S.C. and U.S. Postal Service, Alpharetta Carrier Annex (Board decision, March 26, 2025)

ECAB final decision. The Board reversed OWCP's termination of wage-loss and medical benefits effective February 28, 2022. 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 rural carrier associate challenged the end of benefits for an accepted knee injury. OWCP had sent her for a second opinion without combining files for two injuries involving the same knee. The Board found this incomplete record could not support termination and reversed the decision.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Wage-loss and medical-benefit termination reversed.
• Key point: OWCP had to account for both related knee injury files before ending benefits.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
S.C., Appellant
)
)
and ) Docket No. 25-0349
)
Issued: March 26, 2025
U.S. POSTAL SERVICE, ALPHARETTA
)
CARRIER ANNEX, Alpharetta, GA, Employer )
__________ )

Appearances: Case Submitted on the Record
Wayne Johnson, Esq., for the appellant1
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 March 3, 2025 2 appellant, through counsel, filed a timely appeal from a September 3, 2024 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act3 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.

1
In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 2 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of the last OWCP decision. 20 C.F.R. § 501.3(e). An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. Id. at § 501.3(f). One hundred and eighty days from September 3, 2024, the date of OWCP’s latest decision, was Sunday, March 2, 2025. Because the last day of the 180-day filing period fell on a weekend, appellant had until the close of the next business day, Monday, March 3, 2025, to timely file an appeal. Id. at § 501.3(f)(2). As the Clerk of the Appellate Boards received the appeal on March 3, 2025, the appeal is timely filed. Id. 3 5 U.S.C. § 8101 et seq.
ISSUES

The issues are: (1) whether OWCP has met its burden of proof to terminate appellant’s wage-loss compensation and medical benefits, effective February 28, 2022, as she no longer had disability or residuals causally related to her accepted November 30, 2017 employment injury; and (2) whether appellant has met her burden of proof to establish continuing disability and/or residuals on or after February 28, 2022, causally related to the accepted employment injury.

FACTUAL HISTORY

On December 4, 2017 appellant, then a 32-year-old rural carrier associate, filed a notice of recurrence (Form CA-2a) under OWCP File No. xxxxxx219.4 She indicated that the recurrence began on November 30, 2017, when she felt extreme pain in her left knee while descending stairs, and that it was “the same pain” she experienced as her accepted November 18, 2015 employment injury. OWCP adjudicated the November 30, 2017 incident as a new traumatic injury claim under OWCP File No. xxxxxx122 and accepted it for tear of left medial meniscus.

On October 23, 2020 appellant underwent surgery of the left knee by Dr. John I. Foster, III, a Board-certified orthopedic surgeon, including left knee arthroscopy with plica excision. His postoperative diagnoses included hypertrophic plica, left knee, and grade 3 softening/ chondromalacia of the left knee medial femoral condyle, medial tibial plateau, and lateral tibial plateau. OWCP paid appellant wage-loss compensation for total disability on the supplemental rolls, effective October 9, 2018, and on the periodic rolls, effective November 10, 2019.

A magnetic resonance (MR) arthrogram of the left knee dated August 27, 2021 demonstrated no evidence of meniscal or ligamentous tear and no bone marrow edema.

On December 6, 2021, OWCP prepared a statement of accepted facts (SOAF), which noted that the accepted conditions for the November 30, 2017 employment injury were peripheral tear of medial meniscus and traumatic arthropathy of the left knee.

On December 7, 2021, OWCP referred the case record, a SOAF, and a series of questions to Dr. Rafael A. Lopez, a Board-certified orthopedic surgeon, for a second opinion evaluation.

In a January 15, 2022 report, Dr. Lopez reviewed the SOAF and medical record. He performed a physical examination where he observed a normal gait and station; no evidence of swelling, crepitation, instability, spasm, atrophy, or deformity; negative anterior drawer, posterior drawer, McMurray, pivot shift, and joint line tenderness tests; and normal range of motion (ROM) with flexion and extension. Dr. Lopez indicated that there were no abnormal objective or subjective findings on examination and no current diagnoses causally connected to the November 30, 2017 employment injury. He opined that the work-related conditions had resolved, and that appellant was capable of returning to work without restrictions, was not in need of any

4
Appellant previously filed a traumatic injury claim (Form CA-1) for a November 18, 2015 left knee injury, which OWCP accepted for contusion of left knee and left lower leg and left knee medial meniscus tear under OWCP File No. xxxxxx219. It granted her a schedule award of two percent permanent impairment of the left lower extremity on August 25, 2017. OWCP has not administratively combined OWCP File Nos. xxxxxx219 and xxxxxx122.

2 further medical treatment for the accepted employment injuries, and had reached maximum medical improvement (MMI).

By notice dated January 26, 2022, OWCP advised appellant that it proposed to terminate her wage-loss compensation and medical benefits based on Dr. Lopez’ opinion that the accepted employment-related conditions had ceased without residuals or disability. It afforded her 30 days to submit additional evidence or argument challenging the proposed termination.

In a medical report dated February 16, 2022, Dr. Foster noted that appellant related complaints of worsening left knee pain with episodes of giving way. He reviewed the August 27, 2021 MR arthrogram and documented physical examination findings of moderate medial joint line tenderness, full active ROM, and no instability. Dr. Foster diagnosed left knee arthritis and opined that appellant had reached MMI and had two percent permanent impairment of the left lower extremity. He released her to return to full-duty work without restrictions and prescribed a patellofemoral brace and anti-inflammatory gel.

By decision dated February 28, 2022, OWCP terminated appellant’s wage-loss compensation and medical benefits, effective that date. It found that Dr. Lopez’ opinion constituted the weight of the medical evidence, establishing that she no longer had disability or residuals causally related to the accepted November 30, 2017 employment injury.

OWCP continued to receive evidence, including a March 17, 2022 impairment rating evaluation by Dr. Robert W. Macht, a general surgeon, who diagnosed postoperative state of left knee, with medial meniscus injury. Referencing the sixth edition of the American Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides),5 he found two percent permanent impairment of the left lower extremity for a meniscal injury with minimal palpatory findings. He indicated that there was no evidence of arthritis on appellant’s current x- ray. Dr. Macht opined that she had reached MMI by March 15, 2022.

On March 30, 2022 appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review, which was held on July 5, 2022.

By decision dated August 8, 2022, OWCP’s hearing representative affirmed the February 28, 2022 termination decision.

On August 8, 2023 appellant, through counsel, requested reconsideration of OWCP’s August 8, 2022 decision.

By decision dated August 23, 2023, OWCP denied modification of its August 8, 2022 decision.

OWCP continued to receive evidence. In a September 6, 2023 medical report, Dr. Janelle Snoddy, a Board-certified anesthesiologist and pain medicine specialist, noted that appellant related complaints of pain, reduced ROM, swelling, and weakness of the left knee, which she attributed to the November 30, 2017 employment injury. She also noted the history of the November 18, 2015 employment injury and indicated that appellant had undergone a left knee MRI in 2016, which demonstrated a meniscus tear. Dr. Snoddy performed a physical examination

5
A.M.A., Guides (6 th ed. 2009).

3 and documented reduced active and passive ROM with flexion and extension of the left knee, pain with palpation of the entire knee joint, limited movement and grinding of the patella, positive varus and valgus stress tests, mild edema, and pain with strength testing. She diagnosed peripheral tear of medial meniscus, recommended x-rays and physical therapy, and released appellant to return to work with restrictions, including no more than two hours of walking and standing, no twisting, no more than 15 minutes of squatting, kneeling, or climbing, and no lifting, pushing, or pulling greater than 15 pounds.

In follow-up reports dated October 26 and November 16, 2023, Dr. Snoddy reviewed updated x-rays of the left knee dated October 12, 2023, which were unremarkable. She recommended an updated left knee MRI and continued to release appellant to return to work with the same restrictions.

On August 23, 2024 appellant, through counsel, requested reconsideration of OWCP’s August 23, 2023 decision.

By decision dated September 3, 2024, OWCP denied modification of its August 23, 2023 decision.

LEGAL PRECEDENT -- ISSUE 1

Once OWCP accepts a claim and pays compensation, it has the burden of proof to justify modification or termination of an employee’s benefits.6 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. 7 OWCP’s burden of proof includes the necessity of furnishing rationalized medical opinion evidence based on a proper factual and medical background. 8 The right to medical benefits for an accepted condition is not limited to the period of entitlement for disability. 9 To terminate authorization for medical treatment, OWCP must establish that appellant no longer has residuals of an employment-related condition, which would require further medical treatment. 10

It is OWCP’s responsibility to provide a complete and proper frame of reference for a physician by preparing a SOAF. 11 Its procedures provide that the claims examiner is responsible

6
C.F., Docket No. 21-0003 (issued January 21, 2022); J.T., Docket No. 19-1723 (issued August 24, 2020); S.P., Docket No. 19-0196 (issued June 24, 2020); S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 197 (2005); Paul L. Stewart, 54 ECAB 824 (2003). 7 S.P., Docket No. 22-0393 (issued August 26, 2022); A.T., Docket No. 20-0334 (issued October 8, 2020); E.B., Docket No. 18-1060 (issued November 1, 2018). 8 S.P., id.; C.R., Docket No. 19-1132 (issued October 1, 2020); G.H., Docket No. 18-0414 (issued November 14, 2018).
9
S.P., id.; E.J., Docket No. 20-0013 (issued November 19, 2020); L.W., Docket No. 18-1372 (issued February 27, 2019).
10
C.F., supra note 5; M.E., Docket No. 20-0877 (issued August 17, 2021); L.S., Docket No. 19-0959 (issued September 24, 2019); R.P., Docket No. 18-0900 (issued February 5, 2019). 11 D.M., Docket No. 19-0749 (issued August 19, 2019); N.W., Docket No. 16-1890 (issued June 5, 2017); K.V., Docket No. 15-0960 (issued March 9, 2016).

4 for ensuring that the SOAF is correct, complete, unequivocal, and specific. 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.12

ANALYSIS -- ISSUE 1

The Board finds that OWCP failed to meet its burden of proof to terminate appellant’s wage-loss compensation and medical benefits, effective February 28, 2022.

OWCP’s procedures provide that cases should be administratively combined when correct adjudication of the issues depends on frequent cross-referencing between case files and when two or more injuries occur to the same part of the body. 13 For example, if a new injury case is reported for an employee who previously filed an injury claim for a similar condition or the same part of the body, doubling is required. 14 Herein, appellant’s claims under OWCP File Nos. xxxxxx219 and xxxxxx122 both involve injuries to her left knee. However, OWCP had not administratively combined OWCP File Nos. xxxxxx219 and xxxxxx122 when it referred appellant to Dr. Lopez, the second opinion physician.

Once OWCP accepts a claim and pays compensation, it has the burden of proof to justify termination or modification of benefits. 15 As OWCP did not administratively combine the files prior to the termination, the Board finds that it failed to meet its burden of proof. 16

CONCLUSION

The Board finds that OWCP has failed to meet its burden of proof to terminate appellant’s wage-loss compensation and medical benefits, effective February 28, 2022.17

12
Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 (October 1990); see also R.P., Docket No. 18-0900 (issued February 5, 2019). 13 Order Remanding Case, M.J., Docket No. 22-1357 (issued June 12, 2023); Order Remanding Case, L.B., Docket No. 21-0241 (issued October 28, 2021); Federal (FECA) Procedure Manual, Part 2 -- Claims, File Maintenance and Management, Chapter 2.400.8c (February 2000). 14 Id.
15
D.G., Docket No. 19-1259 (issued January 29, 2020); S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 197 (2005); Paul L. Stewart, 54 ECAB 824 (2003).
16
Order Reversing Case, C.V., Docket No. 23-0913 (issued December 4, 2023).
17
In light of the Board’s disposition of Issue 1, Issue 2 is rendered moot.

5
ORDER

IT IS HEREBY ORDERED THAT the September 3, 2024 merit decision of the Office of Workers’ Compensation Programs is reversed.

Issued: March 26, 2025
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

6