United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

C.O., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

D’Iberville, MS, Employer 

__________________________________________ 

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Docket No. 16-0396 

Issued: April 18, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On December 29, 2015 appellant filed a timely appeal from an August 3, 2015 merit 

decision and a September 8, 2015 nonmerit 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

ISSUES 

The issues are: (1) whether appellant met his burden of proof to establish head, 

abdominal, and right upper extremity injuries causally related to a June 18, 2015 employment 

incident; and (2) whether OWCP properly denied appellant’s request for reconsideration under 

5 U.S.C. § 8128(a). 

 1

 5 U.S.C. § 8101 et seq. 

2

 Appellant submitted additional evidence accompanying his request for appeal to the Board. The Board may not 

consider evidence for the first time on appeal that was not before OWCP at the time it issued the final decision in the 

case. 20 C.F.R. § 501.2(c)(1). 
2

FACTUAL HISTORY 

On June 19, 2015 appellant, then a 57-year-old rural carrier, filed a traumatic injury claim 

(Form CA-1) alleging right upper extremity, abdominal, and head injuries in a June 18, 2105 

motor vehicle accident while in the performance of duty. The employing establishment issued a 

Form CA-16 authorizing medical treatment related to the accident. Appellant submitted June 18, 

2015 emergency room discharge instructions for “minor head injury,” signed by Deborah 

Anderson, a nurse practitioner. He did not return to work. 

In a June 29, 2015 letter, OWCP advised appellant of the additional evidence needed to 

establish his claim, including a description of the motor vehicle accident alleged to have caused 

the claimed injuries, and a narrative report from his attending physician explaining how and why 

that accident would cause those injuries. It afforded appellant 30 days to submit such evidence. 

Appellant provided reports dated from June 24 to July 20, 2015 by Dr. Eric Graham, an 

attending Board-certified orthopedic surgeon, who held appellant off work for unspecified 

reasons. 

By decision dated August 3, 2015, OWCP denied the claim, finding that appellant had 

not established causal relationship as there was no medical diagnosis of an injury. It accepted 

that the June 18, 2015 motor vehicle accident occurred at the time, place, and in the manner 

alleged. OWCP found, however, that appellant had failed to provide sufficient medical evidence 

supporting that the incident caused any injury. 

Appellant disagreed and on August 12, 2015 signed the appeal rights form accompanying 

the August 3, 2015 decision, marking an “X” on the line next to the paragraph describing 

reconsideration. He did not provide additional evidence or argument on or before 

September 8, 2015. 

By decision dated September 8, 2015, OWCP denied reconsideration, finding that 

appellant’s August 12, 2015 reconsideration request neither raised substantive legal questions 

nor included new and relevant evidence. 

LEGAL PRECEDENT -- ISSUE 1 

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 the 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.3

 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.4

 3 Joe D. Cameron, 41 ECAB 153 (1989). 

4 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999). 
3

In order to determine whether 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 

conjunctively. First, the employee must submit sufficient evidence to establish that he or she 

actually experienced the employment incident that is alleged to have occurred.5

 Second, the 

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

establish that the employment incident caused a personal injury.6

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is a causal relationship 

between the claimant’s diagnosed condition and the implicated employment factors. The 

opinion of the physician must be based on a complete factual and medical background of the 

claimant, must be one of reasonable medial 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.7

ANALYSIS -- ISSUE 1 

OWCP accepted that appellant was involved in a June 18, 2015 motor vehicle accident. 

Appellant claimed that this incident caused head, abdominal, and right arm injuries. 

The Board finds, however, that appellant has failed to submit sufficient medical evidence 

to establish his traumatic injury claim. To be of probative value, a physician’s opinion must 

relate the condition to the accepted incident, must be based on a complete and accurate factual 

history, and must contain adequate medical rationale in support of the conclusions.8 

Dr. Graham, an attending Board-certified orthopedic surgeon, provided reports dated 

from June 24 to July 20, 2015 holding appellant off work. However, he did not provide a 

diagnosis, or identify any injury or condition disabling appellant for work. The Board has held 

that medical opinions which do not provide a firm diagnosis are insufficient to establish causal 

relationship.9

 As Dr. Graham did not opine that the June 18, 2015 motor vehicle accident caused 

any injury, his reports are insufficient to establish causal relationship.10 

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

6 Deborah L. Beatty, 54 ECAB 340 (2003).

7 Solomon Polen, 51 ECAB 341 (2000). 

8 Mary J. Ruddy, 49 ECAB 545 (1998). 

9 Paul Foster, 56 ECAB 208 (2004). 

10 Deborah L. Beatty, 54 ECAB 340 (2003).
4

The June 18, 2015 hospital discharge instructions signed by Ms. Anderson are not 

probative medical evidence, as nurse practitioners are not considered physicians under FECA.11 

Section 8101(2) of FECA provides that physicians include surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their 

practice as defined by State law.12

OWCP advised appellant on June 29, 2015 of the necessity of providing a narrative 

report from his attending physician with medical rationale supporting causal relationship. As 

appellant did not provide such evidence, OWCP’s August 3, 2015 decision denying the claim is 

proper under the law and facts of the case. 

On appeal appellant contends that he submitted all medical evidence necessary to 

establish his claim. He alleges that OWCP did not fully consider his physician’s reports. As 

explained, Dr. Graham failed to diagnose any condition resulting from the June 18, 2015 

accident. The discharge instructions do not constitute medical evidence as they were signed only 

by a nurse practitioner. Therefore, OWCP properly found that appellant had not provided 

sufficient medical evidence to establish his claim. 

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. 

LEGAL PRECEDENT -- ISSUE 2 

To require OWCP to reopen a case for merit review under section 8128(a) of FECA,13

section 10.606(b)(3) of Title 20 of the Code of Federal Regulations provides that a claimant must 

set forth arguments and contain evidence that either: (1) shows OWCP erroneously applied or 

interpreted a specific point of law; (2) advances a relevant legal argument not previously 

considered by OWCP; or (3) constitutes relevant and pertinent new evidence not previously 

considered by OWCP.14 Section 10.608(b) provides that when an application for review of the 

merits of a claim does not meet at least one of the three requirements enumerated under section 

10.606(b)(3), OWCP will deny the application for reconsideration without reopening the case for 

a review on the merits.15 

In support of a request for reconsideration, a claimant is not required to submit all 

evidence which may be necessary to discharge his or her burden of proof.16 A claimant need 

 11 P.W., Docket No. 15-1814 (issued January 15, 2016); L.D., 59 ECAB 648 (2008). 

12 5 U.S.C. § 8101(2). 

13 Id. at § 8128(a). 

14 20 C.F.R. § 10.606(b)(3). 

15 20 C.F.R. § 10.608(b). See also D.E.., 59 ECAB 438 (2008). 

16 Helen E. Tschantz, 39 ECAB 1382 (1988). 
5

only submit relevant and pertinent new evidence not previously considered by OWCP.17 When 

reviewing an OWCP decision denying a merit review, the function of the Board is to determine 

whether OWCP properly applied the standards set forth at section 10.606(b)(3) to the claimant’s 

application for reconsideration and any evidence submitted in support thereof.18 

ANALYSIS -- ISSUE 2 

OWCP accepted that appellant was involved in a June 18, 2015 motor vehicle accident 

that occurred in the performance of his duties. It denied the claim because appellant had failed to 

provide medical evidence from a physician diagnosing any conditions causally related to the 

accepted incident. Appellant on August 12, 2015 requested reconsideration, but did not provide 

additional evidence or argument. 

The Board finds that OWCP appropriately denied reconsideration as appellant failed to 

submit any relevant or pertinent new evidence or argument for OWCP to consider. He submitted 

nothing other than the appeal form requesting reconsideration. A claimant may be entitled to a 

merit review by submitting argument or evidence that either shows that OWCP erroneously 

applied or interpreted a specific point of law, advances a relevant legal argument not previously 

considered by OWCP, or constitutes relevant and pertinent new evidence not previously 

considered by OWCP. Appellant did not do so in this case. Therefore, pursuant to 20 C.F.R. 

§ 10.608, OWCP’s September 8, 2015 decision properly denied merit review. 

On appeal appellant contends that his physician provided additional evidence on 

reconsideration. However, there is no medical evidence of record submitted between the 

August 3 and September 8, 2015 decisions. 

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 establish that he sustained a cervical spine injury 

causally related to a June 18, 2015 employment incident. The Board further finds that OWCP 

properly denied reconsideration under 5 U.S.C. § 8128(a).19

 17 See 20 C.F.R. § 10.606(b)(3). See also Mark H. Dever, 53 ECAB 710 (2002). 

18 Annette Louise, 54 ECAB 783 (2003). 

19 The Board notes that the record contains a CA-16. Ordinarily, where there is a properly executed CA-16 form, 

OWCP is under a contractual obligation to pay for the medical care provided. Upon return of the case record, this 

matter should be reviewed. Val D. Winn, 40 ECAB 666 (1989). 
6

ORDER 

IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’ 

Compensation Programs dated September 8 and August 3, 2015 are affirmed. 

Issued: April 18, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board