United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.W., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

White Cloud, MI, Employer 

__________________________________________ 

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Docket No. 17-0644 

Issued: July 10, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 February 1, 2017 appellant, through counsel, filed a timely appeal from a 

December 14, 2016 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

Pursuant to the Federal Employees’ Compensation Act2

 (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 his burden of proof to establish an injury causally 

related to a November 28, 2015 employment incident. 

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 
2

On appeal counsel asserts that the December 14, 2016 decision is contrary to fact and 

law. 

FACTUAL HISTORY 

On December 2, 2015 appellant, then a 41-year-old rural carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on November 28, 2015, while placing a package on the bottom 

shelf of an all-purpose container, he felt a sharp back pain that caused spasms and locked-up his 

back. He subsequently indicated that he stopped work on December 3 or 4, 2015. 

On a form medical report dated December 3, 2015, Dr. Jocelyn Pouliot, a Board-certified 

internist at Family Health Care, noted a diagnosis of back pain with sciatica. She recommended 

physical therapy. Additional reports from Dr. Pouliot’s office dated December 3, 2015 were 

signed by Mary Snell, a nurse practitioner. She noted a history of low back injury on 

November 28, 2015 that was work related and found back pain on examination. Ms. Snell 

advised that appellant should remain off work until his next visit in two weeks.3

 She also 

completed a duty status report (Form CA-17) on December 3, 2015 in which she noted findings 

of decreased back range of motion and severe pain from the shoulder blades down. Ms. Snell 

advised that appellant could not work. On an attending physician’s report (Form CA-20) also 

dated December 3, 2015, she noted a history of injury that on November 28, 2015 appellant was 

sorting mail and, when he bent over to do a task, his back froze. Ms. Snell reiterated appellant’s 

complaints and checked a form box marked “yes,” indicating that his condition was employment 

related. A December 3, 2015 thoracic spine x-ray was negative. 

In December 15, 2015 reports, Dr. Pouliot noted complaints of constant back pain since 

November 28, 2015. Examination findings of pain with palpation across the shoulder to the low 

back and a positive straight leg raise test bilaterally were described. Dr. Pouliot diagnosed back 

pain with sciatica and appellant was advised to remain off work for another two weeks. On a 

form report dated December 29, 2015 Ms. Snell reiterated her findings and conclusions, again 

advising that he remain off work for two weeks. In reports dated January 11, 2016, Dr. Pouliot 

noted examination findings of an antalgic gait and bilateral positive straight leg raise tests. A 

magnetic resonance imaging (MRI) scan of the lumbar spine was recommended. 

By letter dated February 11, 2016, OWCP informed appellant of the evidence needed to 

support his claim. This included a narrative report from a physician with a medical explanation 

as to how the reported work incident caused or aggravated the claimed injury. OWCP informed 

appellant that a nurse practitioner was not considered a qualified physician under FECA, and that 

a chiropractor was only considered a physician if spinal subluxation was demonstrated by x-ray. 

Appellant thereafter submitted a patient history that he had completed on 

December 3, 2015. He noted that his job required sorting, pulling down, loading, and delivering 

mail which included packages weighing up to 70 pounds. Appellant indicated that he hurt his 

back loading packages onto a low shelf.4

 In reports dated December 29, 2015 and February 19, 

 3

 An undated, unidentified, and unsigned handwritten note from Great Lakes Family Care was also submitted. 

4

 An undated, unidentified, and unsigned medical report was also submitted. 
3

2016, Ms. Snell provided examination findings and reiterated her conclusions. In the latter 

report, she indicated that appellant should remain off work until March 4, 2016. 

A January 28, 2016 MRI scan of the lumbar spine demonstrated chronic degenerative 

disc disease at L3-4 and L4-5 with a small disc protrusion at L3-4 without nerve root 

impingement. 

In a report dated February 15, 2016, Dr. Hayden M. Boyce, a Board-certified 

neurosurgeon, noted his review of the January 28, 2016 MRI scan. He diagnosed bilateral low 

back pain without sciatica. Dr. Boyce recommended physical therapy and referral to a pain 

clinic. 

In correspondence dated March 7, 2016, Dr. Pouliot and Ms. Snell noted that appellant 

was under their care for a work-related injury. They asserted that patients with workers’ 

compensation injuries should be told of the requirements for medical evidence and recommended 

that physical therapy be authorized. 

By decision dated March 17, 2016, OWCP found that the claimed November 28, 2015 

incident occurred as alleged, but denied the claim because the medical evidence submitted did 

not establish a causal relationship between the diagnosed condition and the November 28, 2015 

accepted work incident. 

On August 11, 2016 appellant, through counsel, requested reconsideration. He 

resubmitted the March 7, 2016 correspondence from Dr. Pouliot. 

Additional medical evidence received by OWCP subsequent to the March 17, 2016 

decision included a more complete February 15, 2016 report from Dr. Boyce who noted that 

appellant had reported that on November 28, 2015, while loading packages onto a bottom shelf 

at work, he had sudden back pain, his back locked up, and he was unable to stand. Appellant 

reported that he had to change positions frequently, that he had been off work for three months, 

and that physical therapy helped, but his aching back pain continued. Dr. Boyce reviewed the 

MRI scan. He provided physical and neurological examination findings, noting that gait and 

station were normal, and that sensation to light touch was intact. Dr. Boyce diagnosed bilateral 

low back pain without sciatica, and recommended medication, pain management, and physical 

therapy. 

In a progress note dated March 31, 2016, Dr. Pouliot reported examination findings of 

negative straight leg raise, normal thoracic and lumbar range of motion with pain, and that 

appellant could heel walk without difficulty. She advised that he could return to work with a 

10-pound weight restriction and a sit/stand option. Dr. Pouliot reiterated the work restriction on 

April 14, 2016. On April 28, 2016 she advised that appellant could return to work without 

restriction on May 3, 2016, working every-other-day for three days a week. 

On August 2, 2016 Dr. Nick Dreliozis, a chiropractor, reported that he began treating 

appellant on March 29, 2016. He advised that the repetitive work duties of bending and twisting, 

up and down for a long time reached the point in November 2015 where appellant’s “back could 

not take it anymore” Dr. Dreliozis noted that his examination on August 1, 2016 demonstrated 

severe subluxations in the lumbar region. He diagnosed lumbalgia and sprain/strain of the 
4

lumbar region. Dr. Dreliozis opined that appellant’s back problems resulted from his injury in 

November 2015. 

In a merit decision dated December 14, 2016, OWCP denied modification of the 

March 17, 2016 decision, again finding the medical evidence of record insufficient to establish 

causal relationship. 

LEGAL PRECEDENT 

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

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

evidence,5 including that he or she is an “employee” within the meaning of FECA and that he or 

she filed a claim within the applicable time limitation.6 The employee must also establish that he 

or she sustained an injury in the performance of duty as alleged and that disability for work, if 

any, was causally related to the employment injury.7

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.8

Causal relationship is a medical issue, and the medical evidence required to establish a 

causal relationship is rationalized medical evidence.9 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 employee.10 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 causal relationship.11

Under section 8101(2) of FECA, the term “physician” includes chiropractors only to the 

extent that their reimbursable services are limited to treatment consisting of manual manipulation 

of the spine to correct a subluxation as demonstrated by x-ray to exist and subject to regulation 

 5

 J.P., 59 ECAB 178 (2007). 

6 R.C., 59 ECAB 427 (2008). 

7 Id.; Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

8

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

9 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 

10 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 

11 Dennis M. Mascarenas, 49 ECAB 215 (1997). 
5

by the Secretary.12 Implementing regulations indicate that the diagnosis of spinal subluxation 

must appear in the chiropractor’s report, and a chiropractor may interpret his or her x-rays to the 

same extent as any other physician.13 Likewise, a nurse practitioner is not considered a 

physician under FECA.14 

ANALYSIS 

There is no dispute that on November 28, 2015 appellant placed a package on the bottom 

shelf of an all-purpose container at work. The Board also finds, however, that the medical 

evidence is insufficient to establish that this incident resulted in an employment injury. 

Medical evidence submitted to support a claim for compensation should reflect a correct 

history and the physician should offer a medically sound explanation of how the claimed work 

event caused or aggravated the claimed condition.15 No physician did so in this case. 

The December 3, 2015 thoracic spine x-ray and January 28, 2016 lumbar MRI scan did 

not provide a cause of any diagnosed conditions. Likewise, Dr. Boyce did not offer an opinion 

regarding the cause of his diagnosis of low back pain without sciatica. 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.16

As to Dr. Dreliozis’ August 2, 2016 report, as noted, in assessing the probative value of 

chiropractic evidence, the initial question is whether the chiropractor is considered a physician 

under section 8101(2) of FECA. A chiropractor is not considered a physician under FECA 

unless it is established that there is a spinal subluxation as demonstrated by x-ray to exist.17 The 

evidence in this case does not reflect that Dr. Dreliozis diagnosed subluxation based on results of 

an x-ray. While he advised that appellant had severe subluxations in the lumbar region, he did 

not reference an x-ray. Dr. Dreliozis’ report, therefore, does not constitute probative medical 

evidence as he does not meet the statutory definition of a physician.18

Dr. Pouliot first saw appellant on December 3, 2015 and continued to submit reports until 

April 28, 2016. She noted his report that low back pain began at work on November 28, 2015 

and diagnosed back pain with sciatica. Dr. Pouliot, however, did not provide an explanation as 

to how the November 28, 2015 work incident caused a diagnosed condition. The fact that a 

 12 5 U.S.C. § 8102(2); see D.S., Docket No. 09-0860 (issued November 2, 2009). 

13 20 C.F.R. § 10.311(b), (c). Section 8101(2) of FECA provides that “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); see Phillip L. Barnes, 55 ECAB 426 (2004). 

14 L.D., 59 ECAB 648 (2008). 

15 D.D., Docket No. 13-1517 (issued April 14, 2014). 

16 Willie M. Miller, 53 ECAB 697 (2002). 

17 Supra note 12. 

18 See J.G., Docket No. 15-1468 (issued October 7, 2015). 
6

condition manifests itself during a period of employment is insufficient to establish causal 

relationship.19 

As to the reports signed solely by Ms. Snell, these do not constitute competent medical 

evidence as a nurse practitioner is not considered a physician under FECA.20

While the medical opinion of a physician supporting causal relationship does not have to 

reduce the cause or etiology of a disease or condition to an absolute certainty, neither can such 

opinion be speculative or equivocal. The opinion of a physician supporting causal relationship 

must be one of reasonable medical certainty that the condition for which compensation is 

claimed is causally related to federal employment and such relationship must be supported with 

affirmative evidence, explained by medical rationale, and be based upon a complete and accurate 

medical and factual background of the claimant.21 There is no medical evidence of record of 

sufficient rationale to establish a back injury caused by the November 28, 2015 employment 

incident.22

It is appellant’s burden of proof to establish that a diagnosed condition is causally related 

to the November 28, 2015 incident. As none of the medical evidence of record provides the 

necessary rationale explaining how and why the physician opines that this accepted incident 

resulted in a diagnosed back condition, the evidence of record is insufficient to establish an 

injury caused by this incident. Appellant has failed to meet his 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 his burden of proof to establish an injury 

causally related to a November 28, 2015 employment incident. 

 19 See R.J., Docket No. 15-0088 (issued February 25, 2015). 

20 5 U.S.C. § 8101(2); supra note 14. 

21 Patricia J. Glenn, 53 ECAB 159 (2001). 

22 Supra note 11. 
7

ORDER 

IT IS HEREBY ORDERED THAT the December 14, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 10, 2017 

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