United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.L., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Macon, GA, Employer 

__________________________________________ 

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Docket No. 16-0896 

Issued: September 13, 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 March 26, 2016 appellant filed a timely appeal from a September 28, 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 has established an injury causally related to an accepted 

October 6, 2014 employment incident. 

On appeal, appellant alleges that she properly told her supervisor of the injury and 

completed the required forms. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On December 1, 2014 appellant, then a 48-year-old city letter carrier, filed a traumatic 

injury claim (Form CA-1) alleging that on October 6, 2014, she was delivering mail when a dog 

approached her in attack mode, she then twisted her right knee as she tried to escape. She 

alleged that this incident also aggravated a previous injury of August 26, 2008 to her lower back 

and left knee. In a handwritten statement submitted with the claim, appellant indicated that 

while escaping a dog attack on her route, she turned abruptly and twisted her right knee. She 

indicated that she refused medical attention at that time. Appellant stopped work on 

November 17, 2014. 

The employing establishment controverted appellant’s claim. The employing 

establishment contended that appellant failed to provide objective, well-reasoned medical 

evidence which demonstrated that her claimed conditions were causally related to factors of her 

federal employment. 

Appellant had a prior claim before OWCP in xxxxxx524 that was accepted for a left leg 

contusion resulting from an August 26, 2008 employment injury. Appellant also submitted some 

diagnostic studies that predated her current alleged injury. A September 3, 2008 magnetic 

resonance imaging (MRI) scan of appellant’s left knee was normal. An April 23, 2009 MRI scan 

revealed possible minor degenerative change at L4-5 with bulge. 

In support of her claim, appellant submitted a November 17, 2014 report wherein 

Dr. Shahram Rezaiamiri, a Board-certified neurosurgeon, noted that appellant injured her back 

on October 26, 2008 while she was pulling a dolly up a set of stairs at a local high school. He 

noted that appellant has been dealing with a myriad of treatment modalities over the past several 

years including lumbar injections in 2010 (which did not give her significant relief), physical 

therapy, NSAIDs, narcotics, and bracing. He indicated that the worsening happened in a gradual 

fashion and appellant denied any new trauma or accident. He noted that appellant’s symptoms 

were worse than at the time of the initial accident. Dr. Rezaiamiri assessed appellant with 

lumbar radiculopathy and low back pain -- lumbago. 

By letter dated December 11, 2014, OWCP informed appellant that additional medical 

evidence was necessary to support her claim and afforded appellant 30 days to provide this 

evidence. Appellant responded to this letter by submitting medical evidence and further 

statements. 

In an October 10, 2014 note, addressed to the employing establishment, appellant 

indicated that while exiting her vehicle a dog attacked her. She alleged that the dog did not bite 

her, but that she turned abruptly and twisted her right knee. Appellant signed a statement 

indicating that she did not seek medical attention nor did she wish to file a claim at that time. 

In an October 27, 2014 initial report, Dr. Robert Karsch, a Board-certified orthopedic 

surgeon, noted that appellant saw him for left knee symptoms associated with an anterior knee 

pain. He noted that the symptoms began on August 26, 2008 when appellant pulled a dolly up 

stairs into a school to deliver mail, the handle pulled off, and she fell backwards twisting her left 

knee and further injuring her low back. Dr. Karsch also noted that appellant has been on limited 
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duty since the date of her original injury with no walking more than two hours. He further noted 

that last month appellant was chased by a dog and had to turn and run quickly to get away, and 

has been limping since that time because her left leg radicular symptoms were present again. 

Dr. Karsch listed his impression as possible tear of medial meniscus of left knee and ordered a 

new MRI scan. In a December 23, 2014 addendum, he clarified that appellant reinjured her knee 

on October 6, 2014 while working and being chased by a dog. Dr. Karsch asked to correct the 

prior note that indicated that she was injured “last month” while attempting to get away from a 

dog. 

On December 12, 2014 appellant accepted OWCP’s offer to work as a modified city 

carrier for 2.25 hours a day. 

In a December 19, 2014 note, Dr. Tiffany Sanders, a physician Board-certified in 

emergency medicine, indicated that appellant was treated in the emergency department on 

December 19, 2014 and that she may return to work on December 22, 2014. 

In an attending physician’s report (Form CA-20) dated January 2, 2015, Dr. Rezaiamiri 

diagnosed appellant with bulging lumbar disc and checked a box indicating that he believed that 

the condition was caused or aggravated by her employment. He specifically noted that on 

October 6, 2014 appellant claimed that she was frightened by a dog at work and that a sudden 

trauma would aggravate this type of injury. Dr. Rezaiamiri noted that appellant was partially 

disabled. 

In January 7, 2015 responses to questions from OWCP, appellant indicated that while 

walking on the grass to deliver mail, a dog leaped off a porch and charged her in an attacking 

manner. She stated that, following postal regulations, she pulled her dog spray and positioned 

her satchel in front of her while slowly backing up. Appellant stated that while doing so she lost 

her balance on the crest that joins the two yards together and the dog retreated back to the porch. 

She stated that when she was losing her footing, she turned abruptly to gain her balance and that 

was when she felt something pop. Appellant noted that she was already experiencing some 

discomfort and aching from her previous job-related injury dated August 26, 2008 that was 

documented in OWCP file number xxxxxx524. 

In a statement received by OWCP on January 13, 2015, B.R., a coworker, indicated that 

appellant told her on October 6, 2014 that a dog had chased her, that she twisted her leg trying to 

get away from the dog, and that she advised her supervisor in writing. In another statement, S.J., 

a coworker, indicated that she speaks to appellant on a daily basis and that on October 6, 2014 

appellant spoke to her about a dog that approached her in an attacking manner on her route that 

date, told her that she hurt her knee due to being startled by the dog, and stated that she was in 

pain. She continued to talk to her about how the pain was not subsiding. 

By decision dated January 16, 2015, OWCP denied appellant’s claim, finding that she 

had not established that the incident occurred as alleged. It also noted that the medical evidence 

did not establish that appellant sustained a diagnosed medical condition causally related to the 

employment incident. 
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By letter dated and received by OWCP on January 30, 2015, appellant, through counsel, 

requested a telephonic hearing before an OWCP hearing representative. 

A December 26, 2014 MRI scan of the lumbar spine was interpreted by Dr. Richard E. 

Barlow, a Board-certified radiologist, as showing mild early lumbar spinal stenosis at L4-5 

where there is diffuse bulge of the disc annulus that is slightly eccentric to the right and bulging 

into the right neural foramen. 

In a March 16, 2015 report, Dr. Samuel B. Milton, a Board-certified physiatrist, 

discussed appellant’s injuries of August 25, 2008 and October 6, 2014. He assessed appellant 

with complaints of low back pain. Dr. Milton noted a normal neurological examination with the 

left anterior knee pain, MRI scan evidence of severe patellofemoral osteoarthritis with no 

evidence of internal derangement, and chronic low back pain. He noted MRI scan evidence of 

minor disc bulging with some lateral recess stenosis to the right that correlated with appellant’s 

symptomology. Dr. Milton opined that based on medical documentation appellant appeared to 

have complaints of low back pain that had not resolved as a result of her injury from August 25, 

2008 and as a result has ongoing restrictions. He noted that he was unable to relate with the 

medical documentation appellant’s patellofemoral arthritis to her incident of August 25, 2008. 

In a June 30, 2015 report from a follow-up visit, Dr. Karsch listed his impression of the 

left knee as degenerative joint disease -- patellofemoral, and noted that appellant would be a 

candidate for patellofemoral replacement in the future if she failed conservative treatment 

options. He noted that appellant was currently disabled from work from her spine physician. 

At the hearing held on August 5, 2015, appellant described how her injury occurred, 

noted that she promptly reported the injury to her supervisor, and discussed her medical 

treatment. She stated that she told Dr. Rezaiamiri about the dog attack when she first saw him. 

Appellant testified that she was currently not working. She noted that at the time of the injury 

she was working modified duty. 

By decision dated September 28, 2015, the hearing representative found that incident had 

occurred as alleged. However, she denied appellant’s claim because appellant had not met her 

burden of proof to establish that her claimed medical conditions were causally related to the 

accepted employment incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence2 including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.3

 2 J.P., 49 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

3 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 
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To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether “fact of injury” has been established.4 

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

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

the time, place, and in the manner alleged.5

 Second, the employee must submit evidence, 

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

incident caused a personal injury.6

 An employee may establish that the employment incident 

occurred as alleged but fail to show that his or her disability or condition relates to the 

employment incident.7

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.8

 The weight of the 

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.9

ANALYSIS 

OWCP has accepted that the employment incident of October 6, 2014 occurred as 

alleged. However, it denied appellant’s claim because she did not establish an injury causally 

related to the accepted injury. The Board finds that appellant did not meet her burden of proof to 

establish that the accepted October 6, 2014 employment incident resulted in an injury. 

Appellant did not seek medical attention for the October 6, 2014 employment incident 

until October 27, 2014, at which point she saw Dr. Karsch. Dr. Karsch noted in this report that 

appellant was chased by a dog during her employment the prior month and had to turn and run 

quickly to get away, and has been limping since that time. In an addendum dated December 23, 

2014, he issued a correction and noted that appellant reinjured her knee when she was chased by 

a dog on October 6, 2014, and that his prior statement that she was chased the previous month 

was incorrect. Dr. Karsch’s general statement that appellant reinjured her left knee on October 6, 

2014 does not constitute rationalized medical opinion evidence linking a medical diagnosis to the 

accepted employment incident. He did not provide a specific medical diagnosis indicating that a 

medical condition was caused or aggravated by the October 6, 2014 incident, nor did he provide 

an explanation as to how this aggravation occurred. A mere conclusion without the necessary 

 4 S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005). 

5 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968). 

6 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 

7 T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindshi, 57 ECAB 418 (2006). 

8 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005). 

9 James Mack, 43 ECAB 321 (1991). 
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rationale explaining how and why the physician believes that a claimed employment incident 

resulted in a diagnosed condition is insufficient to meet a claimant’s burden of proof.10

Dr. Rezaiamiri did check a box marked “yes” on his attending physician’s report 

indicating that appellant’s condition of bulging lumbar disc was related to the October 6, 2014 

employment incident, and noted that appellant informed him that she was frightened by a dog at 

work on that date, and that a sudden trauma would aggravate this type of injury. The Board has 

held that a physician’s opinion that consists of checking a box on a form report without more by 

way of medical rationale, is of diminished probative value in establishing causal relationship.11 

No medical rationale was provided by Dr. Rezaiamiri on the issue of causal relationship.12 His 

brief statement on the January 2, 2015 attending physician’s report is unrationalized. Although 

Dr. Rezaiamiri’s statement is generally supportive of a causal relationship, he did not explain the 

process by which appellant’s particular work incident caused or contributed to the diagnosed 

condition.13 Furthermore, his statement is inconsistent with his earlier November 17, 2014 report 

wherein he specifically noted that appellant indicated that her lower back and leg pain happened 

in a gradual fashion and that appellant denied any new trauma or accident. 

Although Dr. Milton mentioned the October 6, 2014 dog incident, he did not provide an 

opinion on whether there was any causal relationship between this accepted employment incident 

and appellant’s back and knee conditions. Dr. Sanders merely indicated that appellant received 

treatment in the emergency room on December 19, 2014 and may return to work on 

December 22, 2014. She did not address appellant’s medical condition. The Board notes 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 The diagnostic studies, 

including the December 26, 2014 MRI scan report by Dr. Barlow, do not address a causal 

relationship.15 Accordingly, the medical evidence is insufficient to establish causal relationship 

between appellant’s current medical condition and the accepted employment incident. 

The statements by appellant and by B.R. and S.J. are also insufficient to establish causal 

relationship. Lay persons are not competent to render medical opinions.16 As noted, causal 

relationship is a medical question that generally requires rationalized medical opinion evidence 

to resolve the issue.17 The Board has held that the mere fact that a condition manifests itself 

during a period of employment is insufficient to establish causal relationship; temporal 

 10 G.M., Docket No. 14-2057 (issued May 12, 2015). 

11 N.K., Docket No. 15-1532 (issued March 11, 2016). 

12 Id. 

13 See J.S., Docket No. 14-818 (issued August 7, 2014). 

14 F.T., Docket No. 15-1109 (issued June 17, 2016). 

15 See G.M., supra note 10. 

16 James A. Long, 10 ECAB 538 (1989). 

17 See S.C., Docket No. 16-0002 (issued November 25, 2015). 
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relationship alone will not suffice.18 Furthermore, appellant’s personal belief that her 

employment activities either caused or contributed to her condition is insufficient, by itself, to 

establish causal relationship.19

As the evidence is insufficient to establish a causal relationship, appellant has failed to 

meet her burden of proof to establish her claim. 

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 established an injury causally related to the 

accepted October 6, 2014 employment incident. 

ORDER 

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

Compensation Programs dated September 28, 2015 is affirmed. 

Issued: September 13, 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 

 18 Id. 

19 See D.I., 59 ECAB 158, 162 (2007); Phillip L. Barnes, 55 ECAB 426, 440 (2004).