United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.T., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Clarksville, AR, Employer 

__________________________________________ 

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Docket No. 14-48 

Issued: March 25, 2014 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

RICHARD J. DASCHBACH, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JURISDICTION 

On October 16, 2013 appellant, through his attorney, filed a timely appeal from an 

August 7, 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 his burden of proof to establish his herniated lumbar 

discs at L4-5 and L5-S1 were causally related to a January 4, 2012 employment incident. 

On appeal, appellant’s attorney asserts that the August 7, 2013 decision is contrary to fact 

and law because it ignores hearing testimony and probative medical evidence from attending 

physicians. 

 1

 5 U.S.C. §§ 8101-8193. 
2

FACTUAL HISTORY 

On January 9, 2012 appellant, then a 33-year-old city carrier (transitional employee) filed 

a traumatic injury claim alleging that on January 4, 2012 he sustained an injury to his low back 

when he tripped going up steps while delivering mail. He stopped work that day. 

An OWCP Form CA-16, authorization for examination, dated January 9, 2012, indicated 

that appellant was authorized to receive office and/or hospital treatment as medically necessary 

for the effects of the injury. 

A Yell County, Arkansas emergency medical services (EMS) report dated January 4, 

2012 indicates that a call was received at 12:55 p.m. The paramedic assessment provided a 

history that appellant stepped off a step and heard a pop in his back and indicated that he was 

upset, crying and complaining of lumbar pain when EMS arrived.2 Appellant was stabilized and 

transported to River Valley Medical Center. The emergency department report indicates that he 

was admitted at 1:30 p.m. on January 4, 2012. Dr. Robin Goodman, a Board-certified 

pediatrician, noted a history that appellant almost fell and heard a pop in his back. He noted a 

past history of back injury and chronic back pain and that he had had similar symptoms 

previously. Physical examination demonstrated back muscle spasm. A lumbar spine x-ray was 

negative. Dr. Goodman diagnosed lumbosacral strain and appellant was discharged with 

medication at 3:00 p.m. 

In a January 5, 2012 report, Dr. Darin K. Wilbourn, an attending Board-certified 

physiatrist, noted that appellant returned for follow-up evaluation of chronic lower back pain and 

bilateral lower extremity radiculitis. He indicated that appellant had a mid-line disc protrusion at 

L5-S1 and a bulging disc at L4-5 without compression on the thecal sac. Dr. Wilbourn reported 

a history that while delivering mail the previous day appellant sneezed as she was walking down 

stairs, tripped and jarred his lower back; he then hobbled back to the mail truck and was then 

taken to River Valley Medical Center by ambulance. He advised that appellant was in distress 

secondary to increased pain in his lower back and into his left hip and leg. Physical examination 

demonstrated positive straight leg raises bilaterally and tenderness to palpation across the lower 

back. Dr. Wilbourn next saw appellant on January 11, 2012 when he reiterated his findings and 

performed an L5-S1 epidural steroid injection. He advised that she could not perform his regular 

work. On January 18, 2012 Dr. Wilbourn advised that appellant could return to work and 

recommended a magnetic resonance imaging (MRI) scan study of the lumbar spine. 

Appellant returned to full time, full duty on January 27, 2012. Dr. Wilbourn continued to 

submit reports describing her physical findings.3

 On March 27, 2012 he advised that appellant 

was unable to work. 

The employing establishment controverted the claim and provided medical reports from 

Dr. Wilbourn dated May 4 to October 6, 2011. In the May 4, 2011 report, Dr. Wilbourn reported 

 2

 The signatures of the paramedics are illegible. 

3

 The record also contains emergency department reports from Johnson Regional Medical Center dated 

February 14 and 15, 2012. The record indicates that OWCP is adjudicating this under a separate claim. 
3

that appellant had been referred with a history of chronic low back pain that had occurred off and 

on for the past three years. He noted that in addition to work as a mail carrier, she also worked 

in environmental services at a hospital. Dr. Wilbourn reported that appellant had an MRI scan 

study on April 18, 2011 that demonstrated a bulging disc at L4-5 and a mid-line disc protrusion 

at L5-S1 without compression on the thecal sac or displacement of the exiting nerve roots. 

Physical examination demonstrated a mildly positive straight leg raise bilaterally and tenderness 

to palpation across the lower back. Dr. Wilbourn performed an epidural steroid injection on 

May 18, 2011 and on June 9, 2011 indicated that appellant was doing better. On October 6, 2011 

he stated that she reported increased low back pain and that he had quit his hospital job due to 

the increased pain. Dr. Wilbourn reiterated his findings and conclusions. 

In correspondence dated April 23, 2012, OWCP notified appellant that when his claim 

was received, it appeared to be a minor injury, but because the medical bills had exceeded 

$1,500.00, the merits of the claim needed to be formally considered. Appellant was informed 

that the medical evidence did not substantiate that the disc protrusion at L5-S1 and the bulging 

disc at L4-5 were caused or aggravated by the January 4, 2012 employment incident. He was 

asked to provide a medical explanation as to how this incident caused or aggravated his 

preexisting condition. 

Appellant thereafter submitted an April 6, 2012 MRI scan study of the lumbar spine that 

demonstrated a disc extrusion at L5-S1 with posterior displacement and compression of the 

descending right S1 nerve and a posterior annular tear and broad-based disc displacement at 

L4-5. In an April 12, 2012 report, Dr. Wilbourn indicated that she reported that he had been 

terminated by the employing establishment on April 2, 2012. He noted the April 6, 2012 MRI 

scan study findings and indicated that he was referring appellant to a spinal surgeon. 

By decision dated May 24, 2012, OWCP denied the claim on the grounds that the 

medical evidence had not established that the claimed condition was causally related to the 

accepted January 4, 2012 employment incident. Appellant, through his attorney, timely 

requested a hearing that was held on September 18, 2012. At the hearing, he described the 

January 4, 2012 incident. Appellant testified that he began having back problems in April 2011 

but did not report it at work, and that he had back surgery on July 25, 2012. Counsel argued that 

the January 4, 2012 work incident caused more than a lumbosacral strain and the conditions 

shown on the MRI scan study should be accepted. The hearing representative advised counsel to 

obtain the operative report. The record was left open for 30 days. Nothing further was 

submitted. 

In a December 14, 2012 decision, OWCP’s hearing representative found that appellant 

established that on January 4, 2012 he sustained a lumbosacral strain but that he did not establish 

that the January 4, 2012 employment incident caused any further lumbar conditions including the 

disc bulge and protrusion at the L4-5 and L5-S1 levels. She affirmed the May 24, 2012 decision 

as modified. 

On December 17, 2012 OWCP accepted that appellant sustained an acute lumbosacral 

sprain. On April 11, 2013 counsel requested that the claim be upgraded to include additional 

diagnoses. On June 19, 2013 OWCP informed him to follow the appeal rights contained in the 

December 14, 2012 decision. 
4

Appellant, through his attorney, requested reconsideration on July 2, 2013. Counsel 

asserted that the medical evidence was sufficient to establish that additional conditions should be 

accepted because the January 4, 2012 work incident aggravated appellant’s preexisting 

condition. Appellant submitted a February 5, 2013 form report in which Dr. Richard Peek, a 

Board-certified orthopedic surgeon, described the incident as “delivering mail for postal service 

before I assumed his care.” Dr. Peek noted subjective complaints of bilateral sciatica, L5-S1 

sensory deficit and spasms with physical examination findings of positive straight leg raises, 

bilateral sensory deficits and spasm. He reported x-ray and MRI scan findings of instability and 

postlaminectomy changes. Dr. Peek diagnosed postlaminectomy instability at L5-S1 and 

herniated nucleus pulposus at L4-5. In an April 4, 2013 progress note, Dr. George Timothy 

Burson, a Board-certified neurosurgeon, noted a two-year history of persistent radiating low back 

pain. He stated that there was no injury and noted that after 2012 back surgery, appellant’s pain 

worsened. Dr. Burson provided physical examination findings and diagnosed chronic pain 

syndrome and postlaminectomy syndrome of the lumbar region. On April 24, 2013 he placed a 

pain pump with intrathecal catheter. 

In a merit decision dated August 7, 2013, OWCP denied modification of the prior 

decision, finding that the medical evidence submitted was insufficient to establish that the L4-5 

and L5-S1 disc bulge and protrusion conditions were causally related to the January 4, 2012 

employment injury. 

LEGAL PRECEDENT 

 Causal relationship is a medical issue and the medical evidence required to establish a 

causal relationship is rationalized medical evidence.4 The opinion of the physician must be 

based on a complete factual and medical background of the claimant, must be 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 employee.5

 Neither the mere fact that a disease or condition manifests itself during a period 

of employment nor the belief that the disease or condition was caused or aggravated by 

employment factors or incidents is sufficient to establish causal relationship.6

 In discussing the range of compensable consequences, once the primary injury is causally 

connected with the employment, Larson notes that, when the question is whether compensability 

should be extended to a subsequent injury or aggravation related in some way to the primary 

injury, the rules that come into play are essentially based upon the concepts of direct and natural 

results and of the claimant’s own conduct as an independent intervening cause. 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.7

 

 4 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 

5 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 

6 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

7

 Larson, The Law of Workers’ Compensation § 10.01 (June 2010); see Charles W. Downey, 54 ECAB 

421 (2003). 
5

ANALYSIS 

The Board finds that appellant did not meet his burden of proof to establish that the 

January 4, 2012 employment injury caused or aggravated his preexisting disc protrusion at L5-S1 

and a bulging disc at L4-5 because the medical evidence is insufficient to establish causal 

relationship. OWCP accepted that he sustained an employment-related acute lumbosacral sprain 

on January 4, 2012. 

The April 6, 2012 MRI scan study did not provide a cause of any diagnosed conditions 

and medical evidence that does not offer any opinion regarding the cause of an employee’s 

condition is of limited probative value on the issue of causal relationship.8 Likewise, the opinion 

of Dr. Wilbourn is insufficient to establish causal relationship. He clearly indicated in a May 4, 

2011 report, seven months before the January 4, 2012 employment injury, that appellant had a 

two- to three-year history of chronic back pain and that an April 18, 2011 MRI scan study 

demonstrated a bulging disc at L4-5 and a mid-line disc protrusion at L5-S1. These conditions 

therefore predated the January 4, 2012 employment injury. In numerous reports submitted by 

Dr. Wilbourn subsequent to the January 4, 2012 employment injury, he did not include an 

opinion as to the cause of any diagnosed conditions at L4-5 and L5-S1. 

Dr. Goodman, in the January 4, 2012 emergency department report, diagnosed a 

lumbosacral strain. A lumbosacral sprain has been accepted as employment related and he did 

not discuss additional lumbosacral conditions.9 Dr. Peek merely indicated that there was an 

incident while appellant was delivering mail that occurred prior to his care. He did not describe 

the January 4, 2012 incident or provide any explanation regarding the cause of appellant’s 

diagnosed conditions of postlaminectomy instability at L5-S1 and herniated nucleus pulposus at 

L4-5. Dr. Burton did not provide a cause of appellant’s diagnosed condition. In fact, he stated 

that there was no injury. 

The opinion of a physician supporting causal relationship must be one of reasonable 

medical certainty that the condition for which compensation is claimed is causally related to his 

federal employment and such relationship must be supported with affirmative evidence, 

explained by medical rationale and be based upon a complete and accurate medical and factual 

background of the claimant.10 It is appellant’s burden to establish that his claimed back 

 8 Willie M. Miller, 53 ECAB 697 (2002). 

9

 The Board notes that in the December 14, 2012 decision, OWCP’s hearing representative stated lumbosacral 

strain was accepted. The December 17, 2012 OWCP correspondence to appellant indicated that acute lumbosacral 

sprain was accepted. 

10 A.D., 58 ECAB 149 (2006). 
6

condition is causally related to factors of his federal employment. In this case, he submitted 

insufficient evidence to show that the diagnosed conditions at L4-5 and L5-S1 were caused by 

the January 4, 2012 employment injury.11 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

The Board finds that appellant did not establish that the conditions of disc protrusion at 

L5-S1 and a bulging disc at L4-5 were caused or aggravated by the January 4, 2012 employment 

injury. 

 11 Supra note 6. The Board, however, notes that where, as in this case, an employing establishment properly 

executes a Form CA-16 which authorizes medical treatment as a result of an employee’s claim for an employmentrelated injury, the Form CA-16 creates a contractual obligation, which does not involve the employee directly, to 

pay for the cost of the examination or treatment regardless of the action taken on the claim. See Tracy P. Spillane, 

54 ECAB 608 (2003). The period for which treatment is authorized by a Form CA-16 is limited to 60 days from the 

date of issuance, unless terminated earlier by OWCP. 20 C.F.R. § 10.300(c). The record in this case indicates that 

emergency room medical treatment was a covered expense. 
7

ORDER 

IT IS HEREBY ORDERED THAT the August 7, 2013 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 25, 2014 

Washington, DC 

 

 Richard J. Daschbach, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board