United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.T., Appellant 

and 

DEFENSE HEALTH AGENCY, FORT 

BELVOIR COMMUNITY HOSPITAL, 

Bethesda, MD, Employer 

__________________________________________ 

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Docket No. 15-0994 

Issued: July 24, 2015 

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 March 30, 2015 appellant filed a timely appeal from a March 4, 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 she sustained a 

trapezius strain causally related to the October 10, 2014 employment incident. 

 1

 5 U.S.C. § 8101 et seq.

2

 The Board notes that appellant submitted additional evidence following the March 4, 2015 decision. Since the 

Board’s jurisdiction is limited to evidence that was before OWCP at the time it issued its final decision, the Board 

may not consider this evidence for the first time on appeal. See 20 C.F.R. § 501.2(c); Sandra D. Pruitt, 57 ECAB 

126 (2005). Appellant may submit that evidence to OWCP along with a request for reconsideration, pursuant to 

5 U.S.C. § 8128(a) and 20 C.F.R. § 10.606(b)(2). 
2

FACTUAL HISTORY 

On October 28, 2014 appellant, then a 44-year-old clinical nurse, filed a traumatic injury 

claim alleging that on October 10, 2014 she experienced muscle strain with severe spasms in her 

lower back when she had to care for an intubated patient for approximately three hours. She 

stated that during her shift she had performed numerous patient care activities requiring bending, 

turning, lifting, and assisting with procedures. Appellant reported that one week later she still 

had pain and spasms and was taking pain medication. 

In hospital records dated October 14 and 20, 2014, Dr. Daniel E. Jimenez, Board-certified 

in emergency medicine and occupational medicine, examined appellant for a possible work 

injury to her lower back that occurred on October 10, 2014. He stated that she worked as a nurse 

and was attending to a critically ill patient when she suddenly felt pain in the right lower back. 

Dr. Jimenez reported that appellant was seen in the emergency room and given pain medication. 

Upon examination of the lumbar spine, he observed severe spasms on the right suprascapular 

muscles suggestive of trigger points. Dr. Jimenez reported that an x-ray of the cervical spine 

revealed mild degenerative changes C3-4 and C6-7 and an x-ray of the lumbar spine 

demonstrated grade 2 spondylolisthesis L5-S1. He diagnosed trapezius strain and authorized 

appellant to return to work with restrictions of no lifting more than five pounds. 

Appellant submitted various physical therapy progress reports dated November 6, 2014 to 

January 7, 2015. 

By letter dated January 27, 2015, OWCP advised appellant that her claim was initially 

accepted as a minor injury, but was being reopened for consideration because the medical bills 

had exceeded $1,500.00. It informed her that the evidence submitted was insufficient to 

establish her traumatic injury claim and requested additional medical evidence to demonstrate 

that she sustained a diagnosed condition causally related to the October 10, 2014 employment 

incident. 

On February 28, 2015 appellant requested a 30-day extension on her case in order to get 

all the information needed properly submitted. She explained that she received the notification 

much later than the printed date because mail delivery was not available on some days due to 

weather conditions and closures of the Fort Belvoir nonessential clinics. 

In a decision dated March 4, 2015, OWCP denied appellant’s claim. It accepted that the 

October 10, 2014 incident occurred as alleged, but denied her claim finding insufficient medical 

evidence to demonstrate that she sustained a diagnosed condition causally related to the accepted 

incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3

 has the burden of proof to establish the 

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

 3

 5 U.S.C. §§ 8101-8193. 
3

evidence4

 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.5

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.6 

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 

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

employment incident caused a personal injury.8 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.9

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.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 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.12

ANALYSIS 

Appellant has alleged that on October 10, 2014 she sustained a lower back condition as a 

result of caring for a critically intubated patient during one shift. OWCP accepted that the 

October 10, 2014 incident occurred as alleged but denied the claim finding insufficient medical 

evidence to establish that she sustained a diagnosed condition causally related to the accepted 

incident. The Board finds that appellant did not meet her burden of proof to establish her 

traumatic injury claim. 

 4 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

5 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

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

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

8

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

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

10 See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005). 

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

12 James Mack, 43 ECAB 321 (1991). 
4

Appellant was examined in the hospital by Dr. Jimenez who provided hospital records 

dated October 14 and 20, 2014. Dr. Jimenez examined her for a possible work injury to her 

lower back that occurred on October 10, 2014 while attending to a critically ill patient. Upon 

examination of appellant’s lumbar spine, he observed severe spasms on the right suprascapular 

muscles suggestive of trigger points. Dr. Jimenez also reported that an x-ray of the cervical 

spine revealed mild degenerative changes and diagnosed trapezius strain. The Board notes that 

he provided examination findings, a medical diagnosis, and a description of the October 10, 2014 

incident. 

Dr. Jimenez did not, however, provide any opinion on the cause of appellant’s trapezius 

strain or conclude that she sustained the strain as a result of the October 10, 2014 work incident. 

The Board has found 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.13 

Dr. Jimenez’ reports, therefore, are insufficient to establish appellant’s claim. 

Appellant also submitted various physical therapy progress reports dated November 6, 

2014 to January 7, 2015. These physical therapy reports are of no probative value to establish 

her claim as physical therapists are not physicians as defined under FECA.14

The issue of causal relationship is a medical question that must be established by 

probative medical opinion from a physician.15 Because appellant has not provided such 

probative medical evidence in this case, the Board finds that she did not meet her burden of proof 

to establish her claim. 

CONCLUSION 

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

sustained a trapezius strain causally related to the October 10, 2014 employment incident. 

 13 R.E., Docket No. 10-679 (issued November 16, 2010); K.W., 59 ECAB 271 (2007). 

14 Section 8102(2) of 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. 5 U.S.C. § 8101(2); Roy L. Humphrey, 57 ECAB 238 (2005). 

15 W.W., Docket No. 09-1619 (June 2, 2010); David Apgar, supra note 8. 
5

ORDER 

IT IS HEREBY ORDERED THAT the March 4, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 24, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board