United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.W., Appellant 

and 

U.S. POSTAL SERVICE, PROCESSING & 

DISTRUBUTION CENTER, Brooklyn, NY, 

Employer 

__________________________________________ 

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Docket No. 17-0205 

Issued: June 12, 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 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On November 8, 2016 appellant, through counsel, filed a timely appeal from an 

August 12, 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. 

 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 sustained an injury causally related to a July 8, 2014 

employment incident. 

FACTUAL HISTORY 

On August 4, 2014 appellant, then a 49-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on July 8, 2014 she experienced pain in her middle and 

lower back, neck, and right shoulder radiating into her right arm and leg while casing mail. She 

stopped work on July 8, 2014 and did not return. 

Appellant received treatment at the emergency room on July 8, 2014 from a physician 

assistant for upper back and right shoulder strain. 

In a report dated July 10, 2014, Dr. Maxim Tyorkin, a Board-certified orthopedic 

surgeon, discussed appellant’s complaints of radiating neck and back pain which began at work 

on July 8, 2014. He noted a history of previous back and bilateral shoulder injuries with surgery 

on the left shoulder in 2005 and the right shoulder in 2010. Dr. Tyorkin diagnosed cervical and 

lumbar radiculopathy and found that appellant was totally disabled. He further advised that the 

referenced “accident” was the “competent producing cause of [the] injuries sustained....” 

Dr. Tyorkin also completed an authorization for examination and/or treatment (Form CA-16) on 

July 10, 2014. He diagnosed cervical and lumbar radiculopathy, checked a box marked “yes” 

that the condition was caused or aggravated by the employment activity, and described the 

condition as sharp pain in the back, neck, and shoulders radiating into the hand. 

By letter dated July 9, 2014, the employing establishment controverted the claim, noting 

that appellant performed light duty. Appellant returned to work on June 10, 2014 after being out 

of work 10 years due to an employment injury. The employing establishment noted that the 

volume of mail was light and advised that she spent time away from her work duties. 

In reports dated July and August 2014, a chiropractor indicated that he treated appellant 

for back pain. 

By letter dated August 21, 2014, OWCP requested additional factual and medical 

information from appellant, including a detailed report from an attending physician addressing 

the causal relationship between any diagnosed condition and the employment incident. It further 

advised her of the limitations of chiropractic reports under FECA. 

Appellant submitted additional medical evidence. In a report dated July 31, 2014, 

Dr. Tyorkin evaluated her for “injuries sustained in a work-related accident on July 8, 2014 when 

[appellant] injured her neck and back while working for the [employing establishment] as a mail 

processing clerk and felt pain while sorting mail.” He diagnosed cervical and lumbar 

radiculopathy, opined that appellant was totally disabled, and found that the identified incident 

was the cause of her injuries and need for treatment. 

Dr. Albert J. Ciancimino, a gastroenterologist, in progress reports dated July and 

August 2014, diagnosed derangement of the shoulder joint, pain in the upper arm joint, and neck 
3

sprain. He indicated the date of injury as July 8, 2014 and checked a box marked “yes” that the 

described incident caused the injury. Dr. Ciancimino opined that appellant was totally disabled. 

In an initial report dated August 5, 2014, Dr. Jess Collins, a Board-certified neurologist, 

obtained a history of appellant receiving treatment in the emergency room on July 8, 2014 after 

experiencing pain sorting mail. He discussed her complaints of neck and low back pain radiating 

into the right leg since the incident. Dr. Collins diagnosed cervical and lumbar radiculitis and 

noted that a lumbar spine x-ray revealed a rotary scoliotic deformity. He found that appellant 

was totally disabled and related that, “[w]ithin a reasonable degree of medical certainty, the 

accident of July 8, 2014 [was] the substantial cause of [appellant’s] condition.” 

A magnetic resonance imaging (MRI) scan study of the cervical spine, obtained on 

August 12, 2014, revealed a disc herniation at C5-6 with moderate impingement on the anterior 

thecal sac and a disc bulge at C2-3 moderately impacting the anterior thecal sac. 

Appellant, in a September 15, 2014 statement, related that she had resumed work on 

June 10, 2014 after being off work on compensation for 10 years. She worked continually from 

July 8, 2014 until she stopped to take pain medication. Appellant noted that, after she resumed 

work, she informed management that she had pain from prior injuries, but she did not previously 

have any pain in her middle back and neck until July 8, 2014. 

By decision dated September 23, 2014, OWCP denied appellant’s claim as the medical 

evidence was insufficient to establish an injury causally related to the accepted July 8, 2014 

employment incident. It found that the medical evidence failed to contain a reasoned medical 

opinion attributing a diagnosed condition to the work incident. 

In a September 9, 2014 progress report, received by OWCP on October 20, 2014, 

Dr. Collins diagnosed cervical radiculitis due to a disc herniation at C5-6 and disc bulge at C2-3 

by MRI scan study and lumbar radiculitis.3

 He advised that the July 8, 2014 accident was the 

“substantial cause of [appellant’s] condition.” 

In a September 18, 2014 attending physician’s report (Form CA-20), Dr. Douglas 

Schottenstein, a Board-certified neurologist, diagnosed cervical and lumbar radiculitis and 

checked a box marked “yes” that the condition was caused or aggravated by the described 

history of appellant experiencing back and neck radiculopathy after an “injury while working.” 

Dr. Robert W. Sandell, a chiropractor, provided September 24 and 30, 2014 form reports, 

diagnosing neck, thoracic, and lumbar sprain/strains, indicating that the history of injury was a 

competent cause of the condition, and finding appellant totally disabled. 

On October 8, 2014 counsel requested a telephone hearing before an OWCP hearing 

representative. She submitted September and October 2014 chiropractic notes confirming 

appellant’s treatment. 

 3

 Dr. Collins submitted a similar progress report dated October 21, 2014. 
4

In an August 27, 2014 initial evaluation, received by OWCP on January 12, 2015, 

Dr. Ciancimino evaluated appellant for a July 8, 2014 work injury that occurred when she 

sustained neck and back pain radiating into the extremities while casing mail. He diagnosed 

cervical and lumbosacral derangement with radiculopathy and provided treatment options. 

Dr. Ciancimino opined that appellant was totally disabled and that the “above-referenced 

accident is the substantial cause of [appellant’s] condition and the need for further treatment.”4 

Dr. Collins, in a report dated December 16, 2014, advised that he had provided pain 

management treatment for appellant beginning August 5, 2014 for a July 8, 2014 injury. He 

noted that on July 8, 2014 she experienced pain sorting mail and had continued symptoms of 

neck pain radiating to the upper extremities and back pain radiating to the lower extremities. 

Dr. Collins reviewed the results of MRI scan studies, finding a cervical disc herniation at C5-6 

and disc bulge at C2-3 and the lumbar MRI scan study showing disc bulging at L4-5 and L5-S1 

impressing the anterior thecal sac at these levels. He related: 

“This pain from the condition has been ongoing since the accident, and has 

persisted every day without remission. The neck and low back injury likely 

resulted from the incident in which [appellant] was working as a mail processing 

clerk. Within a reasonable degree of medical certainty, the accident of July 8, 

2014 is the substantial cause of [her] condition.” 

Dr. Michael Neely, an osteopath and Board-certified physiatrist, evaluated appellant on 

January 13, February 24, and April 7, 2015 for neck pain and low back pain radiating to the 

extremities.5

 He diagnosed cervical radiculitis due to a disc herniation at C5-6 and disc bulge at 

C2-3 and lumbar radiculitis due to a disc bulge. Dr. Neely attributed the diagnosed conditions to 

the July 8, 2014 injury and found that appellant was totally disabled. 

At the hearing, held on May 6, 2015, OWCP’s hearing representative noted that appellant 

had a history of a prior work injury to her neck, left shoulder, and lumbosacral spine under 

OWCP File No. xxxxxx590 and right shoulder sprain and impingement under File 

No. xxxxxx255. Appellant related that after being off work for 10 years due to her shoulder 

injury she returned to work casing mail at a reduced schedule. She used a chair because she 

continued to have symptoms from her back sprain. 

In progress reports dated May 19 and June 30, 2015, Dr. Neely diagnosed cervical 

radiculitis due to a disc herniation, and bulge and lumbar radiculitis due to a disc bulge. He 

found that appellant was totally disabled and attributed the diagnosed conditions to the July 8, 

2014 incident. 

By decision dated July 1, 2015, OWCP’s hearing representative affirmed the 

September 23, 2014 decision. 

 4

 Dr. Ciancimino provided similar findings in an October 8, 2014 progress report. 

5

 On February 16, 2015 Dr. Schottenstein noted that appellant experienced pain on July 8, 2014 sorting mail and 

explained the benefits she received from medication and treatment. 
5

Dr. Schottenstein, in progress reports dated September 2015 through April 2016, 

provided examination findings and diagnosed cervical and lumbar radiculitis.6

 He determined 

that appellant was totally disabled and that the July 8, 2014 accident caused her condition. 

In a report dated May 9, 2016, Dr. Schottenstein advised that he was providing pain 

management to appellant for lumbar and cervical radiculitis. He related, “[Appellant] was 

involved in an accident on July 8, 2014 when she was working as a mail processing clerk and 

repetitively utilizing a pulling motion to lift trays and sort mail, when she felt a sharp pain in her 

neck.” Dr. Schottenstein described his treatment and the objective studies. He opined, “Within a 

certain degree of medical certainty, [appellant’s] exacerbated neck and low back pain are directly 

related to the injury sustained while repetitively lifting and sorting mail as a mail processing 

clerk. [She] has suffered persisting neck and low back pain every day without remission since 

the date of accident.” Dr. Schottenstein concluded that appellant injured her back and neck 

lifting trays and mail sorting and thus her pain was “directly related to the initial injury....” 

On May 16, 2016 appellant, through counsel, requested reconsideration. 

Dr. Schottenstein provided a progress report, dated May 31, 2016, describing his 

treatment of appellant, diagnosing cervical and lumbar radiculitis, and finding that the July 8, 

2014 incident was the cause of her condition. 

In a decision dated August 12, 2016, OWCP denied modification of the July 1, 2015 

decision. 

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

any disability and/or specific condition for which compensation is claimed are causally related to 

the employment injury.7

 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.8

To determine whether an employee sustained a traumatic injury in the performance of 

duty, OWCP must determine whether “fact of injury” is established. First, an employee has the 

burden of demonstrating the occurrence of an injury at the time, place, and in the manner 

alleged, by a preponderance of the reliable, probative, and substantial evidence.9 Second, the 

 6

 Electrodiagnostic testing performed on January 13, 2016 showed positive findings at the right and left S1 sural 

nerve and bilateral L5 peroneal nerve. Testing performed June 8, 2016 revealed positive findings at the left C2 

occipital nerve and right C7 radial medial branch nerve. 

7 Alvin V. Gadd, 57 ECAB 172 (2005); Anthony P. Silva, 55 ECAB 179 (2003). 

8 See Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117 (2005); Ellen L. Noble, 55 ECAB 530 (2004). 

9 David Apgar, 57 ECAB 137 (2005); Delphyne L. Glover, 51 ECAB 146 (1999). 
6

employee must submit sufficient evidence, generally only in the form of medical evidence, to 

establish a causal relationship between the employment incident and the alleged disability and/or 

condition for which compensation is claimed.10 An employee may establish that the employment 

incident occurred as alleged, but fail to show that her disability and/or condition relates to the 

employment incident.11

ANALYSIS 

Appellant alleged that she sustained an injury to her middle and lower back, neck, and 

right shoulder causing pain down her right arm and leg on July 8, 2014 after casing mail. There 

is no dispute that on July 8, 2014 she was casing mail at the time, place, and in the manner 

alleged. The issue, consequently, is whether the medical evidence establishes that appellant 

sustained an injury as a result of this employment incident. 

The Board finds that appellant has not established that the July 8, 2014 employment 

incident resulted in an injury. The determination of whether an employment incident caused an 

injury is generally established by medical evidence.12

On May 9, 2016 Dr. Schottenstein noted that on July 8, 2014 appellant felt a sharp neck 

pain after using repetitive movements lifting trays and sorting mail. He diagnosed lumbar and 

cervical radiculitis and attributed her symptoms to her repetitive injury lifting and sorting mail 

and noted that she had experienced pain daily since the accident. In September 2015 through 

May 2016 progress reports, Dr. Schottenstein diagnosed lumbar and cervical radiculitis and 

indicated that the July 8, 2014 incident caused appellant’s condition. While he related that 

appellant had pain after repetitively sorting mail, he did not explain the mechanism by which the 

repetitive work duties caused a disc injury such that she sustained radiculitis. Medical evidence 

that states a conclusion, but does not offer any rationalized medical explanation regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal 

relationship.13 Dr. Schottenstein, in a form report dated September 18, 2014, noted diagnoses 

and checked a box marked “yes” that the condition was caused or aggravated by employment. 

However, a report that addresses causal relationship with a checkmark, without medical rationale 

explaining how the work condition caused the alleged injury, is of diminished probative value 

and insufficient to establish causal relationship.14 

On August 5, 2014 Dr. Collins reviewed appellant’s history of receiving treatment at the 

emergency room on July 8, 2014 after experiencing pain sorting mail. He diagnosed lumbar and 

cervical radiculitis and found that the July 8, 2014 employment incident caused her condition. 

Dr. Collins provided similar findings in a report dated September 9, 2014. On December 16, 

 10 Gary J. Watling, 52 ECAB 278 (2001); Shirley A. Temple, 48 ECAB 404, 407 (1997). 

11 Id.

12 Lois E. Culver (Clair L. Culver), 53 ECAB 412 (2002). 

13 See J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006). 

14 See D.B., Docket No. 16-0798 (issued December 2, 2016). 
7

2014 he noted that appellant had neck and back pain radiating into the extremities on July 8, 

2014 after sorting mail at work. Dr. Collins offered diagnoses, noted that her pain had persisted 

since the work incident, and attributed her condition to the July 8, 2014 employment incident. 

He did not, however, support his causal relationship finding with medical rationale. Dr. Collins 

did not explain why appellant’s actions of sorting mail on July 8, 2014 resulted in disc bulges 

and herniations other than to note that she had experienced pain since that time. A physician 

must provide a narrative description of the identified employment incident and a reasoned 

opinion on whether the employment incident described had caused or contributed to appellant’s 

diagnosed medical condition.15 The Board has held that the mere fact that a disease or condition 

manifests itself during a period of employment does not raise an inference of causal relationship 

between the condition and the employment.16 

On July 10, 2014 Dr. Tyorkin noted that appellant experienced radiating neck and back 

pain at work on July 8, 2014. He diagnosed cervical and lumbar radiculopathy and found that 

she was disabled from work. Dr. Tyorkin attributed the diagnoses to the described work injury. 

He provided a similar report dated July 31, 2014. Dr. Tyorkin, however, did not provide any 

rationale for his causation finding. Medical evidence that states a conclusion, but does not offer 

any rationalized medical explanation regarding the cause of an employee’s condition is of 

limited probative value on the issue of causal relationship.17 In a July 10, 2014 Form CA-16, 

Dr. Tyorkin noted diagnoses and checked a box marked “yes” that the condition was caused or 

aggravated by work activity.18 The Board has held, however, that when a physician’s opinion on 

causal relationship consists only of checking “yes” to a form question, without explanation or 

rationale, that opinion has little probative value and is insufficient to establish a claim.19 Thus, 

these reports are insufficient to establish the claim. 

On August 27, 2014 Dr. Ciancimino obtained a history of a work injury on July 8, 2014 

to her neck and back casing mail. He diagnosed derangement of the lumbar and cervical spine 

with radiculopathy and found that the described accident was the cause of her condition. 

Dr. Ciancimino also provided form reports in July and August 2014, which noted diagnoses and 

indicated by a checkmark on the form that the incident described caused the injury. He, 

however, did not explain how or why appellant’s back and neck conditions resulted from the 

accepted employment incident, and thus his opinion is insufficient to meet her burden of proof.20 

 15 John W. Montoya, 54 ECAB 306 (2003). 

16 D.E., 58 ECAB 448 (2007); Roy L. Humphrey, 57 ECAB 238 (2005). 

17 See J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006). 

18 The Board notes that where an employing establishment properly executes a Form CA-16 which authorizes 

medical treatment as a result of an employee’s claim for an employment-related injury, the Form CA-16 creates a 

contractual obligation, which does not involve the employee directly, to pay for the cost of the examination or 

treatment regardless of the action taken on the claim. See Tracy P. Spillane, 54 ECAB 608 (2003). The period for 

which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated 

earlier by OWCP. See 20 C.F.R. § 10.300(c). 

19 See supra note 14; Deborah L. Beatty, 54 ECAB 3234 (2003). 

20 See H.F., Docket No. 16-1603 (issued December 14, 2016); A.D., 58 ECAB 149 (2006). 
8

As noted, a checkmark in response to a question on causation is of diminished probative value 

without an explanation for the conclusions reached. 

Dr. Neely, in reports dated January through April 2015, diagnosed a cervical disc 

herniation and cervical and lumbar disc bulges, which he determined were causally related to the 

July 8, 2014 employment incident. He, however, did not provide a well-rationalized medical 

opinion, based on a complete and accurate medical history, explaining the mechanism by which 

the diagnosed conditions resulted from the accepted employment incident when casing mail.21 

Consequently, Dr. Neely’s reports are of diminished probative value. 

The record also contains records of chiropractic treatment. In reports dated September 24 

and 30, 2014, Dr. Sandell, a chiropractor, diagnosed neck, thoracic, and lumbar strains. Section 

8101(2) of FECA provides that 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.22 A chiropractor cannot be 

considered a physician under FECA unless it is established that there is a subluxation as shown 

by x-ray evidence.23 Neither Dr. Sandell nor the other chiropractors who treated appellant 

diagnosed a subluxation by x-ray and thus they are not considered “physicians” under FECA and 

their reports are of no probative value.24 

Appellant also received treatment on July 8, 2014 by a physician assistant. A physician 

assistant, however, is not considered a “physician” as defined by FECA and thus the report has 

no probative medical value.25

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 she sustained an injury causally 

related to a July 8, 2014 employment incident. 

 21 See R.B., Docket No. 16-0885 (issued November 25, 2016). 

22 5 U.S.C. § 8101(2); see also I.C., Docket No. 14-1927 (issued February 13, 2015). 

23 20 C.F.R. § 10.5(bb); see Mary A. Ceglia, 55 ECAB 626 (2004). 

24 Isabelle Mitchell, 55 ECAB 623 (2004). 

25 See 5 U.S.C. § 8101(2); Allen C. Hundley, 53 ECAB 551 (2002). 
9

ORDER 

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

Workers’ Compensation Programs is affirmed. 

Issued: June 12, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board