United States Department of Labor

Employees’ Compensation Appeals Board

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P.H., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SAFETY 

ADMINISTRATION, LAMBERT-ST. LOUIS 

INTERNATIONAL AIRPORT, St. Louis, MO, 

Employer

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Docket No. 23-0665

Issued: October 13, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On April 4, 2023 appellant filed a timely appeal from a January 6, 2023 merit decision of 

the Office of Workers’ Compensation Programs (OWCP).1 Pursuant to the Federal Employees’

Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction to 

consider the merits of this case.

1 The Board notes that,following the January 6, 2023 decision, OWCP received additional evidence. 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). Thus, the Board is precluded from reviewing this additional 

evidence for the first time on appeal. Id.

2

5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether OWCP met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits, effective January 6, 2023, as he no longer had disability or

residuals causally related to his accepted December 4, 2011 employment injury.

FACTUAL HISTORY

This case has previously been before the Board on a different issue.

3

 The facts and 

circumstances of the case as set forth in the Board’s prior decision are incorporated herein by 

reference. The relevant facts are as follows.

On December 5, 2011 appellant, then a 39-year-old transportation security officer, filed a 

traumatic injury claim (Form CA-1) alleging that on December 4, 2011 he injured his upper back, 

neck, and left arm when lifting a heavy bag from the x-ray machine while in the performance of 

duty. He stopped work on that date. OWCP accepted the claim for cervical and thoracic sprains. 

Appellant returned to full-duty work on December 15, 2011. On February 10, 2012 he underwent 

an OWCP-authorized interval instrumented discectomy and anterior fusion with bone graft at 

C4-5. OWCP paid appellant wage-loss compensation on the supplemental rolls beginning 

February 12, 2012 and on the periodic rolls beginning October 21, 2012. It subsequently expanded 

the acceptance of the claim to include cervical herniated disc at C4-5, cervical myelopathy, 

dysphagia, complete rotator cuff tear on the left, deep vein thrombosis (DVT), and pulmonary 

embolism.

On December 10, 2021 OWCP referred appellant, a statement of accepted facts (SOAF), 

and a series of questions to Dr. Michael H. Ralph, a Board-certified orthopedic surgeon, for a 

second opinion evaluation. 

In a December 15, 2021 report, Dr. Keith J. Odegard, an orthopedic surgeon, reviewed 

appellant’s left shoulder x-rays and found moderate degenerative arthritis with a possible large 

chronic rotator cuff tear, and early rotator cuff arthropathy.

OWCP subsequently received a January 5, 2022 report, wherein second opinion physician

Dr. Ralph noted the accepted conditions and performed a physical examination. He recounted that 

appellant had undergone multiple surgical procedures on appellant’s cervical and thoracic spines

and found no neurological deficits in his upper extremities, but a tremendous number of subjective 

complaints. Dr. Ralph related that, prior to the January 4, 2021 surgery, appellant had normal 

electromyography and nerve conduction velocity studies of the upper extremities which were 

compatible with successful bilateral carpal tunnel releases. He requested additional left shoulder 

diagnostic studies. Dr. Ralph opined that none of OWCP-accepted diagnoses were causally related 

to the accepted employment injury. However, he listed the accepted conditions and found that, in 

regard to thoracic and cervical sprains, these conditions had resolved, if in fact they had ever 

occurred. Dr. Ralph opined that there was no residual deficit from C4-5 herniated disc, and that 

dysphagia, left leg DVT, and pulmonary emboli had resolved. He opined that appellant required 

3 Docket No. 18-1020 (issued November 1, 2018).
3

no further treatment. Dr. Ralph found that, in regard to the accepted conditions, other than left 

shoulder, appellant was capable of returning to his date-of-injury position.

Dr. Ralph completed a supplementalreport on July 29, 2022notingthat he had not received 

additional left shoulder magnetic resonance imaging (MRI) scan results. He found that the 

December 6, 2021 left shoulder MRI scan and December 15, 2021 x-rays did not demonstrate

rotator cuff tear, but instead partial-thickness changes in the rotator cuff and substantial 

glenohumeral arthritis. Dr. Ralph opined that appellant’s current left shoulder symptomatology 

was not part of the accepted conditions and that his accepted rotator cuff tear had resolved. He 

further reported that the accepted condition of rotator cuff tear never existed and was not currently 

an issue. Dr. Ralph concluded that appellant could return to his date-of-injury position without

work-related restrictions.

On October 12, 2022 OWCP issued a notice of proposed termination of appellant’s wageloss compensation and medical benefits based on the January 5 and July 29, 2022 second opinion 

examination reports from Dr. Ralph, which supported that the accepted conditions had resolved 

without disability or residuals. It afforded appellant 30 days to submit additional evidence or 

argument challenging the proposed termination.

In a November 11, 2022 letter, appellant objected to the proposed termination. He 

provided additional physical therapy notes dated October 11 through December 29, 2022.

By decision dated January 6, 2023, OWCP finalized the termination of appellant’s wageloss compensation and medical benefits, effective that date. It found that the weight of the medical 

evidence rested with the second opinion physician, Dr. Ralph, and established that appellant no 

longer had disability or residuals causally related to his accepted December 4, 2011 employment 

injury.

LEGAL PRECEDENT

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

termination or modification of an employee’s benefits.4 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 

the employment.5 Its burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background. 6

4

S.J., Docket No. 22-0936 (issued April27, 2023); 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).

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

Minor, 37 ECAB 541 (1986).

6 D.G., id.; M.C., Docket No. 18-1374 (issued April 23, 2019); Del K. Rykert, 40 ECAB 284, 295-96 (1988).
4

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

entitlement for disability compensation.7 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.8

ANALYSIS

The Board finds that OWCP failed to meet its burden of proof to terminate appellant’s 

wage-loss compensation and medical benefits, effective January 6, 2023.

In his January 5, 2022 report, Dr. Ralph noted all of OWCP-accepted conditions opined

then opined that none of those conditions were related to the accepted employment injury. He 

further opined that, even if appellant had thoracic and cervical sprains, these conditions had 

resolved. Dr. Ralph concluded that there was no residual deficit from C4-5 herniated disc, and 

that dysphagia, left leg DVT, and pulmonary emboli had also resolved. He completed a 

supplemental report on July 29, 2022 and opined that appellant’s current left shoulder 

symptomatology was not part of the accepted conditions and that his accepted rotator cuff tear had 

resolved. Dr. Ralph further reported that the accepted condition of rotator cuff tear never existed 

and was not currently an issue. He concluded that appellant could return to his date-of-injury 

position without work-related restrictions.

It is well established that a physician’s opinion must be based on a complete and accurate 

factual and medical background. When OWCP has accepted an employment condition as 

occurring in the performance of duty, the physician must base his opinion on these accepted 

conditions.9

OWCP’s procedures and Board precedent dictate that, when an OWCP medical adviser, 

second opinion specialist, or referee physician renders a medical opinion based on a SOAF, which 

is incomplete or inaccurate, or does not use the SOAF as the framework in forming his or her 

opinion, the probative value of the opinion is seriously diminished or negated altogether.10

Dr. Ralph did not rely on the SOAF as a framework in reaching his conclusions. He 

reached findings and conclusions that were contrary to the findings in the SOAF.

11

 The Board, 

7 D.G., id.; A.G., Docket No. 19-0220 (issued August1, 2019); A.P., Docket No. 08-1822 (issued August5, 2009); 

T.P., 58 ECAB 524 (2007); KathrynE. Demarsh, 56 ECAB 677 (2005); Furman G. Peake, 41 ECAB 361 (1990).

8 D.G., id.; A.G., id.; James F. Weikel, 54 ECAB 660 (2003); Pamela K. Guesford, 53 ECAB 727 (2002); 

Furman G. Peake, id.

9 K.S., Docket No. 22-1011 (issued January 5, 2023); D.T., Docket No. 21-1168 (issued April 6, 2022); G.B., 

Docket No. 20-0750 (issued October 27, 2020); T.P., supra note 7.

10 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990). See also K.S., id.; D.T., id.; D.C., Docket No. 21-0780 (issued December 22, 2021); Paul King, 54 

ECAB 356 (2003).

11 V.L., Docket No. 22-0336 (issued September 28, 2022); P.M., Docket No. 22-0211 (issued August 5, 2022); J.M.,

III, Docket No. 21-1213 (issued May 16, 2022).
5

thus, finds that Dr. Ralph’s report is of diminished probative value and is insufficient to carry the 

weight of the medical evidence.12 As such, OWCP failed to meet its burden of proof to terminate 

appellant’s wage-loss compensation and medical benefits, effective January 6, 2023.

CONCLUSION

The Board finds that OWCP failed to meet its burden of proof to terminate appellant’s 

wage-loss compensation and medical benefits, effective January 6, 2023.

ORDER

IT IS HEREBY ORDERED THAT the January 6, 2023 decision of the Office of 

Workers’ Compensation Programs is reversed.

Issued: October 13, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

12 Supra note 10.