United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

G.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Phoenix, AZ, Employer 

__________________________________________ 

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Docket No. 14-1236 

Issued: September 10, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA HOWARD FITZGERALD, Judge 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On May 5, 2014 appellant filed a timely appeal from a March 19, 2014 merit decision of 

the Office of Workers’ Compensation Programs (OWCP) which denied her occupational disease 

claim. 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.2

ISSUE 

The issue is whether appellant met her burden of proof to establish that her back 

condition was causally related to factors of her employment. 

 1

 5 U.S.C. § 8101 et seq.

2

 The Board notes that appellant submitted additional evidence following the March 19, 2014 decision. The 

Board’s jurisdiction is limited to evidence that was before OWCP at the time it issued its final decision. The Board 

may not consider this evidence for the first time on appeal. See 20 C.F.R. § 501.2(c); Sandra D. Pruitt, 57 ECAB 

126 (2005). Appellant may submit that evidence to OWCP with a request for reconsideration. 
2

FACTUAL HISTORY 

On December 16, 2013 appellant, then a 50-year-old distribution clerk, filed an 

occupational disease claim alleging tension and pain in her back left side as a result of walking 

back and forth, while loading and pulling packages to the side door. She first became aware of 

her condition and realized it resulted from her employment on December 6, 2013. Appellant 

stopped work.3

In a December 13, 2013 treatment note, Dr. Bernice Ly, a Board-certified internist, noted 

that she treated appellant for chronic low back pain. She recommended that appellant take 

ibuprofen for pain control. Dr. Ly recommended that appellant not work until 

December 16, 2013. On December 18, 2013 she noted that appellant was incapacitated from 

December 16 to 29, 2013 due to low back pain. Dr. Ly recommended rest and pain medications. 

She authorized appellant to return to work full time on December 30, 2013 with restrictions of 

lifting up to 10 pounds for five hours a day; standing and walking intermittently for four hours a 

day; reaching above the shoulders, twisting, pushing and pulling for four hours a day; and 

bending, stooping and kneeling for five hours a day. Dr. Ly anticipated that appellant could 

resume full-duty work on February 3, 2014. 

By letter dated December 19, 2013, the employing establishment controverted appellant’s 

claim contending that she failed to establish causal relationship and fact of injury. The 

employing establishment reported that appellant had complained of a work-related accident five 

times in the past six years. It noted that she had requested leave but was denied before she filed 

an occupational disease claim. The employing establishment stated that the week of 

December 6, 2013 appellant worked an average of 6.16 hours a day and that on December 6, 

2014 she worked 7.09 hours without requesting additional help or informing her supervisors of 

any back problems. It further alleged that the medical documentation failed to show a 

correlation between the injury and the condition being work related. The employing 

establishment provided statements from Sheryl Yazzie and Mary A. Speck, distribution clerks at 

the employing establishment, and Daniel Fuller, appellant’s postmaster, which noted that she 

complained of back pain for the past five to seven years and that she never alleged that her 

condition was related to her employment. It also provided a December 19, 2013 job offer for a 

modified distribution clerk, which appellant refused to accept.4

By letter dated January 3, 2014, OWCP advised appellant that the evidence received was 

insufficient to establish her claim. It requested additional evidence to establish that she sustained 

a diagnosed condition as a result of her duties as a distribution clerk. OWCP also sent a 

development letter to the employing establishment. 

 3

 The record reflects that appellant previously filed an occupational disease claim on January 10, 2006 and two 

traumatic injury claims for December 24, 2009 and September 21, 2011 employment injuries. 

4

 The duties of the modified assignment included boxing mail up to three hours and window clerk duties up to 

four hours. Its physical requirements involved standing, walking, reaching above the shoulders, kneeling, bending, 

stooping, pushing and pulling, and lifting and carrying up to 10 pounds for four hours per day. 
3

On January 7, 2014 the employing establishment responded to OWCP’s development 

letter. It did not agree with appellant’s allegations, noting that she failed to notify her 

supervisors of any job injury. The employing establishment stated that, although appellant 

reported that she continuously walked, stood, and picked up packages all day, workers were 

provided with a 10-minute break every 2 hours and a lunch break each day. It noted that all 

employees received mandatory classes on proper lifting techniques and that equipment was 

provided for heavy and/or multiple packages. The employing establishment provided statements 

by appellant’s postmaster and a human resource specialist challenging appellant’s claim. It also 

provided a description of duties for a sales or distribution associate. 

In a handwritten January 21, 2014 report, Dr. Ly stated that she was appellant’s primary 

care provider. She examined her on December 18, 2013 for exacerbation of low back pain with 

radicular symptoms to the left leg suggestive of a neuropathy. Dr. Ly opined that this 

exacerbation was work related during one of the busiest times of the year at the employing 

establishment. During her January 15, 2014 examination, appellant’s condition had worsened. 

When Dr. Ly examined her again on January 21, 2014 her symptoms had improved after 

complete rest from work for six days. She opined that appellant’s low back pain exacerbation 

and neuropathy were work related. In a duty status report, Dr. Ly stated that appellant could not 

work until she was reevaluated on February 10, 2014. 

In February 10 and March 1, 2014 duty status reports, Dr. Ly noted that appellant worked 

as a sales distribution clerk. She stated that appellant’s pain on the left side of her back and left 

leg had improved. Dr. Ly diagnosed low back pain exacerbation. She advised appellant to 

resume work part time on February 10, 2014 with restrictions. 

In a February 24, 2014 handwritten report, Dr. Ly stated that she had treated appellant for 

the past 21⁄2 months for a low back strain that she incurred at work. She opined that appellant’s 

duties at work worsened her low back strain. Dr. Ly reported that work restrictions were 

recommended on December 18, 2013 but were not followed, which led to complete rest from 

work on January 15, 2014. She explained that appellant’s prognosis for recovery was excellent 

as long as appellant followed a gradual return to work. 

On February 25, 2014 appellant stated that she received medical treatment from 

December 13, 2013 to February 24, 2014, including a February 20, 2014 magnetic resonance 

imaging (MRI) scan and steroid injections. She described her symptoms as lower back and hip 

pain, an inability to stand for long periods of time, limited strength and movement and inability 

to stoop. Appellant described the pain as chronic right side pain from the bottom of her heel 

with neuropathy pain, numbness and tingling that radiated into her right thigh. She explained 

that she was still under medical care for a work-related injury that occurred six to seven years 

ago at her employing establishment. Appellant stated that because of the heavy volume of work 

required in December she experienced stress to the left side of her body, which carried a lot of 

her weight. She noted that she attempted to resume light duty on December 30, 2014 based on 

her physician’s recommendations but full duty was imposed on her. Appellant alleged that this 

work caused more injury and time off without pay from January 11 to February 25, 2014. She 

stated that she received steroid injections. Appellant provided a description of her employment 

duties. 
4

In a February 28, 2014 handwritten report, Dr. Ly stated that appellant’s low back 

exacerbation had continued to improve. She authorized appellant to return to work part time on 

March 3, 2014 with restrictions of lifting and carrying up to five pounds, sitting or standing up to 

90 minutes before taking a break, and walking, kneeling or bending up to 90 minutes before 

taking a break. 

In a decision dated March 19, 2014, OWCP denied appellant’s occupational disease 

claim. It accepted that appellant worked as a distribution clerk, but denied her claim finding 

insufficient medical evidence to establish that her low back condition was causally related to her 

employment. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish the 

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

evidence5

 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.6 In an occupational disease claim, appellant’s burden requires 

submission of the following: (1) a factual statement identifying employment factors alleged to 

have caused or contributed to the presence or occurrence of the disease or condition; (2) medical 

evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the employee.7

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

establish causal relationship is rationalized medical opinion evidence.8 The opinion of the 

physician must be based on a complete factual and medical background of the employee, 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.9

 

ANALYSIS 

Appellant alleged that she sustained a low back condition as a result of her repetitive 

duties as a distribution clerk. OWCP accepted that she worked as a distribution clerk and was 

diagnosed with low back strain. It denied appellant’s claim, finding insufficient medical 

evidence to establish that her back condition was causally related to factors of her employment. 

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

6 M.M., Docket No. 08-1510 (issued November 25, 2010); G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 

ECAB 1143, 1145 (1989). 

7 R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000). 

8 I.R., Docket No. 09-1229 (issued February 24, 2010); D.I., 59 ECAB 158 (2007). 

9

 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005). 
5

Appellant submitted various reports by Dr. Ly, who initially treated appellant on 

December 13, 2013 for low back pain and recommended that she not return to work. In duty 

status reports dated February 10 and March 1, 2014, Dr. Ly noted that appellant worked as a 

sales distribution clerk and provided work restrictions. In handwritten reports dated January 21 

to February 28, 2014, she stated that she had treated appellant for a low back strain that occurred 

at work. Dr. Ly opined that appellant’s duties at work worsened her low back strain. She 

reported that she recommended work restrictions on December 18, 2013 but they were not 

followed. Dr. Ly recommended that appellant return to work part time on March 3, 2014 with 

restrictions. 

The Board notes that Dr. Ly provided a medical diagnosis and an opinion that appellant’s 

low back was related to her duties at work. Dr. Ly did not, however, provide adequate 

explanation of how appellant’s specific duties as a distribution clerk caused or contributed to her 

back condition. She did not provide a factual history that described appellant’s employment 

duties with details of the repetitive duties or lifting appellant was required to perform. The 

Board has found that rationalized medical opinion evidence must relate specific employment 

factors identified by the claimant to the claimant’s condition, with stated reasons by a 

physician.10 The Board also notes that a physician’s opinion must be based upon a complete 

factual and medical background. Dr. Ly did not provide sufficient medical opinion which 

discussed appellant’s prior back injuries and her medical condition prior to December 2013.11 

Although she generally attributed appellant’s back condition to her duties, the mere fact that 

78work activities may produce symptoms revelatory of an underlying condition does not raise an 

inference of an employment relation. Such a relationship must be shown by rationalized medical 

evidence of a causal relation based upon a specific and accurate history of employment 

conditions which are alleged to have caused or exacerbated a disabling condition.12 Dr. Ly has 

failed to provide a rationalized medical opinion in this case and her reports are insufficient to 

establish appellant’s 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 did not meet her burden of proof to establish that her low 

back condition was causally related to factors of her employment. 

 10 L.F., Docket No. 10-2287 (issued July 6, 2011); Solomon Polen, 51 ECAB 341 (2000). 

11 Supra note 9. 

12 Patricia J. Bolleter, 40 ECAB 373 (1988). 
6

ORDER 

IT IS HEREBY ORDERED THAT the March 19, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 10, 2014 

Washington, DC 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board