United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.Z., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Phoenix, AZ, Employer 

__________________________________________ 

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Docket No. 14-1544 

Issued: March 4, 2015 

Appearances: Case Submitted on the Record

Lonnie Boylan, for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 30, 2014 appellant, through her representative, filed a timely appeal from a 

March 6, 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 injuries to her back, 

neck, shoulders, arms, and lower extremities in the performance of duty. 

On appeal, counsel contends that the medical evidence sufficiently established causal 

relationship, particularly the reports from Dr. Kimy Charani, a physician Board-certified in 

osteopathic manipulative medicine, and Dr. Demitri Adarmes, a Board-certified physiatrist. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On September 21, 2012 appellant, then a 56-year-old rural carrier associate, filed an 

occupational disease claim (Form CA-2) alleging that she injured her back, neck, shoulders, 

arms, and lower extremities due to factors of her federal employment, including lifting tubs, 

pushing heavy carts of mail, twisting, driving, and walking. She became aware of her condition 

on December 2, 2011 and attributed it to her federal employment on December 28, 2011.2

On December 28, 2011 Dr. Charani excused appellant from work until January 16, 2012 

“due to illness.” 

In a June 6, 2012 report, Dr. Adarmes stated that appellant complained of right low back 

pain, right hip pain, and right leg pain. He indicated that the date of injury was May 21, 2007 

when she was involved in a motor vehicle accident while delivering mail and sustained injuries 

to her right shoulder, neck, low back, left knee, and forehead. Appellant stated that “everything 

ha[d] improved except the low back pain and the right shoulder pain” and that “she had right 

lower extremity pain since the accident.” She reported that she had neck surgery in 2009 and 

subsequently underwent a fusion. Dr. Adarmes noted that appellant had a claim accepted for 

neck sprain, cervical myelopathy, and lumbar sprain3

 and diagnosed right greater trochanteric 

bursitis and right sacroiliac joint pain. 

In an October 1, 2012 letter, OWCP notified appellant of the deficiencies of her claim 

and requested factual and medical evidence. It afforded her 30 days to submit additional 

evidence and respond to its inquiries. 

Appellant submitted a narrative statement dated October 8, 2012 and a series of pay 

stubs. 

In an October 16, 2012 report, Dr. Adarmes diagnosed increased muscular tone and 

motor weakness in the upper and lower limbs secondary to cervical myelopathy. He opined that 

appellant’s accepted conditions of cervical disc herniation and lumbosacral sprain were 

permanently aggravated by her repeated lifting of tubs of mail every day, pushing heavy carts 

filled with mail, and getting in and out of her postal vehicle “on a more probable than not basis.” 

On October 22, 2012 the employing establishment indicated that appellant had been a 

rural carrier associate for the past 10 years. Appellant’s duties included: delivering a hamper of 

mail to four prisons, lifting tubs of mail, and delivering mail from a postal vehicle. 

By decision dated January 8, 2013, OWCP denied the claim on the basis that the medical 

evidence failed to establish a causal relationship between appellant’s condition and the 

established factors of her federal employment. 

 2

 Appellant has the following additional claims: xxxxxx854 (May 21, 2007 motor vehicle accident); xxxxxx431 

(October 15, 2009 short form closure); xxxxxx699 (February 13, 2010 recurrence of the May 21, 2007 injury); 

xxxxxx901 (September 15, 2010 date of injury); and xxxxxx270 (February 22, 2011 stress condition). 

3

 OWCP No. xxxxxx854. 
3

On January 15, 2013 appellant, through her representative, requested an oral hearing 

before an OWCP hearing representative. 

Appellant submitted reports dated December 28, 2011 through February 15, 2013 from 

Dr. Charani, who diagnosed chronic cervical and lumbar pain with right leg radiculopathy, 

myofascial pain across the lower back, chronic right hip pain, and chronic right leg pain due to 

motor vehicle accident. On March 20, 2012 Dr. Charani indicated that a study revealed leftsided radiculopathy, although most of appellant’s pain was down the right leg at that time. On 

May 10, 2012 he found a positive abnormal electromyography (EMG), which revealed a right 

leg radiculopathy. Dr. Charani opined that appellant was not capable of performing the 

repetitive tasks required by her federal employment, including sitting, driving, stooping, bending, 

and lifting. 

On May 1, 2012 Dr. Ali Araghi, an orthopedic surgeon, diagnosed lumbago, lumbalgia, 

and lumbar radiculopathy. He stated that her chief complaint was low back pain due to a motor 

vehicle accident that occurred on May 21, 2007. Appellant returned to work in May 2009 and 

continued to have lower back pain radiating down her right leg which was aggravated by 

bending forward, leaning back, sitting, standing, walking, physical activity, rising out of 

bed/chair, coughing, and sneezing. Upon examination, Dr. Araghi found no erythema, no 

significant joint swelling, no tenderness to palpation, no sign of instability, and range of motion 

within functional limits in the bilateral upper and lower extremities. 

In a January 25, 2013 report Dr. George Wang, a sleep medicine specialist, diagnosed 

cervical radiculopathy, neck pain, cerebral concussion, headache, and migraine. He indicated 

that appellant’s conditions began in 2007 subsequent to a motor vehicle accident on the job. 

On April 16, 2013 a telephonic oral hearing was held before an OWCP hearing 

representative. 

By decision dated July 3, 2013, the hearing representative affirmed the January 8, 2013 

decision. 

On January 7, 2014 appellant, through her representative, requested reconsideration and 

submitted a position description and terms of employment. 

In a July 31, 2013 report, Dr. Charani stated that he initially saw appellant on 

December 9, 2008 for an employment-related motor vehicle injury, which occurred on 

May 21, 2007. He reported that she underwent cervical spinal surgery on March 5, 2009 and 

continued to have issues, particularly in the lower back with radiculopathy into the right leg, 

which was made worse by her continued work schedule at the employing establishment. 

Dr. Charani indicated that appellant’s duties included repeated bending, lifting, squatting, 

walking, sitting, and climbing in and out of her vehicle. Appellant filled and pushed one to two 

carts filled with mail weighing anywhere between 70 to 100 pounds each day. Her duties also 

included a lot of driving, which at times was 30 miles of unpaved roads with lots of bumps. 

Dr. Charani stated that over the course of two years it came to a point where appellant could no 

longer function at work due to her chronic pain issues. He reported that an October 19, 2011 

magnetic resonance imaging (MRI) scan revealed degenerative disc disease with possible 
4

radiculopathy on her EMG. Dr. Charani stated that he took appellant off work and put her on 

full disability beginning December 28, 2011 because of her deteriorating condition and the 

constant pain in her neck, lower back, down her leg, and into her shoulder and because her pain 

was not being adequately controlled with medication. He opined that her injuries were chronic 

in nature and “clearly related to the activities of her work.” 

An MRI scan of the cervical spine dated October 2, 2013 showed anterior cervical 

discectomy and fusion with hardware in place from C5-7, mild spinal stenosis at C4-5, 

effacement of the central subarachnoid space at C6-7 and small focus of myelomalacia in the 

spinal cord at C5-6. 

An MRI scan of the lumbar spine dated October 16, 2013 revealed no spinal canal or 

neural exit foraminal stenosis, a straightened thoracolumbar lordosis, circumferential disc 

bulging, disc desiccation, endplate hypertrophic degenerative changes, and posterior element 

degenerative changes. 

In a November 1, 2013 report, Dr. Adarmes indicated that appellant was first seen on 

June 6, 2012 for evaluation of her right shoulder, neck, low back, left knee, and forehead pain 

that began after a motor vehicle accident in 2007. Abnormal findings on his examination of 

appellant showed a magnetic shuffling gait, wide-based station, restriction of lumbar flexion and 

extension and a positive right Patrick’s test. Muscle strength was 4/5 in both lower limbs. 

Appellant had right C5 and C6 myotomal weakness rated with strength of 3/5. She had positive 

bilateral Babinski reflexes and increased muscle tone in the upper and lower limbs. Dr. Adarmes 

stated that it was “a miracle that she returned to work in a physically demanding position 

considering that she sustained a spinal cord injury in the mid cervical spine.” He reviewed the 

physical requirements of appellant’s federal employment and opined that the repetitive physical 

demands of her job had a direct impact on her cervical and lumbar spine conditions. 

Dr. Adarmes opined that her “lumbar spine intervertebral disc disorder was permanently 

aggravated as a consequence of the physical demands of her job on a more probable than not 

basis.” He indicated that repetitive carrying, lifting, and pushing, as well as prolonged standing 

to sort mail and operating a vehicle on unpaved roads “can cause injury or exacerbate already 

injured lumbar discs and contribute to degenerative changes in the lumbar spine.” Dr. Adarmes 

further indicated that repetitive reaching activities, carrying, lifting, pushing, pulling, and driving 

a vehicle “also contribute to [appellant’s] cervical spine problem.” He concluded that appellant’s 

workplace exposure of repetitive lifting, bending, stooping, twisting, pushing, pulling, climbing, 

and operating a motor vehicle while performing her federal duties accelerated the expected 

progression of her preexisting conditions of intervertebral disc disorder with myelopathy of the 

cervical region and lumbosacral sprain with evidence of left L4, L5, and S1 radiculopathy. 

Dr. Adarmes opined that “her present debilitating condition would not have manifested itself but 

for her employment.” 

By decision dated March 6, 2014, the hearing representative affirmed the July 3, 2013 

decision. 
5

LEGAL PRECEDENT 

An employee seeking benefits under FECA4 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, and that an injury5

 was sustained in the performance of duty. These 

are the essential elements of each compensation claim, regardless of whether the claim is 

predicated upon a traumatic injury or an occupational disease.6

To establish that an injury was sustained in the performance of duty in a claim for an 

occupational disease claim, an employee must submit 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 evidence. Rationalized medical opinion 

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

is a causal relationship between the employee’s diagnosed condition and the implicated 

employment factors.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 

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

federal employment factors caused or aggravated her back, neck, bilateral upper and lower 

extremity conditions. Appellant submitted a statement in which she identified the factors of 

employment that she believed caused the conditions, including lifting tubs, pushing heavy carts 

of mail, twisting, driving, and walking. However, in order to establish a claim that she sustained 

an employment-related injury, she must also submit rationalized medical evidence which 

 4 See supra note 2.

5

 OWCP regulations define an occupational disease or illness 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). 

6 See J.C., Docket No. 09-1630 (issued April 14, 2010). See also Ellen L. Noble, 55 ECAB 530 (2004). 

7 Id. See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994). 

8 See D.N., Docket No. 10-1762 (issued May 10, 2011). 

9 See D.E., Docket No. 07-27 (issued April 6, 2007). See also Victor J. Woodhams, 41 ECAB 345 (1989). 
6

explains how her medical conditions were caused or aggravated by the implicated employment 

factors.10

In his reports, Dr. Charani diagnosed chronic cervical and lumbar pain with right leg 

radiculopathy, myofascial pain across the lower back, chronic right hip pain, and chronic right 

leg pain due to motor vehicle accident. He opined that appellant was not capable of performing 

the repetitive tasks required by her federal employment, including sitting, driving, stooping, 

bending, and lifting. In his report dated July 31, 2013, Dr. Charani stated that he initially saw 

her on December 9, 2008 for an employment-related motor vehicle injury, which occurred on 

May 21, 2007. He reported that appellant underwent cervical spinal surgery on March 5, 2009 

and continued to have issues, particularly in the lower back with radiculopathy into the right leg, 

which was made worse by her continued work schedule at the employing establishment. 

Dr. Charani indicated that appellant’s duties included repeated bending, lifting, squatting, 

walking, sitting, climbing in and out of her vehicle, and driving, which at times was 30 miles of 

unpaved roads with lots of bumps. He stated that over the course of two years it came to a point 

where she could not function any longer at work due to her chronic pain issues. Dr. Charani 

stated that he took appellant off work and put her on full disability beginning December 28, 2011 

because of her deteriorating condition and her constant pain in her neck, lower back, down her 

leg and into her shoulder and because her pain was not being adequately controlled with 

medication. He opined that her injuries were chronic in nature and “clearly related to the 

activities of her work.” Dr. Charani failed to directly address the issue of causal relationship as 

he did not provide a rationalized medical opinion explaining how factors of appellant’s federal 

employment, such as repeated bending, lifting, squatting, walking, sitting, driving, and climbing 

in and out of her vehicle, caused or aggravated her conditions. The Board has held that the mere 

fact that her symptoms arise during a period of employment or produce symptoms revelatory of 

an underlying condition does not establish a causal relationship between her condition and her 

employment factors.11 Although Dr. Charani noted that appellant’s conditions occurred while 

she was at work and stated that her injuries were “clearly related to the activities of her work,” 

such generalized statements do not establish causal relationship because they are unsupported by 

adequate medical rationale explaining how her physical activity at work actually caused or 

aggravated the diagnosed conditions.12 Thus, the Board finds that his reports are insufficient to 

establish that she sustained an employment-related injury. 

In his reports, Dr. Adarmes diagnosed right greater trochanteric bursitis, right sacroiliac 

joint pain, increased muscular tone, and motor weakness in the upper and lower limbs secondary 

to cervical myelopathy. He opined that appellant’s accepted conditions of cervical disc 

herniation and lumbosacral sprain were permanently aggravated by her repeated lifting of tubs of 

mail every day, pushing heavy carts filled with mail and getting in and out of her postal vehicle 

“on a more probable than not basis.” On November 1, 2013 Dr. Adarmes stated that it was “a 

miracle that she returned to work in a physically demanding position considering that she 

 10 See A.C., Docket No. 08-1453 (issued November 18, 2008); Donald W. Wenzel, 56 ECAB 390 (2005); 

Leslie C. Moore, 52 ECAB 132 (2000). 

11 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

12 See K.W., Docket No. 10-98 (issued September 10, 2010). 
7

sustained a spinal cord injury in the mid cervical spine.” He reviewed the physical requirements 

of appellant’s federal employment and opined that the repetitive physical demands of her job had 

a direct impact on her cervical and lumbar spine conditions. Dr. Adarmes opined that her 

“lumbar spine intervertebral disc disorder was permanently aggravated as a consequence of the 

physical demands of her job on a more probable than not basis.” He indicated that repetitive 

carrying, lifting, and pushing, as well as prolonged standing to sort mail and operating a vehicle 

on unpaved roads “can cause injury or exacerbate already injured lumbar discs and contribute to 

degenerative changes in the lumbar spine.” Dr. Adarmes further indicated that repetitive 

reaching activities, carrying, lifting, pushing, pulling, and driving a vehicle “also contribute to 

[appellant’s] cervical spine problem.” He concluded that appellant’s workplace exposure of 

repetitive lifting, bending, stooping, twisting, pushing, pulling, climbing, and operating a motor 

vehicle while performing her federal duties accelerated the expected progression of her 

preexisting conditions of intervertebral disc disorder with myelopathy of the cervical region and 

lumbosacral sprain with evidence of left L4, L5 and S1 radiculopathy. Dr. Adarmes opined that 

“her present debilitating condition would not have manifested itself but for her employment.” 

He noted that appellant’s conditions occurred while she was at work, however, he repeatedly 

maintained that her conditions were aggravated “on a more probable than not basis” and such 

generalized statements do not establish causal relationship because they are unsupported by 

adequate medical rationale explaining how her physical activity at work actually caused or 

aggravated the diagnosed conditions.13 The Board finds that Dr. Adarmes failed to provide a 

rationalized opinion explaining how factors of her federal employment, such as prolonged 

standing, repetitive carrying, lifting, bending, stooping, twisting, pushing, pulling, climbing, and 

operating a motor vehicle, caused or aggravated her conditions. Therefore, appellant has failed 

to meet her burden of proof to establish a claim. 

In his May 1, 2012 report, Dr. Araghi diagnosed lumbago, lumbalgia and lumbar 

radiculopathy, indicating that appellant’s condition was aggravated by bending forward, leaning 

back, sitting, standing, walking, physical activity, rising out of bed/chair, coughing, and 

sneezing. He failed to provide a rationalized opinion explaining how factors of her federal 

employment caused or aggravated her lumbar condition. Lacking thorough medical rationale on 

the issue of causal relationship, the Board finds that Dr. Araghi’s reports are insufficient to 

establish that appellant sustained an employment-related injury. 

In his January 25, 2013 report, Dr. Wang diagnosed cervical radiculopathy, neck pain, 

cerebral concussion, headache, and migraine. He indicated that appellant’s conditions began in 

2007 subsequent to a motor vehicle accident on the job. 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 on the issue of causal relationship.14 As such, the Board finds that 

appellant did not meet her burden of proof with the submission of this report. 

In support of her claim, appellant submitted a position description, terms of employment, 

and MRI scans dated October 2 and 16, 2013. These documents do not constitute competent 

medical evidence as they do not contain rationale by a physician relating her disability to her 

 13 Id. 

14 See C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009). 
8

employment.15 As such, the Board finds that appellant did not meet her burden of proof with 

these submissions. 

As appellant has not submitted any rationalized medical evidence to support her 

allegation that she sustained an injury causally related to the indicated employment factors, she 

failed to meet her burden of proof to establish a claim. 

On appeal, appellant’s representative contends that the medical evidence sufficiently 

established causal relationship, particularly the reports from Dr. Charani and Dr. Adarmes. For 

the reasons stated above, the Board finds that the representative’s arguments are not 

substantiated. 

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 has not met her burden of proof to establish injuries to her 

back, neck, shoulders, arms, and lower extremities in the performance of duty causally related to 

factors of her federal employment. 

 15 See 5 U.S.C. § 8101(2). 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.” See also Paul Foster, 56 ECAB 208, 212 n.12 (2004); Joseph N. 

Fassi, 42 ECAB 677 (1991); Barbara J. Williams, 40 ECAB 649 (1989). 
9

ORDER 

IT IS HEREBY ORDERED THAT the March 6, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 4, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board