A.D. and U.S. Postal Service, West Allis Post Office (Board decision, May 21, 2025)

ECAB remand decision. The Board set aside OWCP's decision and remanded for an impartial opinion on complex regional pain syndrome and recurrence of disability. 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 carrier technician had an accepted left-foot contusion after a pallet jack struck her foot. She sought to add complex regional pain syndrome and establish a later recurrence of disability. The Board found a conflict between the treating physician and OWCP's referral physician on those questions. It set aside OWCP's decision and ordered an impartial medical examination.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Decision set aside; additional condition and recurrence questions remanded.
• Key point: A conflict between medical opinions required an impartial examiner.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
A.D., Appellant
)
)
and ) Docket No. 25-0409
)
Issued: May 21, 2025
U.S. POSTAL SERVICE, WEST ALLIS POST )
OFFICE, West Allis, WI, Employer )
__________ )

Appearances: Case Submitted on the Record
Alan J. Shapiro, 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 24, 2025, appellant, through counsel, filed a timely appeal from a March 21, 2025 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act2 (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 expand the acceptance of the claim to include complex regional pain syndrome (CRPS), resulting in a recurrence of disability

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 5 U.S.C. § 8101 et seq. from work commencing June 6, 2020, causally related to, or consequential to, the accepted August 12, 2019 employment injury.

FACTUAL HISTORY

This case has previously been before the Board. 3 The facts and circumstances of the case as set forth in the Board’s prior order and decision are incorporated herein by reference. The relevant facts are as follows.

On August 16, 2019 appellant, then a 32-year-old carrier technician, filed a traumatic injury claim (Form CA-1) alleging that, on August 12, 2019, she sustained an injury to her left foot when a coworker pushed a hand pallet jack that struck the top of her left foot while in the performance of duty. 4 She stopped work on August 13, 2019. OWCP accepted the claim for contusion of the left foot. It paid appellant wage-loss compensation on the supplemental rolls, effective September 27, 2019. Appellant returned to full-time, full-duty work on October 26, 2019.

Beginning October 27, 2020, appellant filed claims for compensation (Form CA-7) for disability from work commencing June 6, 2020.

In an October 15, 2020 note, Dr. Robert A. Rawski, a podiatrist, diagnosed left peroneal tendinitis, stress fracture of the left foot, sinus tarsi syndrome of the left ankle, swelling of the left foot and ankle, left bunion, and left foot pain. He found that she was disabled from work.

In a November 4, 2020 development letter, OWCP informed appellant that the evidence of record was insufficient to establish her disability claim. It advised her of the type of additional factual and medical evidence needed and afforded 30 days to submit the necessary evidence .

OWCP subsequently received additional evidence. In a report dated September 1, 2020, Dr. Rawski diagnosed left foot pain and stress fracture of the metatarsal bone on the left foot. He related that he had prescribed physical therapy on January 23 and May 21, 2020.

In a letter dated November 2, 2020, appellant, through counsel, requested that OWCP expand the acceptance of her claim to include left peroneal tendinitis, stress fracture of the metatarsal bone of the left foot, sinus tarsi syndrome of the left ankle, swelling of the left ankle joint, and swelling of the left foot.

In treatment notes dated October 15, 2020, Dr. Rawski diagnosed peroneal tendinitis, stress fracture of the metatarsal bone of the left foot sinus tarsi syndrome of the left ankle, left sinus tarsi syndrome, tendinitis, and opined that appellant was totally disabled from work through

3
Docket No. 24-0770 (issued October 22, 2024); Order Remanding Case, Docket No. 22-0147 (issued July 1, 2022).
4
OWCP assigned the present claim OWCP File xxxxxx713. Appellant has a prior traumatic injury claim (Form CA-1) under OWCP File No. xxxxxx993, wherein she alleged that she sprained her left lower leg on March 25, 2019 when walking on an uneven surface while in the performance of duty.

2
October 20, 2020. In treatment notes dated November 10, 2020, he also diagnosed possible CRPS following fracture, and opined that appellant was disabled from work through December 1, 2020.

Dr. Rawski prescribed physical therapy. Commencing November 11, 2020 appellant sought treatment from Melissa Post, a physical therapist.

In a November 12, 2020 report, Dr. Rawski recounted that he had initially examined appellant due to her alleged March 25, 2019 employment injury, that he examined x-rays, and diagnosed stress fracture of the fourth metatarsal, which was likely missed on her original March 28, 2019 films. He noted that she had described the injury as occurring when she stepped on uneven ground causing her left foot to invert. Dr. Rawski opined that the body’s physiologic response was likely to aggressively evert the foot to bring it back to neutral, which likely caused an unbalance to the muscle/tendon/ligament tension relationship and was too much stress for the distal fourth metatarsal, causing fracture. He then treated appellant on August 27, 2019 following the accepted August 12, 2019 employment injury and found that this incident likely irritated the already fragile and healing stress fracture of the fourth metatarsal of the left foot. Dr. Rawski related that, on May 21, 2020, appellant reported improvement with physical therapy; however, on October 15, 2020 she experienced increased pain resulting in diagnoses of possible peroneal tendinitis and sinus tarsi syndrome “most likely from favoring the foot secondary to pain from the injury.” He reviewed his November 10, 2020 notes and indicated that CRPS was possible due to her hypersensitivity to normal stimuli in her left lower extremity. Dr. Rawski reported that this condition could develop following an injury.

Dr. Rawski completed a December 1, 2020 note, finding that she was disabled from work.

In a December 16, 2020 development letter, OWCP notified appellant that her claim for compensation implicated a recurrence of disability commencing June 19, 2020. It advised her of the type of additional factual and medical evidence needed and provided a questionnaire for her completion. OWCP afforded appellant 30 days to respond.

In a separate development letter also dated December 16, 2020, OWCP requested a supplemental opinion from Dr. Rawski.

In a December 23, 2020 response, Dr. Rawski related appellant’s symptoms of pain in the left ankle and at the area of the previous stress fracture. He reported findings of mild edema to the sinus tarsi and fifth metatarsal base area and direct pain on palpation to the distal course of the peroneal tendons and sinus tarsi. Dr. Rawski opined that, due to the close proximity of the previously fractured fourth metatarsal appellant “compensated biomechanically by inverting her left foot and putting more pressure on the lateral column and lateral aspect of the subtalar joint causing sinus tarsi syndrome, swelling of the left ankle, swelling of the foot, and irritation to the peroneal tendons.” He again explained how the March 25, 2019 employment incident resulted in the fourth metatarsal fracture as described in his November 12, 2020 report. Dr. Rawski opined that the August 12, 2019 employment incident was a substantial factor in aggravation beyond the normal progression the preexisting condition of fourth metatarsal stress fracture.

In a December 29, 2020 note, Dr. Rawski advised that appellant was totally disabled from December 29, 2020 through January 19, 2021. In a separate note of even date, he opined that she was totally disabled and diagnosed stress fracture of metatarsal bone of the left foot, sinus tarsi

3 syndrome of the left ankle, posterior tibial tendinitis of the left lower extremity left peroneal tendinitis, left bunion, and CRPS type 1 of the left lower extremity.

On January 5, 2021, appellant completed OWCP’s development questionnaire and reported that she was in pain with irritation, swelling, and stiffness when standing or walking.

By decision dated January 21, 2021, OWCP denied appellant’s claim for a recurrence of disability, commencing June 19, 2020, causally related to her August 16, 2019 employment injury.

On January 26, 2021, appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review.

OWCP continued to receive medical evidence. In a series of notes dated January 14 through 27 2021, Dr. Rawski opined that appellant was totally disabled from work during the period December 29, 2020 through February 1, 2021.

On January 21, 2021, appellant underwent electromyogram and nerve conduction velocity (EMG/NCV) studies.

Dr. Neal Pollack, an osteopath, Board-certified in neurology, completed a January 21, 2021 report and diagnosed left ankle sprain, left lower extremity neuropathy, and contusion of the left foot as a result of the August 12, 2019 employment injury.

In a narrative dated January 26, 2021, Dr. Rawski reviewed appellant’s diagnostic studies and found them abnormal. On physical examination, he related that she was experiencing electric- type pain moving up toward the thigh from the left outside ankle, mild edema to the sinus tarsi on the left and to the proximal lateral column on the left, and mild pain to palpation along the posterior tibial tendon, sinus tarsi, and anterior left ankle. Dr. Rawski diagnosed CRPS type 1 of the left lower extremity, abnormal peripheral nerve study, stress fracture of the metatarsal bone of the left foot, peroneal tendinitis, sinus tarsi syndrome, and posterior tibial tendinitis of the left lower extremity. He prescribed additional physical therapy.

Appellant underwent a January 29, 2021 left foot magnetic resonance imaging (MRI) scan, which demonstrated marrow edema in the medial aspect of the distal head of the first metatarsal suggesting joint arthropathy, tendinopathy of the peroneus brevis tendon without definite tear, mild edema and fluid in the sinus tarsi, and a small ganglion dorsal to the proximal pole lateral cuneiform.

On February 26, 2021, Dr. Rawski released appellant to perform modified-duty work four hours a day through March 23, 2021.

By decision dated March 31, 2021, OWCP expanded the acceptance of appellant’s claim to include temporary aggravation of a fracture of the fourth metatarsal of the left foot.

OWCP continued to receive medical evidence. Beginning April 22, 2021, Dr. Jennifer N.
Kopfstein, a Board-certified physiatrist, prescribed physical therapy.

A hearing was held on May 10, 2021.

4
By decision dated July 27, 2021, OWCP’s hearing representative affirmed OWCP’s January 21, 2021 decision.

On November 8, 2021, appellant, through counsel, appealed to the Board. By order dated July 1, 2022, the Board set aside the July 27, 2021 decision and directed OWCP to administratively combine OWCP File Nos. xxxxxx993 and xxxxxx713, followed by a de novo decision.5 On remand, OWCP administratively combined the files, with OWCP File No. xxxxxx713 designated as the master file.

Appellant continued to file Form CA-7 claims for wage-loss compensation.

In a December 28, 2021 report, Dr. Jeffrey S. Quintana, a Board-certified anesthesiologist, examined appellant and related that she had a two-year history of a work-related injury which resulted in left lower extremity CRPS. On January 18, 2022, he performed a left-sided lumbar sympathetic block.

On September 13, 2022, Dr. Kopfstein found that appellant was totally disabled from work for the period September 14 through 15, 2022 due to pain and swelling in her left foot.

By de novo decision dated October 27, 2022, OWCP again denied appellant’s claim for a recurrence of disability commencing June 19, 2020, finding that the medical evidence of record was insufficient to establish disability from work during the claimed period causally related to the accepted August 12, 2019 employment injury.

On November 1, 2022, appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review. A hearing was held on May 17, 2023.

OWCP continued to receive medical evidence. In notes dated January 18, 2022 through February 9, 2023, Dr. Quintana diagnosed left lower extremity CRPS and neurogenic pain of the left foot. He described appellant’s March 25, 2019 employment injury of stepping on an uneven surface resulting in a stress fracture of the fourth metatarsal and also reviewed her August 12, 2019 accepted employment injury. Dr. Quintana opined that the August 2019 injury resulted in her diagnosed condition.

On September 13, 2022, Dr. Kopfstein examined appellant and reviewed January 23, 2020 left foot x-rays studies and a January 29, 2021 left foot MRI scan which demonstrated a posterior calcaneal enthesophyte, marrow edema in the medial aspect of the distal head of the first metatarsal, a small osteophyte, a small lobulated ganglion, tendinopathy of the peroneus brevis, and mild edema and fluid in the sinus tarsi. She released appellant to return to full-time modified- duty work on November 29, 2022.

Dr. Quintana completed a June 29, 2023 report and recounted that appellant’s left foot was impacted by a pallet jack while at work. He related her history of medical treatment and provided findings on physical examination, including color and temperature changes of the left lower

5
Order Remanding Case, Docket No. 22-0147 (issued July 1, 2022).

5 extremity along with pain and hypersensitivity, which supported a diagnosis of CRPS type 1. Dr. Quintana opined that this condition was “from the work-related injury.”

By decision dated July 17, 2023, OWCP’s hearing representative set aside the October 27, 2022 OWCP decision and remanded the case for further development of the medical evidence regarding whether appellant sustained CRPS as causally related to the August 12, 2019 employment injury, and whether she sustained a recurrence of employment-related disability commencing June 19, 2020.

On August 14, 2023, OWCP referred appellant, along with the medical record, a statement of accepted facts (SOAF), and a series of questions to Dr. Mysore S. Shivaram, a Board-certified orthopedic surgeon, for a second opinion examination to determine the nature and extent of appellant’s work-related conditions, treatment plan, and to address expansion of the acceptance of the claim.

In an August 30, 2023 report, Dr. Shivaram noted his review of the SOAF and the medical record, and listed appellant’s symptoms, including pain, swelling, achiness, tingling, numbness, and burning from the left foot to the left knee. He found no signs of CRPS on clinical examination, noting that she had normal skin color and temperature in the lower extremities with no trophic changes. Dr. Shivaram determined that there was no correlation between the August 12, 2019 employment injury and the diagnosis of CRPS 1. He noted that the medical records indicated that appellant had vague complaints of persistent pain with no associated f indings recorded by her treating physicians to suggest the presence of CRPS 1. Dr. Shivaram determined that the accepted employment injury had resolved with no need for further treatment and that appellant was capable of returning to her date-of-injury position. Regarding whether she was disabled from work beginning June 19, 2020, he indicated that appellant had primarily sustained a left foot contusion and sprain, which should have healed within four months. Dr. Shivaram noted that she had continued to complain of pain, but clinical examinations revealed no definite findings. He related that he was “unable to explain the reason for her disability beginning June 19, 2020 approximately 10 months following the reported injury at work.”

In an October 23, 2023 development letter, OWCP advised appellant of the additional factual and medical evidence necessary to warrant expansion of the acceptance of the claim to include CRPS, and provided a list of questions for her physician. It afforded her 30 days to respond.

On October 27, 2023, Dr. Shivaram provided a supplemental report addressing whether the condition of temporary aggravation of stress fracture of the fourth metatarsal of the left foot had resolved. He opined that stress fractures were minor injuries of the foot, which under normal circumstances should have completely healed within four months.

Dr. Quintana completed a November 2, 2023 report and related that appellant sustained a work-related injury to her left lower extremity on August 12, 2019. He diagnosed CRPS type 1 based on her continued left lower extremity symptoms of pain, swelling, color and temperature changes, and hypersensitivity. Dr. Quintana opined that the CRPS diagnosis was related to the initial injury that occurred at work on August 12, 2019, and that she received significant relief with lumbar sympathetic blocks. He related that her improvement with the lumbar sympathetic block suggested a sympathetic component to her pain.

6
On November 14, 2023, OWCP requested a supplemental report from Dr. Shivaram addressing the findings of Dr. Quintana’s November 2, 2023 report.

In a November 20, 2023 supplemental opinion, Dr. Shivaram related that his prior opinion remained unchanged.

By decision dated December 29, 2023, OWCP denied expansion of the acceptance of the claim to include CRPS as causally related to the August 12, 2019 employment injury.

By decision dated January 2, 2024, OWCP denied appellant’s recurrence claim, finding that the medical evidence of record was insufficient to establish a recurrence of disability commencing June 6, 2020, causally related to the accepted August 12, 2019 employment injury.

On January 9, 2024, appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review regarding the December 29, 2023 denial of expansion.

On January 18, 2024, appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review regarding the January 2, 2024 denial of recurrence.

A hearing regarding both issues was held on April 5, 2024.

By decision dated June 18, 2024, OWCP’s hearing representative affirmed both the December 29, 2023 decision regarding expansion and the January 2, 2024 decision regarding recurrence.

Appellant, through counsel, appealed the June 18, 2024 OWCP hearing representative’s decision to the Board. By decision dated October 22, 2024, the Board affirmed OWCP’s June 18, 2024 decision. 6

On January 7, 2025, OWCP referred appellant, along with a SOAF, the medical record, and a series of questions, to Dr. Joshua Alpert, a Board-certified orthopedic surgeon, for a second opinion evaluation. It requested that he provide an assessment of her work-related condition and any resulting permanent impairment.

In a January 21, 2025 report, Dr. Alpert related appellant’s history of injury on August 12, 2019 and her preexisting left foot stress fracture in March 2019. He related that she was diagnosed with CRPS and her ongoing treatment for this condition. On physical examination, Dr. Alpert found pain over the fourth and fifth metatarsals into her heel with no numbness or tingling and full range of motion. He determined that there were no skin changes, no redness, warmth, swelling, deformity or cold temperature changes. Dr. Alpert reviewed the SOAF and the medical records noting that the claim had been denied for type 1 CRPS. He determined that appellant’s left foot metatarsal stress fracture and left foot contusion symptoms had completely resolved with no

6
Docket No. 24-0770 (issued October 22, 2024).

7 permanent impairment. Dr. Alpert related that appellant reported subjective complaints of pain without objective findings.

On February 19, 2025, OWCP expanded the acceptance of the March 25, 2019 employment injury for sprain of the tarsometatarsal ligament of the left foot and stress fracture of the fourth metatarsal of the left foot.

On March 5, 2025, appellant, through counsel, requested reconsideration. In support thereof, counsel submitted a report by Dr. Junaid Makda, a Board-certified orthopedic surgeon, dated December 27, 2024.7

In his December 27, 2024 report, Dr. Makda reviewed the SOAF and medical records. He described the accepted employment injury and noted that appellant had been diagnosed with CRPS. Dr. Makda performed a physical examination and diagnosed CRPS. He noted that she injured her ankle and that while the mechanism of injury was unclear it resulted in CRPS which was also diagnosed by the pain management physician. Dr. Makda related that treatment for CRPS had been successful in alleviating some of her symptoms. He explained that the original injury was an inversion injury to the ankle, which had resolved. Dr. Makda reported that appellant’s current condition was CRPS, that she was unable to perform her date -of-injury position as she could walk for two hours a day and work for eight hours a day. He deferred to the pain management physician as he did not treat CRPS. Dr. Makda completed a work capacity evaluation (Form OWCP-5c) and indicated that appellant could perform sedentary or light strength level work with restrictions on walking and standing of two hours a day.

By decision dated March 21, 2025, OWCP denied modification. It found that the medical evidence was insufficient to establish expansion of the acceptance of the claim to include CRPS, resulting in a recurrence of disability from work commencing June 6, 2020, causally related to, or consequential to, the accepted August 12, 2019 employment injury.

LEGAL PRECEDENT

Where an employee claims that a condition not accepted or approved by OWCP was due to an employment injury, he or she bears the burden of proof to establish that the condition is causally related to the employment injury. 8

The claimant bears the burden of proof to establish a claim for a consequential injury.9 As part of this burden, he or she must present rationalized medical opinion evidence, based on a

7
The Board notes that OWCP referred appellant to Dr. Makda under OWCP File No. xxxxxx993 to determine whether the claimed work injury or factors of employment under that claim file caused or contributed to a diagnosed medical condition. However, under the present claim Dr. Makda served as a treating physician as his opinion was requested by counsel. 8 See A.M., Docket No. 22-0707 (issued October 16, 2023); V.P., Docket No. 21-1111 (issued May 23, 2022); S.B., Docket No. 19-0634 (issued September 19, 2019); Jaja K. Asaramo, 55 ECAB 200, 204 (2004). 9 J.P., Docket No. 23-0975 (issued April 25, 2024); S.S., Docket No. 21-1140 (issued June 29, 2022); V.K., Docket No. 19-0422 (issued June 10, 2020); A.H., Docket No. 18-1632 (issued June 1, 2020); I.S., Docket No. 19-1461 (issued April 30, 2020).

8 complete factual and medical background, establishing causal relationship.10 The opinion of the physician must be expressed in terms of a reasonable degree of medical certainty, and must be supported by medical rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s employment injury. 11

When an injury arises in the course of employment, every natural consequence that flows from that injury likewise arises out of the employment, unless it is the result of an independent intervening cause attributable to the claimant’s own intentional misconduct. 12 The basic rule is that, a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is compensable if it is the direct and natural result of a compensable primary injury. 13

Causal relationship is a medical question that requires rationalized medical opinion evidence to resolve the issue. 14 A physician’s opinion on whether there is causal relationship between the diagnosed condition and the accepted employment injury must be based on a complete factual and medical background. 15 Additionally, the physician’s opinion must be expressed in terms of a reasonable degree of medical certainty, and must be supported by medical rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s employment injury. 16

A recurrence of disability means an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition, which resulted from a previous compensable injury or illness and without an intervening injury or new expos ure in the work environment.17 This term also means an inability to work because a light-duty assignment made specifically to accommodate an employee’s physical limitations, and which is necessary because of a work-related injury or illness, is withdrawn or altered so that the assignment exceeds the employee’s physical limitations. A recurrence does not occur when such withdrawal occurs for reasons of misconduct, nonperformance of job duties, or a reduction -in-force.18 An employee who claims a recurrence of disability due to an accepted employment-related injury has the burden of

10
J.P., id.; F.A., Docket No. 20-1652 (issued May 21, 2021); E.M., Docket No. 18-1599 (issued March 7, 2019);
Victor J. Woodhams, 41 ECAB 345 (1989).
11
J.P., id.; M.M., Docket No. 20-1557 (issued November 3, 2021); M.V., Docket No. 18-0884 (issued December 28, 2018).
12
J.P., id.; R.C., Docket No. 19-0845 (issued February 3, 2020); A.F., Docket No. 19-0054 (issued June 12, 2019).
13
Id.
14
E.M., supra note 10; Robert G. Morris, 48 ECAB 238 (1996).
15
M.V., supra note 11; Victor J. Woodhams, supra note 10.
16
Id.
17
20 C.F.R. § 10.5(x); see J.D., Docket No. 18-1533 (issued February 27, 2019).
18
Id.

9 proof to establish by the weight of the substantial, reliable, and probative evidence that the disability for which he or she claims compensation is causally related to the accepted injury. 19

Section 8123(a) of FECA provides, in pertinent part: “If there is disagreement between the physician making the examination for the United States and the physician of the employee, the Secretary shall appoint a third physician (known as a referee physician or an impartial medical examiner (IME) who shall make an examination.”20 This is called an impartial medical examination and OWCP will select a physician who is qualified in the appropriate specialty and who has no prior connection with the case. 21 When there exist opposing medical reports of virtually equal weight and rationale and the case is referred to an IME for the purpose of resolving the conflict, the opinion of such specialist, if sufficiently well rationalized and based upon a proper factual background, must be given special weight. 22

ANALYSIS

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

Preliminarily, the Board notes that it is unnecessary to consider the evidence appellant submitted prior to the issuance of OWCP’s June 18, 2024 decision because the Board considered that evidence in its October 22, 2024 decision. Findings made in prior Board decisions are res judicata absent any further review by OWCP under section 8128 of FECA. 23

Dr. Shivaram determined, in his August 30, 2023 report, that there was no correlation between the August 12, 2019 employment injury and the diagnosis of CRPS 1. Regarding whether she was disabled from work beginning June 19, 2020, he indicated that appellant had primarily sustained a left foot contusion and sprain, which should have healed within four months. Dr. Shivaram noted that she had continued to complain of pain, but clinical examinations revealed no definite findings. He related that he was “unable to explain the reason for her disability beginning June 19, 2020 approximately 10 months following the reported injury at work.” Dr. Shivaram repeated his findings in his supplemental reports of October 27 and November 20, 2023.

In his December 27, 2024 report, Dr. Makda provided a physical examination and diagnosed CRPS. He noted that appellant injured her ankle and that while the mechanism of injury was unclear it had resulted in CRPS. Dr. Makda reported that appellant’s current condition was CRPS, that she was unable to perform her date-of-injury position but could work for eight hours a

19
J.D., Docket No. 18-0616 (issued January 11, 2019); see C.C., Docket No. 18-0719 (issued November 9, 2018).
20
5 U.S.C. § 8123(a).
21
20 C.F.R. § 10.321; P.B., Docket No. 20-0984 (issued November 25, 2020); R.C., 58 ECAB 238 (2006).
22
See W.N., Docket No. 21-0123 (issued December 29, 2021); A.G., Docket No. 21-0315 (issued December 29, 2021); R.R., Docket No. 19-0086 (issued February 10, 2021); Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. Godfrey, 52 ECAB 486 (2001); James P. Roberts, 31 ECAB 1010 (1980). 23 J.H., Docket No. 22-0981 (issued October 30, 2023); G.W., Docket No. 22-0301 (issued July 25, 2022); C.H., Docket No. 19-0669 (issued October 9, 2019); Clinton E. Anthony, Jr., 49 ECAB 476, 479 (1998).

10 day performing sedentary or light strength level work with restrictions on walking and standing of two hours a day.

As noted above, if there is a disagreement between an employee’s physician and an OWCP referral physician, OWCP will appoint an IME who shall make an examination. 24 The Board finds that a conflict in medical opinion exists between Dr. Shivram and Dr. Makda regarding whether the acceptance of appellant’s claim should be expanded to include CRPS, resulting in a recurrence of disability from work commencing June 6, 2020, causally related to, or consequential to, the accepted August 12, 2019 employment injury. 25

The case must, therefore, be remanded for OWCP to refer appellant to an IME for resolution of the conflict in medical opinion evidence in accordance with 5 U.S.C. § 8123(a).26 After this and other such further development as deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

24
See R.R., Docket No. 25-0090 (issued January 31, 2025); E.B., Docket No. 23-0169 (issued August 24, 2023);
S.S., Docket No. 19-1658 (issued November 12, 2020); C.S., Docket No. 19-0731 (issued August 22, 2019). 25 See R.R., id.; D.W., Docket No. 24-0157 (issued March 26, 2024); S.T., Docket No. 21-0906 (issued September 2, 2022); S.M., Docket No. 19-0397 (issued August 7, 2019).
26
Y.M., Docket No. 23-0091 (issued August 4, 2023); V.B., Docket No. 19-1745 (issued February 25, 2021).

11
ORDER

IT IS HEREBY ORDERED THAT the March 21, 2025 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 21, 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

12