United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.W., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Hartford, CT, 

Employer

__________________________________________

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Docket No. 17-1120

Issued: July 20, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 1, 2017 appellant, through counsel, filed a timely appeal from a February 21, 2017 

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.

 

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

ISSUE

The issue is whether appellant has met his burden of proof to establish that his diagnosed 

cervical condition is causally related to the accepted December 8, 2015 employment incident.

FACTUAL HISTORY

On January 22, 2016 appellant, then a 53-year-old mail handler, filed a traumatic injury

claim (Form CA-1) for a neck condition that allegedly arose in the performance of duty on 

December 8, 2015. While pulling a postal container (post-con) up to a tow-motor, he reportedly 

felt pain in his neck. Appellant stated that the pain went away, but later it felt like he was having 

a heart attack. He described his injury as a pinched nerve in his neck. Appellant stopped work on 

December 14, 2015. 

The employing establishment controverted the claim, noting that appellant initially 

complained of chest pains on December 8, 2015 and was treated in the emergency department. 

According to his supervisor, P.B., appellant never reported a work-related injury on 

December 8, 2015. The employing establishment further stated that, on December 14, 2015, 

appellant filed an occupational disease claim (Form CA-2) for the same alleged pinched nerve, 

and more than a month later submitted the current Form CA-1 claiming to have injured his neck 

on December 8, 2015 while hooking up a piece of equipment to a tow-motor.

In a report of work restrictions dated January 28, 2016, Dr. Stanley Glassman, a Boardcertified internist, examined appellant and diagnosed him with cervical radiculopathy. He assessed 

appellant with pain and weakness, greater on the left upper extremity than the right upper 

extremity, as well as parasthesias. Dr. Glassman recommended work restrictions of no lifting, 

carrying, climbing, kneeling, bending/stooping, twisting, pulling/pushing, simple grasping, fine 

manipulation, reaching above the shoulder, driving a vehicle, or operating machinery; and no more 

than one to two hours of sitting, standing, walking, temperature extremes, high humidity, use of 

chemicals/solvents, exposure to fumes/dust, and exposure to noise per day. In an accompanying 

note dated January 28, 2016, he stated that appellant had been incapacitated since December 10, 

2015 due to an acute medical condition.

By development letter dated February 12, 2016, OWCP informed appellant that he had not 

submitted sufficient evidence to support his claim. First, it noted that he had not submitted 

sufficient evidence to establish that the incident occurred as described, second, that no diagnosis 

of a condition related to his injury had been provided, third, that the evidence was not sufficient to 

support that he was injured in the performance of duty, and lastly, that no physician’s opinion as 

to how his claimed injury had resulted in a diagnosed condition had been provided. OWCP also 

requested additional information regarding how the injury occurred, whether appellant had 

reported the incident to a supervisor, statements from witnesses, an explanation of the 45-day 

period between the date of injury and the date of filing of a claim for traumatic injury, whether he 

sustained any other injuries between the date of injury, the date it was reported to a supervisor or 

a physician, and a description of his condition between the date of injury and the date he first 

received medical attention, as well as the nature and frequency of any home treatment. 
3

In an undated response to OWCP’s questionnaire, appellant clarified that the injury 

occurred when he was pulling a post-con of third-class mail to a tow-motor for hookup. When he 

stood up, his neck was hurting. Appellant stated that his supervisor told him it could be a heart 

attack. He noted that he had reported the injury on December 8, 2015, but that his supervisors 

thought it was a heart attack due to the numbness in his left arm. Appellant was taken by 

ambulance to the hospital. He explained that his delay in submitting his claim for traumatic injury 

was due to his incorrectly filing a claim for occupational disease first. Appellant noted that he had 

not sustained any other injuries between the date of injury and the date it was first reported to a 

supervisor or physician. He stated that he was unable to turn his head and experienced numbness 

in the left arm all the way to his left hand.

In a December 8, 2015 emergency department visit summary and instructions, Dr. Carol 

Abbatiello, Board-certified in emergency medicine, diagnosed back pain, chest wall pain, and 

muscle spasm. She prescribed Robaxin, Ultram, and ibuprofen, and advised appellant to followup with occupational medicine.

In an undated attending physician’s report (Form CA-20), Dr. Glassman assessed appellant 

with pain and reduced range of motion (ROM) of the neck. He did not identify a specific date of 

injury, but reported that appellant developed acute neck pain and left arm numbness. Dr. Glassman 

checked a box marked “yes” indicating his belief that appellant’s condition was caused or 

aggravated by an employment activity, and explained that he was “pulling a heavy weight.” He

recommended a course of physical therapy. 

By letter dated February 24, 2016, Dr. Glassman stated that per appellant’s 

musculoskeletal examination on December 10, 2015, he noted a decreased ROM of the neck to the 

left and on extension. He reevaluated appellant on January 28, 2016 and again noted pain on neck 

ROM along with some weakness of the left upper extremity, greater than the right, on resistance. 

Dr. Glassman stated that, although he was “unclear how the injury happened,” appellant suffered 

from cervical radiculopathy.

By decision dated March 18, 2016, OWCP denied appellant’s claim, finding that he failed 

to establish fact of injury. It accepted that the employment incident occurred as alleged, but found 

that appellant had not established a diagnosed medical condition in connection with the 

employment incident. OWCP explained that pain was a symptom and not a medical diagnosis. It

further explained that Dr. Glassman’s February 24, 2016 report indicated that it was unclear how 

appellant’s injury occurred.

Appellant timely requested an oral hearing before an OWCP hearing representative.

A March 18, 2016 cervical spine magnetic resonance imaging (MRI) scan interpreted by

Dr. Anu Bansal, a radiologist, revealed a focal left paracentral soft disc protrusion at C4-5 

deforming the cord contour and leading to mild-to-moderate canal stenosis, as well as additional 

multilevel degenerative changes, probably worst at C6-7, where there was moderate canal and 

foraminal stenosis. Dr. Glassman reviewed the cervical MRI scan, diagnosed herniated disc, and 

referred appellant for pain management. 
4

An April 1, 2016 report from Jason Milbert, a physician assistant, noted an onset of neck 

pain following a December 8, 2015 work injury “pulling a heavy weight.” Appellant’s diagnoses 

included left-sided cervical radiculopathy and myofascial pain syndrome.

The hearing was held on October 11, 2016. Appellant explained that the injury occurred 

on December 8, 2015, when he was performing his duties as a tow-motor driver and picking up a

post-con to be delivered. He grabbed a post-con and it would not move. Appellant struggled in 

attempting to pull it into an aisle in order to be attached to the tow-motor when he felt a pinch in 

his neck. He then tried to “walk it off” outside. Appellant saw a supervisor and told her that he 

had hurt himself on the job. The supervisor then called an emergency response team and appellant 

was taken to the hospital, where he was checked for a heart attack. Two days later, appellant saw

Dr. Glassman, who recommended physical therapy. Appellant stated that he had completed a 

course of physical therapy, after which he was treated with injections, which did not help to reduce 

his pain. Dr. Glassman referred appellant to another physician for surgery on his neck, which was 

performed on September 26, 2016.

During the hearing, counsel argued that there was sufficient medical evidence for the claim 

to be accepted, referring to the April 1, 2016 report. He further argued that myofascial pain was a 

diagnosable condition that was a result of weakness in trigger points of muscles. OWCP’s hearing 

representative asked why appellant took over a month to file his claim, and appellant explained 

that he had incorrectly filed an occupational disease claim first. Appellant noted that OWCP had 

denied his occupational disease claim -- File No. xxxxxx679 -- a week before it denied the current 

traumatic injury claim.

Post hearing OWCP received September 19 and 26, 2016 treatment records from 

Michelle C. Savarese, a physician assistant. Ms. Savarese noted that appellant had recently 

undergone 2 level cervical fusion, and was currently unable to work. The reported diagnosis was 

cervical herniated nucleus pulposus (HNP).

In an undated statement, appellant recalled that, on December 8, 2015, he reported to work 

at 2:30 p.m., picked up his tow-motor, and began to perform his duty of moving post-cons to mail 

sorting machines. Between 5:00 p.m. and 6:00 p.m., he approached a post-con and struggled to 

pull it. Appellant felt a pinch in his neck with slight pain. He went outside for fresh air and saw 

his supervisor. Appellant told his supervisor that he had pain in the neck and chest, who told him 

something similar had happened to her brother. The fire department and ambulance arrived and 

attempted to determine if appellant had a heart attack. He was taken to the hospital, where he was 

monitored. Appellant woke up in pain the next morning and attempted to attend a follow-up 

appointment, but was told that they did not have paperwork for him and to see his primary care 

physician. He noted that supervisors had not filled out an accident report as they assumed he was 

having a heart attack.

By decision dated November 14, 2016, the hearing representative affirmed OWCP’s 

March 18, 2016 decision, finding that appellant had not submitted evidence sufficient to establish 

a medical diagnosis in connection with his federal employment. 

On February 13, 2017 appellant, through counsel, requested reconsideration of the decision 

dated November 14, 2016.
5

By letter dated January 31, 2017, Dr. Maritza Holder, Board-certified in occupational 

medicine, noted that appellant worked as a mail handler and advised that, on December 8, 2015, 

he was pulling a post-con bin of third-class mail up to a tow-motor when he felt an immediate 

pinch in the neck, with pain and spasms.3 The pain radiated to his upper back, chest, and left arm, 

with numbness in the left arm. Appellant told Dr. Holder that he was urged by a coworker to seek 

medical attention, because it could be a heart attack. Dr. Holder reported that appellant was taken 

via ambulance to the hospital where cardiac monitoring revealed that he did not have a heart attack, 

and returned the next day to follow up. However, he could not be treated at the hospital due to an 

administrative issue. Appellant went to his primary care physician the same day, who referred him 

to physical therapy and gave him medication. He completed the course of physical therapy. 

Appellant then followed up with his primary care physician with symptoms of pain and numbness. 

Dr. Holder referred him to a pain treatment center, where he received multiple cervical spinal 

injections. An MRI scan revealed C4-5 disc protrusion that deforms the ventral cord, or a cervical 

herniated disc, and was referred to an orthopedist. The orthopedist performed a cervical 

discectomy and fusion on September 12, 2016. Dr. Holder wrote, “It is my opinion that 

[appellant’s] symptoms and condition is a direct result from pulling the 200-pound bin of third 

class mail on December 8, 2015.” She explained that disc herniation can develop suddenly or 

gradually over weeks or months and lifting or twisting can contribute to disc herniation.

By decision dated February 21, 2017, OWCP modified its prior decision to find that 

appellant has established a diagnosed medical condition, but it denied his claim, finding that he 

had not submitted rationalized medical opinion evidence explaining how his C4-5 disc 

protrusion/herniation was caused or aggravated by pulling a postal container on December 8, 2015. 

It noted that Dr. Holder’s opinion was conclusory in nature and did not contain an explanation as 

to how the incident of December 8, 2015 directly resulted in his diagnosed condition.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 has the burden of proof to establish the 

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

evidence, including that an injury was sustained in the performance of duty, as alleged, and that 

any specific condition or disability claimed is causally related to the employment injury.5

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Generally, fact of 

injury consists of two components that must be considered in conjunction with one another. The 

first component is whether the employee actually experienced the employment incident that 

allegedly occurred.6 The second component is whether the employment incident caused a personal 

 

3 Dr. Holder noted that as a mail handler appellant pushed approximately 200 pounds of mail per bin depending on 

the class of mail requiring transport, with third class weighing the heaviest.

4 See supra note 2.

5 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). 

6 Elaine Pendleton, 40 ECAB 1143 (1989).
6

injury.7 An employee may establish that an injury occurred in the performance of duty, as alleged, 

but fail to establish that the disability or specific condition for which compensation is being 

claimed is causally related to the injury.8

Causal relationship is a medical question that generally requires rationalized medical 

opinion evidence to resolve the issue.9 A physician’s opinion on whether there is a causal 

relationship between the diagnosed condition and the implicated employment factor(s) must be 

based on a complete factual and medical background.10 Additionally, the physician’s opinion must 

be expressed in terms of a reasonable degree of medical certainty, and must be supported by 

medical rationale, explaining the nature of the relationship between the diagnosed condition and 

appellant’s specific employment factor(s).11

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.12 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.13

ANALYSIS

OWCP accepted that the December 8, 2015 employment incident occurred as alleged. It 

also accepted that the medical evidence of record included a diagnosis of C4-5 disc 

protrusion/herniation. OWCP, however, denied his traumatic injury claim because the medical 

evidence was insufficient to establish causal relationship between the December 8, 2015

employment incident and his diagnosed cervical condition. The Board finds that appellant has not

met his burden of proof to establish causal relationship.

The December 8, 2015 emergency room records, as well as Dr. Glassman’s undated 

attending physician’s report (Form CA-20) did not include a specific medical diagnosis.

14

 The 

record also includes several reports authored by physician assistants, which are insufficient to 

 

7

John J. Carlone, 41 ECAB 354 (1989). 

8 Shirley A. Temple, 48 ECAB 404, 407 (1997).

9 Robert G. Morris, 48 ECAB 238 (1996).

10 Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 Id.

12 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

13 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). Federal (FECA) Procedure 

Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) (January 2013).

14 Findings of pain or discomfort alone do not satisfy the medical aspect of the fact of injury medical determination. 

Federal (FECA) Procedure Manual, id. at Chapter 2.803.4a(6) (August 2012).
7

satisfy appellant’s burden of proof as physician assistants are not physicians under FECA15 and, 

thus, their reports do not constitute competent medical evidence.

16

When Dr. Glassman examined appellant on January 28, 2016 he diagnosed cervical 

radiculopathy, but did not offer an opinion regarding the etiology of appellant’s diagnosis. 

Medical evidence offering no opinion about the cause of an employee’s condition is of limited 

probative value on the issue of causal relationship.17 In his February 24, 2016 note, Dr. Glassman 

pointed out that when he examined appellant on December 10, 2015 he noticed a decreased ROM

of the neck. When he reevaluated appellant on January 28, 2016 he again noticed pain with neck 

ROM, as well as left upper extremity weakness on resistance. Dr. Glassman again diagnosed 

cervical radiculopathy, and specifically commented that “[he] was unclear how the injury 

happened.” His uncertainty as to the cause of injury clearly does not support appellant’s claim for 

an employment-related neck injury.

Appellant’s March 18, 2016 cervical spine MRI scan revealed a C4-5 disc protrusion, as 

well as multilevel degenerative changes with moderate canal and foraminal stenosis. Neither

Dr. Bansal, the radiologist who initially interpreted the scan, nor Dr. Glassman who reviewed it 

and diagnosed a herniated disc, offered an opinion regarding the cause of appellant’s diagnosed 

cervical conditions. As noted, medical evidence that does not include an opinion regarding the 

cause of a diagnosed condition is of limited probative value on the issue of causal relationship.18 

In her January 31, 2017 report, Dr. Holder reviewed appellant’s history of injury, 

diagnostic testing, and treatment received, including surgery. She noted that a cervical MRI scan 

revealed C4-5 disc protrusion, and that appellant had undergone a cervical discectomy and fusion 

on September 12, 2016. Dr. Holder stated that appellant’s symptoms and condition were the direct 

result of pulling the 200-pound bin of 3rd class mail on December 8, 2015. She also stated that 

disc herniation can develop suddenly or gradually over weeks or months, and lifting or twisting 

can contribute to disc herniation. However, such generalized statements do not establish causal 

relationship because they merely repeat appellant’s assertions and are unsupported by adequate 

medical rationale.19 Dr. Holder’s opinion is of limited probative value as it does not contain any 

medical rationale explaining how the accepted employment incident of December 8, 2015 

physiologically caused appellant’s condition.20

The issue of causal relationship between appellant’s claimed conditions and a work-related 

incident is a medical question that must be established by probative medical opinion from a 

 

15 B.L., Docket No. 16-1205 (issued November 23, 2016); Roy L. Humphrey, 57 ECAB 238 (2005).

16 See L.B., Docket No. 16-0486 (issued June 28, 2016); David P. Sawchuk, supra note 13

17 C.B., Docket No. 09-2027 (issued May 12, 2010); J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 

58 ECAB 149 (2006).

18 See supra note 16.

19 See G.O., Docket No. 16-0311 (issued June 14, 2016); K.W., Docket No. 10-0098 (issued September 10, 2010).

20 See A.D., Docket No. 17-1136 (issued November 9, 2017).
8

physician.21 The Board finds that the medical evidence submitted is insufficient to establish causal 

relationship between the accepted work incident and his diagnosed conditions.22 Accordingly, the 

Board finds that appellant 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 has not met his burden of proof to establish that his 

diagnosed cervical condition is causally related to the accepted December 8, 2015 employment 

incident.

ORDER

IT IS HEREBY ORDERED THAT the February 21, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 20, 2018

Washington, DC

Patricia H. Fitzgerald, Deputy 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

 

21 W.W., Docket No. 09-1619 (issued June 2010); David Apgar, 57 ECAB 137 (2005).

22 See T.C., Docket No. 16-0586 (issued August 9, 2016); Patricia J. Bolleter, 40 ECAB 373 (1988).