United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.M., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Brooklyn, NY, Employer 

__________________________________________ 

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Docket No. 16-0188 

Issued: March 24, 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 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On November 12, 2015 appellant filed a timely appeal from a September 17, 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.2

 

ISSUE 

The issue is whether appellant met her burden of proof to establish that her head and 

brain conditions are causally related to a February 3, 2015 employment incident. 

On appeal, appellant reiterated the factual history, contending that she sustained an injury 

due to her employment. 

                                                             1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that, following the issuance of the September 17, 2015 OWCP decision, appellant submitted 

new evidence. The Board is precluded from reviewing evidence which was not before OWCP at the time it issued 

its final decision. See 20 C.F.R. § 501.2(c)(1). 
2 

FACTUAL HISTORY 

On February 3, 2015 appellant, a 52-year-old mail handler, filed a traumatic injury claim 

(Form CA-1) alleging that she sustained injuries to her head on February 3, 2015 as a result of 

being hit in the back of the head by a postal container while getting mail out of another 

container. She stopped work on February 3, 2015. 

An OWCP Form CA-16, authorization for examination, was issued by the employing 

establishment on February 3, 2015. Appellant was authorized to visit Dr. Wagdy F. Girgis, a 

Board-certified family practitioner, in Brooklyn, New York. She submitted a February 9, 2015 

attending physician’s report from Dr. Girgis noting that appellant got hit in the posterior head at 

work by equipment and diagnosed head injury and vertigo. In a February 9, 2015 duty status 

report (Form CA-17), Dr. Girgis noted that the top shelf of a general purpose mail container 

(GPMC) struck the back of appellant’s head on February 3, 2015. He diagnosed headaches and 

opined that appellant was totally disabled for work. 

Appellant further submitted hospital records dated February 4, 2015 from Lutheran 

Medical Center in Brooklyn, New York, regarding a visit for a lower gastrointestinal (GI) bleed 

and hypertension. 

In a February 18, 2015 letter, OWCP advised appellant of the deficiencies of her claim 

and afforded her 30 days to submit additional evidence and respond to its inquiries. 

Appellant submitted a February 13, 2015 computerized tomography (CT) scan of the 

brain which revealed a small hematoma in the right occipital scalp and no evidence of 

intracranial trauma. 

In a report dated February 9, 2015, Dr. Girgis diagnosed benign paroxysmal vertigo, 

benign hypertension, headache, and rectal/anal hemorrhage. He reiterated that appellant was hit 

with a piece of metal equipment from work on the back of the head resulting in vertigo and 

headaches. Dr. Girgis explained that appellant tried to visit his office, but did not make it all the 

way in, fainted, and was taken to the hospital. Appellant experienced rectal bleeding and 

received a colonoscopy, as well as an esophagogastroduodenoscopy (EGD). On March 2, 2015 

Dr. Girgis advised that appellant was totally disabled for work pending neurology clearance. 

By decision dated March 26, 2015, OWCP denied appellant’s claim because the medical 

evidence did not establish a medical condition was diagnosed in connection with the accepted 

event.3

 

 

                                                             3

 On April 1, 2015 appellant filed a recurrence claim (Form CA-2a). In a letter dated April 3, 2015, OWCP 

advised her that it could not consider a recurrence on a denied claim. 
3 

On April 20, 2015 appellant requested a review of the written record by an OWCP 

hearing representative4

 and submitted a February 4, 2015 report from Dr. Girgis supporting that 

appellant had a syncopal episode that same day with profuse bleeding from the rectal area after 

she was hit on the head with equipment at work the day before on February 3, 2015. 

In reports dated March 11 through 23, 2015 Dr. Peiyun Chu, a Board-certified 

neurologist, reported that appellant presented with a chief complaint of headaches after a workrelated injury. He noted that according to appellant she was in her usual state of health until 

February 3, 2015 when she was getting the mail from a metal post cart and a piece of the cart fell 

down on her head and hit the back of her head. Appellant had a CT scan of the brain, which 

showed a small scalp hematoma in the back of her head. She denied any loss of consciousness at 

the time of the incident, however, she experienced intermittent headaches since the injury. 

Dr. Chu diagnosed “persistent headaches after head trauma, possibly representing mild 

postconcussion syndrome” and opined that the small scalp hematoma had resolved because he 

did not feel any hematoma or swelling on the scalp upon examination. In a March 19, 2015 

attending physician’s report, Dr. Chu diagnosed postconcussion syndrome and opined that 

appellant was totally disabled for work for the period February 3 to March 24, 2015. He advised 

that appellant was capable of returning to work effective March 24, 2015. 

By decision dated September 17, 2015, an OWCP hearing representative affirmed the 

March 26, 2015 denial of the claim finding that the medical evidence was insufficient to 

establish a causal relationship between appellant’s diagnosed conditions and the February 3, 

2015 employment incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA5 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 timely filed within the 

applicable time limitation period of FECA, that an injury6 was sustained in the performance of 

duty, as alleged, and that any disability or medical condition for which compensation is claimed 

is causally related to the employment injury.7

 

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. 

A fact of injury determination is based on two elements. First, the employee must submit 

                                                             4

 On April 27, 2015 appellant requested authorization for a CT scan of the head/brain without dye. In a letter 

dated August 4, 2015, OWCP denied authorization because the evidence on file did not explain how the need for the 

procedure resulted from factors of appellant’s federal employment. 

5

 5 U.S.C. § 8101 et seq. 

6

 OWCP regulations 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. Such condition must be caused by external force, 

including stress or strain, which is identifiable as to time and place of occurrence and member or function of the 

body affected. 20 C.F.R. § 10.5(ee). 

7 See T.H., 59 ECAB 388 (2008). 
4 

sufficient evidence to establish that she actually experienced the employment incident at the 

time, place, and in the manner alleged. 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. An employee may establish that the employment incident occurred as alleged 

but fail to show that her condition relates to the employment incident.8 

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

establish causal relationship is rationalized medical opinion evidence. 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 

OWCP has accepted that the employment incident of February 3, 2015 occurred at the 

time, place, and in the manner alleged. The issue is whether appellant’s head and brain 

conditions resulted from the February 3, 2015 employment incident. The Board finds that 

appellant did not meet her burden of proof to establish a causal relationship between the 

conditions for which compensation is claimed and the employment incident. 

In his reports, Dr. Chu diagnosed postconcussion syndrome and opined that appellant was 

totally disabled for work for the period February 3 to March 24, 2015. He noted that appellant 

sustained an employment injury on February 3, 2015 when she was getting the mail from a metal 

post cart and a piece of the cart fell down on her head and hit the back of her head. Appellant 

had a CT scan of the brain, which showed a small scalp hematoma in the back of her head, and 

complained of persistent headaches. Dr. Chu opined that the small scalp hematoma had resolved 

because he did not feel any hematoma or swelling on the scalp upon examination and advised 

that appellant was capable of returning to work effective March 24, 2015. He did not provide 

sufficient medical rationale explaining the mechanism of how appellant’s postconcussion 

syndrome was caused or aggravated by being hit on the back of the head on February 3, 2015. 

Dr. Chu’s opinion was based, in part, on temporal correlation. However, the Board has held that 

neither the mere fact that a disease or condition manifests itself during a period of employment 

nor the belief that the disease or condition was caused or aggravated by employment factors or 

incidents is sufficient to establish a causal relationship.10 Dr. Chu did not otherwise sufficiently 

explain the reasons why diagnostic testing and examination findings led him to conclude that the 

February 3, 2015 incident at work caused or contributed to the diagnosed condition. Thus, the 

Board finds that the reports from Dr. Chu are insufficient to establish that appellant sustained an 

employment-related injury. 

                                                             8 Id. 

9 Id. 

10 E.J., Docket No. 09-1481 (issued February 19, 2010). 
5 

Dr. Girgis asserted that appellant was hit on the posterior head by a general purpose mail 

container at work on February 3, 2015 and diagnosed vertigo and headaches. He further 

indicated that on February 4, 2015 appellant attempted to visit his office, but fainted on the way 

in and was taken to the hospital and diagnosed with syncopal episode and rectal/anal 

hemorrhage. Dr. Girgis opined that appellant was totally disabled for work. The Board finds 

that Dr. Girgis failed to provide a rationalized medical opinion explaining how factors of 

appellant’s federal employment, such as being hit on the back of the head at work, caused or 

aggravated her head and brain conditions. Dr. Girgis noted that appellant’s conditions occurred 

while she was at work, but such generalized statements do not establish causal relationship 

because they merely repeat appellant’s allegations and are unsupported by adequate medical 

rationale explaining how her physical activity at work actually caused or aggravated the 

diagnosed conditions.11 He failed to provide an opinion adequately addressing how the 

February 3, 2015 employment incident contributed to appellant’s conditions. Thus, the Board 

finds that the reports from Dr. Girgis are insufficient to establish that appellant sustained an 

employment-related injury. 

The hospital records dated February 4, 2015 diagnosed a lower GI bleed and 

hypertension but did not specifically address whether the February 3, 2015 employment incident 

caused or contributed to the diagnosed conditions. Medical evidence that does not offer any 

opinion regarding the cause of an employee’s condition is of diminished probative value on the 

issue of causal relationship.12 Thus, appellant has not met her burden of proof with this 

evidence. 

The February 13, 2015 CT scan of the brain is of limited probative medical value as it 

does not specifically address whether appellant’s head and brain conditions are attributable to her 

accepted work injury.13 

On appeal, appellant reiterated the factual history of her claim and submitted new 

medical evidence. However, she has not submitted any rationalized medical evidence to support 

her allegation that she sustained an injury causally related to the February 3, 2015 employment 

incident and failed to meet her burden of proof to establish a claim for compensation. 

The Board also notes that the employing establishment issued appellant a Form CA-16 on 

February 3, 2015 authorizing medical treatment. The Board has held that where an 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, it creates a contractual obligation, which 

does not involve the employee directly, to pay the cost of the examination or treatment regardless 

of the action taken on the claim.14 Although OWCP denied appellant’s claim for an injury, it did 

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

12 Jaja K. Asaramo, 55 ECAB 200 (2004). 

13 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Linda I. Sprague, 48 ECAB 386 (1997) (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 See D.M., Docket No. 13-535 (issued June 6, 2013). See also 20 C.F.R. §§ 10.300, 10.304. 
6 

not address whether she is entitled to reimbursement of medical expenses pursuant to the Form 

CA-16. Upon return of the case record, OWCP should further address this issue. 

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 that her head 

and brain conditions are causally related to a February 3, 2015 employment incident. On return 

of the record, OWCP should consider the Form CA-16 issued in this case. 

ORDER 

IT IS HEREBY ORDERED THAT the September 17, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 24, 2016 

Washington, DC 

 

 Christopher J. Godfrey, 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