K.P., widow of J.P., and U.S. Postal Service, Watertown Post Office (Board decision, May 12, 2025)

ECAB remand decision. The Board set aside OWCP's denial and returned the survivor claim for a clarified medical opinion; entitlement remains unresolved. A party may petition the Board for reconsideration within 30 days of issuance unless this order 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 postal worker's widow sought survivor benefits, alleging that his death by suicide was related to accepted work conditions. The Board found OWCP's second-opinion physician gave an internally inconsistent opinion about the role of pain, opioid use, and the accepted conditions. It returned the claim for a supplemental medical opinion and a new decision.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Survivor claim denial set aside; medical causation remanded.
• Key point: OWCP needed a consistent medical opinion addressing whether accepted conditions or related medication use contributed to the death.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
K.P., claiming as widow of J.P., Appellant ) )
and ) Docket No. 23-0936
)
Issued: May 12, 2025
U.S. POSTAL SERVICE, WATERTOWN POST )
OFFICE, Watertown, NY, 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 28, 2023, appellant filed a timely appeal from a January 17, 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 appellant has met her burden of proof to establish that the employee’s suicide on January 17, 2016 was causally related to factors of his federal employment.

1
5 U.S.C. § 8101 et seq.
FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances as set forth in the Board’s prior decision are incorporated herein by reference. The relevant facts are set forth below.

OWCP accepted the employee’s April 30, 2007 occupational disease claim (Form CA-2) for bilateral carpal tunnel syndrome that developed as of April 1, 2006 as a result of his federal employment as a letter carrier. The employee subsequently returned to work in a full-time full- duty capacity on April 4, 2007 and worked until January 28, 2008, when he stopped work again due to authorized surgery. OWCP paid him wage-loss compensation on the supplemental rolls, effective February 28, 2008, and on the periodic rolls effective February 17, 2008.

On January 17, 2016 the employee died by suicide at the age of 48.

On June 3, 2016, appellant, the employee’s widow, filed a claim for compensation by widow, widower, and/or children (Form CA-5). On the reverse side of the claim form, a provider with an illegible signature completed an attending physician ’s report dated June 2, 2016. The provider related that the employee had chronic regional pain syndrome (CRPS)/reflex sympathetic dystrophy (RSD) of the right hand with necrosis and amputation of digits with intractable pain. The provider noted that the direct cause of death was suicide. The provider indicated that contributory causes were unknown; however, the intractable pain from CRPS of the right hand may have triggered suicide.

In support of the claim, OWCP received several documents including a January 17, 2016 death certificate, which listed the immediate cause of death as cerebral avulsion due to gunshot injury, and depression as another significant condition contributing to, but not related to, the cause of death.

In a September 22, 2015 medical report, Dr. Bhupinder S. Bolla, a Board-certified anesthesiologist, provided an assessment of neuropathy pain right arm and CRPS, Type II, upper extremity. He noted that the employee was being maintained on high doses of opioid medications until he began a process of weaning off of them. In a treatment note of the same date, Dr. Bolla indicated that the employee was totally disabled from his employment-related condition. In an October 15, 2015 report, Dr. Raymond Alcuri, a Board-certified physiatrist, noted the employee’s employment injury and that his active problems included CRPS, upper limb; long-term (current) use of medications; and long-term current use of opiate analgesic. The employee was reported to be following weaning instructions for high-dose opioids, and was continuing use of Clonidine and Clonazepam to help with withdrawal symptoms. Dr. Alcuri opined that the employee may have a strong component of opiate-induced hyperalgesia, which complicated his pain management. He also reported that the employee was frustrated.

2
Docket No. 20-0918 (issued June 23, 2021).

2
On June 6, 2017, OWCP informed appellant of the deficiencies of her claim. It advised her of the type of factual and medical evidence needed and provided a questionnaire for her completion. OWCP afforded appellant 30 days to respond.

OWCP subsequently received a series of medical reports dating back to 2011, regarding the employee’s CRPS and RSD of the upper extremities and long-term chronic use of medications and opiate analgesic. The reports noted recurrent infections, that the employee ’s phalanges were deteriorating secondary to CRPS, and that debilitating pain rendered his hands unusable. Depression from not working was also reported.

In an August 4, 2017 response to OWCP’s development letter, appellant advised that the employee was diagnosed with employment-related bilateral carpal tunnel syndrome, and that his multiple OWCP-approved surgeries caused CRPS. She indicated that the employee had been in constant pain for six years and that the CRPS caused his fingers to “disintegrate.” Appellant related that both digits of the employee’s hands were eroded nearly to the middle knuckles, and the index and middle fingers were open wounds that were always extremely painful. Therefore, the employee was forced to realize that he would not be able to go back to work or enjoy the activities he once enjoyed. The week of the employee’s death, appellant indicated that the employee had been in more pain than ever and was desperate to find a doctor to treat his condition so that he could have a quality of life. She also noted that he had a restless night of sleep the night before his suicide. Appellant stated that the employee had been under stress for the last few months of his life due in part to the actions of his medical providers and OWCP, and that he felt abandoned because of the way he was treated. She denied that the employee had “mental problems” prior to the accepted employment injury. Appellant noted that the employee was treated with a psychiatrist for anxiety due to not being able to work and for the emotional distress of his condition. He was prescribed Clonazepam, which he had been taking for a few years. Appellant indicated that the psychiatrist refused to provide her with the employee’s treatment records.

Appellant provided letters written by the employee during the last few months of his life, which concerned the denial of his pain medications needed for his worsening RSD and his need for a new physician.

On August 18, 2017, OWCP requested additional information from the employing establishment regarding appellant’s survivor’s benefits claim, including comments from a knowledgeable supervisor. It afforded the employing establishment 30 days to respond.

Appellant subsequently submitted a copy of the January 18, 2016 autopsy report.
Dr. Samuel A. Livingstone, a family medical specialist and medical examiner, indicated that the death was classified as suicide, and that the cause of death was cerebral avulsion due to gunshot wound. Anxiety disorder was listed as an “other significant condition.” The toxicology report indicated that the employee’s ethanol level was considered by the State of New York as intoxicated. The remaining medications were in subtherapeutic or therapeutic ranges.

On March 22, 2018, OWCP referred the case record, along with a December 8, 2017 statement of accepted facts (SOAF), to Dr. Christina Conciatori-Vaglica, a Board-certified psychiatrist, for a second opinion regarding whether there were any additional conditions causally related to the accepted employment injury; whether the suicide death was the direct result of the

3 accepted work-related injury, factors of employment, and/or medical conditions as outlined in the SOAF, without any intervening cause; and whether the suicide death was related to the prescribed opioids.

In an April 24, 2018 report, Dr. Conciatori-Vaglica noted her review of the employee’s medical file and the SOAF. She opined that the employee’s suicide death was the direct result of the accepted employment-related injury. Specifically, the employee developed anxiety and depression as a result of chronic pain due to carpal tunnel of his right hand and its complications, including CRPS of the right hand, which produced a compulsion to commit suicide and disabled the employee from exercising sound discretion or judgment so as to control that compulsion. Factors which likely compounded the employee’s compulsion to commit suicide include the forced weaning of his opioids and use of alcohol on the date of his suicide . Dr. Conciatori-Vaglica opined that the employee’s suicide was not related to his prescribed opioids, as there were no opioids found in his blood on the autopsy report.

By decision dated August 16, 2018, OWCP denied appellant’s claim for survivor’s benefits. It found that appellant had not provided supporting evidence demonstrating an unbroken chain of causation between the accepted employment-related injury and the employee’s suicide. OWCP noted that “although the medical report from the second opinion specialist, [Dr. Conciatori- Vaglica], dated April 24, 2018 noted a connection between the suicide and the work injury, the medical evidence we have received fails to support that the accepted bilateral carpal tunnel syndrome contributed to an emotional condition that caused him to commit suicide on January 1, 2016.”

On August 24, 2018, appellant, through her then-counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review. A hearing was held on January 17, 2019.

By decision dated April 3, 2019, an OWCP hearing representative set aside OWCP’s August 16, 2018 decision, finding that referral for a psychiatric peer review was premature as the adjudication of whether “the additional claimed conditions of RSD and chronic pain” are causally related to the April 1, 2006 employment injury must be resolved prior to the resolution of the emotional condition. The hearing representative also noted that there were several factual inconsistencies with regard to the suicide that must also be resolved prior to addressing the chain of causation.3 She further found that Dr. Conciatori-Vaglica’s report was not based on a complete history, as it failed to reference the factual discrepancies in the January 17, 2016 police report. 4 The hearing representative, therefore, remanded the case for further development.

3
The January 17, 2016 police report indicated that appellant was initially uncooperative and the 911 call report from appellant’s daughter had advised that there was some type of spousal argument or domestic issue prior to the suicide, which was described as an accidental shooting in the 911 record. The reporting of the incident was noted to conflict with appellant’s testimony that there were no family issues and that the employee was in extreme pain prior to the suicide. 4 Id.

4
In a May 2, 2019 statement, appellant denied that there was an argument between the employee and herself preceding his death. She noted that Dr. Sadaquat Khan, a Board-certified psychiatrist, refused to release the employee’s records to her.

OWCP also received an April 16, 2019 statement, wherein J.P., appellant’s daughter clarified that no argument occurred between her parents that night and that when she called 911 she was unsure of what had occurred.

In a June 11, 2019 development letter, OWCP requested that Dr. Khan provide copies of the employee’s medical treatment records related to the treatment of his emotional state. Dr. Khan was afforded 30 days to provide the information. No response was received.

OWCP referred the case record, along with an updated SOAF and a series of questions, to Dr. Joseph Jares, a Board-certified neurologist, for a second opinion regarding whether the conditions of RSD and chronic pain were causally related to the accepted employment injury .

In a July 5, 2019 report, Dr. Jares noted his review of the medical record. He opined that the diagnoses of right carpal tunnel syndrome, neuropathic pain, and CRPS were causally related to the accepted employment injury. The aggravation was permanent and led to the development of CRPS/neuropathic pain of the right upper extremity, which was unresolved at the time of the employee’s death. Dr. Jares indicated that, when the employee died, he had persistent symptoms of neuropathic pain/RSD as evidenced in the reports of the employee’s various pain management and orthopedic providers.

By de novo decision dated September 16, 2019, OWCP denied appellant’s survivor’s benefits claim, finding that the medical evidence of record was insufficient to establish that appellant’s bilateral carpal tunnel syndrome and/or CRPS were directly caused or aggravated an emotional condition, which in turn caused the suicide.

On September 26, 2019, appellant, through her then-counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review.

By decision dated December 6, 2019, OWCP’s hearing representative conducted a preliminary review and set aside the September 16, 2019 decision. The hearing representative remanded the case for OWCP to obtain the treatment records from Dr. Khan and a supplemental opinion concerning the relationship between the suicide and the employment-related injury from either Dr. Khan or a second opinion specialist.

On remand, OWCP issued an updated SOAF dated December 20, 2019, which noted that the acceptance of the claim was expanded to include CRPS/RSD.

On December 20, 2019, OWCP provided a detailed letter to Dr. Khan, along with the December 20, 2019 SOAF explaining why the employee’s medical records were necessary for appellant’s survivor’s claim. It noted that, if the physician was unwilling to provide either the employee’s records or his medical opinion, then he should provide a response as to why the request could not be met in order to document the record. OWCP afforded the physician 30 days to respond. No response was received.

5
By de novo decision dated January 31, 2020, OWCP denied appellant’s claim for survivor’s benefits. It found that, since the requested information on which the claim hinged had not been received, the medical evidence of record did not support an unbroken chain of causation between the employee’s January 17, 2016 suicide and the accepted employment-related injury.

On March 23, 2020, appellant, through her then-counsel, appealed to the Board. By decision dated June 23, 2021, the Board set aside OWCP’s January 31, 2020 decision and remanded the case for further proceedings.5 The Board found that the case was not in posture for decision as OWCP’s referral to Dr. Conciatori-Vaglica was premature as the additional claimed conditions of RSD and chronic pain had not yet been resolved and there were factual inconsistencies that had to be resolved. It noted that while OWCP had prepared a new SOAF and received additional witness statements clarifying the discrepancies in the police report, it had failed to request that Dr. Conciatori-Vaglica supplement her report based on the new SOAF and evidence. Thus, the Board found that OWCP should refer the updated SOAF and the case record to Dr. Conciatori-Vaglica for a supplemental opinion based on all the evidence. After such further development, OWCP was to issue a de novo decision with respect to appellant’s claim for survivor’s benefits.

OWCP prepared an updated SOAF on October 6, 2021. This SOAF noted that the acceptance of employee’s claim was expanded to include mononeuritis multiplex. It also noted the surgical procedures the employee had undergone and his numerous prescribed medications, including opioids for pain management.6

OWCP subsequently referred the employee’s file, along with the October 6, 2021 SOAF, to Dr. Varsha Vaidya Kunnirickal, a psychiatrist, for a second opinion record review to determine whether the employee’s suicide was causally related to his accepted employment-related conditions, either directly or consequentially. 7

In a May 1, 2022 report, Dr. Vaidya 8 reviewed the employee’s history of injury and medical treatment, including numerous surgeries, prior injuries, and other medical treatment. Pain management and psychological records were discussed, noting that the employee was being treated for depression and anxiety due to pain and an adjustment disorder. Use of narcotic pain medications were discussed with noted attempts to reduce usage of narcotics documented in 2010, but resumption of opiates in 2011 with drug dependency acknowledged in 2013. Records from 2013 and 2015 denied suicidal ideation, and there was no evidence or events immediately prior to the suicide in the file such as planned attempts, suicide notes, verbal suicide ideation, or history of violence towards self or others. Dr. Vaidya noted that while it was generally known that chronic

5
Supra note 2.
6
The SOAF listed the employee’s use of opioid medications which were prescribed for pain management following the development of his accepted employment-related conditions, including Vicodin, Dilaudid, Oxycontin, Hydrocodone, Oxycodone, Tramadol, and Fentanyl. 7 On October 6, 2021, OWCP had requested that Dr. Conciatori-Vaglica provide a supplemental report. However, Dr. Conciatori-Vaglica was unavailable.
8
The second opinion physician signed the report as Dr. Vaidya.

6 pain was a suicide risk factor, it was unclear that the work injury was the cause of the pain because several listed surgeries and causes of pain were documented , and the records documented appropriate mood and normal judgement, with denial of suicidal ideation and pleasant demeanor. She opined that the “main factors causing the suicide” were opiate dependance, and alcohol intoxication, and that the other factors important in attributing risk of suicide were unavailable such as family history, past psychiatric history, childhood trauma and relationships. Dr. Vaidya also indicated that the employee had multiple surgeries for which he had been prescribed opiates over the years, and it was unclear when opiates were last used and whether he could have been in withdrawal. Based on her review of the records and absent information, Dr. Vaidya indicated that it was difficult to conclude that the employee’s death by suicide was a direct result of the accepted work-related injury as the records were unclear whether the employee had a primary depressive disorder or an anxiety disorder, and there were significant gaps in his medical history to suggest his suicide was caused by the pain from the work-related injury. She indicated that the employee had an opiate dependance, alcohol intoxication, depressive symptoms and anxiety symptoms which could have been preexisting and exacerbated by opiate/alcohol use. Dr. Vaidya also indicated that diagnostic criteria for depressive/anxiety disorder exclude symptoms related to a medical problem or substance abuse. Thus, Dr. Vaidya opined that there was no clear chain of causation between the employee’s death by suicide and the work-related injury/pain.

By de novo decision dated July 15, 2022, OWCP denied appellant’s claim for survivor’s benefits. It accorded the weight of the medical evidence to Dr. Vaidya’s opinion.

On July 25, 2022, appellant, through her then-counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review, which was held on November 4, 2022. No new evidence was received.

By decision dated January 17, 2023, OWCP’s hearing representative affirmed the July 15, 2022 decision.

LEGAL PRECEDENT

A claimant for survivor’s benefits has the burden of proof to establish by the weight of the reliable, probative, and substantial evidence that the employee’s death was causally related to his or her employment. 9 To establish his or her claim that a deceased employee sustained stress in the performance of duty, which precipitated his or her death, a claimant must submit the following: (1) factual evidence identifying and supporting employment factors or incidents alleged to have caused or contributed to his or her condition; (2) rationalized medical evidence establishing that his or her death was due to or aggravated by an emotional reaction; and (3) rationalized medical opinion evidence establishing that the identified compensable employment factors are causally related to his or her death. 10

9
C.S. (K.S.), Docket No. 18-1733 (issued May 24, 2019); L.B. (A.V.), Docket No. 17-1671 (issued November 6, 2018); L.R. (E.R.), 58 ECAB 369 (2007). 10 C.S. (K.S.), id.; see also Martha L. Watson, 46 ECAB 407 (1995).

7
Appellant has the burden of proof to establish by a preponderance of the reliable, probative, and substantial evidence the existence of causal relationship between the employee ’s death by suicide and factors of his or her federal employment.11 The suicide itself must arise out of the employee’s assigned duties to such an extent as to be regarded as arising out of and in the course of employment.12 In determining whether an employee’s suicide is causally related to factors of his or her federal employment, OWCP has adopted the chain of causation test. 13

OWCP’s procedures provide instructions relating to the development of the evidence and the adjudication of such a claim and further notes that all suicide claims are not precluded by 5 U.S.C. § 8102(a)(2)14 providing, “[C]ompensation can be paid if the job-related injury (or disease) and its consequences directly resulted in the employee’s domination by a disturbance of the mind and loss of normal judgment which, in an unbroken chain, resulted in suicide. 15 Under the chain of causation test, OWCP’s procedures provide that, if the injury and its consequences directly resulted in a mental disturbance, or physical condition, which produced a compulsion to commit suicide, and disabled the employee from exercising sound discretion or judgment so as to control that compulsion, then the test is satisfied and the suicide is compensable.16 OWCP’s procedures add that, for the suicide to be compensable, the chain of causation from the injury to the suicide must be unbroken. 17

ANALYSIS

The Board finds that this case is not in posture for decision.

OWCP initially referred the case record to Dr. Conciatori-Vaglica for a second opinion regarding whether the employee’s suicide death was the direct result of the accepted work-related injury, factors of employment, and/or medical conditions as outlined in the SOAF, without any intervening cause; and whether the suicide death was related to the prescribed opioids. In an April 24, 2018 report, Dr. Conciatori-Vaglica noted her review of the medical record and the SOAF. She opined that the employee’s suicide death was the direct result of the accepted employment-related injury. Dr. Conciatori-Vaglica explained that the employee developed anxiety and depression as a result of chronic pain due to carpal tunnel of his right hand and its complications, including CRPS of the right hand, which produced a compulsion to commit suicide and disabled the employee from exercising sound discretion or judgment so as to control that

11
C.S. (K.S.), id.; Rosita Mahana (Wayne Mahana), 53 ECAB 503 (2002).
12
Id.
13
Id.
14
Section 8102(a)(2) of FECA precludes payment of compensation for disability or death sustained in the performance of duty where the injury or death is caused by the employee’s intention to bring about the injury or death of himself, herself, or another. See 5 U.S.C. § 8102(a)(2). 15 Federal (FECA) Procedure Manual, Part 2 -- Claims, Performance of Duty, Chapter 2.804.15 (September 1995).
16
Id. at Chapter 2.804.15b(2).
17
Id. at Chapter 2.804.15b(3).

8 compulsion. Factors which likely compounded the employee’s compulsion to commit suicide included the forced weaning of his opioids and use of alcohol on the date of his suicide.

Following further development, OWCP expanded the acceptance of the claim to include CRPS/RSD and mononeuritis multiplex, and the factual discrepancies noted by the hearing representative in the April 3, 2019 decision were resolved. It subsequently referred the case record, along with the October 6, 2021 SOAF, to Dr. Vaidya, for a second opinion. The updated SOAF specifically listed the employee’s history of surgical procedures and his numerous prescribed medications, including opioids. 18

In a May 1, 2022 report, Dr. Vaidya noted her review of the case record and the updated SOAF. She noted that it was generally known that chronic pain was a suicide risk factor and specifically opined that one of the “main factors” which caused the employee’s suicide was opiate dependance. However, Dr. Vaidya further opined that it was difficult to conclude that the employee’s death by suicide was a direct result of the accepted work-related injury.

It is well established that proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter. While the claimant has the burden of proof to establish entitlement to compensation, OWCP shares the responsibility in the development of the evidence to see that justice is done. 19 Once OWCP undertook development of the record it was required to complete development of the record by procuring medical evidence that would resolve the relevant issue in the case.20

As Dr. Vaidya’s opinion is internally inconsistent, the case shall be remanded for further development of the medical evidence.21 On remand, OWCP shall obtain a supplemental opinion from Dr. Vaidya, which clarifies whether the employee’s accepted employment-related conditions, including the employee’s history of opioid use in relation to those conditions and/or the weaning off of those medications, caused or contributed to his depression/anxiety, which led to his suicide. If Dr. Vaidya is unavailable or unwilling to provide a supplemental opinion, OWCP shall refer the case record to a new OWCP physician in the appropriate field of medicine for a second opinion regarding causal relationship.22 Following this and other such further development as deemed necessary, OWCP shall issue a de novo decision.

18
See supra note 9.
19
M.W., Docket No. 20-2052 (issued May 24, 2021); L.F., Docket No. 20-0549 (issued January 27, 2021).
20
See M.E., Docket No. 21-1058 (issued March 2, 2022); N.W., Docket No. 21-0653 (issued September 30, 2021);
J.F., Docket No. 17-1716 (issued March 1, 2018).
21
See D.T. (W.T.), Docket No. 24-0649 (issued February 3, 2025); C.C., Docket No. 18-1229 (issued March 8, 2019); S.K., Docket No. 18-0836 (issued February 1, 2019); E.D., Docket No. 17-1064 (issued March 22, 2018). 22 G.L, Docket No. 23-0584 (issued April 1, 2024); S.F., Docket No. 23-0509 (issued January 24, 2024); D.W., Docket No. 20-0674 (issued September 29, 2020).

9
CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the January 17, 2023 decision of the Office of Workers’ Compensation Programs is set aside and the case is remanded for further proceedings consistent with this decision of the Board.

Issued: May 12, 2025
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

10