United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.Q., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

SAN FRANCISCO VETERANS 

ADMINISTRATION HEALTH, 

San Francisco, CA, Employer 

__________________________________________ 

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Docket No. 16-1563 

Issued: January 12, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se

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 July 26, 2016 appellant filed a timely appeal from a June 21, 2016 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 the case. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish an injury causally 

related to a February 23, 2016 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On March 10, 2016 appellant, then a 47-year-old medical instrument technician, filed a 

traumatic injury claim (Form CA-1), alleging that on February 23, 2016, while working in the 

hemodialysis unit, she was disinfecting dialysis machines and felt lower back pain. She stopped 

work on March 11, 2016. 

Appellant was treated by an employing establishment nurse practitioner on March 10, 

2016 for low back pain and left thigh numbness which began on February 23, 2016. She 

reported pushing and pulling a dialysis machine from room to room while cleaning it. The nurse 

practitioner diagnosed acute low back pain with intermittent thigh numbness which began on 

February 23, 2016 while appellant was moving heavy equipment at work. 

Appellant submitted a March 14, 2016 California Doctor’s First Report of Occupational 

Injury or Illness prepared by Dr. Sarah J. Janssen, Board-certified in occupational medicine, who 

treated appellant for a lower back strain. She reported that on February 23, 2016 appellant was 

moving a 500-pound machine as part of her daily work when she felt numbness in her left thigh 

and weakness in her lower back. She noted appellant’s history was significant for lower back 

pain and right leg symptoms. Dr. Janssen indicated that a magnetic resonance imaging (MRI) 

scan of the lumbar spine dated September 15, 2014 revealed multilevel lumbar degenerative disc 

disease, most notably at L4-5. Findings upon examination revealed tenderness of the thoracic 

spine, lumbar spine at L3-5 and paralumbar spine, decreased range of motion of the lumbar 

spine, and paraesthesias. Dr. Janssen diagnosed lumbar disc degeneration with neurological 

manifestation and lumbar muscle strain. She recommended physical therapy and modified duty. 

Dr. Janssen opined that the underlying cause of appellant’s symptoms was lumbar spondylosis, a 

nonindustrial condition. However, she advised that, but for the employment activities, the 

preexisting condition would not have become disabling or needed medical treatment. In an 

industrial work status report dated March 14, 2016, Dr. Janssen noted that appellant could return 

to work modified duty. 

In a primary treating physician’s progress report dated April 4, 2016, Dr. Janssen treated 

appellant for persistent low back pain, radicular symptoms, numbness, and tingling. Appellant 

reported her job involved frequent heavy pushing, pulling, and patient transfers. She indicated 

that her restrictions could not be accommodated and therefore she was not working. Dr. Janssen 

noted appellant’s history was significant for chronic low back pain. Examination findings 

included tenderness to palpation of the parathoracic, lumbar, and paralumbar areas and decreased 

range of motion. Dr. Janssen noted a September 15, 2014 lumbar spine MRI scan revealed 

degenerative and discogenic disease at L4-5 with grade 1 anterolisthesis, moderate broad-based 

posterior disc bulge, facet hypertrophy, and mild bilateral neural foraminal narrowing. She 

diagnosed lumbar disc degeneration with neurological manifestation and lumbar muscle strain. 

Dr. Janssen advised that appellant was making slow progress and prescribed a prednisone taper, 

Tramadol, and physical therapy. She opined that the underlying cause of appellant’s symptoms 

was lumbar spondylosis, a nonindustrial condition; however, but for the employment activities, 

the preexisting condition would not have become disabling or needed medical treatment. 

In an industrial work status report dated April 4, 2016, Dr. Saquib Syed Rizvi, a Boardcertified internist, diagnosed lumbar disc degeneration with neurological manifestation and 
3

lumbar muscle strain. He noted that appellant could work modified duty from April 4 to 28, 

2016 and attended physical therapy. 

In a primary treating physician’s progress report dated April 28, 2016, Dr. Janssen noted 

that appellant presented with minimal improvement since the initial date of injury. Physical 

examination was unchanged. Dr. Janssen noted an MRI scan of the lumbar spine dated 

February 28, 2016 showed multilevel degenerative change of the lumbar spine most notably at 

L4-5, crowding of the lateral recesses, and probable abutment of the traversing bilateral L5 nerve 

roots. She diagnosed lumbar disc degeneration, neurological manifestation, and lumbar muscle 

strain. Dr. Janssen noted that appellant had delayed recovery with minimal improvement in 

radicular symptoms. She recommended acupuncture and physical therapy. Dr. Janssen returned 

appellant to modified work on April 28, 2016. 

By letter dated May 10, 2016, OWCP advised appellant that her claim had originally 

been received as a simple, uncontroverted case which resulted in minimal or no time loss from 

work. It indicated that appellant’s claim was administratively handled to allow medical 

payments up to $1,500.00, but the merits of the claim had not been formally adjudicated. OWCP 

advised that because a claim for wage loss was received her claim would be formally 

adjudicated. It advised appellant of the evidence needed to establish her claim, including a 

comprehensive medical report from her treating physician which included a reasoned 

explanation as to how the specific work factors or incidents had contributed to her claimed 

lumbar condition. 

Appellant submitted an incident report and related that, while working in the 

hemodialysis unit on February 23, 2016, she pulled and repositioned eight dialysis machines and 

several heavy tables, which caused radiating pain in her low back with numbness in her left 

thigh. She ignored the pain and continued to work. 

In work status reports dated April 28, May 19, June 3 and 13, 2016, Dr. Janssen 

diagnosed lumbar disc degeneration with neurological manifestation, lumbar muscle strain and 

urinary incontinence. She continued appellant on modified duty. In primary treating physician’s 

progress reports dated May 19 and June 3, 2016, Dr. Janssen advised that appellant presented 

with minimal improvement since the initial date of injury with three episodes of urinary 

incontinence. Physical examination was unchanged. Dr. Janssen diagnosed lumbar disc 

degeneration with neurological manifestation and lumbar muscle strain. She noted that appellant 

had minimal improvement in radicular symptoms with physical therapy and prednisone taper. 

Dr. Janssen recommended physical therapy, acupuncture, and modified work duties. 

In a primary treating physician’s progress report dated June 7, 2016, Dr. Rizvi noted that 

appellant presented with minimal improvement since the initial date of injury with episodes of 

incontinence. He noted that the physical examination was unchanged and diagnosed lumbar disc 

degeneration with neurological manifestation and lumbar muscle strain. Dr. Rizvi recommended 

physical therapy, acupuncture, and modified work duties. Also submitted were physical therapy 

reports from May 20 to June 14, 2016. 
4

By decision dated June 21, 2016, OWCP denied appellant’s claim because the medical 

evidence of record was insufficient to establish that the medical condition was causally related to 

the accepted work incident. 

LEGAL PRECEDENT 

 An employee seeking benefits under FECA has the burden of establishing 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 

of FECA, that an injury was sustained in the performance of duty as alleged, and that any 

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

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

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.2

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. 

There are two components involved in establishing 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. Second, the employee must submit medical evidence 

to establish that the employment incident caused a personal injury.3

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on a complete factual and medical 

background, 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.4

ANALYSIS 

OWCP accepted that on February 23, 2016 appellant was working in the hemodialysis 

unit and pulled and repositioned dialysis machines and several heavy tables. Appellant was 

diagnosed with degenerative and discogenic disease at L4-5 with grade 1 anterolisthesis, 

moderate broad-based posterior disc bulge, facet hypertrophy with neurological manifestation, 

and lumbar muscle strain. However, the Board finds that appellant has not submitted sufficient 

medical evidence to establish that these work activities caused or aggravated her diagnosed low 

back conditions. 

Appellant was treated by Dr. Janssen on March 14, 2016 who diagnosed lumbar disc 

degeneration with neurological manifestation and lumbar muscle strain. She reported that on 

February 23, 2016 she was moving a 500-pound machine as part of her daily work when she felt 

numbness in her left thigh and weakness in her lower back. Dr. Janssen noted a September 2014 

 2 Gary J. Watling, 52 ECAB 357 (2001). 

3

 T.H., 59 ECAB 388 (2008). 

4 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 
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lumbar MRI scan showed multilevel lumbar degenerative disc disease, most notably at L4-5. 

She opined that the underlying cause of appellant’s symptoms was lumbar spondylosis, a 

nonindustrial condition. However, Dr. Janssen advised that, but for the employment activities 

stated above, the preexisting condition would not have become disabling or needed medical 

treatment. The Board finds that, although Dr. Janssen supported causal relationship, she did not 

provide sufficient medical rationale explaining the basis of her conclusory opinion regarding the 

causal relationship between appellant’s lumbar condition and the factors of employment.5

 

Dr. Janssen did not explain the process by which pulling and repositioning dialysis machines and 

heavy tables would cause the diagnosed condition and why such condition would not be due to 

any nonwork factors such as age-related degenerative changes. Thus, these reports are 

insufficient to meet appellant’s burden of proof. 

Similarly, Dr. Janssen provided other reports from April 4 to June 3, 2016, where she 

diagnosed lumbar disc degeneration with neurological manifestation and lumbar muscle strain. 

She noted appellant’s history was significant for degenerative and discogenic disease at L4-5. 

Dr. Janssen opined that the underlying cause of appellant’s symptoms was lumbar spondylosis, a 

nonindustrial condition, but advised that appellant’s condition would not have become disabling 

or require medical treatment but for employment activities. Again, she did not explain why such 

activity would result in a causal relationship to the diagnosed condition. Dr. Janssen did not 

adequately explain why moving dialysis machines and heavy tables was a competent cause or 

contributor to appellant’s diagnosed lumbar conditions, specifically, when appellant had a 

preexisting degenerative disease on multiple lumbar levels.6 She did not explain the medical 

reasoning, or rationale, that formed the basis of her conclusion on causal relationship. 

Dr. Janssen provided other work status reports dated March 14 to June 13, 2016 who 

diagnosed lumbar disc degeneration with neurological manifestation, lumbar muscle strain, and 

urinary incontinence. However, these reports did not specifically address whether appellant’s 

employment activities caused or aggravated the diagnosed medical conditions. These reports are 

of limited probative value.7

 

In an industrial work status report dated April 4, 2016, Dr. Rizvi diagnosed lumbar disc 

degeneration with neurological manifestation and lumbar muscle strain. He noted that appellant 

could work modified duty from April 4 to 28, 2016. Similarly, in a June 7, 2016 report, 

Dr. Rizvi noted that appellant presented with minimal improvement since the initial date of 

injury with episodes of incontinence. He diagnosed lumbar disc degeneration with neurological 

manifestation and lumbar muscle strain. Dr. Rizvi returned appellant to modified work. These 

reports are insufficient to establish the claim as Dr. Rizvi did not provide a history of injury8

 or 

 5 Id.

6 Franklin D. Haislah, 52 ECAB 457 (2001) (medical reports not containing rationale on causal relationship are 

entitled to little probative value); Jimmie H. Duckett, 52 ECAB 332 (2001). 

7 A.D., 58 ECAB 149 (2006) (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). 

8 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 
6

specifically address whether appellant’s employment activities had caused or aggravated a 

diagnosed medical condition.9 

Appellant submitted a report from a nurse practitioner dated March 10, 2016. Also 

submitted were physical therapy reports from May 20 to June 14, 2016. The Board has held that 

reports signed by a nurse or physical therapist are not considered medical evidence as a nurse 

and physical therapist are not physicians under FECA.10 Thus, the treatment records from the 

nurse and physical therapist are of no probative medical value in establishing appellant’s claim. 

The remainder of the medical evidence, including diagnostic test reports, is of limited 

probative value as it does not provide an opinion on the causal relationship between the 

February 23, 2016 work incident and appellant’s diagnosed medical conditions.11 

On appeal appellant asserts that OWCP improperly denied the claim and that she 

submitted sufficient medical evidence to establish that on February 23, 2016 she injured her 

lumbar spine while pushing and pulling dialysis machines and other equipment. As found above, 

the medical evidence does not establish that appellant’s diagnosed conditions are causally related 

to her employment. Appellant has not submitted a physician’s report, based on an accurate 

history, which explains how work activities on February 23, 2016 caused or aggravated a lumbar 

condition. She 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. 

CONCLUSION 

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

causally related to a February 23, 2016 employment incident. 

 9 See A.D., supra note 7. 

10 See David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician assistants, nurses, 

and physical therapists are not competent to render a medical opinion under the FECA); 5 U.S.C. § 8101(2) (this 

subsection defines a ‘‘physician’’ as surgeons, podiatrists, dentists, clinical psychologists, optometrists, 

chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law). 

11 See A.D., supra note 7. 
7

ORDER 

IT IS HEREBY ORDERED THAT the June 21, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 12, 2017 

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