United States Department of Labor 

Employees’ Compensation Appeals Board 

_________________________________________ 

K.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Albany, NY, Employer 

___________________________________________

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Docket No. 16-0130 

Issued: April 19, 2016 

Appearances: Case Submitted on the Record 

George P. Ferro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On October 30, 2015 appellant, through counsel, filed a timely appeal from an August 20, 

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 her burden of proof to establish that she sustained a 

traumatic injury causally related to a September 30, 2014 employment incident. 

FACTUAL HISTORY 

On September 30, 2014 appellant, then a 35-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that date, she felt a twinge in the lower left side while exiting 

her delivery vehicle to deliver mail while in the performance of duty. She stopped work on 

October 1, 2014. 

 1

 5 U.S.C. § 8101 et seq. 
2

In an October 6, 2014 letter, OWCP advised appellant that additional factual and medical 

evidence was needed. It explained that a physician’s opinion explaining how the reported work 

incident caused or contributed to appellant’s condition was crucial to her claim. 

In a September 30, 2014 initial report, Dr. John C. Radford, Board-certified in emergency 

medicine, noted that on September 30, 2014 appellant was delivering mail and parcels when she 

was exiting her work vehicle and felt a sharp pain in her lower and middle back. He diagnosed a 

lumbosacral strain and checked the box marked “yes” in response to whether the incident was 

the cause of the injury. In addition, Dr. Radford checked the box marked “yes” in response to 

whether the patient’s complaints were consistent with the history of injury/illness and to whether 

the patient’s history was consistent with the objective findings. He assigned 20 percent 

temporary impairment. Dr. Radford indicated that appellant had low back pain that was tender 

to palpation. He listed work restrictions on bending, twisting, no lifting over 10 pounds, 

operation of motor vehicles, no driving a route truck/van, no pushing, and no overhead work. 

OWCP also received reports from physician assistants and nurses. 

In an October 14, 2014 narrative statement, appellant indicated that, while delivering 

mail on September 30, 2014, she turned to exit her vehicle and took a few steps. She noted that 

she felt a pain and twinge in her lower back and the left side. Appellant advised that she had no 

symptoms or disability with her back prior to this day. 

In an October 10, 2014 report, Dr. Thomas Haher, a Board-certified orthopedic surgeon, 

noted that appellant presented with pain and dysfunction in the lumbar spine with no radiation in 

the lower extremity and lower back pain. He explained that on September 30, 2014 she 

complained of low back pain with no radiculopathy. Dr. Haher advised that appellant was seen 

in urgent care, x-rayed and denied having radicular pain. He found no weakness or sensory loss 

of the lower extremities. Dr. Haher related that appellant’s pain was in her posterior and was 

sharp and severe. He found the problem was worsened by bending and worsened in the morning, 

but was relieved by ice. Dr. Haher advised that appellant underwent physical therapy. He 

examined her and diagnosed lower back pain. In an October 10, 2014 duty status report, 

Dr. Haher diagnosed a muscle strain due to her injury. He indicated that appellant was not 

advised to return to work. 

By decision dated November 18, 2014, OWCP denied appellant’s claim finding that she 

did not submit sufficient medical evidence establishing that a diagnosed condition was 

attributable to the claimed work incident. Therefore, appellant did not establish fact of injury. 

On January 13, 2015 appellant requested reconsideration and submitted new medical 

evidence. In a November 10, 2014 report, Dr. Haher noted that appellant presented for follow up 

and had attended physical therapy for the past month. He advised that she was frustrated by 

persisting pain. Dr. Haher examined appellant and provided findings which included that she 

had difficulty moving from a seated to a standing position due to low back pain and she appeared 

to be in moderate pain. Examination of the spine and gait indicated that her station was normal, 

her spinal alignment had normal lordosis, and she had a well-healed incision.2

 Dr. Haher 

diagnosed lower back pain and lumbar radiculopathy. He opined that the incident described by 

the patient was a competent medical cause of this injury and that the patient’s complaints were 

 2

 Dr. Haher did not further elaborate on what procedure or incident that gave rise to the incision. 
3

consistent with the history of injury/illness, which was consistent with the objective findings. 

Dr. Haher advised that appellant was not working. 

In a December 1, 2014 report, Dr. Haher again noted that appellant was not working. He 

related that she came in frustrated with persistent complaints, left-sided lower back pain, and 

radicular-type pain into the left-sided buttock. Dr. Haher indicated that appellant underwent 

physical therapy and took anti-inflammatory medicine and was still unable to return to work. He 

advised that she was complaining of this type of pain for the past two months since she stepped 

out of her mail truck awkwardly on September 30, 2014. Dr. Haher examined appellant and 

provided findings. He diagnosed lower back pain. Dr. Haher opined that appellant’s symptoms 

were causally related to the injury on September 30, 2014. 

Dr. Haher saw appellant on December 19, 2014 and advised in a report that physical 

therapy was ineffective. He repeated his diagnosis of lower back pain and opined that the 

incident on September 30, 2014 was the cause of her current symptoms. OWCP also received 

nurses notes and physical therapy notes, and copies of previously submitted reports. 

By decision dated January 30, 2015, OWCP denied modification of its prior decision. 

In a June 5, 2015 letter, counsel for appellant again requested reconsideration. He 

submitted new medical evidence and argued that the new medical evidence supported causal 

relationship. 

In a December 19, 2014 duty status report, Dr. Haher diagnosed low back pain and 

advised that appellant was unable to work. On January 22, 2015 he reported that appellant’s pain 

persisted and physical therapy was not effective. Dr. Haher diagnosed lower back pain. He 

reiterated that the incident described by appellant was a competent medical cause of her injury 

and that her complaints were consistent with the history of injury/illness, which was consistent 

with the objective findings. Dr. Haher advised that she was totally disabled. In a March 13, 

2015 report, he saw appellant and repeated his opinion on causal relationship. In a March 27, 

2015 report, Dr. Haher diagnosed lower back pain and lumbar radiculopathy. He explained that 

due to the severity of her pain, appellant was a candidate for pain management or surgery. 

Dr. Haher again advised that she was unable to work and repeated his opinion on causal 

relationship. 

On June 15, 2015 Dr. Haher examined appellant and provided findings. He diagnosed 

lower back pain, lumbar radiculopathy and lumbar herniated disc. Dr. Haher advised that 

appellant was totally disabled and reiterated that the work incident described by her was a 

competent cause of her injury. He indicated that her “complaints were consistent with the 

history of the injury/illness. [Appellant’s] history of the injury/illness is consistent with my 

objective findings. The percentage of temporary impairment is 100 percent. [Appellant] is not 

working at this time. [She] is on total disability until next visit or further notice.” 

A March 20, 2015 magnetic resonance imaging (MRI) scan of the lumbosacral spine 

revealed L5-S1 disc degeneration with moderate central disc protrusion extrusion subtype with 

mild indents of the ventral sac and mild right greater than left foraminal narrowing. OWCP also 

received physical therapy reports and copies of prior reports. 
4

By decision dated August 20, 2015, OWCP denied modification if its prior decision 

finding that appellant’s physician failed to provide sufficient medical rationale supported by 

objective medical evidence and an accurate history to establish that the diagnosed lumbar 

conditions were causally related to the work incident of September 30, 2014. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3 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 FECA4

 and that an injury was sustained in the performance of duty.5 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 determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether the fact of injury has been established. 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that he or she actually experienced the employment 

incident at the time, place, and in the manner alleged.7 Second, the employee must submit 

sufficient evidence, generally only in the form of medical evidence, to establish that the 

employment incident caused a personal injury.8

 

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on a complete factual and medical 

background, 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.9

ANALYSIS 

Appellant alleged that on September 30, 2014 she felt a twinge in her back in the lower 

left side while exiting her delivery vehicle to deliver mail in the performance of duty. OWCP 

found and the evidence supports that she exited her work vehicle on September 30, 2014 as 

alleged. The Board thus finds that the first component of fact of injury is established. 

 3 Supra note 1. 

4 Joe D. Cameron, 41 ECAB 153 (1989). 

5 James E. Chadden, Sr., 40 ECAB 312 (1988). 

6 Delores C. Ellyett, 41 ECAB 992 (1990). 

7 Julie B. Hawkins, 38 ECAB 393, 396 (1987); see Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of 

Injury, Chapter 2.803.2a (June 1995). 

8 Id. For a definition of the term “traumatic injury,” see 20 C.F.R. § 10.5(ee). 

9 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 
5

The medical evidence of record, however, is insufficiently rationalized to establish the 

second component of fact of injury, that the employment incident caused an injury. The medical 

evidence contains no reasoned explanation of how the September 30, 2014 employment incident 

caused or aggravated an injury.10 

In reports dated November 10, December 1 and 19, 2014, Dr. Haher examined appellant 

and provided findings and diagnosed lower back pain and lumbar radiculopathy. He opined that 

the incident described by appellant was a competent cause of her injury and that her complaints 

were consistent with the history of injury/illness and with objective findings.11 In other reports, 

such as those issued on January 22, March 13 and 27, and June 15, 2015, Dr. Haher expressed a 

similar opinion on causal relationship and advised that appellant was totally disabled. However, 

it is unclear how he formed this conclusion. The record reflects that appellant has degenerative 

conditions revealed on MRI scan and he has not adequately explained how he arrived at this 

conclusion. While the medical opinion of a physician supporting causal relationship does not 

have to reduce the cause or etiology of a disease or condition to an absolute certainty, neither can 

such opinion be speculative or equivocal. The opinion of a physician supporting causal 

relationship must be one of reasonable medical certainty that the condition for which 

compensation is claimed is causally related to federal employment and such relationship must be 

supported with affirmative evidence, explained by medical rationale and be based upon a 

complete and accurate medical and factual background of the claimant.12 Dr. Haher has not 

explained why exiting a work vehicle on September 30, 2014, caused or aggravated appellant’s 

diagnosed conditions. 

In a September 30, 2014 initial report, Dr. Radford, noted that on September 30, 2014 

appellant was delivering mail and parcels when she was exiting her work vehicle and felt a sharp 

pain in her lower and middle back. He diagnosed a lumbosacral strain and checked the box 

marked “yes” in response to whether the incident was the cause of the injury. Dr. Radford also 

checked the box marked “yes” in response to whether the patient’s complaints were consistent 

with the history of injury/illness and to whether the patient’s history was consistent with the 

objective findings. However, he did not explain how he arrived at this conclusion. The checking 

of a box marked “yes” in a form report, without additional explanation or rationale, is not 

sufficient to establish causal relationship.13

 10 See George Randolph Taylor, 6 ECAB 986, 988 (1954) (where the Board found that a medical opinion not 

fortified by medical rationale is of little probative value). 

11 It is unclear whether Dr. Haher presents an accurate history in his November 10, 2014 report as he indicates 

that appellant has no prior surgical history involving the back but his examination findings for the spinal area 

indicate that appellant has a well-healed old surgical incision. The Board has held that medical opinions based upon 

an incomplete history have little probative value. See Leonard J. O’Keefe, 14 ECAB 42, 48 (1962). 

12 Samuel Senkow, 50 ECAB 370 (1999); Thomas A. Faber, 50 ECAB 566 (1999). 

13 Calvin E. King, 51 ECAB 394 (2000). 
6

Other medical reports of record are of limited probative value and insufficient to establish 

the claim as they do not contain a physician’s opinion supporting causal relationship.14 

OWCP also received reports from physician assistants, nurses, and physical therapists. 

Section 8101(2) of FECA15 provides that the term “physician” includes surgeons, podiatrists, 

dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within 

the scope of their practice as defined by the applicable state law. Consequently, this evidence 

cannot be considered medical evidence as physician assistants, nurses, and physical therapists are 

not considered physicians under FECA.16 

Because the medical reports submitted by appellant do not adequately address how the 

September 30, 2014 activities at work caused or aggravated a back condition, these reports are of 

limited probative value17 and are insufficient to establish that the September 30, 2014 

employment incident caused or aggravated a specific injury.18

On appeal, appellant’s counsel made several arguments in support of her claim. He 

contended that she had established causal relationship. However, as found above, the evidence 

was insufficient to establish causal relationship. 

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 she 

sustained a traumatic injury causally related to a September 30, 2014 employment incident. 

 14 See Charles H. Tomaszewski, 39 ECAB 461, 467-68 (1988) (finding that medical evidence which does not 

offer any opinion regarding the cause of an employee’s condition is of limited probative value on the issue of causal 

relationship). 

15 See 5 U.S.C. § 8101(2). See also Charley V.B. Harley, 2 ECAB 208, 211 (1949) (where the Board has held 

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

16 Lay individuals such as physician assistants, nurses, and physical therapists are not competent to render a 

medical opinion under FECA. David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). 

17 See Linda I. Sprague, 48 ECAB 386, 389-90 (1997). 

18 The record contains a Form CA-16 dated September 30, 2014 and signed by the employing establishment. A 

properly executed CA-16 form can form a contractual agreement for payment of medical expense, even if the claim 

is not accepted. See 20 C.F.R. § 10.300; Val D. Wynn, 40 ECAB 666 (1989); see also Federal (FECA) Procedure 

Manual, Part 3 -- Medical, Authorizing Examination and Treatment, Chapter 3.300.3(a)(3) (February 2012). Upon 

return of the case record, OWCP should address this issue. 
7

ORDER 

IT IS HEREBY ORDERED THAT the August 20, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 19, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board