healed. In an attachment to the CA-2a, appellant indicated that on February 10, 1986 she returned to work at her position of a warehouseman. Appellant indicated that the conditions she worked in were extremely cold and drafty and she stated that due to her disabilities she could not perform all her duties under these circumstances. Appellant noted that in March 1986 she was transferred to a forklift operator position, but could not perform those duties either. She noted that she was next offered the position of elevator operator at a lower grade level. Appellant also indicated that she had previously injured her right shoulder at work. Appellant also indicated that during the intervening period she was out of work for one year and 10 days, and could not perform any strenuous duties. The supervisor's report on the CA-2a indicated that when appellant returned to work she was provided with limited duty because of her physical restrictions due to her back and knee injuries. The supervisor added that appellant believed that the environmental conditions encountered upon returning to work caused complications to her recovery. The supervisor noted that appellant was unable to meet the full physical requirements of her position as a warehouseman and consequently on June 8, 1986 was transferred to the position of elevator operator at a lower grade level, but retaining the same pay level. In another attachment to the CA-2a, an employee relations assistant indicated that appellant had informed her that she believed her present condition was related to the original employment since she never had any problems in her back or legs until she was injured on the job. Appellant also indicated that her physical condition got better, but that she has never been the same since the injury and that cold weather conditions caused her pain and stiffness.

On March 16, 1988 the Office medical adviser again reviewed the medical evidence and stated that there was a gap of two years from the May 2, 1984 injury to the March 3, 1986 surgery on appellant's right knee. Further, he noted that the operative diagnosis was chondromalacia which is a degenerative developmental process commonly present in everyone 25 years and older. The Office medical adviser stated that appellant's current diagnosis was chondromalacia and that the medical evidence of record did not establish that appellant's condition was due to factors of appellant's employment or caused or aggravated by her employment injury of May 2, 1984. The Office medical adviser added that the medical evidence of record did not establish that appellant's continuing disability was due to the May 2, 1984 injury.

By compensation order dated September 30, 1988 the Office denied appellant's claim for recurrence of her employment disability due to injury on the basis that appellant failed to establish by reliable, probative and substantial medical evidence that her condition subsequent to October 11, 1984 was causally related to her May 2, 1984 work injury. In an attached memorandum, the Office noted that appellant failed to support her contention that her knee surgery of March 3, 1986 was causally related to the May 2, 1984 employment injury.

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

The Office by memorandum dated October 24, 1986 vacated its decision dated December 5, 1984 denying appellant's claim on the grounds "that it has not been established that the claimant sustained a personal injury while in the performance of duty" and accepted the claim for "contusion right knee" and referred the claim for "further development regarding the claimant's request for permanent impairment rating of the right knee."

The above memorandum did not indicate or address a specific period of disability aside from authorizing continuation of pay from May 2, 1984 through May 14, 1984, lost wages, whether there were residuals of the employment injury, or whether appellant returned to work following the injury despite the passage of approximately two and one-half years. The Board notes that once the Office accepts an employment-related injury and, as in the instant case, authorizes continuation of pay for the period May 2 through May 14, 1984 based on temporary total disability it has the burden of establishing that disability ceased or was no longer causally related to the employment injury.1 The Office has not produced any evidence that disability ceased in this case. Thus, the Office has not met its burden of proof with respect to terminating benefits in this case. The Board further notes that section 8103 of the Act, 5 U.S.C. § 8103, provides as follows:

"(a) 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 the Secretary of Labor considers likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation. These services, appliances, and supplies shall be furnished—

'James R. Dorris, 30 ECAB 979 (1979).

'(1) whether or not disability has arisen:

'(2) notwithstanding that the employee has accepted or is entitled to receive benefits under subchapter III of chapter 83 of this title or another retirement system for employees of the Government; and

'(3) by or on the order of United States medical officers and hospitals, or, at the employee's option, by or on order of physicians and hospitals designated or approved by the Secretary.'

"The employee may initially select a physician to provide medical services, appliances, and supplies, in accordance with such regulations and instructions as the Secretary considers necessary.

Because the Office accepted that appellant was injured in the performance of duty, it must determine what services rendered by appellant's treating physicians are compensable under the above section of the Act. This includes whether the surgery performed on appellant's knee is causally related to the accepted injury and was a reasonable and accepted means of treating the employment-related injury.

The Board notes that the Office did not definitively address the date appellant returned to work following her employment injury; whether she returned to her regular job or a light-duty job; whether there were subsequent periods of disability and whether there was a job reassignment or loss of wage-earning capacity or wages at any time due to the accepted injury. In this connection, the Board further notes that the Office by letter dated January 25, 1988 requested appellant to "please file form CA-2a.” In filing the foregoing form on January 27, 1988 appellant stated under item number 9, date and hour of recurrence, that her accepted injury "never healed." The official superior who signed this form stated:

"When returned to work, employee was handicapped from performing the full function of her usual duties. She was provided light duty due to her limitations. These limitations were due to her injured back and legs. Employee believes that the environmental conditions caused complications in any full recovery. Employee was unable to meet the full requirements of her position and therefore was changed to a lower grade with pay retention from the position of warehouse worker WG-5 to an El

evator Operator WG-1. This change was effective on 8 June 1986."

In view of the Board's finding that the Office has not met its burden of showing that disability ceased following the initial period of disability accepted by the Office as well as the unadjudicated items referenced in the issue portion of this decision, the case must be remanded to the Office for further action.2

The decision of the Office of Workers' Compensation Programs dated September 30, 1988 is hereby reversed and the case is remanded for further action consistent with this decision of the Board.

"The Board notes that appellant, by her new representative, submitted medical evidence to the Board. Such evidence was not before the Office at the time of its September 30, 1988 decision and therefore may not be reviewed by the Board at this time. Appellant may submit this evidence to the Office for consideration on remand of the case record. 20 C.F.R. § 501.2(c).

In the Matter of WILLIAM A. COUCH and DEPARTMENT OF THE ARMY, Dugway Proving Grounds, Utah

Docket No. 89-1910; Submitted on the Record;
Issued March 23, 1990

Before MICHAEL J. WALSH, GEORGE E. RIVERS,
WILLIE T.C. THOMAS

The issue is whether appellant sustained a back injury in the performance of duty on June 5, 1988 as alleged.

On October 4, 1988, appellant, then a 47-year-old security guard, filed a notice of traumatic injury and claim for compensation, (Form CA-1), alleging that on June 5, 1988 he injured his lower back while "stooping down to retrieve weapons from drawers." Appellant returned to work on light duty in February 1989. The employing establishment did not controvert the claim.

On the attending physician's form report, appellant's physician, Dr. Mark V. Reichman, a resident neurosurgeon at the Veterans Administration Medical Center in Salt Lake City, Utah, indicated that appellant was first examined on June 6, 1988. Attached to the form report were various clinical notes and medical reports. In a report dated June 6, 1988, appellant's attending physician indicated that he examined appellant on that date and reported appellant was ambulatory and noted "chronic lower back pain" under history

of injury. A notation dated June 24, 1988 indicated that appellant has had chronic back pain "20 years since an injury in Vietnam— no recent injury. Pain present upon awakening one morning." Dr. Reichman also stated that appellant was "100 percent temporarily disabled" from work until his condition resolved, either with bed rest or surgery if necessary. Appellant underwent a myelogram on September 13, 1988 and was temporarily disabled. The radiologic report indicated a mild anular bulge at L4-5 and “some narrowing of the L5-S1 disc space which could be either developmental or secondary to degenerative disease. There is calcification in the aorta. Otherwise normal."

By letter dated November 1, 1988, the Office of Workers' Compensation Programs requested appellant provide additional factual and medical information, including a narrative medical report. In a letter received by the Office on December 6, 1988, appellant responded, stating that he had an earlier injury to his lower back in 1965 while in military service, and stating he had not yet incurred any medical bills because his care was being provided by the Veterans Administration Medical Center at no cost to him.

In a narrative report received by the Office on November 7, 1988, Dr. W.L. Craddock, an internist at the Veterans Administration Medical Center, reported that he had examined appellant on July 14, 1988. Dr. Craddock noted the history of injury was related to a 1965 lower back injury for which appellant "was hospitalized at the Army Field Hospital in Quinhon, Vietnam for two to three weeks" and noted appellant told him "They placed me in traction and a brace. I am sure they did x-rays." Dr. Craddock noted that appellant was returned to full duty in 1967 and his medical file indicated that an examination of appellant in 1967 at Fort Lewis, Washington stated that appellant was in excellent health, but appellant was treated for back pain again in 1969. Appellant was admitted to the Veterans Administration Medical Center in Salt Lake City, Utah in 1986 for "chronic back pain with sudden onset of acute exacerbations of the pain." Dr. Craddock stated:

"[Appellant's] evaluations here in September 1986 indicated that the back pain localized to the lower back without radiation, muscle weakness, numbness or bowel or bladder disturbances. Apparently, he was able to go back to work as a recording on September 29, 1986 indicated 'the pain is resolving.' At the present time he is on sick leave from a security job where he works at [the employing establishment]. He has been seen again here in June 1988 on two occasions as he has had recur