United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.W., Appellant

and

DEPARTMENT OF JUSTICE, FEDERAL 

BUREAU OF INVESTIGATION, 

Clarksburg, WV, Employer

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Docket No. 23-0504

Issued: July 11, 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

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On February 27, 2023 appellant filed a timely appeal from a February 3, 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.

ISSUE

The issue is whether OWCP abused its discretion in denying authorization for the 

medication Dronabinol effective March 9, 2023.

FACTUAL HISTORY

On January 5, 2000 appellant, then a 28-year-old legal instrument examiner, filed a 

traumatic injury alleging that on December 8, 1999 she injured a nerve in her left arm when she 

1

5 U.S.C. § 8101 et seq.
2

donated blood while in the performance of duty. She asserted that a technician hit a nerve in her 

arm with a needle at a blood drive sponsored by the employing establishment. OWCP accepted 

the claim for reflex sympathetic dystrophy of the upper limb. It subsequently expanded its 

acceptance of the claim to include nausea with vomiting and chronic atrophic gastritis without 

bleeding. Appellant stopped work following her injury and returned to modified work on 

May 8, 2002.2 She sustained intermittent recurrences of disability. Appellant subsequently 

resumed modified full-time work. 

In a December 21, 2021 report, Dr. Samuel W. Samuel, a Board-certified anesthesiologist, 

evaluated appellant for left hand pain due to complex regional pain syndrome (CRPS), Type 1. He 

noted that the medication Dronabinol managed her nausea. Dr. Samuel diagnosed CRPS, Type 1 

of the left upper extremity and nausea. He listed appellant’s prescription medications, including 

Dronabinol daily for six months. The report was prepared by Dr. Emily L. Bitticker, an 

anesthesiologist, but signed by Dr. Samuel.

On May 5, 2022 Optum, the pharmacy benefits manager (PBM), advised appellant that it 

was managing pharmacy benefits for injured employees covered under FECA. It noted that a drug 

formulary, or list of medications that a claimant was eligible to receive under FECA, had gone into 

effect on December 9, 2021. The PBM informed appellant that her currently prescribed drug 

Dronabinol was not allowed under its formulary. It requested that she notify her physician to 

determine if there was an alternative medication available or, if not, to have her physician complete 

a Prior Authorization Request (PAR) form to request continued use of the nonformulary medicine. 

The PBM indicated that it would allow the medication until December 8, 2022. 

In a May 6, 2022 letter, the PBM requested that Dr. Bitticker transition appellant to a 

formulary-approved medication, or complete a PARform to request approval for the nonformulary 

medication. It provided similar letters to appellant and Dr. Bitticker on July 6 and 7, 2022, 

respectively. On October 4, 2022 the PBM issued a final reminder to appellant that Dronabinol 

was not covered by its formulary, and indicated that it would only allow the medication until 

December 8, 2022. It again requested that she switch to another medication covered by the 

formulary or submit a PAR form and request approval for Dronabinol. In a separate letter of even 

date, the PBM advised Dr. Samuel C. Overley, a Board-certified orthopedic surgeon, that 

Dronabinol was not covered under its formulary, and requested that he either transition appellant 

to another medication or submit a PAR form to request approval for Dronabinol.

In a report dated December 7, 2022, Dr. Samuel diagnosed CRPS of the left upper 

extremity and nausea. He listed appellant’s prescribed medications, including Dronabinol for 180 

days.

On December 21, 2022 OWCP again notified appellant that she was receiving medication 

for her employment injury through its PBM. It indicated that it now used a drug formulary, or list 

of medications covered by FECA, as a way to ensure the safe and effective use of medication. 

OWCP asserted that its PBM had notified appellant and her provider on May 5, July 6, and 

2 By decision dated August 8, 2002, OWCP reduced appellant’s wage-loss compensation to zero based on its 

finding that her actual earnings as a modified legal instruments examiner effective May 6, 2002 fairly and reasonably 

represented her wage-earning capacity. 
3

October 4, 2022 that Dronabinol was not covered under the formulary, and had requested a PAR 

form if there were no appropriate alternative medications. It informed her that this was her final 

notice to allow time for her prescriber to transition her to an alternative medication covered by the 

formulary or submit a PAR form if her prescriber believed that the medication was currently 

necessary. OWCP indicated that coverage for Dronabinol would continue until March 8, 2023. 

In a memorandum of telephone call (Form CA-110) dated December 29, 2022, appellant 

left a voicemail message advising that OWCP’s December 21, 2022 letter was the first notice that 

she had received regarding her medication, and requested the necessary form to complete. In a 

January 6, 2023 voicemail, she advised that the director of her agency had approved her use of the 

medication. 

By decision dated February 3, 2023, OWCP denied authorization for the medication 

Dronabinol effective March 9, 2023. 

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 in the amount of monthly compensation.4 

In general, drugs and medications which are necessary to treat an injury or occupational disease 

may be purchased at OWCP’s expense on the recommendation of the attending physician. These 

include prescription as well as nonprescription medications.5

The Board has found that OWCP has great discretion in determining whether a particular 

type of treatment is likely to cure or give relief.6 The only limitation on OWCP’s authority is that 

of reasonableness.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. 

3

Supra note 1.

4

5 U.S.C. § 8103;see L.W., Docket No. 21-0607 (issued October 18, 2022); N.G.,Docket No. 18-1340 (issued 

March 6, 2019).

5 Federal (FECA) Procedure Manual, Part 3 -- Medical, Medical Services and Supplies, Chapter 3.400.3(a) 

(October 1995).

6 C.Y., Docket No. 21-0335 (issued November 7, 2022); R.C.,Docket No. 18-0612 (issued October 19, 2018);

Vicky C. Randall, 51 ECAB 357 (2000).

7 M.S., Docket No. 22-0113 (issued June 7, 2022); B.L.,Docket No. 17-1813 (issued May 23, 2018); Lecil E. 

Stevens, 49 ECAB 673, 675 (1998).
4

FECA Bulletin No. 21-07 provides that OWCP has contracted with a PBM for claimants 

covered under FECA.8 It further provides, “PBMs are primarily responsible for developing and 

maintaining formularies which include an approved listing of prescriptions....”

9

ANALYSIS

The Board finds that OWCP did not abuse its discretion in denying authorization for the 

medication Dronabinol effective March 9, 2023.

On December 21, 2021 Dr. Samuel diagnosed CRPS, Type 1 and nausea. He provided a 

list of appellant’s prescribed medications, including Dronabinol. The report was prepared by

Dr. Bitticker and signed by Dr. Samuel. 

In letters dated May 5, July 6, and October 4, 2022, the PBM informed appellant that 

Dronabinol was not allowed under its formulary of medications that a claimant was eligible to 

receive under FECA. It requested that she ask her physician if there was alternative medication 

available or, if not, have the physician complete a PAR form to request continued use of 

Dronabinol. The PBM also sent the May 6 and July 7, 2022 letters to Dr. Bitticker.10

On December 21, 2022 OWCP notified appellant that Dronabinol was not covered under 

the drug formulary, and noted that she had received prior letters from the PBM requesting that she 

transition to another medication or have her provider submit a PAR form. It advised that this was 

her final notice for her provider to change to another medication or submit a PAR form. OWCP 

informed appellant that her coverage for Dronabinol would end on March 8, 2023. In a voicemail 

response, appellant asserted that she had not received any letters from the PBM; however, these 

letters were properly addressed and mailed in the ordinary course of business and thus presumed 

to have been received under the mailbox rule.11

As noted, OWCP contracted with a PBM for claimants covered under FECA and the PBM 

developed a list of medications, or drug formulary, for claimants covered by FECA.12 As 

Dronabinol was not a medication on the PBM’s drug formulary, on December 21, 2022 OWCP 

requested that appellantsubmit a PAR form from her physician or transition to another medication. 

It provided her a reasonable period of time to respond to its request. Appellant, however, did not 

submit a PAR form from her provider requesting authorization for Dronabinol to the PBM as 

repeatedly requested. OWCP has great discretion in determining whether a particular type of 

treatment is likely to cure or give relief, and the only limitation on OWCP’s authority is that of 

reasonableness.13 It has the general objective of fully ensuring that an employee recovers from his 

8 FECA Bulletin No. 21-07 (issued March 9, 2021).

9

Id.

10 The PBM sent the October 4, 2022 letter to Dr. Overley instead of appellant’s physician.

11 See C.W., Docket No. 21-0943 (issued February 17, 2023); James A. Gray, 54 ECAB 277 (2002).

12 Id.

13 See R.B., Docket No. 21-0598 (issued May 19, 2022).
5

or her injury possible, in the shortest amount of time, and has broad administrative discretion in 

choosing means to achieve this goal.14 Accordingly, the Board finds that OWCP did not abuse its 

discretion in denying authorization for Dronabinol.

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 did not abuse its discretion in denying authorization for the 

medication Dronabinol effective March 9, 2023.

ORDER

IT IS HEREBY ORDERED THAT the February 3, 2023 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 11, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

14 See R.C., Docket No. 18-0612 (issued October 19, 2018); M.G.,Docket No. 18-0099 (issued April 26, 2018).