United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.L., Appellant 

and 

DEPARTMENT OF TRANSPORTATION, 

FEDERAL AVIATION ADMINISTRATION, 

Vienna, OH, Employer 

__________________________________________ 

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Docket No. 17-0306 

Issued: April 25, 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 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On November 23, 2016 appellant filed a timely appeal from a June 17, 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.2

ISSUE 

The issue is whether appellant sustained a recurrence of a medical condition on 

October 19, 2014 causally related to his July 29, 2012 employment injury. 

 1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that appellant submitted additional evidence on appeal. The Board’s jurisdiction however is 

limited to reviewing the evidence that was before OWCP at the time of its final decision. Therefore, this additional 

evidence cannot be considered by the Board. 20 C.F.R. § 501.2(c)(1). 
2

FACTUAL HISTORY 

On July 30, 2012 appellant, then a 29-year-old air traffic control specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on July 29, 2012 he injured his low back and 

buttocks when he fell to the floor after attempting to sit in a chair that had been moved. He 

obtained medical treatment on July 29 and 30, 2012 and returned to his usual employment 

without restrictions on August 3, 2012. 

Appellant, on October 20, 2014, filed a claim for a recurrence (Form CA-2a) alleging that 

he experienced a recurrence of the need for medical treatment on October 19, 2014 due to his 

July 29, 2012 work injury. He did not stop work. 

By letter dated November 13, 2014, OWCP advised appellant that it had paid a limited 

amount of medical expenses without formally adjudicating his claim as his injury appeared 

minor and resulted in little or no time lost from work. It had now adjudicated his claim and 

accepted that he sustained a back contusion. 

In another letter dated November 13, 2014, OWCP informed appellant of the definition 

of a recurrence of disability and a recurrence of a medical condition and requested that he submit 

additional factual and medical information, including a detailed report from his attending 

physician explaining why appellant’s current condition resulted from his accepted work injury. 

In a report dated November 17, 2014, Dr. Koshy Oommen, a Board-certified internist, 

evaluated appellant for pain in his middle and lower back radiating into the right thigh. He noted 

that appellant had a history of a fall at work two years earlier. Dr. Oommen diagnosed back pain 

and radiculopathy and referred appellant for diagnostic studies. 

A magnetic resonance imaging (MRI) scan of the lumbar spine dated December 1, 2014 

revealed degenerative disc disease with mild disc bulges at L2-3, L3-4, and L5-S1 with bilateral 

neural foraminal narrowing at L2-3 and L3-4 and facet hypertrophy and foraminal narrowing at 

L5-S1. 

Appellant, on December 12, 2014, related that he had experienced pain in his lower and 

upper back over the past year that had progressively worsened. He performed his usual 

employment after his July 29, 2012 work injury. Appellant advised that he had experienced no 

other injuries. 

Dr. Oommen, in a report dated December 12, 2014, indicated that he began treating 

appellant on November 17, 2014 for low back pain. He related, “At the visit, [appellant] 

reported to me that he sustained an injury caused by a coworker pulling a chair out from 

underneath him approximately two years ago.” Dr. Oommen diagnosed back pain with 

radiculopathy and noted that a lumbar spine MRI scan showed a disc bulge and facet arthropathy 

at L5-S1. He advised that appellant had a temporary disability that resulted from “his original 

injury.” 

By decision dated January 21, 2015, OWCP found that appellant had not established a 

recurrence of a medical condition beginning October 2014 causally related to his accepted work 

injury. It determined that his factual statement was not sufficiently detailed and that he had not 
3

submitted rationalized medical evidence supporting that his current condition of degenerative 

disc disease resulted from the July 29, 2012 employment injury. 

In progress reports dated December 12, 2014 and January 13, 2015, Dr. Oommen 

provided examination findings and diagnosed low back pain and back pain. 

On April 7, 2015 Dr. Oommen discussed appellant’s complaints of pain in the thoracic 

and lumbar spine at the time of his December 12, 2014 and January 13, 2015 evaluations. He 

noted that a prior MRI scan showed degenerative disc disease, but that appellant was 

“asymptomatic until the point of injury at work (according to [appellant]). The pain is consistent 

from the date of injury to present.” 

On April 23, 2015 appellant requested reconsideration. 

By decision dated July 7, 2015, OWCP denied modification of its January 21, 2015 

decision. It found that the medical evidence of record was insufficient to show either that 

appellant required medical care as a result of his work injury or that his current condition was 

due to his accepted employment injury. 

In a report dated October 20, 2015, Dr. Vince S. Hume, an osteopath, diagnosed low back 

pain, left-sided low back pain without sciatica, and lumbar radiculopathy. He related, 

“[Appellant’s] mechanism of injury from having his chair pulled out from under him and him 

falling on his buttock region is consistent with his pain and symptoms. He was completely 

asymptomatic before the fall. [Appellant] does not have a pinched nerve[;] however, the injury 

could have aggravated it.” Dr. Hume referred appellant for physical therapy. 

On November 9, 2015 appellant requested reconsideration. 

By decision dated January 27, 2016, OWCP denied modification of the July 7, 2015 

decision. It found that the medical evidence did not explain why appellant had symptoms two 

years after the work injury. 

Dr. Hume, in a report dated March 18, 2016, noted that he initially evaluated appellant in 

October 2015 for symptoms of pain in his lower back beginning a year earlier when he had a 

chair pulled out from under him at work and he fell on his buttocks. He discussed appellant’s 

complaints of pain and intermittent paresthesias in his left buttocks and bilateral lower 

extremities. Dr. Hume advised that diagnostic studies showed L4-5 and L5-S1 degenerative disc 

disease. He related, “There is no nerve root impingement; however, the disc itself was very 

likely inflamed by [appellant’s] injury that would result in pain and paresthesias in the lower 

extremities.” Dr. Hume noted that a computerized tomography scan showed slight L5-S1 

spondylolisthesis which could contribute to appellant’s bulging discs and pain. He advised, 

“[Appellant’s] symptoms are very typical of this type of injury. Intermittent paresthesias and 

pain are very common in a lumbar radiculopathy. The mechanism of injury is consistent with 

image findings.” Dr. Hume opined that it was rare for an individual of appellant’s age to have 

“degenerative changes like this without a precipitating trauma.” 
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In a decision dated June 17, 2016, OWCP denied modification of its January 27, 2016 

decision. It found that Dr. Hume relied upon an inaccurate date of injury and did not support his 

opinion with sufficient rationale. 

On appeal appellant contends that each of his physicians found that his condition was 

related to his work injury and asserts that OWCP was trying to disprove his claim. 

LEGAL PRECEDENT 

Recurrence of medical condition means a documented need for further medical treatment 

after release from treatment for the accepted condition or injury when there is no accompanying 

work stoppage. Continuous treatment for the original condition or injury is not considered a 

need for further medical treatment after release from treatment, nor is an examination without 

treatment.3

If a claim for recurrence of medical condition is made more than 90 days after release 

from medical care, a claimant is responsible for submitting a medical report supporting a causal 

relationship between the employee’s current condition and the original injury in order to meet his 

burden.4

An employee has the burden of proof to establish that he sustained a recurrence of a 

medical condition that is causally related to his accepted employment injury. To meet this 

burden, the employee must submit medical evidence from a physician who, on the basis of a 

complete and accurate factual and medical history, supports that the condition is causally related 

and supports the conclusion with sound medical rationale.5

ANALYSIS 

OWCP accepted that appellant sustained a back contusion on July 29, 2012 in the 

performance of duty. Appellant returned to work without limitations on August 3, 2012. The 

issue is whether he has established a recurrence of a medical condition on or after October 19, 

2014 due to his accepted employment injury. 

Appellant last sought treatment for his back contusion on July 30, 2012. As more than 90 

days has elapsed from his last medical treatment, he has the burden to submit a reasoned medical 

opinion establishing that the additional medical treatment was causally related to an objective 

worsening of the accepted condition without intervening cause.6

 3

 20 C.F.R. § 10.5(y). 

4

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4(b) (June 2013); see also 

J.M., Docket No. 09-2041 (issued May 6, 2010). 

5 See K.T., Docket No. 15-1758 (issued May 24, 2016). 

6 See supra note 4; see also id. 
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On April 7, 2015 Dr. Oommen discussed his evaluations of appellant for thoracic and 

lumbar back pain on December 12, 2014 and January 13, 2015. He advised that the MRI scan 

study revealed degenerative disc disease. Dr. Oommen noted that appellant was asymptomatic 

prior to work injury and had consistent pain subsequent to the injury. On December 12, 2014 he 

indicated that appellant experienced an injury around two years ago when a coworker pulled a 

chair from under him. Dr. Oommen diagnosed back pain with radiculopathy. He noted that a 

lumbar MRI scan showed a disc bulge and facet arthropathy at L5-S1. Dr. Oommen opined that 

appellant had disability due to the original injury. OWCP, however, has not accepted 

degenerative disc disease, radiculopathy, a disc bulge, or L5-S1 facet arthropathy as employment 

related. Where appellant claims that a condition not accepted or approved by OWCP was due to 

his employment injury, he bears the burden of proof to establish that the condition is causally 

related to the employment injury through the submission of rationalized medical evidence.7

 

Furthermore, a medical opinion that a condition is causally related to an employment injury 

because the employee was asymptomatic before the injury, but symptomatic after it is 

insufficient, without supporting rationale, to establish causal relationship.8

 Dr. Oommen did not 

provide any rationale for appellant’s opinion that the work injury caused any of the diagnosed 

condition. Medical conclusions unsupported by rationale are of little probative value.9

Dr. Oommen, on November 17, 2014, discussed appellant’s complaints of middle and 

low back pain radiating into his right thigh. He obtained a history of a fall at work two years 

earlier and he noted diagnoses. Dr. Oommen, however, did not specifically address the cause of 

the diagnosed condition. Likewise, his progress reports on December 12, 2014 and January 13, 

2015 did not address causation. The Board has held that medical evidence that does not offer 

any opinion regarding the cause of an employee’s condition is of diminished probative value on 

the issue of causal relationship.10 

On March 18, 2016 Dr. Hume discussed appellant’s history of low back pain beginning 

one year earlier when he fell on his buttocks after a chair was pulled out from underneath him at 

work. He found that appellant also had symptoms of intermittent pain and paresthesias in his left 

buttocks and both legs. Dr. Hume offered diagnoses that included L4-5 and L5-S1 degenerative 

disc disease and opined that the disc was “very likely inflamed by [appellant’s] injury” causing 

lower extremity pain and paresthesias. He advised that the mechanism of injury was consistent 

with diagnostic studies, noting that it was unusual at appellant’s age to have degeneration 

without an inciting traumatic event. On October 20, 2015 Dr. Hume diagnosed low back pain, 

left-sided low back pain without sciatica, and lumbar radiculopathy. He determined that the 

mechanism of injury, that of a chair being pulled out from under appellant resulting in his falling 

on his buttocks, was consistent with his symptoms, noting that he was “asymptomatic before the 

fall.” As noted, OWCP has not accepted any condition other than a back contusion as 

employment related. Also, as explained, an opinion that a condition is causally related because 

 7 JaJa K. Asaramo, 55 ECAB 200, 204 (2004). 

8 Cleopatra McDougal-Saddler, 47 ECAB 480 (1996). 

9 Willa M. Frazier, 55 ECAB 379 (2004); Jimmy H. Duckett, 52 ECAB 332 (2001). 

10 See S.E., Docket No. 08-2214 (issued May 6, 2009); Conard Hightower, 54 ECAB 796 (2003). 
6

the employee was asymptomatic before the injury is insufficient, without adequate rationale, to 

establish causal relationship.11 While Dr. Hume advised that, the mechanism of injury was 

consistent with diagnostic studies, he did not explain the lengthy gap in time between appellant’s 

last medical treatment of record on July 30, 2012 and the time he again sought treatment on 

November 17, 2014. The Board also notes that Dr. Hume relied upon an inaccurate history of 

injury, that of appellant experiencing work injury a year prior to the October 2015 evaluation 

instead of in July 2012. Medical opinions based on an incomplete or inaccurate history are of 

little probative value.12 Dr. Hume’s also couched his opinion in speculative terms, finding that 

the workplace fall could have aggravated a condition, which further diminishes the probative 

value.13 For these reasons, his opinion is insufficient to establish a spontaneous recurrence of the 

low back contusion. 

On appeal appellant contends that his physicians found that his condition resulted from 

his work injury and that OWCP was trying to disprove his claim. As discussed, however, he 

failed to submit a medical report from a physician who, on the basis of a complete and accurate 

factual and medical history, concluded that he required additional medical treatment due to the 

accepted work injury.14 

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 and 

20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

The Board finds that appellant has not established that he sustained a recurrence of a 

medical condition on October 19, 2014 causally related to his July 29, 2012 employment injury. 

 11 Supra note 8; see also T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 

379 (2006). 

12 See Douglas M. McQuaid, 52 ECAB 382 (2001). 

13 See L.R., (E.R.), 58 ECAB 369 (2007); Kathy A. Kelley, 55 ECAB 206 (2004). 

14 See supra note 5. 
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ORDER 

IT IS HEREBY ORDERED THAT the June 17, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 25, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board