United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

J.P., Appellant 

and 

DEPARTMENT OF JUSTICE, BUREAU OF 

PRISONS, Butner, NC, Employer 

__________________________________________ 

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Docket No. 15-1825 

Issued: December 22, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On September 3, 2015 appellant filed a timely appeal from a June 23, 2015 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 her broken front 

tooth was causally related to the September 9, 2014 employment incident. 

FACTUAL HISTORY 

On September 12, 2014 appellant, then a 32-year-old unit secretary, filed a traumatic 

injury claim (Form CA-1) alleging that on September 9, 2014 she sustained a broken front, upper 

left tooth from hitting her mouth with a file cabinet drawer. She explained that the file cabinet 

 1

 5 U.S.C. § 8101 et seq.
2

drawer had been stuck and, when the drawer finally opened, her mouth was hit. The record does 

not indicate whether she stopped work. 

The record contains an unsigned Form CA-16, authorization for treatment form, which 

noted that appellant sustained an injury to the lip and chipped her tooth from a file cabinet 

drawer. 

Appellant submitted a September 10, 2014 attending physician’s report with an illegible 

signature, which noted that appellant chipped her tooth. The author checked a box marked “No” 

that appellant’s condition was caused or aggravated by the employment activity. Appellant was 

advised to undergo a comprehensive examination to rule out other dental concerns. She also 

submitted diagnostic images that were mostly illegible. 

In a September 10, 2014 patient note, an unknown provider related that appellant chipped 

her front tooth at work on the filing cabinet. The provider further noted extensive decay and 

recommended a crown. 

On April 2, 2015 appellant wrote a letter requesting that OWCP adjudicate her workers’ 

compensation claim. 

By letter dated April 8, 2015, OWCP informed appellant that her claim was initially 

accepted as a minor injury, but was being reopened for adjudication at her request. It advised her 

that the evidence submitted was insufficient to establish her claim and requested additional 

evidence to demonstrate that she sustained a diagnosed condition causally related to her 

employment. 

In a decision dated June 23, 2015, OWCP accepted that the September 9, 2014 incident 

occurred as alleged and that she sustained a broken front tooth, but OWCP denied the claim due 

to insufficient medical evidence that her condition was causally related to the accepted incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2

 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence3 including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.4

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether “fact of injury” has been established.5

 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that she actually experienced the employment incident at 

 2

 5 U.S.C. §§ 8101-8193. 

3 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

4 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

5 S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005). 
3

the time, place, and in the manner alleged.6

 Second, the employee must submit evidence, 

generally only in the form of probative medical evidence, to establish that the employment 

incident caused a personal injury.7 An employee may establish that the employment incident 

occurred as alleged but fail to show that her disability or condition relates to the employment 

incident.8

OWCP procedures recognize in clear-cut traumatic injury claims, such as a fall resulting 

in a broken arm, a physician’s affirmative statement is sufficient and no rationalized opinion on 

causal relationship is needed. In all other traumatic injury claims, a rationalized medical opinion 

supporting causal relationship is required.9

ANALYSIS 

Appellant alleged that on September 9, 2014 she broke her front, upper left tooth when 

she was hit in the mouth by a file cabinet drawer. OWCP initially accepted her claim as a minor 

injury but, upon appellant’s request, OWCP reopened her claim on April 2, 2015. By decision 

dated June 23, 2015, OWCP accepted that the September 9, 2014 incident occurred as described 

and that appellant sustained a broken tooth, but denied her claim finding insufficient medical 

evidence to establish that her broken front tooth resulted from the accepted employment incident. 

The Board finds that appellant failed to establish that her broken front tooth was causally related 

to the September 9, 2014 employment incident. 

Appellant submitted an illegible September 10, 2014 attending physician’s report, which 

noted that appellant chipped her tooth. A box marked “No” had been checked as to whether 

appellant’s condition had been caused or aggravated by the employment incident. The Board 

finds that the report lacks proper identification as the signature is illegible. The Board has held 

that reports that are unsigned or that bear illegible signatures cannot be considered as probative 

medical evidence because they lack proper identification.10 Accordingly, this report is 

insufficient to establish appellant’s claim. 

The record also contains diagnostic reports dated September 16, 2014, an unsigned 

CA-16 form, and a September 10, 2014 patient note from an unknown provider. While these 

medical reports relate that appellant chipped her front tooth at work, they are not medical reports 

as they lack proper identification and are thus of no probative medical value.11 For these 

reasons, the Board finds that appellant has failed to establish her claim. 

The Board notes that in clear-cut traumatic injury claims when the condition is a minor 

one, a physician’s affirmative statement may be sufficient and no rationalized opinion on causal 

 6 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968). 

7

 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 

8 T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006). 

9 Id. 

10 Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55 ECAB 343 (2004). 

11 Id.
4

relationship is needed.12 While appellant submitted medical reports which related that she 

chipped her tooth at work, none of the reports are qualified medical reports.13

On appeal, appellant alleges that her medical provider had explained how her 

employment injury occurred. Causal relationship is a medical question that must be established 

by probative medical opinion from a physician.14 Because appellant has not provided such 

probative medical evidence in this case, the Board finds that she did not meet her burden of proof 

to establish her claim. 

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 failed to establish that her broken front tooth was causally 

related to the September 9, 2014 employment incident. 

ORDER 

IT IS HEREBY ORDERED THAT the June 23, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: December 22, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 12 Gregory J. Reser, 57 ECAB 277 (2005). 

13 See M.K., Docket No. 15-142 (issued March 3, 2015). 

14 W.W., Docket No. 09-1619 (issued June 2, 2010); David Apgar, supra note 7.