United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.T., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

JESSE BROWN VETERANS AFFAIRS 

MEDICAL CENTER, Chicago, IL, Employer

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Docket No. 17-1546

Issued: November 2, 2017

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 July 7, 2017 appellant, through counsel, filed a timely appeal from a March 10, 2017 

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 her burden of proof to establish an injury due to an 

April 11, 2016 employment incident.

FACTUAL HISTORY

On April 27, 2016 appellant, then a 50-year-old Equal Employment Opportunity (EEO) 

assistant, filed a traumatic injury claim (Form CA-1) alleging that on April 11, 2016 she 

sustained an injury at work when she fell against a glass-fronted cabinet in her office, striking 

her right middle/upper back and right wrist. Appellant stopped work on April 12, 2016.3

Appellant submitted an April 12, 2016 statement in which she described the 

circumstances of her April 27, 2016 fall. She indicated that a coworker, E.J., came into her 

office on April 11, 2016 and that, as E.J. was leaving, she attempted to get up from her 

wheelchair with her crutches in order to go to the bathroom located in her office. As appellant

was standing up, she lost her balance and fell into E.J.4 She indicated that she then twisted 

around and fell backwards against a glass-fronted cabinet, striking her right middle/upper side of 

her back and her right wrist on the cabinet. Appellant complained of headaches and pain in her 

neck, right arm, right wrist, ankles, and feet.5

In an April 11, 2016 report, Dr. Kartik Kamaria, a medical resident specializing in

internal medicine and osteopathy, provided an assessment of “mechanical fall” and left posterior 

shoulder and left wrist pain. In another April 11, 2016 report, Angelica Baltazar, an attending 

nurse, noted that appellant related that she was at work earlier that day, when she got up to use 

the restroom and fell down. She denied any head trauma.

In an April 11, 2016 report, Dr. George Hughes-Strange, a medical resident specializing 

in emergency medicine, indicated that appellant presented on that date complaining of right wrist 

pain and left back pain that started after a fall. Appellant reported that she was using crutches 

and wearing a boot on her left leg due to a March 28, 2016 Achilles tendon injury and that, while 

getting up, she caught her boot on the crutch, causing her to fall to the ground. Dr. HughesStrange noted that appellant was a patient “with traumatic fall due to mechanical issue” who 

currently had a brace on her left foot and had difficulty using crutches. He indicated that an xray of appellant’s right wrist was negative for fracture and noted, “Pain in back consistent with 

 

3 On the same form, appellant’s immediate supervisor indicated that a letter challenging the claim would be 

submitted.

4 Appellant indicated that her right ankle was weak and unstable because her right leg had been carrying all her 

weight due to the fact she had a left Achilles tendon injury, for which she was wearing an orthopedic boot on her left 

foot. She thought that one of her crutches might have hit her wheelchair as she was getting up. Under a separate 

claim (OWCP File No. xxxxxx942), appellant had alleged a work-related left Achilles tendon rupture. Appellant’s 

claimed left Achilles tendon is not the subject of the present appeal.

5 Appellant also submitted e-mails from individuals who had not witnessed her April 11, 2016 fall but attended to 

her shortly after the fall. The individuals indicated that appellant related that she fell and hit her right wrist and 

back.
3

lower back strain.” In another April 11, 2016 report, Dr. Hughes-Strange provided a diagnosis 

of right wrist bruise and lower left back strain.

In an April 15, 2016 form report, Dr. Fatima Ahmed, an attending Board-certified 

internist and osteopath, indicated that appellant was examined and should remain home from 

April 12 to 22, 2016 due to a left ruptured Achilles tendon and right leg and hand pain from a fall 

on April 11, 2016.

In a May 5, 2016 letter, a human resources specialist indicated that the employing 

establishment was challenging appellant’s claim for an April 11, 2016 work injury. She 

indicated that appellant had been scheduled for surgery in mid-April 2016 due to a left Achilles 

tendon injury for which she had filed a yet-unresolved workers’ compensation claim. The 

specialist indicated that the history of injury that appellant reported to her medical providers was 

inconsistent with that contained in her April 12, 2016 statement.

In a May 17, 2016 letter, OWCP requested that appellant submit additional evidence in 

support of her claim, including a physician’s opinion supported by a medical explanation as to 

how the reported April 11, 2016 work incident caused or aggravated a medical condition. It 

provided her 30 days to submit such evidence but she did not respond within the allotted period. 

In a June 21, 2016 decision, OWCP denied appellant’s claim for an April 11, 2016 work 

injury. It noted her fall was considered to be an explained idiopathic injury, i.e., an injury caused 

by a personal nonoccupational pathology without intervention or contribution by any hazard or 

special condition of employment, and therefore the injury was not considered compensable.6

Appellant, through counsel, requested a telephone hearing with a representative of 

OWCP’s Branch of Hearings and Review. 

During the hearing held on January 31, 2017, appellant reported that August 16, 2016 

was the first day she was on the clock at the employing establishment following her April 22, 

2016 left Achilles tendon surgery. She provided further details of her April 11, 2016 fall at 

work. Appellant indicated that she arose from her wheelchair while wearing an orthopedic boot

at the same time E.J. was arising from a seat. She advised that in “some kind of way” things got 

entangled and she fell forward onto E.J. and then in “some kind of way” she kicked E.J. with her 

orthopedic boot, twisted around, and fell backwards onto the glass-fronted cabinet. Appellant 

indicated that she struck the upper right part of her back and her wrist. She advised that she 

resigned from the employing establishment on August 17, 2016 due to chronic back pain. 

In a March 10, 2017 decision, an OWCP hearing representative affirmed OWCP’s 

June 21, 2016 decision, as modified to reflect a change in the basis of the denial. He accepted 

that an employment incident occurred on April 11, 2016 in the form of appellant falling after 

 

6 OWCP indicated that appellant fell while wearing a boot for a left Achilles tendon injury and had not identified 

an occupational cause for the fall.
4

rising from a wheelchair while at work.7 The hearing representative further found, however, that 

appellant had failed to submit sufficient medical evidence to establish causal relationship 

between a diagnosed condition and the accepted April 11, 2016 employment incident. He

indicated that appellant had not submitted a medical report, based on a complete and accurate 

factual and medical history, which contained a rationalized medical opinion relating her claimed 

injury to the accepted April 11, 2016 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA8has 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 timely filed within the applicable 

time limitation period of FECA, that an injury was sustained 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.9 These are the essential elements of each 

compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.10

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

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

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

submit sufficient evidence to establish that he or she actually experienced the employment 

incident at the time, place, and in the manner alleged.11 Second, the employee must submit 

evidence, in the form of medical evidence, to establish that the employment incident caused a 

personal injury.12

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence. 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 

 

7 The hearing representative indicated that a fall which occurred after rising from a seated position at work and 

during the course of regular scheduled hours was sufficiently incidental to appellant’s job to be within the 

performance of her work duties.

8

Supra note 2.

9 C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine Pendleton, 40 ECAB 1143 (1989).

10 S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989). A traumatic injury refers to injury 

caused by a specific event or incident or series of incidents occurring within a single workday or work shift whereas an 

occupational disease refers to an injury produced by employment factors which occur or are present over a period 

longer than a single workday or work shift. 20 C.F.R. §§ 10.5(q), (ee); Brady L. Fowler, 44 ECAB 343, 351 (1992).

11 Julie B. Hawkins, 38 ECAB 393 (1987).

12 John J. Carlone, 41 ECAB 354 (1989).
5

nature of the relationship between the diagnosed condition and the specific employment factors 

identified by the claimant.13

ANALYSIS

Appellant filed a traumatic injury claim alleging an injury due to a fall at work on 

April 11, 2016. In its June 21, 2016 decision, OWCP denied appellant’s claim for an April 11, 

2016 work injury because it found her fall to have been idiopathic in nature.

14

 However, in its 

March 10, 2017 decision, it modified its June 21, 2016 decision to reflect that appellant had 

established the occurrence of an employment incident on April 11, 2016 in the form of her 

falling after rising from a wheelchair. OWCP found, however, that appellant had failed to 

submit sufficient medical evidence to establish causal relationship between a diagnosed 

condition and the accepted April 11, 2016 employment incident.

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

injury due to an April 11, 2016 employment incident.

In an April 11, 2016 report, Dr. Kamaria, an attending physician, provided an assessment 

of “mechanical fall” and left posterior shoulder and left wrist pain. This report is of limited 

probative value regarding appellant’s claimed April 11, 2016 employment injury because

Dr. Kamaria did not provide an opinion that she sustained an injury due to her April 11, 2016 

fall. The Board has held that medical evidence which does not offer a clear opinion regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal relationship.15

In an April 11, 2016 report, Dr. Hughes-Strange, an attending physician, noted that 

appellant presented on that date complaining of right wrist pain and left back pain that started 

after a fall. Appellant reported that she was using crutches and wearing a boot on her left leg due 

to a March 28, 2016 Achilles tendon injury and that, while getting up, she caught her boot on the 

crutch, causing her to fall to the ground. Dr. Hughes-Strange indicated that appellant was a 

patient “with traumatic fall due to mechanical issue” and noted, “Pain in back consistent with 

lower back strain.” In another April 11, 2016 report, he provided a diagnosis of right wrist 

bruise and lower left back strain. Although Dr. Hughes-Strange described appellant’s reported 

fall and provided a diagnosis relating to her right wrist and lower back, his reports are of limited 

probative value because he did not provide a clear opinion relating these conditions to the 

April 11, 2016 fall.16 He did not provide a rationalized medical opinion which included a 

 

13 See I.J., 59 ECAB 408 (2008); Donna Faye Cardwell, 41 ECAB 730 (1990).

14 It is a well-settled principle of workers’ compensation law, and the Board has so held, that an injury resulting 

from an idiopathic fall -- where a personal, nonoccupational pathology causes an employee to collapse and to suffer 

injury upon striking the immediate supporting surface and there is no intervention or contribution by any hazard or 

special condition of employment -- is not within the coverage of FECA. Such an injury does not arise out of a risk 

connected with the employment and, therefore, it is not compensable. See Robert J. Choate, 39 ECAB 103, 

106 (1987).

15 See Charles H. Tomaszewski, 39 ECAB 461 (1988).

16 See id. 
6

detailed explanation of how appellant’s April 11, 2016 fall could have caused a diagnosed 

medical condition.17 Further, appellant had not complained of a lower back condition; rather she 

had alleged right upper/middle back pain.

In an April 15, 2016 form report, Dr. Ahmed, an attending physician, indicated that 

appellant was examined and should remain home from April 12 to 22, 2016 due to a left ruptured 

Achilles tendon and right leg and hand pain from a fall on April 11, 2016. Dr. Ahmed’s report is 

of limited probative value regarding appellant’s claimed April 11, 2016 work injury because he 

did not provide adequate medical rationale in support of his opinion on causal relationship. 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.18 Further, appellant had never complained of a right leg injury. Dr. Ahmed did not 

describe the nature of the April 11, 2016 employment incident or explain how it could have caused 

or aggravated the observed right leg and hand conditions, nor did he explain how the fall 

contributed to the need to be off work from April 12 to 22, 2016. He failed to provide objective 

findings on physical examination or diagnostic testing or explain how such findings showed that 

the April 11, 2016 fall contributed to appellant’s right leg/hand condition or her disability.19

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 failed to meet her burden of proof to establish an injury 

due to an April 11, 2016 employment incident.

 

17 Y.D., Docket No. 16-1896 (issued February 10, 2017); D.R., Docket No. 16-0528 (issued August 24, 2016) 

(finding that a report is of limited probative value regarding causal relationship if it does not contain medical 

rationale explaining how an employment activity could have caused or aggravated a medical condition). The Board 

notes that the description of the April 11, 2016 fall that appellant provided to Dr. Hughes-Strange did not include the 

fact that she hit a coworker and a cabinet before she fell to the floor. See supra note 12 regarding the limited

probative value of an opinion that is not based on a complete factual and medical background.

18 C.M., Docket No. 14-88 (issued April 18, 2014).

19 Moreover, Dr. Ahmed did not discuss the extent to which appellant’s left Achilles tendon condition, which has 

not been established as work related, contributed to her need to be off work from April 12 to 22, 2016.
7

ORDER

IT IS HEREBY ORDERED THAT the March 10, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 2, 2017

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