United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.A., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

New York, NY, Employer 

__________________________________________ 

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Docket No. 13-2152 

Issued: March 20, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

RICHARD J. DASCHBACH, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On September 23, 2013 appellant filed a timely appeal from an April 4, 2013 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 met her burden of proof to establish that she sustained an 

injury in the performance of duty on November 16, 2010. 

FACTUAL HISTORY 

On November 17, 2010 appellant, then a 40-year-old food service worker, filed a 

traumatic injury claim (Form CA-1) alleging that on November 10, 2010 she injured the third 

 1

 5 U.S.C. § 8101 et seq. 
2

finger of her left hand when it got squeezed between the two crates in the cook tank while she 

was raising the crates to remove the meat. Appellant’s supervisor noted on the claim form that 

the injury occurred in the performance of duty. No evidence was submitted with the claim. 

By letter dated April 27, 2012, OWCP informed appellant that the evidence of record was 

insufficient to support her claim. Appellant was advised of the medical and factual evidence 

needed and was afforded 30 days to respond. No evidence was submitted. 

By decision dated May 31, 2012, OWCP denied appellant’s claim finding that a medical 

condition had not been diagnosed in connection with the accepted injury and/or event. It noted 

that no medical evidence had been received. 

By letter dated December 31, 2012, appellant requested reconsideration of OWCP’s 

decision. In an undated statement, she indicated that she injured her left middle finger herself 

while hoisting a lift to empty a tank containing a cooked product. Appellant was taken to 

Jamaica Hospital and received treatment for her injury, which included an x-ray, five stiches, a 

tetanus shot and a prescription for pain medicine. She returned to her job and reported her injury 

to the medical department, where she was told that all of the paperwork would be collected and 

submitted to workers’ compensation. Appellant indicated that she submitted all the information, 

but then started receiving bills from the hospital for payment rendered in connection with the 

services rendered. She indicated that she turned all the bills over to the medical department. 

Appellant did not realize that the medical department failed to file her workers’ compensation 

claim until she was contacted by a law firm contracted by the hospital for payment. She 

indicated that she resubmitted all the paperwork to the medical department again and her 

workers’ compensation claim was finally submitted. 

The hospital record and x-ray of appellant’s middle left finger dated November 16, 2010 

from the Jamaica Hospital Center Emergency Department was submitted. Appellant presented 

with a finger laceration, third finger, left. The history of injury provided was that, while lifting a 

pot with meat, her finger was lacerated by the pot. A diagnosis of finger laceration from the 

physician’s assistant, Nilkeshia Stephens, was provided. 

By decision dated April 4, 2013, OWCP denied modification of its prior decision. It 

found that, although a medical condition has been diagnosed in connection with the history of 

injury provided with the reconsideration request, appellant provided differing histories of injury 

on her claim form, on her reconsideration request, and to the hospital without an explanation as 

to why differing histories were provided. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of establishing the essential 

elements of his or her claim, including the fact that the individual is an employee of the United 

States within the meaning of FECA; that the claim was filed within the applicable time 

limitation; that an injury was sustained while in the performance of duty as alleged and that any 

disability or specific condition for which compensation is claimed are causally related to the 
3

employment injury.2 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.3

 

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components, which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident which is alleged to have occurred.4 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

When an employee claims that he or she sustained an injury in the performance of duty 

he or she must submit sufficient evidence to establish that he or she experienced a specific event, 

incident or exposure occurring at the time, place and in the manner alleged. He or she must also 

establish that such event, incident or exposure caused an injury.5 Once an employee establishes 

that he or she sustained an injury in the performance of duty, he or she has the burden of proof to 

establish that any subsequent medical condition or disability for work, for which he or she claims 

compensation, is causally related to the accepted injury.6 

To establish that an injury occurred as alleged, the injury need not be confirmed by 

eyewitnesses, but the employee’s statements must be consistent with the surrounding facts and 

circumstances and his or her subsequent course of action. In determining whether a case has 

been established, such circumstances as late notification of injury, lack of confirmation of injury 

and failure to obtain medical treatment may, if otherwise unexplained, cast substantial doubt on 

the employee’s statements. The employee has not met his or her burden when there are such 

inconsistencies in the evidence as to cast serious doubt on the validity of the claim.7 

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment event or incident, the employee must submit rationalized 

medical opinion evidence based on a complete factual and medical background, supporting such 

a causal relationship.8

 The opinion of the physician must be based on one of reasonable medical 

certainty and must be supported by medical rationale explaining the nature of the relationship 

between the diagnosed condition and the specific employment factors identified by the claimant. 

 2 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

3 Michael E. Smith, 50 ECAB 313 (1999). 

4 Elaine Pendleton, supra note 2 at 1143 (1989). 

5 See generally John J. Carlone, 41 ECAB 354 (1989); see also 5 U.S.C. § 8101(5) (injury defined); 20 C.F.R. 

§ 10.5(q) and (ee) (1999) (occupational disease or illness and traumatic injury defined). See Victor J. Woodhams, 41 

ECAB 345 (1989). 

6 See Elaine Pendleton, supra note 2. 

7 Betty J. Smith, 54 ECAB 174 (2002). 

8 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 
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This medical opinion must include an accurate history of the employee’s employment injury and 

must explain how the condition is related to the injury. The weight of medical evidence is 

determined by its reliability, its probative value, its convincing quality, the care of analysis 

manifested and the medical rationale expressed in support of the physician’s opinion.9

 

ANALYSIS 

 In its May 31, 2012 decision, OWCP accepted that on November 16, 2010 appellant 

injured the third finger of her left hand during the performance of her federal duties but denied 

the claim on the grounds that she did not submit any medical evidence containing a diagnosis in 

connection with the November 16, 2010 event. While it subsequently found a medical condition 

had been diagnosed, it denied modification of the May 31, 2012 decision on the basis that 

appellant provided differing histories of injuries on her claim form, to the hospital and with her 

request for reconsideration. 

 The Board finds that appellant’s descriptions of her November 16, 2010 injury on her 

claim form, to the hospital and with her request for reconsideration are consistent and do not cast 

serious doubt on the validity of the claim. On her claim form dated November 17, 2010, 

appellant indicated that on November 16, 2010 she was raising the crates in the cook tank to 

remove the meat when she injured the third finger of her left hand as her finger was squeezed 

between two crates. In the hospital emergency room report of November 16, 2010, appellant 

stated that she was lifting a pot with meat when her finger was injured or, more specifically, 

lacerated. In her reconsideration request, appellant again states that she injured her left middle 

finger while “hoisting a lift to empty a tank containing a cooked product.” Appellant 

consistently alleged that her injury to the third finger of her left hand occurred when her finger 

was squeezed between crates while lifting or raising the container containing cooked food. This 

is consistent with her duties as a food service worker. Additionally, the employing establishment 

has not contested that an injury occurred during the performance of duty on November 16, 2010. 

Thus, the Board finds that appellant’s statements regarding her November 16, 2010 injury are 

consistent. 

 While OWCP found that a medical condition has been diagnosed in connection with the 

event (i.e., a laceration), OWCP noted the diagnosis was provided by a physician’s assistant, 

Nilkeshia Stephens in the November 16, 2010 hospital record. Healthcare providers such as a 

nurse, acupuncturist, physician’s assistant and physical therapist are not defined as a physician 

under FECA. These reports do not constitute competent medical evidence to establish a medical 

condition, disability or causal relationship.10

 However, the Board notes that OWCP procedures recognize that a claim may be accepted 

without a medical report when the condition is a minor one which can be identified on visual 

 9 James Mack, 43 ECAB 321 (1991). 

10 5 U.S.C. § 8101(2); see also G.G., 58 ECAB 389 (2007); Jerre R. Rinehart, 45 ECAB 518 (1994); Barbara J. 

Williams, 40 ECAB 649 (1989); Jan A. White, 34 ECAB 515 (1983). 
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inspection, if the injury was promptly reported, no dispute exists regarding the occurrence and 

the employee has no lost time from the injury.11 

 The facts of this case establish that appellant’s lacerated finger was a minor condition 

which could be visualized. Appellant’s claim form also establishes that the injury was promptly 

reported and the employing establishment acknowledged that the injury occurred in the 

performance of duty. Furthermore, she has clarified that the claim is for medical expenses, not 

disability. The Board therefore concludes that appellant has established that she sustained a 

lacerated finger in the performance of duty on November 16, 2010. This case is remanded for 

payment of medical expenses. 

CONCLUSION 

The Board finds that appellant met her burden of proof to establish that she sustained an 

injury in the performance of duty on November 16, 2010. 

ORDER 

IT IS HEREBY ORDERED THAT the April 4, 2013 decision of the Office of 

Workers’ Compensation Programs is reversed. 

Issued: March 20, 2014 

Washington, DC 

 

 Richard J. Daschbach, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3(c) (January 2013). 

See also J.W., Docket No. 13-262 (issued April 23, 2013).