United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

H.S., Appellant 

and 

DEPARTMENT OF THE ARMY, U.S. ARMY 

EUROPE 7TH ARMY CIVILIAN PERSONNEL 

ADVISORY CENTER KAISERSLAUTERN 

UNIT, APO, AE, Employer 

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Docket No. 15-0904 

Issued: July 29, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On March 24, 2015 appellant, through counsel, filed a timely appeal from a February 10, 

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 his burden of proof to establish that he sustained a 

consequential Staphylococcus infection, zoster infection, or liver lesion causally related to his 

December 18, 2012 employment injury. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On February 12, 2013 appellant, then a 44-year-old military customs inspector with the 

Department of Army in Germany, filed a traumatic injury claim (Form CA-1) alleging that on 

December 18, 2012 he felt a sharp pain in his lower vertebrae after extending his right arm and 

losing the grip of his right foot while attempting to observe the top of an M1A1 tank. He stated 

that the pain to his vertebrae, hip, upper leg muscle, and bone increased and became unbearable 

in a short period of time. Appellant further stated that his body’s immune system may have 

reacted poorly to bacteria causing a cyst. The employing establishment controverted the claim 

stating that there were no witnesses to the claimed event and that the diagnosis appeared to be 

the result of a preexisting condition. Appellant stopped work on December 26, 2012 and 

returned to work on January 14, 2013. On August 14, 2014 OWCP accepted the claim for back 

bruise. 

By letter dated March 4, 2013, OWCP informed appellant that the evidence of record was 

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

needed and was directed to submit it within 30 days. 

Appellant sought medical treatment in Germany. The medical credentials of the German 

physicians cannot be verified. In a March 26, 2013 medical note, Dr. Rolf Hassel stated that 

appellant was treated for severe lower back pain after slipping accidentally at his work on 

December 21, 2012.2

By decision dated April 8, 2013, OWCP denied appellant’s claim because he did not 

submit any evidence containing a medical diagnosis in connection with the accepted 

December 18, 2012 employment incident. It noted that the medical evidence submitted 

contained a diagnosis of “pain” which is a symptom and not a diagnosed medical condition. 

On May 8, 2013 appellant requested reconsideration of OWCP’s decision. 

In an April 2, 2013 narrative statement, appellant reported that on December 18, 2012 he 

was working alone in cold and icy conditions inspecting the top of an M1A1 tank when he lost 

his grip and footing, as his right hand and foot went in opposite directions. His body 

simultaneously twisted and he struck the tank on the right side of his back. Appellant stated that 

he only noticed a bit of damaged skin on the right side of his lower back where he hit the tank. 

On December 21, 2012 he felt increased pain in his lower back which progressively worsened. 

Appellant sought emergency medical treatment at the local German hospital on December 23, 

2012 and was diagnosed with lower back pain. 

Appellant submitted witness statements from fellow coworkers. Medical reports in 

German were also submitted containing no English translation. 

In an April 25, 2013 medical report, Dr. Markus Dietrich, a neurosurgeon, reported that a 

magnetic resonance imaging (MRI) scan of the lumbar spine revealed likely inflammation. 

 2

 The Board notes that two medical reports written in German dated January 4 and December 24, 2013 were also 

submitted. 
3

However, it could not be excluded that a super infection of soft tissue hematoma resulted 

because of specified trauma to the area. 

In a June 24, 2013 medical report, Dr. Jochen Radle reported that appellant was first 

evaluated in the hospital on December 23, 2012 for severe abscess/infection near the lumbar 

spine at L4-5 caused by Staphylococcus aureus. He noted that appellant had fallen against a U.S. 

Army tank several days before admission. Dr. Radle opined that the work incident caused 

appellant an injury to his lower back that brought him to the medical facility. Appellant’s 

internal injury required several tests over an extended period of time since only the lower back 

pain and laboratory results with rising inflammation were obvious. Dr. Radle noted that the 

severe local infection could only be seen by a final MRI scan. It appeared that a super infection 

of soft tissue occurred after an initial lesion (potential soft tissue hematoma) of the injured area. 

Appellant developed severe Staphylococcus aureus infection during the process. In order to save 

his life, strong antibiotics were given. This coupled with the necessary pain medication caused 

appellant’s liver blood levels to elevate to abnormal conditions requiring additional extensive 

liver and blood examination and controls. Given appellant’s treatment, ongoing observation, and 

final results, Dr. Radle opined that appellant’s fall on the tank was the leading factor to his 

current clinical problems and final diagnosis. 

By decision dated June 27, 2013, OWCP denied appellant’s claim finding that the 

evidence of record failed to establish that his diagnosed conditions were causally related to the 

accepted December 18, 2012 employment incident.3

 

On June 28, 2013 appellant requested reconsideration of OWCP’s decision. 

In a December 23, 2012 translated hospital report, Dr. Dietrich reported that appellant 

presented to the emergency room for back pain. He diagnosed lumbago. 

In a December 27, 2012 translated hospital report, Dr. Radle reported that an MRI scan of 

the lumbar spine revealed para-vertebral abscess in the level of inflammatory involvement of the 

right inter vertebral joint at L4-5 with joint effusion and adjacent bone marrow edema. He 

diagnosed inflammatory involvement of the right inter vertebrae, Staphylococcus aureus, herpes 

zoster gluteal, and hemangioma of the liver. 

In a June 6, 2014 medical report, Dr. Radle reported that appellant sought emergency 

treatment on December 23, 2012 for lower back pain as a result of falling on a tank a few days 

earlier at his employment. He was examined and treated with pain medication only for the small 

bruise and trauma signs discovered to his lower back area. Appellant was released with no signs 

of infections. He had been readmitted to the hospital two days later with increased pain in his 

lower back area and upper leg when it was discovered that his blood had developed signs of an 

infection. Appellant was hospitalized to treat the inflammation to his lower back and rising 

 3

 The Board notes that on June 3, 2013, OWCP issued a decision denying appellant’s claim for failing to establish 

that his diagnosed conditions were causally related to the accepted December 18, 2012 employment incident. By 

letter dated June 27, 2013, appellant notified OWCP that the medical reports reviewed in its decision did not pertain 

to his claim. By letter dated June 27, 2013, OWCP notified him that the June 3, 2013 decision was vacated and a 

new reconsideration decision would be issued which took into consideration the medical evidence pertaining to his 

claim only. 
4

levels of blood infection. He underwent a heavy intake of antibiotics for approximately three 

months and underwent examination of his vital organs on June 24, 2013. An additional blood 

test and examination of appellant’s physical status taken on May 21, 2014 confirmed Dr. Radle’s 

opinion that appellant was generally in good health and the fall on the tank was the initial cause 

that required treatment from the hospital for his lower back injury. 

By decision dated August 14, 2014, OWCP accepted appellant’s claim for bruise of back. 

In another decision dated August 14, 2014, OWCP affirmed in part the June 27, 2013 

decision finding that appellant failed to establish that his Staphylococcus infection was 

consequential to the December 18, 2012 injury. 

On October 6, 2014 appellant requested reconsideration of OWCP decision. 

In an October 20, 2014 report, Dr. Radle reported that the following information was 

being provided for clarification of his prior June 24, 2013 report. He noted that on December 27, 

2012 appellant was admitted to the hospital for examination but no visible signs of any zoster 

infection were noted. Inpatient charts revealed that on January 10, 2012 a newly developed 

zoster infection of the lower back was diagnosed. Dr. Radle noted that the zoster infection was 

triggered by appellant’s bad medical situation at that time and not the cause of his lower back 

injury or Staphylococcus blood infection which was diagnosed two weeks earlier. He further 

stated that with respect to the hemangioma of the liver, this was a typical benign tumor of the 

liver which could be diagnosed through ultrasound examinations. The diagnosis was proven in 

the complete workup concerning the infectious situation which often causes no clinical 

problems. Dr. Radle stated that appellant’s liver lesion existed before December 2012 and had 

no medical connection to his current problems and diseases. 

By decision dated February 10, 2015, OWCP affirmed the August 13, 2014 decision 

finding that the evidence of record failed to establish that appellant’s Staphylococcus infection, 

zoster infection, and liver lesion were causally related to the accepted December 18, 2012 

employment injury. 

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 

employment injury.4

 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or occupational disease.5

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

5 Michael E. Smith, 50 ECAB 313 (1999). 
5

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 supporting such a causal relationship.6 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 claimant. 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.7

The basic rule respecting consequential injuries is that when the primary injury is shown 

to have arisen out of and in the course of employment, every natural consequence that flows 

from the injury likewise arises out of the employment, unless it is the result of an independent 

intervening event.8 Once the work-connected character of an injury has been established, the 

subsequent progression of that condition remains compensable so long as the worsening is not 

shown to have been produced by an independent, nonindustrial cause.9 

ANALYSIS 

OWCP accepted that the December 18, 2012 employment incident occurred as alleged 

and accepted the claim for a back bruise. The issue is whether appellant established that the 

incident caused him any additional consequential medical conditions. The Board finds that this 

case is not in posture for decision and must be remanded for further medical development. 

The claimant has the burden of establishing by the weight of reliable, probative, and 

substantial evidence that the condition for which compensation is sought is causally related to a 

specific employment incident or to specific conditions of the employment. As part of this 

burden, the claimant must present rationalized medical opinion evidence, based upon a complete 

and accurate factual and medical background, establishing causal relationship.10 However, it is 

well established that proceedings under FECA are not adversarial in nature and while the 

claimant has the burden of establishing entitlement to compensation, OWCP shares 

responsibility in the development of the evidence to see that justice is done.11 

 6 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

7 James Mack, 43 ECAB 321 (1991). 

8 See Kathy A. Kelley, 55 ECAB 206 (2004); Carlos A. Marerro, 50 ECAB 170 (1998). 

9 P.B., Docket No. 13-1866 (issued March 7, 2014); S.W., Docket No. 11-1678 (issued February 22, 2012); 

Arnold Gustafson, Docket No. 89-438 (issued October 30, 1989). 

10 See Virginia Richard, claiming as executrix of the estate of Lionel F. Richard, 53 ECAB 430 (2002); see also 

Brian E. Flescher, 40 ECAB 532, 536 (1989); Ronald K. White, 37 ECAB 176, 178 (1985). 

11 Phillip L. Barnes, 55 ECAB 426 (2004); see also Virginia Richard, supra note 10; Dorothy L. Sidwell, 36 

ECAB 699 (1985); William J. Cantrell, 34 ECAB 1233 (1993). 
6

In its February 10, 2015 decision, OWCP denied appellant’s claim because it found that 

his evidence did not establish that his Staphylococcus infection, zoster infection, and liver lesion 

were causally related to the December 18, 2012 employment injury. The Board finds that the 

medical evidence of record is sufficient to require further development of the case record. 

In medical reports dated December 27, 2012 through October 20, 2014, Dr. Radle 

reported that appellant was first evaluated in the hospital on December 23, 2012 after he had 

fallen with his back against an army tank several days earlier. He noted that appellant was 

examined and treated with pain medication only for the small bruise and trauma signs discovered 

to his lower back area. Appellant was released with no sign of infections. 

Appellant was readmitted to the hospital on December 27, 2012 for increased pain in his 

lower back and upper leg when it was discovered that he had developed signs of an infection 

revealed by MRI scan blood testing. The MRI scan revealed the appearance of a super infection 

of soft tissue occurring after an initial lesion (potential soft tissue hematoma) of the injured area. 

Appellant was hospitalized to treat the inflammation to his lower back and severe 

abscess/infection near the lumbar spine at L4-5 caused by Staphylococcus aureus. Dr. Radle 

opined that appellant’s fall on the tank was the leading factor in the development of his clinical 

problems and final diagnosis. In his October 20, 2014 report, he found no visible signs of a 

zoster infection on examination on December 27, 2012. Inpatient charts revealed that on 

January 10, 2012 a newly developed zoster infection of the lower back was diagnosed. 

Dr. Radle noted that the zoster infection was triggered by appellant’s bad medical situation at 

that time and not caused by his lower back injury or Staphylococcus blood infection which had 

been diagnosed two weeks earlier. He further stated that the hemangioma of the liver was a 

typical benign tumor which existed before December 2012 and had no medical connection to 

appellant’s current problems and diseases.12 

The Board notes that, while none of Dr. Radle’s reports are completely rationalized, they 

are consistent in indicating that appellant sustained an employment-related consequential 

Staphylococcus infection and are not contradicted by any substantial medical or factual evidence 

of record.13 While Dr. Radle did not fully describe the mechanism of the injury, he provided a 

clear, if limited, opinion based on examination findings and an accurate factual and medical 

background, that appellant’s Staphylococcus infection was caused by the December 18, 2012 

employment injury. 

Dr. Radle explained that appellant’s fall on the tank caused severe abscess and 

Staphylococcus aureus infection near the lumbar spine at L4-5. He further explained that the 

hemangioma of the liver and zoster infection were not related to appellant’s work injury. 

Dr. Radle demonstrated a clear understanding of the December 18, 2012 employment incident 

and provided a detailed medical history with findings based on diagnostic testing and physical 

examination. His opinion was supportive, bolstered by objective findings, and based on a 

 12 Dr. Radle’s December 27, 2012 hospital report diagnosed inflammatory involvement of the right hand inter 

vertebrae, Staphylococcus aureus, herpes zoster gluteal, and hemangioma of the liver. 

13 Frank B. Gilbreth, Docket No. 02-1310 (issued May 14, 2003). 
7

firm diagnosis and accurate history.14 Though Dr. Radle’s reports are not sufficient to meet 

appellant’s burden of proof to establish his claim, they raise an uncontroverted inference 

between appellant’s Staphylococcus blood infection condition and the accepted incident and 

are sufficient to require OWCP to further develop the medical evidence and the case record.15 

The Board also notes that on remand OWCP shall obtain translation of all of the medical 

reports submitted in the German language.16

On remand, OWCP should prepare a statement of accepted facts which includes a 

description of the December 18, 2012 employment incident and obtain a rationalized medical 

opinion from an appropriate specialist as to whether appellant’s Staphylococcus infection was 

causally related to accept back injury as a consequential injury. Following this and any other 

further development as deemed necessary, it shall issue an appropriate merit decision on 

appellant’s claim. 

CONCLUSION 

The Board finds that this case is not in posture for a decision as to whether appellant 

sustained an injury in the performance of duty on December 18, 2012. 

 14 See L.D., Docket No. 09-1503 (issued April 15, 2010). 

15 See Virginia Richard, supra note 10; see also Jimmy A. Hammons, 51 ECAB 219 (1999); John J. Carlone, 41 

ECAB 354 (1989). 

16 See Armando Colon, 41 ECAB 563 (1990). The Board held that OWCP should have requested a translation of 

a medical report before ruling on the probative value of its contents. See also M.T., Docket No. 09-208 (issued 

November 9, 2009). 
8

ORDER 

IT IS HEREBY ORDERED THAT the February 10, 2015 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further development 

consistent with this decision. 

Issued: July 29, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board