United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.C., Appellant 

and 

U.S. POSTAL SERVICE, RIVERDALE 

STATION, Bronx, NY, Employer 

__________________________________________ 

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Docket No. 16-1506 

Issued: January 5, 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 July 14, 2016 appellant filed a timely appeal from a February 12, 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 met her burden of proof to expand the accepted conditions 

in her claim to include lower back sprain, L5-S1 central disc herniation, and disc bulge at L4-5. 

On appeal appellant asserts that when she fell on June 15, 2015 she tried to break the fall 

with her arm but fell straight onto her back. She maintained that the submitted medical evidence 

established that her back conditions were employment related. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On June 6, 2015 appellant, then a 48-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that she fractured her right wrist that day. 

Dr. Richard Oswald Kirkwood, Board-certified in emergency medicine, indicated that on 

an emergency department report dated June 6, 2015 appellant slipped and fell at work, landing 

on her right wrist, and that she denied any other injuries. He diagnosed closed fracture of radius 

and prescribed medication. 

Appellant was next seen on June 9, 2015 by Dr. David E. Lent, Board-certified in 

orthopedic surgery, who reported a history of right wrist fracture and referred appellant to his 

associate, Dr. Eric M. Spencer, a Board-certified orthopedic surgeon, who first saw appellant on 

June 11, 2015. Dr. Spencer performed right distal radius open-reduction internal fixation on 

June 16, 2015 and provided follow-up care on June 23, 30, July 1 and 21, 2015. He advised that 

appellant was totally disabled. 

By letter dated July 1, 2015, appellant noted that a supervisor filled out her Form CA-1 

on the day of injury because she was unable to use her right hand. She maintained that, in 

addition to the fractured wrist, she also injured her shoulder and back and needed medical 

treatment for these conditions. 

In a July 7, 2015 report, Dr. Lent noted that appellant reported back and shoulder pain 

since the employment injury. He described physical examination findings of paraspinal 

tenderness in the upper lumbar and lower thoracic region, increased pain with flexion and 

extension of the spine, and significant tenderness along the spine of the scapula with some 

resolving ecchymosis in this region. Dr. Lent diagnosed severe contusion of the right scapula 

and lower back strain and contusion. He recommended physical therapy. 

By letter dated August 4, 2015, OWCP notified appellant that the claim had initially been 

administratively handled for payment of limited medical expenses and had now been opened for 

formal adjudication. It indicated that closed fracture of the lower end of radius, right, had been 

accepted. OWCP advised appellant of the type of evidence needed to establish her claim for 

additional conditions, including a physician’s opinion explaining how the accepted work incident 

caused or aggravated any additional conditions. 

On August 7, 2015 appellant began filing claims for compensation (Form CA-7) for 

benefits commencing July 22, 2015, when her continuation of pay expired. She received wageloss compensation. 

In reports dated August 4 to 25, 2015, Dr. Lent noted that appellant’s wrist was 

progressing well but that she still had significant pain and an impingement sign on right shoulder 

examination. Appellant also had lower back pain. On an attending physician’s report (Form 

CA-20) dated August 14, 2015, Dr. Lent diagnosed severe contusion in the right scapula and 

lower back strain. He checked a form box marked “yes,” indicating that these conditions were 

employment related, and changed her shoulder diagnosis to internal derangement. Dr. Lent 

recommended a shoulder magnetic resonance imaging (MRI) scan and advised that appellant 
3

could not return to work. On August 25, 2015 he noted appellant’s report that, when she fell, she 

put her arm out in order to stop her fall and then fell backwards, landing on her right shoulder, 

with significant shoulder pain and difficulty with range of motion. Dr. Lent indicated that he 

thought all conditions stemmed from the initial fall and were all causally related. 

On attending physician’s reports dated September 15 and November 11, 2015, Dr. Lent 

noted appellant’s complaints of shoulder and lower back pain. He diagnosed wrist fracture, 

internal derangement of the shoulder and lower back sprain. Dr. Lent checked a form box 

marked “yes,” indicating that the conditions were employment related, noting that “patient was 

hurt while at work.” He advised that appellant continued to be totally disabled. 

A November 24, 2015 right shoulder MRI scan demonstrated supraspinatus tendinosis 

with a high grade articular surface insertional tear without significant retraction, moderate 

acromioclavicular joint arthrosis, and subscapularis tendinosis. A November 30, 2015 MRI scan 

of the lumbar spine demonstrated straightening of the lumbar lordosis which could represent 

muscular spasm, a broad disc bulge at L4-5 with a left annular fissure, and a protruding disc at 

L5-S1. 

By letter dated December 30, 2015, OWCP again informed appellant that additional 

medical evidence was needed to support her claim for right shoulder and lower back conditions. 

It asked her to provide a narrative report from her physician who explained with supportive 

medical rationale how the claimed conditions were medically connected to the June 6, 2015 

work injury. Appellant was forwarded a questionnaire to complete and given 30 days to 

respond. 

Appellant completed the development questionnaire on January 5, 2016. She indicated 

that she had neither back nor shoulder issues before she fell on June 6, 2015. Appellant 

maintained that she mentioned all of her conditions from the first day but that, due to the severity 

of her wrist injury, the physician put her wrist first. 

In a progress note dated January 11, 2016, Dr. Lent opined that, when appellant fell on 

June 6, 2015 and fractured her right wrist, she also injured her right shoulder. He discussed the 

right shoulder MRI scan findings and diagnosed right shoulder partial almost full-thickness 

rotator cuff tear. Dr. Lent advised that he believed the injury was due to the June 6, 2015 injury 

and requested authorization for right shoulder surgery. 

On January 22, 2016 OWCP additionally accepted partial rotator cuff tear of the right 

shoulder as caused by the June 6, 2015 employment injury. Dr. Lent performed right shoulder 

surgery on June 16, 2015, and provided follow-up care on June 23, 30, July 1 and 21, 2015. 

By decision dated February 12, 2016, OWCP found that, based on the medical evidence 

of record, the additional diagnoses of lower back sprain, L5-S1 central disc herniation, and disc 

bulge at L4-5 were not proven to have been caused by the June 6, 2015 employment injury. 
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LEGAL PRECEDENT 

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

causal relationship is rationalized medical evidence.2

 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.3

 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.4

ANALYSIS 

The Board finds that appellant failed to meet her burden of proof to establish that her 

current lumbar conditions were caused by the June 6, 2015 employment injury. OWCP accepted 

that appellant sustained a fracture of the lower end of her right radius and a partial right rotator 

cuff tear when she fell at work on June 6, 2015. The record, however, does not support that the 

claimed lower back conditions were caused by this employment-related injury. 

In the emergency department report on June 6, 2015, Dr. Kirkwood diagnosed right wrist 

fracture and noted that appellant denied other injuries. Dr. Lent saw appellant on June 9, 2015, 

and Dr. Spencer saw her on June 11, 2015. He performed surgery on June 16, 2015, and 

provided follow-up care on June 23, 30, July 1 and 21, 2015. Neither physician mentioned a low 

back injury in their reports, including Dr. Spencer’s report on July 21, 2015. 

It was not until July 1, 2015 that appellant maintained that, in addition to the fractured 

wrist, she also injured her shoulder and back and needed medical treatment for these conditions. 

Dr. Lent reported on July 7, 2015 that appellant had examination findings of paraspinal 

tenderness in the upper lumbar and lower thoracic region and increased pain with range of 

motion. He diagnosed low back strain and contusion without further explanation. In reports 

dated August 4 to 25, 2015, Dr. Lent merely indicated that appellant had low back pain. While 

he checked a Form CA-20 box marked “yes” on August 14, 2015 indicating that the condition 

was employment related, when a physician’s opinion on causal relationship consists only of 

checking a box, that opinion has little probative value and is insufficient to establish a causal 

relationship.5

 Dr. Lent submitted additional CA-20 forms on September 15 and November 11, 

2015 in which he diagnosed lower back sprain and, in addition to checking a box marked “yes” 

explained: “patient was hurt while at work.” The Board finds this summary statement 

insufficient to establish causal relationship. Dr. Lent provided no rationale for this opinion.6

 

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

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

4 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

5 Gary J. Watling, 52 ECAB 278 (2001). 

6 See E.A., 58 ECAB 677 (2007). 
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Moreover, while repeating the history of injury on August 25, 2015, he noted appellant’s 

description of the incident that, when she fell, she put her arm out to stop her fall and fell 

backwards onto her right shoulder. Dr. Lent did not mention appellant’s back. In his most 

recent report, that of January 11, 2016, he discussed shoulder findings but did not discuss any 

back complaints or diagnoses. 

The lumbar spine MRI scan dated November 30, 2015 did not provide a cause of any 

diagnosed conditions. The Board has long held that 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.7

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 his 

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.8

 It is appellant’s burden to establish that his claimed back condition 

is causally related to the work injury. In this case the medical evidence submitted was 

insufficient to establish that the diagnosed conditions at L4-5 and L5-S1 were caused by the 

June 6, 2015 employment injury.9

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 expand the accepted 

conditions in her claim to include lower back sprain, L5-S1 central disc herniation, and disc 

bulge at L4-5. 

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

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

9 Supra note 4. 
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ORDER 

IT IS HEREBY ORDERED THAT the February 12, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 5, 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