosing means to achieve this goal. 7

Abuse of discretion is generally shown through proof of manifest error, clearly 

unreasonable exercise of judgment, or actions taken which are contrary to both logic and probable 

deductions from established facts. It is not enough to merely show that the evidence could be 

construed so as to produce a contrary factual conclusion. 8

ANALYSIS

The Board finds that OWCP properly denied authorization for BUT/APAP/CAF CAP 

CODEINE for treatment of appellant’s accepted employment-related conditions.

On May 20, August 18, and October 4, 2022 OWCP informed appellant andDr. Barngrover

that it had contracted with Optum to serve as FECA’s new PBM. It advised them that the 

medication, BUT/APAP/CAF CAP CODEINE, did not appear to be related to the accepted 

conditions of nerve root and plexus disorder, lumbosacral sprain, and thoracic or lumbosacral 

neuritis or radiculitis. OWCP requested that Dr. Barngrover provide a reasoned medical opinion 

explaining why the medication prescribed was required for appellant’s accepted conditions.

Alternatively, if the medication was prescribed for a condition not currently accepted,

3

Id. 

4

Id. § 8103(a); see O.M., Docket No. 21-1383 (issued March 1, 2023); R.B., Docket No. 21-0598 (issued May 19, 

2022); N.G., Docket No. 18-1340 (issued March 6, 2019); Thomas W. Stevens, 50 ECAB 288 (1999).

5 R.B., id.; J.M., Docket No. 20-0396 (issued April 9, 20201); M.P., Docket No. 19-1557 (issued February 24, 2020);

M.B., 58 ECAB 588 (2007).

6 O.M., supra note 4; J.M., Docket No. 20-0457 (issued July 16, 2020); Daniel J. Perea, 42 ECAB 214 (1990) 

(abuse of discretion by OWCP is generally shown through proof of manifest error, clearly unreasonable exercise of 

judgment, or administrative actions which are contrary to both logic, and probable deductions from established facts).

7 R.B. supra note 4; P.L., Docket No. 18-0260 (issued April 14, 2020).

8 R.B., supra note 4; J.M., supra note 5; C.S., Docket No. 19-0516 (issued August 15, 2019).
4

Dr. Barngrover was asked to explain the diagnosis of consequential condition and how this 

condition was causally related to appellant’s November 17, 1998 employment injury. 

On January 10, 2023 Optum advised Dr. Barngrover that it spoke with a nurse in his office 

on January 9, 2023 regarding the associated risks with his prescribed medication including 

BUT/APAP/CAF CAP CODEINE, the need to taper one or more of these medications, and that 

appellant be transitioned to alternative preferred formulary alternative such as morphine IR, 

tramadol IR, or hydrocodone-acetaminophen. On April 14, 2023 Dr. Barngrover disagreed with 

Optum and noted that only #10 (ten) tablets of meperidine per mouth was prescribed and soma 

was used mainly at bedtime. However, Dr. Barngrover did not provide any explanation as to why 

the opioid medication was medically necessary in his response to Optum’s January 10, 2023 letter.9

The Board, therefore,finds that OWCP did not abuse its discretion in denying authorization 

for BUT/APAP/CAF CAP CODEINE for treatment of appellant’s accepted employment-related 

conditions.

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.

CONCLUSION

The Board finds that OWCP properly denied authorization for BUT/APAP/CAF CAP 

CODEINE for treatment of appellant’s accepted employment-related conditions.

9

Supra note 6. See also A.M., Docket 23-0593 (issued August 24, 2023).
5

ORDER

IT IS HEREBY ORDERED THAT the June 1, 2023 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: November 30, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board