United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.H., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SECURITY 

ADMINISTRATION, Union, NJ, Employer 

__________________________________________ 

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Docket No. 14-1852 

Issued: January 27, 2015 

Appearances: Case Submitted on the Record

James D. Muirhead, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 20, 2014 appellant, through counsel, filed a timely appeal from a February 21, 

2014 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 a back and neck injury 

in the performance of duty on April 12, 2012. 

FACTUAL HISTORY 

On April 13, 2012 appellant, then a 52-year-old lead transportation security officer, filed 

a traumatic injury claim (Form CA-1) alleging that on April 12, 2012 she sustained pain in her 

 1

 5 U.S.C. § 8101 et seq.
2

shoulder, back, and neck when she was pulling a bag off a carousel and began to feel light 

headed. She notified her supervisor on April 26, 2012. 

In an April 30, 2012 attending physician’s report (Form CA-20), Dr. Christopher M. 

Boni, a Doctor of Osteopathic Medicine, reported that on April 12, 2012 appellant heard a snap 

in her back when she was lifting a heavy bag weighing 85 pounds. He noted findings of right 

arm numbness and right thoracic and lumbar muscle hypertrophy. Dr. Boni diagnosed back 

pain, anxiety, and hypertension and checked the box marked “yes” when asked if the condition 

was caused or aggravated by the employment activity, noting that appellant was lifting an 85-

pound checked bag. He restricted heavy lifting and released her to return to work on 

May 14, 2012. 

In an April 30, 2012 report, Dr. Dominic S. Cerreto, a treating chiropractor, reported that 

examination of the thoracic spine revealed vertebral subluxation complex at the C6-7, and T1 

levels. Examination of the lumbar spine revealed moderate disc degeneration with a grade 1 

spondylolisthesis. 

In a May 2, 2012 diagnostic report, Dr. Frederick D. Gangemi, Board-certified in 

physical medicine and rehabilitation, reported that an electromyography (EMG) study of the 

upper extremities revealed findings consistent with right C6 and right C8 nerve root irritability 

suggestive of radiculopathic changes at the right C6 and right C8 nerve root levels. In a May 8, 

2012 (Form CA-20), he reported that appellant was lifting heavy bags and heard something pop. 

Dr. Gangemi diagnosed cervical radiculopathy and cervicalgia and checked the box marked 

“yes” when asked if he believed that the condition was caused or aggravated by the employment 

activity. 

In a June 1, 2012 (Form CA-20), Dr. Cerreto reported that appellant sustained upper 

thoracic pain when lifting heavy baggage. He noted findings of spinal distortions with 

subluxations and vertebral wedging and diagnosed radiculopathy in the right arm and spinal 

subluxations with myospasms. Dr. Cerreto checked the box marked “yes” when asked if he 

believed that the condition was caused or aggravated by the employment activity. In a June 1, 

2012 duty status report (Form CA-17), he diagnosed sprain with radiculitis. 

By letter dated June 28, 2012, OWCP informed appellant that the evidence of record was 

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

needed and was directed to submit it within 30 days. 

In a June 26, 2012 diagnostic report, Dr. Christian Annese, a Board-certified diagnostic 

radiologist, reported that an x-ray of the cervical spine revealed cervical spondylosis without 

myelopathy and an x-ray of the lumbosacral spine revealed lumbosacral spondylosis without 

myelopathy. A December 28, 2012 computerized tomography (CT) scan of the cervical spine 

revealed cervical spondylosis without myelopathy. A December 28, 2012 CT scan of the lumbar 

spine revealed spondylolisthesis, displacement of lumbar intervertebral disc without myelopathy, 

foraminal stenosis, and aortic atherosclerosis. 

In a July 11, 2012 report, Dr. Gangemi reported that appellant suffered injury to her 

cervical and lumbosacral spine, which were related to her employment duties. He noted that the 

constant lifting of heavy bags caused significant wear and tear on her neck and back causing the 

injuries. Dr. Gangemi restricted appellant from continuing her work activities which he believed 
3

to be the cause of her condition, noting that continued work would allow the pathologic process 

to worsen with nerve root impingement in her neck and back. 

In a July 24, 2012 note, Dr. Richard Boiardo, a Board-certified orthopedic surgeon, 

reported that appellant was under his care for a preexisting spinal anterolisthesis until she 

developed symptoms and changes due to her work-related injury. He opined that her cervical 

problem was directly related to her injury. 

By decision dated August 1, 2012, OWCP denied appellant’s claim finding that the 

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

accepted April 12, 2012 employment incident. 

On August 14, 2012 appellant, through counsel, requested a telephonic oral hearing 

before the Branch of Hearings and Review. 

A hearing was held on December 12, 2012. Appellant testified that she had worked as a 

screener for Newark Airport for 10 years. Her duties included pulling bags, some weighing up to 

85 pounds, off a baggage carousel, and putting them on a machine for scanning. Appellant 

stated that she never had a back problem until April 2012. On April 12, 2012 she went to pull a 

heavy bag and heard something in her shoulder pop, causing numbness on the right side of her 

body and back. Counsel for appellant argued that she had a preexisting back condition that was 

asymptomatic prior to the April 12, 2012 employment incident, which accelerated her underlying 

conditions and caused her to become symptomatic. 

In support of her claim, appellant submitted a November 19, 2012 medical report from 

Dr. Robert Heary, a Board-certified neurological surgeon, who reported that she was a security 

officer at Newark airport and injured herself on April 12, 2012 when she was lifting heavy bags. 

Appellant was placed on light duty but was unable to continue and stopped work on 

April 30, 2012. Dr. Heary noted complaints of pain and summarized diagnostic findings 

pertaining to the cervical and lumbar spine. He diagnosed isthmic spondylolisthesis at the L5-S1 

level with bilateral L5 spondylosis. Dr. Heary opined that this was likely a preexisting condition 

in April 2012 where the trauma disrupted fibrous adhesions and turned an asymptomatic 

condition into a symptomatic condition. After review of a September 7, 2012 magnetic 

resonance imaging (MRI) scan, Dr. Heary also diagnosed cervical herniated disc/osteophyte at 

C5-6 and C6-7 causing significant foraminal stenosis. He recommended surgical intervention 

for appellant’s lumbar and cervical injuries, noting that the lumbar spine condition was currently 

more symptomatic. 

By decision dated February 28, 2013, the Branch of Hearings and Review affirmed the 

August 1, 2012 decision finding that the evidence of record failed to establish that appellant’s 

diagnosed conditions were caused by the accepted April 12, 2012 employment incident. 

On August 9, 2013 appellant, through counsel, requested reconsideration of the 

February 28, 2013 decision. Counsel stated that he was submitting a well-rationalized report 

dated June 26, 2013 from Dr. Heary. 

In a June 26, 2013 medical report, Dr. Heary summarized the April 12, 2012 employment 

incident and provided findings on physical examination. He stated that appellant was in her 

usual state of health on April 12, 2012 when a lifting injury occurred, which rendered her 
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symptomatic from both the cervical and the lumbar spine pathology. The cervical spine 

demonstrated significant disc herniation at both C5-6 and C6-7 and the lumbar spine 

demonstrated a significantly large herniated disc causing severe spinal stenosis at the level of an 

L5-S1 pars defect. Dr. Heary opined that appellant’s symptoms, which were completely absent 

prior to the injury, were a direct result of the injury and would require surgical intervention. 

In a July 16, 2013 diagnostic report, Dr. Gangemi reported that an EMG study of the 

upper extremities revealed findings consistent with a right C8 cervical radiculopathy. 

By decision dated September 24, 2013, OWCP affirmed the February 23, 2013 decision 

finding that the evidence of record failed to establish that appellant’s diagnosed conditions were 

caused by the accepted April 12, 2012 employment incident. 

On December 11, 2013 appellant, through counsel, requested reconsideration of the 

September 24, 2013 OWCP decision. Counsel noted that he was submitting a December 3, 2013 

medical report from Dr. Heary, which established that appellant’s L5 pars fracture and two 

cervical herniated discs at C5-6 and C6-7 were a direct result of the work-related injury. 

In a December 3, 2013 medical report, Dr. Heary presented a history of the April 12, 

2012 employment incident and provided findings on examination. He summarized and reviewed 

a February 5, 2013 x-ray of the lumbar spine. Dr. Heary noted two ongoing active problems: an 

L5 pars fracture without spondylolisthesis and gross instability and a cervical herniated disc 

previously identified at the C5-6 and C6-7 levels. He opined with absolute medical certainty that 

these two problems were a direct result of the work-related injury where appellant developed 

severe intractable pain. Dr. Heary further stated that she required surgery for both her neck and 

low back injuries, recommending an anterior cervical discectomy, and a posterior decompression 

stabilization fusion procedure. He opined that both conditions were directly caused by 

appellant’s work injury, noting that nonoperative therapy had been completely ineffective for the 

past 20 months. Dr. Heary further stated that surgical correction was necessary and should be 

approved by the employing establishment as the injury was a direct result of the work-related 

injury. 

By decision dated February 21, 2014, OWCP affirmed the September 24, 2013 decision 

finding that the evidence of record failed to establish that appellant’s diagnosed conditions were 

caused by the accepted April 12, 2012 employment incident. 

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.2

 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.3

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

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

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 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. 

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.5

 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.6

ANALYSIS 

OWCP accepted that the April 12, 2012 employment incident occurred as alleged. The 

issue is whether appellant established that the incident caused her lumbar and cervical injuries. 

The Board finds that she did not submit sufficient medical evidence to support that her lumbar 

and cervical injuries are causally related to the April 12, 2012 employment incident.7 

In an April 30, 2012 CA-20 form, Dr. Boni reported that on April 12, 2012 appellant 

heard a snap in her back when she was lifting a heavy bag weighing 85 pounds. He diagnosed 

back pain, anxiety, and hypertension. Although Dr. Boni checked the box marked “yes” when 

asked if he believed that appellant’s condition was caused or aggravated by the employment 

incident, the Board has held that a report that addresses causal relationship with a checkmark, 

without medical rationale explaining how the work condition caused the alleged injury, is of 

diminished probative value and insufficient to establish causal relationship.8 Dr. Boni failed to 

explain the mechanism of injury by detailing how lifting an 85-pound bag would cause her 

injury. Moreover, his opinion references back pain as the cause of the April 12, 2012 

employment incident. The Board has consistently held that pain is a description of a symptom 

rather than a compensable medical diagnosis.9

 It is not possible to establish that the cause of a 

 4 Elaine Pendleton, supra note 2. 

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

6 James Mack, 43 ECAB 321 (1991). 

7 See Robert Broome, 55 ECAB 339 (2004). 

8 See Calvin E. King, Jr., 51 ECAB 394 (2000); see also Frederick E. Howard, Jr., 41 ECAB 843 (1990). 

9 C.F., Docket No. 08-1102 (issued October 10, 2008). 
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medical condition, if Dr. Boni has not stated a diagnosis, but only notes pain.10 Without a firm 

medical diagnosis and reasoning explaining how the April 12, 2012 employment incident caused 

appellant injury, Dr. Boni’s report is insufficient to meet her burden of proof.11

In an April 30, 2012 report, Dr. Cerreto, a treating chiropractor, reported that examination 

of the thoracic spine revealed vertebral subluxation complex at the C6, C7, and T1 levels. 

Examination of the lumbar spine revealed moderate disc degeneration with a grade 1 

spondylolisthesis. In a June 1, 2012 CA-20 form, Dr. Cerreto reported that appellant sustained 

upper thoracic pain when lifting heavy baggage and diagnosed radiculopathy in the right arm and 

spinal subluxations with myospasms. He checked the box marked “yes” when asked if he 

believed that the condition was caused or aggravated by the employment activity. 

In assessing the probative value of chiropractic evidence, the initial question is whether 

the chiropractor is considered a physician under 5 U.S.C. § 8101(2). A chiropractor is not 

considered a physician under FECA unless it is established that there is a spinal subluxation as 

demonstrated by x-ray to exist.12 The evidence does not reflect that Dr. Cerreto diagnosed 

subluxation based on the results of an x-ray as there is no indication in the reports that he 

obtained or reviewed x-rays when noting his subluxation findings.13 With respect to his 

diagnoses of moderate disc degeneration, grade 1 spondylolisthesis, and right arm radiculopathy, 

this does not constitute probative medical evidence as he does not meet the statutory definition of 

physician.14

In medical reports dated May 2 to July 16, 2013, Dr. Gangemi provided findings 

pertaining to EMG studies of the upper extremities. In a May 8, 2012 CA-20 form, he diagnosed 

cervical radiculopathy and cervicalgia and checked the box marked “yes” when asked if he 

believed that the condition was caused or aggravated by the employment activity. As previously 

noted, a report that addresses causal relationship with a checkmark is of diminished probative 

value and insufficient to establish causal relationship.15 Moreover, Dr. Gangemi failed to note an 

accurate history of the employment incident. While the CA-20 form noted that appellant was 

lifting heavy bags and heard something pop, he failed to identify the date of incident which she 

alleges injury. The Board has found that a physician must provide a narrative description of the 

 10 T.G., Docket No. 13-76 (issued March 22, 2013). 

11 C.B., Docket No. 08-1583 (issued December 9, 2008). 

12 See Kathryn Haggerty, 45 ECAB 383 (1994). 

13 Section 8101(2) of FECA provides as follows: “(2) ‘physician’ includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. The term ‘physician’ includes chiropractors only to the extent that their reimbursable services are 

limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by 

x-ray to exist and subject to regulation by the secretary.” See Merton J. Sills, 39 ECAB 572, 575 (1988). 

14 L.S., Docket No. 07-560 (issued June 22, 2007). See also Alberta S. Williamson, 47 ECAB 569 (1996) (The 

Board has held that an opinion on causal relationship which consists only of a physician checking “yes” on a 

medical form report without further explanation or rationale is of diminished probative value). 

15 Supra note 8. 
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identified employment incident and a reasoned opinion on whether the employment incident 

described caused or contributed to the diagnosed medical condition.16 

In a July 11, 2012 report, Dr. Gangemi reported that appellant suffered injury to her 

cervical and lumbosacral spine, which was related to her employment duties. He noted that the 

constant lifting of heavy bags caused significant wear and tear on her neck and back, causing the 

injuries. The Board notes that it appears Dr. Gangemi is attributing appellant’s conditions to an 

occupational injury produced by her work environment over a period longer than a single 

workday or shift rather than an injury from a single occurrence within a single workday as 

alleged by her in this claim.17 Moreover, Dr. Gangemi’s statement on causation fails to provide 

a sufficient explanation as to the mechanism of injury pertaining to this traumatic injury claim, 

namely, how lifting a heavy bag would cause or aggravate appellant’s cervical and lumbar 

injuries.18 Thus, his opinion pertaining to her work-related duties as the cause of her injuries 

does not provide support for a traumatic injury claim and is insufficient to meet her burden of 

proof.19 

In medical reports dated November 19, 2012 to December 11, 2013, Dr. Heary reported 

that appellant worked as a security officer at Newark airport and injured herself on April 12, 

2012 when she was lifting heavy bags. He provided findings on physical examination and 

review of diagnostic testing. Dr. Heary diagnosed isthmic spondylolisthesis at the L5-S1 level 

with bilateral L5 spondylosis, disc herniation in the lower cervical spine at C5-6 and C6-7, and 

L5 pars fracture. 

The Board finds that the opinions of Dr. Heary are not well rationalized. In his 

November 19, 2012 report, Dr. Heary opined that appellant’s isthmic spondylolisthesis at the L5-

S1 level with bilateral L5 spondylosis was likely a preexisting condition in April 2012, noting 

the trauma disrupted fibrous adhesions and turned an asymptomatic condition into a symptomatic 

condition. He failed to discuss how this preexisting condition had progressed beyond what 

might be expected from the natural progression of that condition.20 A well-rationalized opinion 

is particularly warranted in this case due to appellant’s history of preexisting conditions.21 

Moreover, the Board has held that an opinion that a condition is causally related because the 

employee was asymptomatic before the injury is insufficient, without adequate rationale, to 

establish causal relationship.22 Dr. Heary’s June 26, 2013 statement that appellant’s symptoms 

 16 John W. Montoya, 54 ECAB 306 (2003). 

17 A traumatic injury means a condition of the body caused by a specific event or incident, or series of events or 

incidents, within a single workday or shift. 20 C.F.R. § 10.5(ee). An occupational disease is defined as a condition 

produced by the work environment over a period longer than a single workday or shift. 20 C.F.R. § 10.5(q). 

18 S.W., Docket 08-2538 (issued May 21, 2009). 

19 S.R., Docket No. 12-1098 (issued September 19, 2012). 

20 R.E., Docket No. 14-868 (issued September 24, 2014). 

21 K.P., Docket No. 14-1330 (issued October 17, 2014). 

22 T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006). 
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were a direct result of the injury is highly speculative as he is attributing symptoms to the 

employment incident and not her diagnosed conditions.23 

In his December 11, 2013 medical report, Dr. Heary reported that appellant’s L5 pars 

fracture and cervical herniated disc at C5-6 and C6-7 were with absolute medical certainty a 

direct result of the work-related injury where appellant developed severe intractable pain. His 

statement on causation fails to provide a sufficient explanation as to the mechanism of injury and 

did not adequately explain how the April 12, 2012 employment incident would cause or 

aggravate her preexisting injuries other than generally noting the development of pain. Medical 

reports without adequate rationale on causal relationship are of diminished probative value and 

do not meet an employee’s burden of proof.24 The opinion of a physician supporting causal 

relationship must rest on a complete factual and medical background supported by affirmative 

evidence, address the specific factual and medical evidence of record, and provide medical 

rationale explaining the relationship between the diagnosed condition and the established 

incident or factor of employment.25 Without explaining how physiologically the movements 

involved in the employment incident caused or contributed to the diagnosed conditions, 

Dr. Heary’s opinion is of limited probative value and insufficient to meet appellant’s burden of 

proof.26 

The remaining medical evidence of record is also insufficient to establish causal 

relationship between appellant’s lumbar and cervical conditions and the April 12, 2012 

employment incident. Dr. Annese’s June 26 and December 28, 2012 reports interpreted 

diagnostic imaging studies and provided no opinion on the cause of appellant’s injury. The 

Board has held that medical evidence that does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value.27 Dr. Boiardo’s July 24, 2012 note is also 

insufficient to establish appellant’s claim as the physician failed to provide examination findings, 

a detailed medical history, description of the employment incident, review of diagnostic studies, 

and an explanation of how her preexisting spinal anterolisthesis was aggravated by her April 12, 

2012 work injury. Any medical opinion evidence appellant may submit to support her claim 

should reflect a correct history and offer a medically sound explanation by the physician of how 

the specific employment incident, in particular physiologically, caused or aggravated her back 

and neck injury.28

Appellant’s honest belief that the April 12, 2012 employment incident caused her 

medical problem is not in question. That belief however sincerely held, does not constitute the 

medical evidence necessary to establish causal relationship. In the instant case, the record lacks 

rationalized medical evidence establishing a causal relationship between the April 12, 2012 

 23 M.R., Docket No. 14-11 (issued August 27, 2014). 

24 Ceferino L. Gonzales, 32 ECAB 1591 (1981). 

25 See Lee R. Haywood, 48 ECAB 145 (1996). 

26 See L.M., Docket No. 14-973 (issued August 25, 2014); R.G., Docket No. 14-113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-548 (issued November 16, 2012). 

27 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

28 T.G., Docket No. 14-751 (issued October 20, 2014). 
9

employment incident and appellant’s injury. Thus, appellant has failed to meet her burden of 

proof. 

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.606 and 10.607. 

CONCLUSION 

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

cervical and lumbar injury is causally related to the April 12, 2012 employment incident, as 

alleged. 

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated February 21, 2014 is affirmed. 

Issued: January 27, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board