United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Tampa, FL, Employer 

__________________________________________ 

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Docket No. 16-0368 

Issued: May 11, 2016 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On December 22, 2015 appellant, through counsel, filed a timely appeal from a 

September 29, 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 a lumbar injury 

causally related to her accepted October 29, 2014 employment incident. 

FACTUAL HISTORY 

On November 1, 2014 appellant, then a 42-year-old rural carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on October 29, 2014 she sustained a strain of her right lower 

back when she was delivering a heavy package weighing 30 to 40 pounds and a customer’s dog 

brushed by her causing her to lose her balance. She noted a burning feeling and pain on her right 

 1

 5 U.S.C. § 8101 et seq.
2

lower back, but she continued with her deliveries. Appellant stopped work on October 29, 2014 

and first received medical care on November 2, 2014. 

In a November 1, 2014 narrative statement, appellant’s supervisor reported that on 

October 29, 2014 appellant called the office informing her that she had just delivered a package 

and her back was hurting. Appellant thought she may have pulled a muscle but wanted to wait 

and see if it would heal on its own. 

The employing establishment issued appellant a properly completed Form CA-16, 

authorization for examination, dated November 1, 2014, which indicated that appellant was 

authorized to seek medical treatment with Lee Convenient Care related to the alleged 

October 29, 2014 injury. The employing establishment noted that there was doubt regarding 

whether the employee’s condition was caused by an injury sustained in the performance of duty 

or otherwise related to employment. 

In a November 2, 2014 diagnostic report, Dr. David S. Gerson, a Board-certified 

diagnostic radiologist, reported that an x-ray of the lumbar spine revealed moderate loss of disc 

space height L3-4 with no definite evidence of fracture or dislocation. 

By letter dated December 1, 2014, OWCP notified appellant that her claim was initially 

administratively handled to allow medical payments, as her claim appeared to involve a minor 

injury resulting in minimal or no lost time from work. The merits of her claim had not been 

formally considered. Her claim was reopened because she had not returned to work in a fulltime capacity. OWCP notified appellant that the evidence of record was insufficient to support 

her claim. Appellant was advised of the medical and factual evidence needed and was asked to 

provide such evidence within 30 days. 

In a November 2, 2014 medical report, Dr. Gustavo Prada, Board-certified in family 

medicine, reported that four days ago while working, appellant was picking up a package and a 

dog crossed her way causing her to become unstable. Appellant immediately felt low back pain 

radiating to the right leg with associated numbness and tingling in the right leg. She continued to 

work throughout the day, but the pain progressively worsened. The physician provided findings 

on physical examination and diagnosed backache and radiculopathy. 

In a December 4, 2014 report, Carolyn Hoffman, a registered nurse (RN), reported that 

appellant sustained a low back injury on October 29, 2014 when she tripped over a client’s dog. 

She noted a history of low back problems with surgery in 2004 for L3-4 fusion. Appellant also 

had residual numbness in the right leg that had resolved. She stated that she had not had 

problems with her back until this injury. 

In a December 8, 2014 medical report, Dr. Paul Fortier, Board-certified in internal 

medicine, reported that appellant sustained an injury on October 29, 2014 when she was carrying 

a 40-pound package and stumbled over a dog as she was delivering the package to a home. 

When she stumbled, the package and her arms were flung forward away from her body, and the 

cantilevered weight of the package multiplied the force on her back as she awkwardly regained 

her footing, causing immediate pain in the right lower back radiating down her right buttock, 

thigh, and lower leg. Appellant complained of continued pain in the right low back radiating 

down the right buttock and thigh. A November 2, 2014 lumbar x-ray showed loss of disc space 

at L3. Dr. Fortier noted a history of lumbar fusion at L3-4 in 2003. Appellant reported that after 
3

the lumbar fusion she had occasional self-limited back pain, but no pain radiating to her leg until 

this injury. Dr. Fortier reported that objective signs included lumbar soft tissue swelling, 

positive straight leg raise test, and loss of patellar reflex. He noted that additional objective 

testing, specifically a magnetic resonance imaging (MRI) scan of the lumbar spine, was 

necessary to treat her condition. Dr. Fortier diagnosed acute lumbar radiculopathy which started 

at the time of the injury and could be explained by mechanism of injury as noted in the history of 

his report. 

In a December 17, 2014 narrative statement, appellant reported that, during the 

October 29, 2014 incident, she stumbled and fell to the ground. She further stated that she had 

no similar symptoms or disability prior to the injury. 

By decision dated January 5, 2015, OWCP accepted the October 29, 2014 employment 

incident, but denied appellant’s claim finding that the medical evidence of record failed to 

establish that her lumbar radiculopathy was causally related to the accepted incident. 

On January 22, 2015 appellant, through counsel, requested a hearing before a hearing 

representative with the Branch of Hearings and Review. 

In support of her claim, appellant submitted a January 28, 2015 medical report from 

Dr. Jaime Alvarez, Board-certified in neurological surgery. Dr. Alvarez reported that he had 

operated on appellant 10 years prior for a right L3-4 microdiscectomy. He provided treatment 

the prior spring for recurrent back pain radiating into the right lower extremity. At that time, 

appellant was found to have a right L4-5 disc herniation and a left L5-S1 disc herniation. 

Appellant improved on her own and was doing well until October 2014 when she fell forward 

while carrying a package at work. She complained of moderate central low back pain radiating 

across the lower back and pain radiating to the right buttock and anterolateral thigh and shin. 

Dr. Alvarez noted that her right leg pain was worse than her low back pain. He further noted that 

appellant was a rural carrier and had not worked since the October 2014 injury. Dr. Alvarez 

provided findings on physical examination and reviewed the results of a January 28, 2015 MRI 

scan of the lumbar spine. He diagnosed bilateral low back pain, noting that appellant continued 

to have neurocompression on the right side at L4-5 with a far lateral disc herniation compressing 

the right L4 nerve root. Dr. Alvarez further noted degenerative changes at L3-4. 

A hearing was held on July 13, 2015. At the hearing, appellant testified that she 

sustained a work-related injury in 2003 when her postal truck was rear ended. The injury 

required back surgery at L3-4 and after two years of treatment, she had returned to work full duty 

without any problems until the most recent work incident in October 2014. Appellant was 

advised of the medical evidence needed in support of her claim and the record was held open for 

30 days. 

By decision dated September 29, 2015, OWCP’s hearing representative affirmed the 

January 5, 2015 decision, finding that the medical evidence of record failed to establish that her 

current lumbar radiculopathy was causally related to the accepted October 29, 2014 employment 

incident. 
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LEGAL PRECEDENT 

An employee seeking benefits under FECA 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 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 an occupational disease.3

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 incident and must explain how the condition is related to the incident. 

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 October 29, 2014 employment incident occurred as alleged. The 

issue is whether appellant established that the incident caused a lumbar injury. The Board finds 

that she failed to submit sufficient medical evidence to support that her current lumbar condition 

was causally related to the October 29, 2014 employment incident.7

 

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

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

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). 
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In a December 8, 2014 medical report, Dr. Fortier reported that appellant sustained an 

injury on October 29, 2014 when she was carrying a 40-pound package and stumbled over a dog 

while delivering the package to a home. He explained that, when she stumbled, the package and 

her arms were flung forward away from her body, and the cantilevered weight of the package 

multiplied the force on her back as she awkwardly regained her footing, causing immediate pain 

in the right lower back radiating down her right buttock, thigh, and lower leg. Dr. Fortier 

diagnosed acute lumbar radiculopathy which started at the time of the injury and could be 

explained by the mechanism of injury noted in the history of his report. 

The Board finds that the opinion of Dr. Fortier is not sufficiently rationalized. Dr. Fortier 

noted a history of lumbar fusion at L3-4 in 2003. Appellant reported that after the lumbar fusion 

she had occasional self-limited back pain, but no pain radiating to her leg until this injury. The 

Board notes that Dr. Fortier based his report on an inaccurate medical history as Dr. Alvarez’ 

report claimed that appellant had continued complaints of right leg pain stemming back as early 

as spring 2014. The Board further notes that appellant has alleged that she had no prior right leg 

pain, but this allegation is inconsistent with the medical evidence of record. 

Dr. Fortier did not address how appellant’s current complaints could not have been 

caused by her preexisting injury nor did he discuss whether her preexisting injury had progressed 

beyond what might be expected from the natural progression of that condition.8

 A wellrationalized opinion is particularly warranted when there is a history of preexisting condition.9

 

Moreover, while Dr. Fortier diagnosed acute lumbar radiculopathy, he indicated that a lumbar 

MRI would have been necessary to accurately assess appellant’s injury. Thus, Dr. Fortier did not 

have a complete medical history to provide an opinion on appellant’s injury and the cause of her 

condition. Medical reports without adequate rationale on causal relationship are of diminished 

probative value and do not meet an employee’s burden of proof.10 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.11 Given this assessment, Dr. Fortier has failed to 

establish that appellant’s symptoms and injury are causally related to the October 29, 2014 

employment incident.12 

Dr. Alvarez’s January 28, 2015 medical report is also insufficient to establish appellant’s 

claim. Dr. Alvarez reported performing the right L3-4 microdiscectomy 10 years prior. He 

further noted treating appellant in spring 2014 for recurrent back pain radiating into the right 

lower extremity where she was found to have a right L4-5 disc herniation and a left L5-S1 disc 

herniation. Dr. Alvarez’ interpretation of the January 28, 2015 lumbar MRI scan indicated 

neurocompression on the right side at L4-5 with a far lateral disc herniation compressing the 

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

9 T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

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

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

12 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. Supra note 9. 
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right L4 nerve root and degenerative changes at L3-4. 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 lumbar injury.13 Dr. Alvarez’ report supports that the 

current symptoms are related to appellant’s preexisting condition and not the October 29, 2014 

incident.14

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

relationship between appellant’s lumbar injury and the October 29, 2014 employment incident. 

Dr. Prada’s November 2, 2014 report provided a diagnosis of radiculopathy but failed to provide 

any opinion regarding the cause of appellant’s injury. Dr. Gerson’s November 2, 2014 report 

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.15

The December 4, 2014 nursing notes are also insufficient to establish appellant’s claim. 

Registered nurses, physical therapists, and physician assistants, are not considered physicians as 

defined under FECA. Their opinions are of no probative value regarding the medical issue of 

causal relationship.16 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 lumbar 

condition.17

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.18 An award of compensation may not 

be based on surmise, conjecture, speculation, or on the employee’s own belief of causal 

relation.19 Appellant’s honest belief that the October 29, 2014 employment incident caused her 

medical injury is not in question, but that does not constitute the medical evidence necessary to 

establish causal relationship.20

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

14 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). 

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

16 5 U.S.C. § 8102(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. FECA 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 State law. See also Roy L. Humphrey, 57 ECAB 238 (2005). 

17 Supra note 15. 

18 Daniel O. Vasquez, 57 ECAB 559 (2006). 

19 D.D., 57 ECAB 734 (2006). 

20 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009). 
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In the instant case, the record lacks rationalized medical evidence establishing causal 

relationship between the October 29, 2014 employment incident and appellant’s lumbar 

radiculopathy. Thus, appellant has failed to meet her 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, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607.21

CONCLUSION 

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

condition causally related to the October 29, 2014 employment incident. 

ORDER 

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

decision dated September 29, 2015 is affirmed. 

Issued: May 11, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 21 The record contains a Form CA-16 signed by the employing establishment official on November 1, 2014. 

When the 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. 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. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 

608 (2003). 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.