United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.A., Appellant 

and 

DEPARMENT OF HOMELAND SECURITY, 

CUSTOMS & BORDER PROTECTION, 

Yuma, AZ, Employer 

__________________________________________ 

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Docket No. 14-179 

Issued: March 9, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

RICHARD J. DASCHBACH, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On November 1, 2013 appellant filed a timely appeal from the July 3, 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 an injury in the 

performance of duty on January 25, 2013, as alleged. 

On appeal, appellant contends that his injury occurred in the performance of duty. He 

further noted that he supplied additional evidence on appeal in support of his claim. 

 1

 5 U.S.C. §§ 8101-8193. 
2

FACTUAL HISTORY 

On January 26, 2013 appellant, then a 31-year-old border patrol agent, filed a traumatic 

injury claim alleging that on January 25, 2013, while driving an all-terrain vehicle (ATV), he 

approached a curve, his right front tire hit a boulder causing uneven weight distribution, the 

vehicle began to rollover, and he was ejected from the vehicle. He noted that as a result of this 

incident, he had head swelling to the left side, right wrist swelling, right and left knee pain, 

stiffness to the neck and back, and left ankle sprain and swelling. The employing establishment 

properly issued appellant an authorization for medical examination (Form CA-16). He was 

treated and released at St. Joseph’s Hospital Emergency Room.2

 

By letter dated February 1, 2013, OWCP informed appellant that it was necessary to 

submit further information, including medical information, to support his claim. Appellant did 

not file a timely response to OWCP’s letter. 

By decision dated March 4, 2013, OWCP denied appellant’s claim as it found that he had 

not submitted medical evidence establishing a diagnosis in connection with the accepted 

incident. 

On March 12, 2013 appellant requested review of the written record by an OWCP 

hearing representative. 

Appellant submitted a January 25, 2013 injury report by the Buckey Valley Rural 

Volunteer Fire District that indicated that he was transported to St. Joseph’s Hospital 

complaining of right wrist pain. 

Appellant submitted notes from his visit at the Emergency Department at St. Joseph’s 

Hospital on January 25, 2013. An emergency room intake note authored by Jason Jacobson, RN, 

dated January 25, 2013 indicated that during working hours appellant was thrown from his 

vehicle striking his head and was notable for right wrist deformity. 

In the CA-16 attending physician’s report form dated January 25, 2013, Dr. Michael 

Christopher, a physician Board-certified in emergency medicine, noted that appellant was thrown 

from an ATV after it struck a rock. He diagnosed wrist sprain, closed head injury and cervical 

strain. Dr. Christopher also checked a box indicating that the injuries were caused or aggravated 

by appellant’s employment activity. Appellant had a computerized tomography (CT) scan of the 

head, which was interpreted by Dr. James Murphy, a Board-certified radiologist, as evincing no 

evidence of acute intracranial abnormality. A CT scan of the cervical spine was interpreted as 

detecting no abnormalities. Appellant’s right wrist x-ray, as interpreted Dr. Nell Dunn, a 

radiologist, evinced no acute fracture or dislocation. 

In a March 12, 2013 note, Richard A. Ramirez, a supervisory border patrol agent, stated 

that on January 25, 2013 at approximately 6:30 a.m. appellant was involved a rollover accident 

while in the performance of duty and was transported to St. Joseph’s medical facility in Phoenix, 

 2

 When a CA-16 form is properly executed, it 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 Tracey P. Spillane, 54 ECAB 608 (2003); 20 C.F.R. § 10.300(c). 
3

Arizona. He further noted that during the accident, appellant sustained injuries to his right wrist, 

knees, ankles, head, and cervical spine. 

By decision dated July 3, 2013, the hearing representative modified the prior decision by 

noting that appellant had established that he had a closed head injury, a right wrist sprain and a 

cervical sprain, but that he had not established that these injuries were causally related to the 

accepted employment incident and accordingly affirmed the January 25, 2013 decision as 

modified. 

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 timely filed within the applicable time 

limitation period of FECA, that an injury was sustained in the performance of duty as alleged 

and that any disability and/or specific condition for which compensation is claimed are causally 

related to the employment injury. These are the essential elements of each and every 

compensation claim regardless of whether the claim is predicated upon 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 or exposure, 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.5

 The medical evidence required to 

establish causal relationship is usually rationalized medical evidence. Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on the 

issue of whether there is a causal relationship between the claimant’s diagnosed condition and 

the implicated employment factors. 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.6 

ANALYSIS 

OWCP accepted that appellant was involved in a vehicular accident on January 25, 2013 

while in the performance of duty and that he was diagnosed with wrist sprain, closed head injury 

and cervical sprain. However, it determined that he had not submitted rationalized, probative 

medical evidence to establish that the January 25, 2013 employment accident caused the injuries. 

 3 Jussara L. Arcanjo, 55 ECAB 281, 283 (2004). 

4 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of Injury, Chapter 2.803(2)(a) (June 1995). 

5 John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978). 

6 Judith A. Peot, 46 ECAB 1036 (1995); Ruby I. Fish, 46 ECAB 276 (1994). 
4

Appellant submitted records from his visit to the Emergency Department at St. Joseph’s 

Hospital on the date of the accident, January 25, 2013. Dr. Christopher, the treating physician at 

the Emergency Department, diagnosed appellant with wrist sprain, closed head injury and 

cervical strain. He also checked a box indicating that the injuries were caused or aggravated by 

appellant’s employment activity described, but he did not explain his answer despite instructions 

that asked for an explanation. The Board has held that, without further explanation or rationale, 

a checked box on a form report is not sufficient to establish causal relation.7

 D. Christopher did 

not explain how appellant’s vehicular accident caused his listed injuries. In the absence of such 

explanation, his opinion is insufficient to establish causal relationship in this case.8 The record 

also contains further reports from St. Joseph’s Hospital; however these reports are not helpful in 

establishing a medical diagnosis or causal relationship. Dr. Murphy noted that the CT of 

appellant’s head evinced no acute intracranial abnormality and that the CT of the cervical spine 

showed no abnormalities. Similarly, Dr. Dunn interpreted an x-ray of appellant’s right wrist as 

showing no acute fracture or dislocation. 

Appellant also submitted nurse’s intake notes, however, health care providers such as 

nurses, physician’s assistants and physical therapists are not physicians under FECA. Thus, their 

opinions do not constitute medical evidence and have no weight or probative value.9

The Board notes that appellant’s supervisor indicated that as a result of the January 25, 

2013 accident, appellant sustained injuries to his right wrist, knees, ankles, head and cervical 

spine. The record also contains a report from the Rural Volunteer Fire District that transported 

appellant to the hospital. However, neither of these items constitutes medical evidence. The 

issue of causal relationship is a medical one and must be resolved by probative medical opinion 

from a physician.10

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 employment-related injury, the CA-16 form 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.11 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.12 The record is silent as to whether OWCP paid for the cost of appellant’s 

examination or treatment for the period noted on the form. 

 7 See also T.C., Docket No. 12-1766 (issued February 4, 2013); Calvin E. King, 51 ECAB 284 (2000); Debra S. 

King, 44 ECAB 203 (1992).

8 Deborah L. Beatty, 54 ECAB 340 (2003). 

9 See George H. Clark, 56 ECAB 162 (2004); Jane A. White, 34 ECAB 515, 518 (1983). See 5 U.S.C. § 8101(2). 

This subsection defines the term physician. See also Charley V.B. Harley, 2 ECAB 208, 211 (1949) (where the 

Board held that medical opinion, in general, can only be given by a qualified physician). 

10 I.A., Docket No. 13-1701 (issued January 17, 2014). 

11 See Tracy P. Spillane, 54 ECAB 608 (2003). 

12 See 20 C.F.R. § 10.300(c). 
5

An award of compensation may not be based on surmise, conjecture or speculation. 

Neither the fact that appellant’s claimed condition became apparent during a period of 

employment nor his belief that the condition was caused by his employment is sufficient to 

establish causal relationship.13 As appellant did not establish that his medical condition was 

causally related to the accepted factor of his employment, OWCP properly denied appellant’s 

claim. 

Appellant submitted new medical evidence on appeal. The Board has no jurisdiction to 

review new evidence on appeal.14 However, he may submit 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 has not met his burden of proof to establish that he 

sustained an injury in the performance of duty on January 25, 2013. 

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated July 3, 2013 is affirmed.15

Issued: March 9, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 13 D.I., 59 ECAB 158 (2007); Ruth R. Price, 16 ECAB 688, 691 (1965). 

14 See 20 C.F.R. § 501.2(c)(1). 

15 Richard J. Daschbach, Chief Judge, who participated in the preparation of the opinion, was no longer a member 

of the Board after May 16, 2014.