United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Piqua, OH, Employer 

__________________________________________ 

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Docket No. 15-0772 

Issued: May 12, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On February 20, 2015 appellant filed a timely appeal of an October 7, 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 his burden of proof to establish a lower back injury 

causally related to a July 22, 2013 employment incident. 

FACTUAL HISTORY 

On July 23, 2013 appellant, then a 43-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on July 22, 2013 he strained his lower back while carrying/lifting a 

tray of flats. 

 1

 5 U.S.C. § 8101 et seq. 
2

In attending physician reports (Form CA-20) dated July 23 and 26, 2013, Dr. Joshua 

Oakley, an attending chiropractor, diagnosed lumbar strain/sprain, set periods of disability, and 

noted that appellant’s lumbar sprain/strain was due to the bending/lifting injury on July 22, 2013. 

Dr. Oakley described sustaining intense back pain after attempting to lift a box of mail. 

In a letter dated September 25, 2013, OWCP informed appellant that the evidence of 

record was insufficient to establish his claim. It informed him that a chiropractor was not 

considered a physician under FECA unless there was a diagnosis of subluxation by x-ray 

interpretation. OWCP advised appellant as to the type of medical and factual evidence required 

to establish his claim and afforded him 30 days to provide the requested information. 

In response to OWCP’s request, appellant submitted additional reports from Dr. Oakley. 

In a July 22, 2013 report, he diagnosed upper and lower lumbar subluxations at L1, 2 and 5 for 

strain/sprain with possible disc involvement. Dr. Oakley noted that appellant was seen for lower 

back pain which occurred following lifting containers of mail. He described that appellant began 

to have constant lower back pain due to lifting containers of mail that morning. A physical 

examination revealed moderate lower back spasms, decreased lumbar flexion, moderately 

decreased bilateral rotation with pain, and antalgic posture when leaning forwards. Physical 

examination findings were provided and Dr. Oakley noted that appellant was being treated for 

upper and lower lumbar subluxations at L1, 2 and 5 for strain/sprain. 

In subsequent reports dated July 23 to September 17, 2013, Dr. Oakley diagnosed 

subluxations at L5 and S1 and lumbar strain/sprain, provided physical examination findings, and 

reported the chiropractic adjustments and treatment he provided. 

In an August 14, 2013 CA-20 form, Dr. Oakley noted an injury date of July 22, 2013 

which occurred when appellant attempted to pick up a box of mail. He diagnosed lumbar 

strain/sprain which he attributed to the July 22, 2013 lifting/bending incident. Dr. Oakley 

commented that appellant was asymptomatic prior to the incident and felt instant pain while 

bending to lift the box of mail. He noted that appellant was totally disabled for the period 

July 22 to August 18, 2013 and was released to return to work on August 19, 2013. 

By decision dated November 1, 2013, OWCP accepted that appellant was carrying or 

lifting mail on July 22, 2013, but denied the claim as appellant failed to submit any medical 

evidence diagnosing a condition causally related to the July 22, 2013 accepted employment 

incident. It noted that the medical evidence had not been provided by a physician under FECA. 

OWCP found the chiropractor insufficient as he failed to diagnose a subluxation by x-ray 

interpretation. 

On November 20, 2013 appellant requested reconsideration and submitted a report from 

Dr. Oakley in support of his request. In a November 16, 2013 report, Dr. Oakley diagnosed a 

lumbar spine subluxation based on an x-ray interpretation taken that day. He noted that an x-ray 

was not initially performed because the physical examination revealed a subluxation, to reduce 

insurance cost, and felt it was unwarranted as it would not impact treatment of appellant’s 

condition. Dr. Oakley reiterated that, during the initial July 22, 2013 visit, a diagnosis of lumbar 

sprain/strain and lumbar subluxations were made. He noted that on each visit appellant was 

treated for the subluxations by adjustments. 
3

By decision dated March 5, 2014, OWCP denied modification as it again found that 

Dr. Oakley was not considered a physician under FECA as he had not diagnosed a subluxation 

by x-ray interpretation when he first treated appellant. 

On April 16, 2014 appellant requested reconsideration following the submission of 

additional evidence in support of his request. On November 16, 2013 Dr. Bryan K. Hosler, a 

chiropractor, took an x-ray of appellant’s spine at the request of Dr. Oakley. He reported 

moderate L5-S1 disc space narrowing together with mild-to-moderate T12-L1, L1-2, L2-4, L3-4, 

and L4-5 disc space loss, mild C6-7 disc space narrowing, L4-5 and L5-S1 mild degenerative 

facet arthropathy, and mild T12 anterior vertebral body height. Dr. Hosler diagnosed S1 

lumbarization, cervical arcual kyphosis, C6-7 mild discogenic spondylosis, multilevel thoracic 

discogenic spondylosis, mild anterior T12 vertebral body wedge deformity, L5-S1 moderate 

discogenic spondylosis along mild-to-moderate T12-L1, L1-2, L2-4, L3-4, and L4-5 severity 

involvement, and L4-5 and L5-S1 degenerative facet arthropathy. 

Additionally, in an April 15, 2014 report, Dr. James S. Burkhardt, an osteopathic Boardcertified physician practicing in family and sports medicine, concurred with Dr. Oakley’s 

diagnosis and treatment. He noted that based on his review of the medical evidence that the 

diagnosis was consistent with the history of the July 22, 2013 work incident. Dr. Burkhardt 

opined that appellant’s injury was directly caused by the July 22, 2013 employment incident. 

By decision dated April 28, 2014, OWCP denied modification. It found that as the x-ray 

interpretation was taken approximately four months following the July 22, 2013 incident it was 

insufficient to establish that Dr. Oakley would be considered a physician under FECA. OWCP 

also found the x-ray interpretation did not clearly identify the subluxations. 

By letter dated July 12, 2014, appellant requested reconsideration. In support of his 

request, he submitted a June 16, 2014 report from Dr. Oakley. Dr. Oakley again explained that 

an x-ray interpretation was not initially taken at the time of the July 22, 2013 incident as he did 

not believe it was warranted for treatment of appellant’s condition. Based on his physical 

examination, he diagnosed and treated appellant for lower lumbar strain, lower lumbar disc 

involvement, and multiple lumbar subluxations. Dr. Oakley related that x-rays are unnecessary 

in diagnosing subluxations and are not warranted unless there is no improvement in the patient’s 

condition or there is suspicion of another diagnosis. 

By decision dated October 7, 2014, OWCP denied modification. It found that as no x-ray 

interpretations diagnosing a subluxation had been “taken close in time to the work injury” that 

Dr. Oakley could not be considered a physician under FECA. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2

 has the burden of proof to establish 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 

 2

 5 U.S.C. § 8101 et seq. 
4

disability and/or specific condition for which compensation is claimed are causally related to the 

employment injury.3 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.4

OWCP regulations, at 20 C.F.R. § 10.5(e) define a traumatic injury as a condition of the 

body caused by a specific event or incident or series of events or incidents within a single 

workday or shift.5

 To determine whether a federal employee has sustained a traumatic injury in 

the performance of duty it must first be determined whether a fact of injury has been 

established.6

 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

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

establish causal relationship is rationalized medical opinion evidence.9

 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 

compensable employment factors.10 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.11

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.12 

 3 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006). 

4 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989). 

5

 20 C.F.R. § 10.5(ee); Ellen L. Noble, 55 ECAB 530 (2004). 

6 B.F., Docket No. 09-60 (issued March 17, 2009); Bonnie A. Contreras, supra note 3. 

7 D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005). 

8 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra

note 3. 

9 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006). 

10 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

11 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989). 

12 D.S., Docket No. 09-860 (issued November 2, 2009); Paul Foster, 56 ECAB 208 (2004). See 5 U.S.C. 

§ 8101(2). 
5

ANALYSIS 

OWCP accepted that on July 22, 2013 appellant was carrying/lifting a tray of flats while 

at work and experienced pain. The issue is whether appellant established an injury causally 

related to the employment incident. The Board finds that appellant failed to submit sufficient 

rationalized medical evidence to establish the causal connection between his diagnosed back 

conditions and the July 22, 2013 employment incident. 

Appellant submitted treatment records from Dr. Oakley, a chiropractor. In assessing the 

probative value of opinion evidence of a chiropractor, the initial question is whether the 

chiropractor is a physician as defined under FECA.13 A chiropractor is not considered a 

physician under FECA unless it is established that there is a subluxation as demonstrated by xray to exist.14 As the July 23 and 26 and August 14, 2013 Forms CA-20 and reports dated 

July 22 to September 17, 2013 from Dr. Oakley did not diagnose appellant with subluxations, as 

demonstrated by x-ray to exist, for purposes of these reports, he does not qualify as a physician 

under FECA and, therefore, these reports and CA-20 forms and the opinions contained therein do 

not constitute competent medical evidence.15 Thus, the CA-20 forms and reports signed by 

Dr. Oakley are of no probative value.16

On November 16, 2013 Dr. Oakley obtained an x-ray based on OWCP’s determination 

that he was not considered a physician under FECA. In his subsequent June 16, 2014 report, 

Dr. Oakley opined that the November 16, 2013 x-ray of the lumbar region confirmed his 

diagnosis of upper and lower lumbar subluxations. OWCP’s implementing federal regulations 

define subluxation as an incomplete dislocation, off-centering, misalignment, fixation, or 

abnormal spacing of the vertebrae which must be visible on any x-ray film.17 For purposes of 

FECA and this report, because Dr. Oakley diagnosed subluxations as shown to exist by x-ray, he 

qualifies as a physician as defined by FECA. Thus, at that point in time Dr. Oakley qualified as 

a physician under FECA for this report.18

The October 7, 2014 decision found that Dr. Oakley could not be considered a physician 

under FECA as the x-ray he used to diagnose a subluxation was not taken close in time to the 

July 22, 2013 incident. While diagnostic testing performed immediately after an alleged injury 

tends to increase the reliability of a medical opinion regarding the relationship between any 

condition documented by the testing and the employment injury, the Board has held that the 

timing of diagnostic testing alone should not be given dispositive weight to the exclusion of 

 13 5 U.S.C. § 8101(2). 

14 See 20 C.F.R. § 10.311(a). 

15 5 U.S.C. § 8101(2). See Mary A. Ceglia, 55 ECAB 626 (2004). 

16 Isabelle Mitchell, 55 ECAB 623 (2004). 

17 20 C.F.R. § 10.5(bb). 

18 See Mary A. Ceglia, supra note 15 (as the chiropractor qualified as a physician under FECA, the question was 

whether he provided sufficient evidence to establish the causal relationship between the diagnosed subluxation and 

the accepted incident); Mary J. Briggs, 37 ECAB 578 (1986). 
6

other circumstances.19 Therefore, the fact that Dr. Oakley did not obtain x-rays until 

November 16, 2013 does not preclude him from being considered a physician under FECA.20 To 

discharge appellant’s burden of proof, however, he must provide sufficient medical rationale to 

support the affirmative opinion offered regarding the cause of the diagnosed subluxations.21 

Dr. Oakley provided no opinion as to the cause of the diagnosed conditions in the June 16, 2014 

report other than explaining why x-rays were not taken at the time of the July 22, 2013 incident. 

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.22

In his April 15, 2014 report, Dr. Burkhardt referenced the findings of Dr. Oakley and 

opined that appellant’s injury was directly caused by the July 22, 2013 incident. He did not, 

however, provide any rationale for his causation finding other than noting that he concurred with 

Dr. Oakley’s opinion. The Board has held that brief medical notes consisting solely of 

conclusory statements without supporting rationale are of diminished probative value.23 Medical 

reports not containing rationale on causal relationship are generally insufficient to support an 

employee’s burden of proof.24 In view of the lack of any rationale provided by Dr. Burkhardt on 

the issue of causal relationship, the Board finds that his opinion fails to establish that appellant’s 

diagnosed conditions were caused or aggravated by the July 22, 2013 incident. 

Appellant also submitted a November 16, 2013 report from Dr. Hosler, a chiropractor, 

diagnosing S1 lumbarization, cervical arcual kyphosis, C6-7 mild discogenic spondylosis, 

multilevel thoracic discogenic spondylosis, mild anterior T12 vertebral body wedge deformity, 

L5-S1 moderate discogenic spondylosis along mild-to-moderate T12-L1, L1-2, L2-4, L3-4, and 

L4-5 severity involvement, and L4-5 and L5-S1 degenerative facet arthropathy. Dr. Hosler 

cannot be considered a physician as defined under FECA as his diagnosis did not include a spinal 

subluxation based on x-ray.25

The record before the Board is without rationalized medical evidence establishing a 

diagnosed medical condition causally related to the accepted July 22, 2013 employment incident. 

OWCP advised appellant that it was his responsibility to provide a comprehensive medical report 

which described his symptoms, test results, diagnosis, treatment, and the physician’s opinion, 

with medical reasons, on the cause of his condition. Appellant failed to submit appropriate 

 19 See Linda L. Mendenhall, 41 ECAB 532 (1990). 

20 See Lauramae Heard, 42 ECAB 688 (1991). 

21 See supra note 19. 

22 A.F., 59 ECAB 714 (2008); Ellen L. Noble, 55 ECAB 530 (2004); Jaja K. Asaramo, 55 ECAB 200 (2004). 

23 See T.M., Docket No. 08-975 (issued February 6, 2009); Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006); 

William C. Thomas, 45 ECAB 591 (1994) (a medical report is of limited probative value on the issue of causal 

relationship if it contains a conclusion regarding causal relationship which is unsupported by medical rationale). 

24 See D.U., Docket No. 10-144 (issued July 27, 2010); S.S., 59 ECAB 315 (2008); William C. Thomas, supra

note 23. 

25 5 U.S.C. § 8101(2). See Mary A. Ceglia, supra note 17. 
7

medical documentation in response to OWCP’s request. The Board has held that the mere fact 

that a condition manifests itself during a period of employment does not raise an inference of 

causal relation.26 An award of compensation may not be based on surmise, conjecture, 

speculation, or on the employee’s own belief of causal relation.27 As there is no probative, 

rationalized medical evidence containing a medical diagnosis and explaining how the diagnosed 

condition was causally related to the accepted July 22, 2013 employment incident, he has not 

met his burden of proof. 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision. 

CONCLUSION 

The Board finds appellant did not meet his burden of proof to establish that he sustained a 

lower back injury causally related to a July 22, 2013 employment incident. 

ORDER 

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

Compensation Programs dated October 7, 2014 is affirmed.28

Issued: May 12, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 26 L.D., Docket No. 09-1503 (issued April 15, 2010); D.I., 59 ECAB 158 (2007); Daniel O. Vasquez, 57 ECAB 

559 (2006). 

27 S.S., 59 ECAB 315 (2008); J.M., 58 ECAB 3003 (2007); Donald W. Long, 41 ECAB 142 (1989). 

28 James A. Haynes, Alternate Judge, participated in the original decision but was no longer a member of the 

Board effective November 16, 2015.