United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.R., Appellant 

and 

U.S. POSTAL SERVICE, ALMEDA POST 

OFFICE, Houston, TX, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 16-0005 

Issued: February 5, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

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 September 28, 2015 appellant filed a timely appeal from an April 1, 2015 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1

 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.3

 1

 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of issuance of an 

OWCP decision. An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. See 20 C.F.R. 

§ 501.3(e)-(f). One hundred and eighty days from April 1, 2015, the date of OWCP’s last decision, was 

September 28, 2015. Since using October 1, 2015, the date the appeal was received by the Clerk of the Appellate 

Boards would result in the loss of appeal rights, the date of the postmark is considered the date of filing. The date of 

the U.S. Postal Service postmark is September 28, 2015, rendering the appeal timely filed. See 20 C.F.R. 

§ 501.3(f)(1). 

2

 5 U.S.C. § 8101 et seq.

3

 The Board notes that, following the issuance of the April 1, 2015 OWCP decision, appellant submitted new 

evidence. The Board is precluded from reviewing evidence which was not before OWCP at the time it issued its 

final decision. See 20 C.F.R. § 501.2(c)(1). 
2

ISSUE 

The issue is whether appellant has met his burden of proof to establish additional cervical 

and lumbar conditions as a consequence of his accepted August 31, 2013 employment injuries. 

FACTUAL HISTORY 

On August 31, 2013 appellant, then a 40-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) for injuries received as a result of a motor vehicle accident while delivering 

mail. He claimed a neck sprain, sprain of the back, lumbar region, left knee and left leg sprain of 

unspecified sites, and left hip and left thigh sprain of unspecified sites. Appellant stopped work 

on the date of injury and has not returned to work. 

In a September 9, 2013 report, Dr. Anthony Melillo, a Board-certified orthopedic 

surgeon, noted the history of the August 31, 2013 motor vehicle accident and that appellant had 

been seen at an emergency room. He noted findings which included full motion of the left knee 

with no instability, and normal motion of the left hip with no grinding. Dr. Melillo reported 

reviewing left knee, left hip, pelvis, and cervical spine x-rays which were negative. Appellant 

was intact neurologically. Dr. Melillo assessed mild left knee sprain and a left hip sprain due to 

the work injury. He recommended physical therapy. Dr. Melillo noted that appellant should not 

work until his next visit. 

Thereafter, appellant sought treatment from Dr. Louis Train, a family practitioner. On 

September 26, 2013 Dr. Train noted the history of the work injury and reported findings that 

included neck muscle spasms, decreased pinprick sensations in the median and ulnar nerves, 

decreased bilateral shoulder motion, decreased grip strength in the forearms, positive straight leg 

raising at 90 degrees bilaterally, and left patella crepitus and tenderness. He diagnosed neck 

sprain with thoracic outlet syndrome triggered by sprained neck muscles, low back sprain, left 

knee sprain, and left hip/thigh sprain. Dr. Train concluded that “in my medical rationale,” 

appellant’s diagnosed conditions were due to the work-related motor vehicle accident. He 

opined that appellant could not work as a postal carrier. 

On October 17, 2013 OWCP accepted sprains of the neck, back (lumbar region), left 

knee, leg, hip, and thigh. Appellant received continuation of pay beginning September 1, 2013. 

He was placed on the periodic rolls effective October 16, 2013. 

By letter dated January 29, 2014, OWCP referred appellant, together with a statement of 

accepted facts, a list of questions, and the medical record, to Dr. James F. Hood, a Boardcertified orthopedic surgeon, for a second opinion to determine whether he had any residuals 

from his accepted conditions and to determine if he had continued disability. In a February 19, 

2014 medical report, Dr. Hood provided a history of the August 31, 2013 employment injuries 

and appellant’s medical treatment. He noted appellant’s complaints of neck, back, right hip, and 

right knee pain. Dr. Hood reported findings on examination of the lumbar and cervical spines, 

and left knee. He diagnosed left knee contusion with no evidence of any internal derangement, 

hip sprain/contusion, and soft tissue sprain of the lumbar and cervical spine without 

radiculopathy. Dr. Hood advised that appellant’s subjective complaints were no longer related to 

the accepted employment injuries. He opined that there was secondary gain and symptom 

magnification. Dr. Hood concluded that although appellant could not return to his city carrier 
3

position due to his medications, he could return to full-duty work eight hours a day with no 

restrictions. 

In a March 12, 2014 report, Dr. Train noted appellant’s complaints of neck and low back 

pain. He reported findings on examination of the neck, lower back, and left knee. Dr. Train 

diagnosed cervical herniated nucleus pulposus and lumbar herniated nucleus pulposus with left 

sciatica. Based on magnetic resonance imaging (MRI) scan results, appellant’s history and 

physical findings, he requested that his accepted injuries be upgraded to include cervical 

herniated nucleus pulposus. 

On March 28, 2014 OWCP requested that Dr. Hood review additional medical evidence 

of record and provide an opinion as to whether appellant’s current cervical condition was 

causally related to the accepted work injuries and whether he had continued disability. In a 

supplemental report dated April 9, 2014, Dr. Hood reviewed the additional medical evidence and 

reiterated his prior diagnoses of left knee contusion with no evidence of any internal 

derangement, hip sprain/contusion, and soft tissue sprain of the lumbar and cervical spine 

without radiculopathy. He advised that appellant’s current cervical condition was no longer 

medically connected to his accepted August 31, 2013 employment injuries as there were no 

objective findings to correlate with his subjective complaints. Dr. Hood concluded that he could 

return to his city carrier position after he was off all prescribed medications. 

In an April 9, 2014 report, Dr. Train again provided appellant’s history. Appellant 

complained about constant low back pain that radiated down his left leg. Dr. Train reported 

physical examination findings. He also reported that a February 24, 2014 cervical MRI scan 

showed C3-4 disc herniation, three to four millimeters that caused flattening of the thecal sac. 

Electromyogram/nerve conduction (EMG/NC) studies dated March 8, 2014 showed L5-S1 

radiculopathy on the left. A March 17, 2014 lumbar MRI scan showed L5-S1 disc herniation, 

four to five millimeters. Dr. Train noted the accepted conditions and advised that appellant’s 

claim was not limited to a lumbar sprain/strain based on his examination findings, and MRI scan 

and EMG/NC results. He requested that the new diagnoses be included in appellant’s claim. 

Dr. Train reasoned that these conditions were a direct result of his work-related injuries. He 

ordered a functional capacity examination and advised that appellant could not perform any 

sedentary work or stand, push, or pull. 

On May 6, 2014 OWCP found a conflict in medical opinion between Drs. Train and 

Hood regarding appellant’s work capacity. By letter dated May 14, 2014, it referred him, 

together with a statement of accepted facts, a list of questions, and the medical record, to 

Dr. Grant R. McKeever, a Board-certified orthopedic surgeon, for an impartial medical 

examination. 

In a June 4, 2014 report, Dr. McKeever reviewed appellant’s history and medical record. 

He noted appellant’s complaint of intermittent pain in his back, cervical spine, and left leg, and 

reported examination findings. Dr. McKeever opined that appellant’s accepted employmentrelated conditions had resolved based on his examination findings. These conditions had 

resolved within eight weeks post injury and ceased to be a factor. Dr. McKeever concluded that 

appellant could return to his city carrier position with no restrictions. He also concluded that no 

further medical treatment was necessary as the compensable injuries had long resolved. 
4

In a November 12, 2014 report, Dr. Train provided appellant’s history and findings on 

examination. He again noted the February 24 and March 17, 2014 cervical and lumbar MRI scan 

and March 8, 2014 EMG/NC results. Dr. Train reported that a December 9, 2013 left knee MRI 

scan showed mild patellar tendinosis. A May 20, 2014 functional capacity evaluation showed 

appellant’s work restrictions.4

 Dr. Train again advised that appellant’s claim was not limited to a 

lumbar sprain/strain. He requested that his claim be upgraded to include the diagnoses of 

cervical and lumbar disc displacement, and reactive depression. Dr. Train reasoned that these 

conditions were a direct result of appellant’s August 31, 2013 employment injuries. 

On March 16, 2015 an OWCP medical adviser reviewed a statement of accepted facts 

and the medical record, including Dr. Train’s April 9 and November 12, 2014 reports, to 

determine whether appellant’s claim should be upgraded to include cervical and lumbar disc 

displacement, and reactive depression. He noted Dr. McKeever’s opinion that appellant’s 

employment-related injuries had resolved. The medical adviser related that he was unable to 

find an acceptable causation analysis explaining the relationship of the disc pathology in the 

cervical and lumbar spines to the August 31, 2013 traumatic work event. Therefore, he opined 

that the diagnoses of cervical and lumbar disc displacement were likely unrelated to the 

August 31, 2013 traumatic work event and more likely the result of degenerative spinal 

conditions. The medical adviser concluded that, based on the above reasons, he could not 

support a consequential injury in appellant’s claim to include cervical and lumbar disc 

displacement. He, however, recommended that his claim be upgraded to include the diagnosis of 

reactive depression as proposed by Dr. Train. The medical adviser reasoned that it appeared 

appellant’s chronic pain complaints persisted and they were consistent with this condition. 

In an April 1, 2015 decision, OWCP found that the medical evidence of record was 

insufficient to establish that appellant sustained cervical and lumbar disc displacement as a 

consequence of his accepted August 31, 2013 work injuries. However, it accepted his claim for 

chronic pain syndrome. OWCP found that further medical development was necessary to 

determine whether appellant had reactive depression due to his accepted work injuries. 

LEGAL PRECEDENT 

With respect to consequential injuries, it is an accepted principle of workers 

compensation law that, when the primary injury is shown to have arisen out of and in the course 

of employment, every natural consequence that flows from the injury is deemed to arise out of 

the employment, unless it is the result of an independent intervening cause which is attributable 

to the employee’s own intentional conduct.5 The basic rule is that a subsequent injury, whether 

an aggravation of the original injury or a new and distinct injury, is compensable if it is the direct 

and natural result of a compensable primary injury.6

 4

 The Board notes that the May 20, 2014 EMG/NC results are not contained in the case record. 

5 See Albert F. Ranieri, 55 ECAB 598 (2004); A. Larson, The Law of Workers’ Compensation § 10.01 

(November 2000). 

6 See Charles W. Downey, 54 ECAB 421-23 (2003). 
5

A claimant bears the burden of proof to establish a claim for a consequential injury. As 

part of this burden, he or she must present rationalized medical opinion evidence.7 Rationalized 

medical evidence is evidence which relates a work incident, work injury or factors of 

employment to a claimant’s condition, with stated reasons of a physician.8 The opinion of the 

physician must be one of reasonable medical certainty and must be supported by medical 

rationale explaining the nature of the relationship of the diagnosed condition and the specific 

employment injury.9

ANALYSIS 

OWCP accepted that on August 31, 2013 appellant sustained a neck sprain, sprain of the 

back, lumbar region, left knee and left leg sprain of unspecified sites, left hip and left thigh 

sprain of unspecified sites, and chronic pain syndrome while in the performance of duty. 

Appellant claimed that he sustained additional neck and lumbar injuries, including cervical and 

lumbar disc displacement as a consequence of his accepted neck, back, and left knee, left leg, left 

hip, and left thigh conditions. He bears the burden of proof to establish his claim for a 

consequential injury.10 The Board finds that appellant has not submitted sufficient medical 

evidence to establish his additional neck and back conditions as a consequence of his accepted 

employment injuries. 

Dr. Train failed to relate how the accepted neck, back, left knee, left leg, left hip, left 

thigh, and chronic pain conditions caused the additional cervical and lumbar conditions. On 

April 9 and November 12, 2014 he briefly addressed causal relationship by opining that 

appellant’s L5-S1 radiculopathy on the left, C3-4 and L5-S1 disc herniation, cervical disc 

displacement, and lumbar disc displacement (sciatica) were a direct result of the accepted workrelated injuries. However, Dr. Train failed to explain the mechanism of injury by detailing how 

this motor vehicle accident caused the diagnosed conditions. 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.11 The Board finds, therefore, that 

Dr. Train’s reports are insufficient to meet appellant’s burden of proof. 

The Board notes that it is appellant’s burden of proof and finds insufficient rationalized 

medical evidence of record to establish that appellant’s cervical and lumbar conditions were a 

consequence of his accepted employment injuries. Appellant did not meet his burden of proof to 

establish a consequential injury. Moreover, an OWCP medical adviser reviewed the medical 

record and related that he could not recommend the expansion of appellant’s claim to include 

consequential cervical and lumbar disc displacement. He reasoned that there was no acceptable 

causation analysis explaining the relationship between the disc pathology in the cervical and 

lumbar spines and the accepted August 31, 2013 employment incident. The medical adviser 

 7 J.A., Docket No. 12-603 (issued October 10, 2012). 

8 See supra note 6. 

9 Id. 

10 Supra note 7. 

11 T.M., Docket No. 08-0975 (issued February 6, 2009). 
6

further reasoned that these conditions were more likely the result of degenerative spinal 

conditions and not the accepted work incident. Furthermore, Dr. Hood, an OWCP referral 

physician, and Dr. McKeever, an impartial specialist, found no basis on which to attribute 

additional conditions to the August 31, 2013 work injury.12 Dr. Hood reported that there were no 

objective findings to correlate his subjective complaints, while Dr. McKeever concluded that the 

accepted orthopedic conditions had resolved, thus negating further medical treatment. 

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 that he 

sustained additional cervical and lumbar conditions as a consequence of his accepted August 31, 

2013 employment injuries. 

ORDER 

IT IS HEREBY ORDERED THAT the April 1, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 5, 2016 

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 

 12 The Board notes that Dr. McKeever was an impartial specialist with regard to appellant’s work capacity and not 

with regard to whether additional conditions should be accepted. However, his report may still be considered for its 

own intrinsic value. See Cleopatra McDougal-Saddler, 47 ECAB 480 (1996).