United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.H., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Philadelphia, PA, Employer 

__________________________________________ 

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Docket No. 17-0178 

Issued: May 10, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On November 3, 2016 appellant filed a timely appeal from a September 30, 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 this case. 

ISSUE 

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

related to a May 23, 2016 employment incident. 

FACTUAL HISTORY 

On June 14, 2016 appellant, then a 50-year-old housekeeping aid, filed a traumatic injury 

claim (Form CA-1) alleging that while cleaning a room on May 23, 2016 he felt pain in the 

 1

 5 U.S.C. § 8101 et seq. 
2

lower right side of his back and sustained a lower back strain. He stopped work on May 23, 

2016 and returned to work on May 27, 2016. 

Appellant was treated by Dr. Christopher T. Plastaras, a Board-certified physiatrist, on 

June 14, 2016, who took appellant off work from June 14 to 27, 2016.2

 On June 14, 2016 he was 

also treated by Dr. Marzena M. Buzanowska, a Board-certified physiatrist, for low back pain. 

Dr. Buzanowska noted a magnetic resonance imaging (MRI) scan of the lumbar spine revealed 

left L5-S1 radiculopathy, large left L4-5 interior foraminal disc extrusion with left L4-5 and right 

L4-5 foraminal stenosis, and left L3-4 disc protrusion with left L3-4 foraminal stenosis. She 

noted that appellant’s history was significant for transforaminal epidural steroid injections at L4-

5 and L5-S1. Dr. Buzanowska diagnosed right-sided low back pain with sciatica, essential 

hypertension, depression, and degeneration of the lumbar or lumbosacral intervertebral disc. She 

recommended physical therapy, avoid prolonged sitting, use of lumbar support, and right S1 

transforaminal epidural steroid injection. 

On June 28, 2016 appellant was treated by Dr. Gerard T. Hart, a Board-certified 

physiatrist, for low back pain and sciatica. He noted that appellant received a steroid injection 

with some improvement, but still had significant pain and was unable to stand for any length of 

time or work. Dr. Hart noted active problems of left L5-S1 radiculopathy, left L3-4 and L4-5 

disc extrusions, sciatica, and gout. He indicated that a lumbar MRI scan revealed a large inferior 

L4-5 disc extrusion. Appellant’s past history included left anterior cruciate ligament (ACL) 

surgery in the 1990’s and transforaminal epidural lumbar steroid injections on September 10, 

2013 and June 23, 2016. Findings on physical examination revealed tenderness of the right 

sciatic notch, positive straight leg test on the right, mild decreased strength in the right hip 

flexors, and decreased distal reflexes bilaterally. Dr. Hart diagnosed left L5-S1 radiculopathy, 

large left L4-5 interior foraminal disc extrusion, left L4-5 and right L4-5 foraminal stenosis, left 

L3-4 disc protrusion, left L3-4 foraminal stenosis, essential hypertension, and left knee pain. 

Appellant submitted a July 25, 2016 attending physician’s report from Dr. Ibrahim A. 

Usman-Oyowe, a Board-certified physiatrist, who noted that on May 23, 2016 appellant bent 

down to clean and when he attempted to rise he felt back pain. Dr. Usman-Oyowe noted no 

concurrent or preexisting injury or disease. He diagnosed lumbar disc degeneration and noted by 

checking a box marked “yes” that this condition was caused by bending and twisting at work. 

Dr. Usman-Oyowe provided transforaminal injections and found that appellant was totally 

disabled from June 14 to July 14, 2016 and could return to light duty on August 7, 2016. On 

July 27, 2016 he noted treating appellant on June 14, 2016 for low back and right leg pain that 

started on May 23, 2016 when appellant bent down to clean a toilet at work. Examination 

revealed pain with flexion and bending, and also weakness of his right ankle. Diagnostic testing 

revealed an L4-5 diffuse posterior disc bulge with superimposed left paracentral disc extrusion 

which was causing mild central stenosis, bilateral lateral recess stenosis, bilateral ligamentum 

flavum, and facet joint hypertrophy impinging on the traversing left L5 nerve root. Dr. UsmanOyowe diagnosed lumbar disc disease with disc extrusion at L4-5 and mild central canal 

stenosis. He recommended physical therapy, lumbar support, and avoiding prolonged sitting. 

 2

 The record also includes an incomplete copy of a June 2, 2016 medical report that diagnosed right-sided 

sciatica. It did not address the cause of the diagnosed condition and there is no indication that it was authored by a 

physician. 
3

Dr. Usman-Oyowe noted that appellant had transforaminal epidural steroid injections on June 23 

and July 25, 2016. He opined that “bending at the job could have worsened low back pain. Disc 

extrusion described below could have been as result of sharp turn or bending and lifting heavy 

objects.” Dr. Usman-Oyowe recommended that appellant limit lifting objects heavier than 

10 pounds and avoid bending and twisting. 

In a report dated July 8, 2016, Dr. William Bonner, a Board-certified physiatrist, noted 

seeing appellant on June 14, 2016 for worsening back pain. He indicated that appellant had 

temporary relief with a transforaminal epidural lumbar steroid injection on June 23, 2016, but the 

pain returned with tingling in the right posterior calf. Dr. Bonner noted findings of antalgic gait 

and intact strength and reflexes in the bilateral lower extremities. He diagnosed right low back 

and L5 radicular pain, a large L4-5 inferior foraminal disc extrusion, left L4-5 and right L4-5 

severe foraminal stenosis, left L3-4 disc protrusion, left L3-4 foraminal stenosis, depression, and 

essential hypertension. Dr. Bonner recommended physical therapy, a further epidural steroid 

injection, lumbar support, and avoiding prolonged sitting. On July 8, 2016 he noted diagnoses 

and referred appellant for physical therapy. 

On August 11, 2016 appellant filed a claim for compensation (Form CA-7) for total 

disability for the period July 7 to August 11, 2016. 

By letter dated August 19, 2016, OWCP advised appellant that his claim had originally 

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

work. It indicated that his claim was administratively handled to allow limited medical 

expenses, but the merits of the claim had not been formally adjudicated. OWCP advised that, 

because appellant filed a claim for wage loss his claim would be formally adjudicated. It 

requested that he submit additional information including a comprehensive medical report from 

his treating physician which included a reasoned explanation as to how the specific work factors 

or incidents identified by appellant had contributed to his claim. 

In a narrative statement dated September 15, 2016, appellant indicated that on May 23, 

2016 he was performing his housekeeping aid duties and was bending at the waist to clean under 

a toilet and, as he began to rise, he felt a sharp pain in his right lower back causing him to fall 

forward onto his left knee. He advised that when he was able to stand his low back pain 

worsened and he had difficulty moving his leg and had to drag it. Appellant reported an ACL 

tear in his left knee in 1990, which was surgically repaired and lumbar issues in 2013 or 2014. 

He submitted physical therapy reports from September 30, 2013 to August 10, 2016. 

Dr. Buzanowska examined appellant on June 14, 2016 and diagnosed left L5-S1 

radiculopathy, large left L4-5 interior foraminal disc extrusion with left L4-5 and right L4-5 

foraminal stenosis, left L3-4 disc protrusion with left L3-4 foraminal stenosis, and degeneration 

of the lumbosacral intervertebral disc. She noted prior treatment and recommended physical 

therapy, avoiding prolonged sitting, and use of lumbar support when sitting. 

On June 23, 2016 Dr. Plastaras administered a right S1 transforaminal epidural injection 

and noted appellant’s diagnoses. A July 15, 2016 lumbar spine MRI scan revealed multilevel 

severe degenerative changes, central and foraminal stenosis, and impingement on left-sided L5 

nerve root by extruded disc. 
4

Appellant was seen by Dr. Usman-Oyowe on July 22 and August 5, 2016 for worsening 

right and left lateral thigh and leg pain. Diagnoses included lumbar degenerative disc disease, 

L5 radicular pain, a large L4-5 inferior foraminal disc extrusion with left L4-5 and right L4-5 

severe foraminal stenosis, and left L3-4 disc protrusion with left L3-4 foraminal stenosis. 

Dr. Usman-Oyowe recommended physical therapy, a prednisone taper, and epidural steroids. 

Appellant submitted a September 13, 2016 report from Dr. Michael D. Johnson, a Boardcertified general surgeon, who treated him for low back pain. He reported while performing his 

housekeeping aide duties he bent down and reached under a toilet bowl and felt a sudden pain in 

his right lower back causing him to fall forward onto his left knee. When appellant was able to 

stand, his low back pain worsened and he had difficulty moving his right leg and had to drag it. 

He has not worked since the date of injury. Appellant reported lower back pain, right leg 

weakness, a sensation of tingling and numbness in his right leg and foot, and left hip pain. His 

prior history that was significant for a 1987 torn ACL of the left knee with surgical repair, an 

injury to his back in May 2014, and a May 2011 motor vehicle accident which resulted in an 

acute sprain and strain of the cervical and lumbar muscles as well as a left shoulder sprain and 

strain and traumatic myositis of the left upper trapezius. Dr. Johnson compared the July 15, 

2016 MRI scan of the lumbar spine with the May 2011 MRI scan and advised that the degree of 

foraminal stenosis appeared to have increased, although he thought this may also be due to slight 

differences in technique. He indicated that a May 11, 2011 electromyogram (EMG) showed no 

evidence of lumbosacral radiculopathy, tarsal tunnel syndrome, sensory entrapment neuropathy, 

or peripheral neuropathy in the legs. Dr. Johnson noted findings of antalgic gait favoring the left 

leg, normal cervical and thoracic spine, and relative weakness of the right leg when compared to 

the left on flexion of the knee. Both patellar reflexes were diminished symmetrically, and the 

left knee was tender. Diagnoses included lumbar spinal disc herniation, lumbar spinal stenosis, 

lumbar spinal bilateral radiculopathy right greater than left, internal derangement left knee, 

internal derangement left hip, and gait disturbance. Dr. Johnson recommended chiropractic 

manipulation and trigger point injections for pain and spasm. He advised that appellant could 

not perform his work duties because it would exacerbate his symptoms. Dr. Johnson noted that 

appellant’s prognosis was poor due to the long-standing nature of his other chronic conditions as 

well as what appeared to be an acute exacerbation of these conditions. He opined that with a 

reasonable degree of medical certainty the symptoms and findings were causally related to and 

an exacerbation of previous injuries, most significantly the radiculopathy symptoms which 

presented at the onset May 23, 2016. 

By decision dated September 30, 2016, OWCP denied appellant’s claim finding that the 

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

related to the accepted work incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA 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 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 are causally related to 
5

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.3

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 he 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.4

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.5

ANALYSIS 

Appellant reported having low back pain while performing his work duties on 

May 23, 2016. The evidence establishes that the injury occurred as alleged on May 23, 2016 as 

he was bending at the waist to clean under a toilet. However, the Board finds that appellant has 

not submitted sufficient medical evidence to establish that this work incident caused or 

aggravated his diagnosed lumbar conditions. 

Appellant submitted a September 13, 2016 report from Dr. Johnson who diagnosed 

lumbar spinal disc herniation, lumbar spinal stenosis, lumbar spinal bilateral radiculopathy right 

greater than left, internal derangement left knee, internal derangement left hip, and gait 

disturbance. He reported while performing his housekeeping aide duties he bent down and 

reached under a toilet bowl and felt a sudden pain in his right lower back causing him to fall 

forward onto his left knee. Dr. Johnson noted appellant’s medical history was significant for an 

injury to his back in May 2014 and a May 2011 motor vehicle accident which resulted in an 

acute sprain and strain of the cervical and lumbar muscles. He opined that given a reasonable 

degree of medical certainty that appellant’s symptoms and physical findings were causally 

related to and an exacerbation of previous injuries, most significantly, the radiculopathy 

symptoms which presented on May 23, 2016. The Board finds that, although Dr. Johnson 

supported causal relationship, he did not provide medical rationale explaining the basis of his 

opinion regarding the causal relationship between appellant’s lumbar condition and the May 23, 

2016 employment incident.6

 For example, Dr. Johnson did not explain the process by which 

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

4

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

5 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 

6 See T.M., Docket No. 08-975 (issued February 6, 2009) (a medical report is of limited probative value on the 

issue of causal relationship if it contains a conclusion regarding causal relationship which is unsupported by medical 

rationale). 
6

bending down and reaching under a toilet bowl and then standing erect would cause or aggravate 

the diagnosed condition and why such condition would not be due to any nonwork factors such 

as the May 2014 back injury, the motor vehicle accident in May 2011, or his diagnosed agerelated degenerative changes.7

 Therefore, this report is insufficient to meet appellant’s burden of 

proof. 

In a July 27, 2016 report, Dr. Usman-Oyowe treated appellant on June 14, 2016 for low 

back and right leg pain that started after he bent down to clean toilet at work on May 23, 2016. 

He diagnosed lumbar disc disease with disc extrusion at L4-5 and mild central canal stenosis. 

Dr. Usman-Oyowe opined that bending at the job “could have” worsened appellant’s low back 

pain and the disc extrusion described “could have” been as result of sharp turn or bending and 

lifting heavy objects. While he provides some support for causal relationship his opinion is 

insufficient to establish that the claimed lumbar condition was causally related to appellant’s 

employment duties. However, this opinion is of limited probative value as it provides only 

speculative support for causal relationship.8 In a July 25, 2016 attending physician’s report, 

Dr. Usman-Oyowe diagnosed lumbar disc degeneration and noted by checking a box marked 

“yes” that the lumbar disc herniation was caused by bending and twisting at work. The Board 

has held that when a physician’s opinion on causal relationship consists only of checking “yes” 

to a form question, without explanation or rationale, that opinion is of diminished probative 

value and is insufficient to establish a claim.9

 Dr. Usman-Oyowe has provided no medical 

rationale explaining the reasons for his opinion on causal relationship. Other reports he had 

authored are of limited probative value as they do not specifically address whether appellant’s 

employment activities had caused or aggravated a diagnosed medical condition.10 Therefore, 

Dr. Usman-Oyowe’s opinion is insufficient to meet appellant’s burden of proof. 

Appellant was treated by Dr. Hart on June 28, 2016, for low back pain and sciatica. 

Dr. Hart noted that appellant received a steroid injection with some improvement, but still had 

significant pain and was unable to stand for any length of time or return to work. Similarly, in a 

report dated July 8, 2016, Dr. Bonner noted diagnoses and indicated that appellant gained only 

temporary relief from steroid injections. However, these reports are insufficient to establish the 

claim as neither physician provided a history of injury11 or specifically addressed whether 

appellant’s employment activities had caused or aggravated a diagnosed medical condition.12 

 7 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). 

8

 Medical opinions that are speculative or equivocal in character are of diminished probative value. D.D., 57 

ECAB 734 (2006). 

9 D.D., id; Sedi L. Graham, 57 ECAB 494 (2006). 

10 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). 

11 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). 

12 A.D., supra note 10. 
7

A June 14, 2016 note from Dr. Plastaras indicated that appellant was off work from 

June 14 to 27, 2016. On June 23, 2016 he performed a right S1 transforaminal epidural injection 

and noted diagnoses. Similarly, on June 14, 2016 Dr. Buzanowska diagnosed right-sided low 

back pain with sciatica, essential hypertension, depression, and degeneration of the lumbar or 

lumbosacral intervertebral disc. She recommended physical therapy and transforaminal epidural 

steroid injections. However, these reports are insufficient to meet appellant’s burden of proof as 

they did not address the cause of his claimed lumbar condition.13 

Likewise, the other medical evidence of record, such as diagnostic test reports, is of 

limited probative value as it fails to provide an opinion on the causal relationship between 

appellant’s job and his diagnosed lumbar condition.14 For this reason, this evidence is 

insufficient to meet his burden of proof. 

Appellant also submitted physical therapy reports. However, the Board has held that 

physical therapists are not considered physicians under FECA and their reports are of no 

probative value.15 Thus, this evidence is insufficient to establish the claim. 

An award of compensation may not be based on surmise, conjecture, or speculation. 

Neither the fact that appellant’s condition became apparent during a period of employment nor 

the belief that his condition was caused, precipitated, or aggravated by his employment is 

sufficient to establish causal relationship. Causal relationship must be established by 

rationalized medical opinion evidence.16 Appellant failed to submit such evidence and therefore 

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 May 23, 2016 employment incident. 

 13 Id. 

14 See id.

15 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 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). 

16 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 
8

ORDER 

IT IS HEREBY ORDERED THAT the September 30, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 10, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board