United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

W.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Lyons, NJ, Employer

__________________________________________

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Docket No. 17-0422

Issued: October 13, 2017

Appearances: Case Submitted on the Record

Jeffrey P. Zeelander, Esq., for the appellant1

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 January 2, 2017 appellant, through counsel, filed a timely appeal from an August 26, 

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 met his burden of proof to establish an injury causally 

related to the accepted December 9, 2014 employment incident. 

FACTUAL HISTORY

On January 6, 2015 appellant, then a 50-year-old certified respiratory therapist, filed a 

traumatic injury claim (Form CA-1) alleging that on December 15, 2014 he experienced pain in 

his lower back, left buttocks, left leg, and left foot while pushing a rolling computer cart. The 

claim form does not indicate whether he stopped work. On the reverse side of the claim form, 

the employing establishment controverted appellant’s claim because he had not worked on that 

date. 

Dr. Vito Loguidice, a Board-certified orthopedic surgeon, initially treated appellant and

related in a December 16, 2014 report that appellant had complained of left leg pain for one 

week. He noted that appellant had a history of lumbar radiculopathy and a long-standing history 

of right hand numbness. Dr. Loguidice reviewed appellant’s history and conducted an 

examination. He reported painful limited lumbar movement and spasm and positive straight leg 

raise testing on the left at 10 degrees. Dr. Loguidice diagnosed left lumbar radiculopathy with 

weakness. He recommended that appellant remain off work. 

Appellant underwent a lumbar spine magnetic resonance imaging (MRI) scan by Dr. Joel 

Swartz, a Board-certified diagnostic radiologist, who provided a December 18, 2014 report. 

Dr. Swartz observed central herniation at L4-5 with right-sided bulging of the disc and central 

and left-sided herniation at L5-S1. He also indicated that desiccation was seen throughout 

appellant’s lumbar disc spaces being most pronounced at the levels of L3-4 through L5-S1. 

Dr. Loguidice continued to treat appellant and indicated in follow-up reports dated 

December 19, 2014 and January 8, 2015 that a lumbar MRI scan showed degenerative disc 

disease at L3-4, L4-5, and L5-S1 and herniation on the left side at L5-S1. He related appellant’s 

complaints of left lower extremity pain and reported examination findings of weakness of the 

peroneals and hamstrings on the left. Straight leg raise testing was positive. Dr. Loguidice 

diagnosed herniated disc L5-S1 with left-sided radiculopathy and asymptomatic stenosis and 

degenerative disc disease at L4-5. He recommended that appellant remain off work and undergo 

an epidural steroid injection. 

Appellant was examined in the employing establishment’s employee health unit. In a 

January 6, 2015 handwritten examination note, a physician with an illegible signature related that 

appellant had been put out of work for three weeks due to an injury he sustained on 

December 15, 2014 at 9:00 p.m. in Building 135, Unit 2B. He described that appellant was 

pushing a computer cart when he felt pain in his lower back. The physician noted that appellant 

had a history of herniated disc problems and still treated with a chiropractor. He provided 

examination findings and diagnosed herniated lumbar disc (by history) and lumbar back strain. 

In an attending physician’s report (Form CA-20) dated January 13, 2015, Dr. Loguidice

noted a date of injury of December 16, 2014. He provided examination findings and diagnosed 
3

lumbar radiculopathy and stenosis. Dr. Loguidice checked a box marked “no” indicating that 

appellant’s condition was not work related. He noted that appellant was totally disabled from 

work beginning December 16, 2014 with an estimated return to work of February 2, 2015. 

The employing establishment controverted appellant’s claim in a January 15, 2015 letter

and asserted that according to his timecard he was not on duty on December 15, 2014. It also 

pointed out that a January 13, 2015 Form CA-20 indicated that his condition was not work

related. 

In a letter dated January 26, 2015, OWCP advised appellant that the evidence of record 

was insufficient to establish his claim. It requested that he provide further information to 

substantiate that the December 15, 2014 incident occurred as alleged and that he provide medical 

evidence to establish a diagnosed condition causally related to the alleged incident. Appellant 

was afforded 30 days to submit this additional evidence. 

OWCP received additional medical evidence on February 23, 2015. In a report dated 

December 12, 2014, Dr. Richard Goga, Board-certified in emergency medicine, related in an 

examination note that appellant complained of left lower extremity pain, which worsened with 

movement and walking, that started three days ago. Upon physical examination, he observed no 

midline tenderness of appellant’s back and normal sensory examination. Straight leg raise 

testing was positive. Dr. Goga diagnosed sciatica. 

Appellant also provided hospital records dated December 19, 2014 and January 12, 2015, 

which revealed that he had received epidural steroid injections for a diagnosis of lumbar disc 

herniation by Dr. Loguidice. 

Dr. Loguidice continued to treat appellant. In a January 29, 2015 follow-up report, he 

noted that appellant had a herniated disc prior to this injury. Dr. Loguidice related that on 

December 9, 2014 around 9:00 p.m. appellant turned to the right while pushing a scanner at work

and felt a pull in his back. He explained that appellant’s radiculopathy worsened and the 

herniated disc became symptomatic. Dr. Loguidice reported: “It is my opinion that it’s very 

clear that the accident at [appellant’s] work exacerbated his underlying disc herniation.” He 

diagnosed herniated disc L5-S1 and indicated that appellant was still unable to work. 

On January 30, 2015, Rebecca Zeigler, a certified physician assistant, indicated that upon 

reviewing the examination notes, appellant’s first visit was on December 16, 2014, but the work 

injury occurred a week prior to the examination on December 9, 2014. 

Appellant provided a narrative statement dated February 7, 2015, wherein he described

that, on December 9, 2014 at approximately 9:00 p.m., he was doing a second round of 

treatments in Building 135. He explained that he was pushing a computer cart on wheels and 

made a sharp right turn when he felt a slight pull in his lower back. Appellant related that he was 

able to finish his rounds, but had a small discomfort in his lower back. He noted that, around 

3:00 a.m., he woke up with a burning sensation from the lower part of the left side of his back all 

the way to his left calf muscle. Appellant indicated that on December 10, 2014 he telephoned 

M.P. his supervisor and informed her that he would not be able to come to work due to his back 

pain. He described the various medical treatments he had sought for his continuing lumbar pain. 
4

Appellant reported that he was unable to remain sitting for a long period of time until January 6, 

2015, at which point he was driven to the employee health unit where he filed the incident report. 

He explained that he mistakenly noted the wrong date of December “16,” 2014, instead of 

December 9, 2014, on the claim form. Appellant noted that he did not initially tell anyone at the 

time of the injury because he did not think it was a big deal. He asserted that he had not 

sustained any other injuries since this incident and that he had stayed home trying to recuperate 

as much as possible. 

In a February 26, 2015 follow-up report, Dr. Loguidice related appellant’s continued 

complaints of back and leg pain and difficulty with standing, walking, bending, twisting, and 

lifting. Upon physical examination, he reported diminished repetitive toe rise on the left and 

positive straight leg raise testing at 60 degrees. Dr. Loguidice diagnosed left-sided radiculopathy 

secondary to herniated disc L5-S1. He indicated that appellant planned to proceed with surgery. 

OWCP denied appellant’s claim in a decision dated March 2, 2015. It accepted that the 

employment incident occurred as alleged, but denied his claim because the medical evidence did 

not establish a diagnosed condition as a result of the accepted incident. OWCP further noted that 

the medical evidence did not contain a clear history of injury. 

On April 2, 2015 OWCP received appellant’s request for a review of the written record

before an OWCP hearing representative. 

Appellant submitted a March 11, 2015 report by Dr. Justin Melia, a chiropractor, who 

related that appellant had been under his care for neck pain, low back pain with herniation, left 

leg pain, and knee pain since October 21, 2014 with diagnoses of cervicalgia, lumbago, 

segmental dysfunction, and joint stiffness. Dr. Melia noted that appellant had a preexisting 

lumbar spine herniation and explained that “pushing the computer cart at work made the 

herniation unstable and begin to swell.” 

Dr. Loguidice continued to treat appellant and in a March 24, 2015 report described that 

on December 9, 2014 appellant was pushing a computer cart at work when he turned and felt 

pain in his back. He explained that appellant was not symptomatic and was able to function at 

work without any significant pain before the December 9, 2014 work injury and then became 

symptomatic as a result of the incident. Dr. Loguidice opined that all of the medical treatment 

appellant had received was a result of the December 9, 2014 injury. In an April 30, 2015 

examination note, he indicated that appellant should proceed with surgery. 

On June 2, 2015 appellant underwent lumbar discectomy surgery. The surgery was not 

authorized by OWCP. 

Dr. Loguidice provided reports dated June 3 to July 16, 2015 and indicated that appellant 

was status post lumbar discectomy, but still complained of some low back pain and fatigue. He 

diagnosed herniated nucleus pulposus, lumbago, and status post discectomy. Dr. Loguidice 

noted that appellant was unable to work from June 15 to September 1, 2015. 

By decision dated August 13, 2015, an OWCP hearing representative affirmed the 

March 2, 2015 decision with modification. She accepted that the medical evidence of record 

provided valid diagnoses of lumbar stenosis, lumbar radiculopathy, and lumbar herniated discs at 
5

the L4-5 and L5-S1, but denied appellant’s claim because the medical evidence of record failed 

to establish that his lumbar conditions were causally related to the accepted employment 

incident. The hearing representative further noted that he clarified the date of the employment 

incident as December 9, 2014. 

In reports dated August 27, 2015 to January 14, 2016, Dr. Loguidice noted that appellant 

was status post discectomy and complained of mild left lateral thigh pain, back pain, fatigue, and 

stiffness. He reviewed appellant’s history and conducted an examination. Dr. Loguidice 

reported no tenderness in appellant’s lumbar spine. He related range of motion findings of full 

range and painless flexion and limited extension. Dr. Loguidice diagnosed status post 

discectomy L5-S1, lumbar herniated nucleus pulposus, and degenerative lumbar disc disease. 

He indicated that appellant was unable to work from August 27, 2015 until his next evaluation. 

Appellant underwent a lumbar spine MRI scan by Dr. Joseph Estacio, an osteopathic 

physician specializing in radiology. Dr. Estacio provided a January 11, 2016 report. He noted 

multilevel disc disease and postsurgical changes, severe neural foraminal narrowing L4-5 on the 

right, moderate-to-severe neural foraminal narrowing L4-5 and L5-S1 on the left, and moderate

neural foraminal narrowing L3-4 bilaterally. 

On February 18, 2016 appellant, through counsel, requested reconsideration. He 

indicated that he was attaching a narrative report from Dr. Michael Cohen, an osteopathic 

physician specializing in orthopedic surgery, which explained the mechanism of injury to 

establish appellant’s traumatic injury claim. Counsel asserted that even if Dr. Cohen’s report 

was not found to be sufficient to meet appellant’s burden of proof to establish his claim, it was 

sufficient to require further development of the medical evidence by referral for a second opinion 

evaluation. 

Appellant provided a December 16, 2015 narrative report from Dr. Cohen, who 

accurately described that on December 9, 2014 appellant felt a pull in his lower back while 

pushing his computer on a cart. Dr. Cohen reviewed the medical treatment that appellant had 

received and related that he currently complained of lumbar spine pain and stiffness and left 

lower extremity radicular pain. He related appellant’s physical examination findings and

concluded that appellant had suffered a work-related injury on December 9, 2014 and had 

sustained significant musculoskeletal pathology to his lumbar spine. Dr. Cohen opined that “the 

competent producing factor of this claimant’s permanent orthopedic impairments to the lumbar 

spine which includes a chronic post-traumatic lumbosacral strain and sprain, herniated discs L4-

5 and L5-S1 with associated radiculopathy, the necessity for the lumbar discectomy as well as 

the postoperative sexual dysfunction is to be considered the work[-]related injury of 

December 9, 2104.” He explained that appellant had a “torsional-type injury to his lumbar spine

which on a more likely than not basis caused the disc herniations he sustained during the course 

of employment on December 9, 2014.” 

In a February 11, 2016 report, Dr. Steven Mazza, Board-certified in physical medicine 

and rehabilitation, related that he treated appellant for complaints of low back pain. He noted 

that appellant had a lumbar discectomy in June 2015 and, while appellant’s left lower extremity 

radiculopathy had resolved, he still had persistent lower back pain. Upon physical examination,

Dr. Mazza observed bilateral lumbar paraspinal tenderness of the lumbar spine. Range of motion 
6

testing revealed painful and decreased extension and flexion. Dr. Mazza diagnosed degenerative 

lumbar disc, herniated nucleus pulposus, and lumbago. He noted that he discussed possible 

discogram surgery. 

Appellant continued to receive medical treatment from Dr. Loguidice, who noted in 

reports dated March 17 and April 7, 2016 that appellant’s lumbar discogram was negative. 

Dr. Loguidice provided physical examination findings and diagnosed de Quervain’s disease 

tenosynovitis, herniated nucleus pulposus, and status post lumbar discectomy. In the April 7, 

2016 report, he related that appellant’s functional capacity evaluation (FCE) was consistent with 

sedentary work and provided a March 31, 2016 FCE report. 

By decision dated May 2, 2016, OWCP denied modification of its August 13, 2015 

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

appellant’s diagnosed lumbar conditions were causally related to the accepted December 9, 2014 

employment incident. OWCP determined that the medical reports of Dr. Loguidice and

Dr. Cohen provided no rationale explaining how the December 9, 2014 incident caused or 

contributed to appellant’s lumbar condition. 

On June 6, 2016 appellant, through counsel, requested reconsideration. He noted that he 

was including another report from Dr. Cohen, who provided additional explanation of the 

mechanism of how the accepted work factors contributed to appellant’s lumbar condition and 

need for surgery. 

Appellant submitted a June 6, 2016 letter from Dr. Cohen, who indicated that he 

reviewed OWCP’s May 2, 2016 decision. He described the December 9, 2014 employment 

incident and the medical treatment appellant had received. Dr. Cohen related that, in an attempt 

to explain the mechanism of injury leading to appellant’s exacerbation of lumbar spine pain due

to disc pathology, he reviewed an article entitled “Body Mechanics of Lifting and Lower Back 

Pain,” which noted that low back pain was caused by chemical and mechanical irritation of pain 

sensitive nerve endings and structures of the lumbar spine. He reported that appellant’s workrelated risk factors could lead to that, including heavy physical work, frequent bending, twisting, 

lifting, pulling, pushing, and repetitive work. Dr. Cohen noted that appellant had underlying disc 

pathology since the age of 15 and explained that an increase in spinal load would cause more 

nerve root impingement in someone with underlying pathology. He opined that, after reviewing 

appellant’s history of pushing a computer cart, it was his opinion that this was sufficient to 

aggravate the underlying low back condition. 

In a decision dated August 26, 2016, OWCP denied modification of its prior decision. It 

found that Dr. Cohen’s opinion was not sufficiently rationalized to establish appellant’s claim as 

he based his opinion on an article regarding repetitive and heavy physical work, not a traumatic 

injury. OWCP determined that the medical evidence of record was insufficient to establish that 

appellant’s lumbar condition was causally related to the accepted December 15, 2014 

employment incident. 
7

LEGAL PRECEDENT

An employee seeking benefits under FECA3has the burden of proof to establish the 

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

evidence4including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability from work for which he or she claims compensation is causally 

related to that employment injury.5

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established.6 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that he actually experienced the employment incident at 

the time, place, and in the manner alleged.7 Second, the employee must submit evidence, 

generally only in the form of probative medical evidence, to establish that the employment 

incident caused a personal injury.

8

 An employee may establish that the employment incident 

occurred as alleged, but fail to show that his or her disability or condition relates to the 

employment incident.9

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.10 The opinion of the physician must be 

based on a complete factual and medical background of the employee, 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.11 The weight of the medical evidence is determined by its reliability, its probative 

value, its convincing quality, the care of analysis manifested, and the medical rationale expressed 

in support of the physician’s opinion.12

 

3

Id. 

4

J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

5 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

6

S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005).

7 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968).

8 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 

9

T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006).

10 See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005).

11 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).

12 James Mack, 43 ECAB 321 (1991).
8

ANALYSIS

Appellant alleged that on December 9, 2014 he injured his back when he pushed a 

computer cart and suddenly turned in the performance of duty. OWCP accepted that the 

employment incident occurred as alleged and found that the evidence confirmed a diagnosed 

back condition. It denied appellant’s claim, however, finding insufficient medical evidence of 

record to establish that his back condition was causally related to the December 9, 2014 

employment incident. 

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

back condition resulted from the accepted employment incident.

Appellant was primarily treated by Dr. Loguidice, who provided attending physician’s 

reports, examination notes, and narrative reports from December 16, 2014 to April 7, 2016. He 

initially noted a date of injury of December 16, 2014, but clarified in a January 29, 2015 report 

that appellant was injured on December 9, 2014 when he turned to the right while pushing a 

scanner at work. Dr. Loguidice related that appellant had a history of lumbar radiculopathy, 

herniated disc, and right hand numbness. In a December 19, 2014 report, he noted that a lumbar 

MRI scan showed degenerative disc disease at L3-4, L4-S1 and herniation on the left side at L5-

S1. Dr. Loguidice provided physical examination findings and diagnosed herniated disc L5-S1 

and degenerative disc disease at L4-5. In a January 13, 2015 Form CA-20, he checked a box 

marked “no” indicating that appellant’s condition was not work related. In a January 29, 2015 

report, Dr. Loguidice opined that “the accident at [appellant’s] work exacerbated his underlying 

disc herniation.” In a March 24, 2015 report, he noted that appellant became symptomatic after 

the December 9, 2014 work injury. Dr. Loguidice recommended that appellant remain off work.

Dr. Loguidice accurately described the December 9, 2014 work incident and diagnosed a 

back condition along with providing his opinion on causal relationship. He indicated in a 

January 13, 2015 Form CA-20 that appellant’s back condition was not work related. In a 

January 29, 2015 report, Dr. Loguidice opined that the December 9, 2014 accident at work had 

exacerbated appellant’s underlying disc herniation. In a March 24, 2015 report, he suggested 

that causal relationship was based on the fact that appellant’s current back condition only became

symptomatic after the December 9, 2014 work injury. The Board has held, however, that an 

opinion that a condition is causally related because the employee was asymptomatic before the 

injury is insufficient, without sufficient rationale, to establish causal relationship.13 For these 

reasons, Dr. Loguidice’s reports are insufficiently rationalized to establish appellant’s claim.

Dr. Cohen also treated appellant. In a December 16, 2015 narrative report, he accurately 

described that on December 9, 2014 appellant felt a pull in his lower back when he pushed a 

computer on a cart at work. Upon examination of appellant’s lumbar spine, Dr. Cohen observed 

left-sided paraspinal muscle spasm and limited range of motion. Straight leg raise testing and 

Lasegue signs were positive. Dr. Cohen diagnosed chronic post-traumatic traumatic strain and 

sprain of the lumbar spine, lumbar radiculopathy, herniated disc L4-5 and L5-S1, status post L5-

S1 discectomy. He reported that the “competent producing factor of this claimant’s permanent 

 

13 T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).
9

orthopedic impairments to the lumbar spine ... is to be considered the work-related injury of 

December 9, 2014.” Dr. Cohen explained that appellant had a “torsional-type injury” during the 

course of employment on December 9, 2014 that “on a more likely than not basis” caused 

appellant’s lumbar disc herniations. He further noted in a June 6, 2016 letter that he reviewed an 

article about the cause of low back pain. Dr. Cohen related that appellant had underlying disc 

pathology since the age of 15 and indicated that an increase in spinal load would cause more 

nerve root impingement in someone with underlying pathology. He reported that after reviewing 

appellant’s history of pushing a computer cart, this was sufficient to aggravate the underlying 

low back condition. 

Although Dr. Cohen provided an affirmative opinion on causal relationship, he did not 

support his opinion with any medical rationale. He failed to explain the mechanism of injury of 

how pushing a computer cart and suddenly turning at work caused or contributed to appellant’s 

back condition.14 The need for rationalized medical opinion based on medical rationale is 

especially important in this case as appellant had a preexisting lumbar condition. In light of this 

prior injury, rationalized medical evidence is particularly important to explain how his back 

condition resulted from the December 9, 2014 work incident, and not his preexisting back 

condition. The description of a “torsional-type injury” did not explain how the accepted 

December 9, 2014 employment incident caused or contributed to appellant’s lumbar condition.15 

The Board has held that a medical report is of limited probative value on the issue of causal 

relationship if it contains a conclusion regarding causal relationship which is unsupported by 

medical rationale.16 Because Dr. Cohen has not provided such medical rationale to support his 

opinion on causal relationship, his reports are insufficient to establish appellant’s claim.

Appellant was also treated in the emergency room. In a December 12, 2014 emergency 

room report, Dr. Goga treated appellant for complaints of left lower extremity pain. He provided 

examination findings and diagnosed sciatica. The Board finds that Dr. Goga did not provide an 

opinion as to whether the December 9, 2014 employment incident caused or contributed to 

appellant’s diagnosed back condition.17

Similarly, the diagnostic scan reports from Dr. Swartz, Dr. Estacio, and Dr. Mazza did 

not offer any opinion or explanation on the cause of appellants back condition. They provided 

examination and diagnostic findings, which revealed herniated discs and degenerative changes in 

appellant’s lumbar spine. None of the physicians, however, opined on whether the December 9, 

2014 work incident caused or contributed to his back condition. The Board has held that medical 

evidence that does not offer any opinion regarding the cause of an employee’s condition is of 

 

14 See B.T., Docket No. 13-0138 (issued March 20, 2013).

15 See L.R., Docket No. 16-0736 (issued September 2, 2016). 

16 S.E., Docket No. 08-2214 (issued May 6, 2009); T.M., supra note 13. 

17 A medical report is of limited probative value on the issue of causal relationship if it contains a conclusion 

regarding causal relationship which is unsupported by medical rationale. Id. 
10

limited probative value on the issue of causal relationship.18 These reports, therefore, are 

insufficient to establish appellant’s claim.

Appellant was also examined in the employing establishment’s health unit on January 6, 

2015 by a physician with an illegible signature. The Board has previously held, however, that 

reports that are unsigned or that bear illegible signatures cannot be considered as probative 

medical evidence because they lack proper identification.19 Likewise, the January 30, 2015 

physician assistant’s report lacks probative value because physician assistant are not considered 

physicians as defined under FECA and their medical opinions regarding diagnosis and causal 

relationship are of no probative value.20

Dr. Melia, a chiropractor, also treated appellant. In a March 11, 2015 report, he noted 

diagnoses of cervicalgia, lumbago, segmental dysfunction, and joint stiffness. Dr. Melia 

explained that pushing the computer cart at work made appellant’s preexisting lumbar spine 

herniation unstable and begin to swell. Section 8101(2) of FECA, however, 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.21 As Dr. Melia did not provide a diagnosis of subluxation, his 

opinion on causal relationship is of no probative value.

On appeal, counsel contends that Dr. Cohen adequately explained the mechanism of 

injury, specifically the torsional forces that caused appellant’s lumbar spine injury, and 

established that the accepted work factors caused or contributed to appellant’s diagnosed 

condition. Counsel further argues, in the alternative, that even if Dr. Cohen’s reports were 

insufficient to meet appellant’s burden of proof, there was sufficient evidence to require further 

development of appellant’s claim by referral for a second opinion evaluation. As noted above, 

however, Dr. Cohen’s report is of diminished probative value and is insufficient to meet 

appellant’s burden of proof to establish causal relationship or to require further development of 

the medical evidence. The issue of causal relationship is a medical question that must be 

established by probative medical opinion from a physician.22 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 are sufficient 

 

18 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).

19 Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55 ECAB 343 (2004).

20 See David P. Sawchuk, 57 ECAB 316, 320, n.11 (2006) (lay individuals such as physician assistants, nurses 

and physical therapists are not competent to render a medical opinion under FECA); section 8102(2) of FECA 

provides that the term “physician” includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, 

chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law. See also R.M.,

Docket No. 16-1845 (March 6, 2017).

21 5 U.S.C. § 8101(2). 

22 W.W., Docket No. 09-1619 (June 2, 2010); David Apgar, supra note 8. 
11

to establish causal relationship.23 The Board finds, therefore, 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 a back injury 

causally related to the accepted December 9, 2014 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the August 26, 2016 merit decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 13, 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

 

23 E.J., Docket No. 09-1481 (issued February 19, 2010).