W.B. and Department of the Interior, U.S. Geological Survey, EROS Data Center, Sioux Falls, SD (Board decision, January 4, 2024)

ECAB final decision. The Board affirmed OWCP's denial of authorization for a prescription medication because the medical record did not establish that it was needed to treat the accepted work-related conditions. A party may petition the Board for reconsideration within 30 days of issuance unless this decision specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A retired Geological Survey financial manager had an accepted claim for depression and a urological condition. He sought coverage for metoprolol, which doctors prescribed for anxiety and also associated with blood pressure or heart conditions. The Board found that the reports did not explain why the drug was medically necessary for the accepted employment-related conditions. It upheld OWCP's refusal to authorize the prescription.

Decision snapshot

• Authority: FECA medical treatment authorization, 5 U.S.C. § 8103.
• Outcome: May 25, 2023 OWCP medication decision affirmed.
• Key point: A prescription needed a documented medical connection to the accepted conditions for OWCP authorization.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
W.B., Appellant
)
)
and ) Docket No. 23-0935
)
Issued: January 4, 2024
DEPARTMENT OF THE INTERIOR,
)
U.S. GEOLOGICAL SURVEY, EROS DATA )
CENTER, Sioux Falls, SD, Employer )
__________ )

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 JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 26, 2023 appellant filed a timely appeal from a May 25, 2023 merit decision of the Office of Workers’ Compensation (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 May 25, 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.

ISSUE

The issue is whether OWCP properly denied appellant’s request for authorization for a prescription medication.

FACTUAL HISTORY

On November 29, 1991 appellant, then a 53-year-old financial manager, filed an occupational disease claim (Form CA-2) alleging that he sustained a physical and mental breakdown on or about October 11, 1991 due to factors of his federal employment, including job stress, necessitating a psychiatric hospitalization. He noted that he first became aware of his condition on October 11, 1991 and realized its relation to factors of his employment on November 7, 1991. Appellant stopped work on October 14, 1991 and returned to work in a new position in 1993. OWCP accepted the claim for a temporary episode of depression. Appellant retired from the employing establishment in January 1995. OWCP later expanded the acceptance of his claim to include major depression, recurrent episode, and a urological condition. Appellant remained under medical treatment and participated in an OWCP-authorized wellness center physical exercise program.

In reports dated October 31, 2016, Dr. Ryan T. Santin, a Board-certified psychiatrist, noted appellant had been followed since 1991 for depression, anxiety, post-traumatic stress disorder (PTSD), and panic disorder. He was prescribed Metoprolol Succinate (Metoprolol) “[f]or Blood Pressure, heart.”

In a September 26, 2017 letter, Dr. Seth Parsons, a psychiatrist, noted that Metoprolol “assists with anxiety, but also hypertension.”

In reports dated from April 4, 2018 through April 1, 2019, Dr. David A. Schlagel, a Board- certified psychiatrist, recounted a history of the accepted occupational condition and treatment. He prescribed Metoprolol for anxiety. Commencing October 2, 2019, Dr. Schlagel reduced the Metoprolol dose to lessen appellant’s symptoms of dizziness and fatigue.

In an August 5, 2020 report, Dr. Schlagel diagnosed generalized anxiety disorder, PTSD by history, major depressive disorder, recurrent, in full remission, insomnia, and cardiovascular conditions. He opined that appellant had not fully recovered from the accepted emotional condition. Dr. Schlagel maintained appellant on Metoprolol for anxiety in reports dated through July 12, 2021.

In a letter dated May 20, 2022, Optum, OWCP’s pharmacy benefit manager (PBM), advised appellant that, although OWCP had previously authorized Metoprolol, the medical evidence of record was insufficient to establish that it was medically necessary to treat his employment-related conditions. In a development letter of even date, it requested that Dr. Schlagel provide a report explaining the medical necessity for Metoprolol and its relationship to the accepted conditions. OWCP afforded both parties were afforded 30 days to submit the requested evidence.

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In response, Dr. Schlagel submitted a May 31, 2022 report noting that appellant required Metoprolol for hypertension and coronary artery disease, as he had a history of myocardial infarction.

In a letter dated August 19, 2022, OWCP advised Dr. Schlagel that additional documentation was needed to support continued authorization of Metoprolol. It requested a medical report with a reasoned opinion as to why the medication was required to address symptoms of the accepted occupational conditions. OWCP afforded Dr. Schlagel 30 days to respond. It provided a copy of the letter to appellant and advised him of his responsibility “to ensure that all requested information is provided as promptly as possible.”

In development letters dated October 3 and 4, 2022, the PBM advised Dr. Schlagel and appellant, respectively, that the medical evidence of record was insufficient to establish that Metoprolol was medically necessary to treat the accepted conditions. It requested a medical report explaining why the medication was necessary to treat the accepted conditions .

On December 16, 2022 Dr. Schlagel noted that appellant remained under psychiatric treatment and was compliant with attendance at a cardiovascular exercise and mobility program.

In a February 8, 2023 report, Dr. Schlagel diagnosed generalized anxiety disorder, PTSD by history, major depressive disorder, recurrent, in full remission, insomnia disorder, coronary artery disease, ischemic cardiomyopathy, status-post implantable cardioverter-defibrillator (ICD) placement, mitral valve repair, and a urological condition. He prescribed Metoprolol “for anxiety.”

Appellant also submitted a June 15, 2022 report by Dr. Schlagel with the same diagnoses and prescription information as presented in the February 8, 2023 report.

By decision dated May 25, 2023, OWCP denied appellant’s request for authorization of Metoprolol, finding that the evidence of record did not support that it was medically necessary to treat the effects of his accepted employment-related conditions.

LEGAL PRECEDENT

Section 8103 of FECA 3 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 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

3
5 U.S.C. § 8103.
4
Id., see also N.G., Docket No. 18-1340 (issued March 6, 2019).

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reasonableness. 5 OWCP has administrative discretion in choosing the means to achieve this goal and the only limitation on OWCP’s authority is that of reasonableness. 6

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. 7

ANALYSIS

The Board finds that OWCP properly denied appellant’s request for authorization for a prescription medication.

Dr. Santin noted in reports dated October 31, 2016 that Metoprolol had been prescribed for hypertension and cardiac conditions, while Dr. Parsons noted in a September 16, 2017 letter that Metoprolol addressed both hypertension and anxiety. Dr. Schlagel, in reports dated from April 4, 2018 through July 12, 2021, and February 8, 2023, explained that Metoprolol had been prescribed for anxiety.

In a letter dated May 20, 2022, the PBM indicated that additional information was necessary before the request for Metoprolol could be approved. It requested a complete response to its development letter and afforded 30 days to submit the necessary evidence. In response, Dr. Schlagel submitted a May 31, 2022 report noting that he prescribed Metoprolol to address hypertension and coronary artery disease with a history of myocardial infarction.

Thereafter, the PBM issued October 3 and 4, 2022 development letters to Dr. Schlagel and appellant, requesting additional medical reports addressing whether Metoprolol had been prescribed to treat the accepted employment-related conditions. It subsequently received Dr. Schlagel’s June 15, 2022 and February 8, 2023 reports, indicating that he prescribed Metoprolol for anxiety.

As noted, the only restriction on OWCP’s authority to authorize medical treatment is one of reasonableness. 8 OWCP requested a rationalized explanation on the medical necessity of the prescription medication. While Dr. Schlagel noted in his reports dated April 4, 2018 through February 8, 2023 that appellant should continue taking the medication, he attributed the necessity of the medication to anxiety, hypertension, and cardiovascular disease. He failed to explain why it was medically necessary to treat the accepted employment-related conditions. The Board,

5
D.W., Docket No. 19-0402 (issued November 13, 2019); see also Daniel J. Perea, 42 ECAB 214, 221 (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). 6 S.K., Docket No. 22-0950 (issued June 23, 2023); J.E., Docket No. 18-0228 (issued August 8, 2019); Daniel J.
Perea, id.
7
E.L., Docket No. 17-1445 (issued December 18, 2018); L.W., 59 ECAB 471 (2008); P.P., 58 ECAB 673 (2007).
8
B.I., Docket No. 18-0988 (issued March 13, 2020); see also Daniel J. Perea, supra note 5.

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therefore, finds that OWCP has not abused its discretion in denying appellant’s request for authorization for prescription medication. 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(a) and 20 C.F.R.
§§ 10.605 through 10.607.

CONCLUSION

The Board finds that OWCP properly denied appellant’s request for authorization for a prescription medication.

ORDER

IT IS HEREBY ORDERED THAT the May 25, 2023 decision of the Office of Workers’ Compensation is affirmed.

Issued: January 4, 2024
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

9
See G.B., Docket No. 18-1478 (issued February 4, 2019); R.C., Docket No. 18-0612 (issued October 19, 2018);
G.A., Docket No. 09-2153; Lewis J. Wheeler, Jr., Docket No. 00-0026 (issued June 6, 2001) (OWCP did not abuse its discretion in denying authorization for non-opioid prescription medication where the treating physicians did not provide medical rationale explaining why the requested medication was medically necessary to address the accepted occupational conditions).

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