United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.R., Appellant

and

U.S. POSTAL SERVICE, RESEDA POST 

OFFICE, Reseda, CA, Employer

__________________________________________

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Docket No. 18-0202

Issued: June 5, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 6, 2017 appellant filed a timely appeal from an October 18, 2017 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 claim.

ISSUE

The issue is whether appellant has established a recurrence of a medical condition on or 

after September 10, 2016 causally related to her accepted December 22, 2015 employment injury. 

 

1 The Board notes that appellant submitted a timely request for oral argument with her appeal. By letter dated 

November 17, 2017, appellant withdrew her request for oral argument. 

2 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On December 22, 2015 appellant, then a 58-year-old mail carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that same date she sustained a back and right arm injury when 

she slipped and fell on stairs while delivering mail. She stopped work, notified her supervisor, and 

sought medical treatment on that same date. 

On the date of the alleged injury, the employing establishment issued appellant a properly 

completed authorization for examination and/or treatment, Form CA-16, which indicated that 

appellant was authorized to seek medical treatment for her December 22, 2015 right arm and lower 

back injury. 

In medical reports dated December 22, 2015 through January 18, 2016, Dr. Ezequiel 

Suarez, a treating physician specializing in internal medicine, documented treatment for 

appellant’s claimed December 22, 2015 injury after she slipped and fell while delivering mail, 

injuring her lower back and arm. He diagnosed low back contusion, right elbow contusion, and 

right elbow abrasion, stating that the conditions were a result of the work-related fall. Dr. Suarez 

restricted appellant from working through December 28, 2015 when he released her to modified 

light duty. 

In a December 23, 2015 diagnostic report, Dr. Myungsun Moon, a Board-certified 

diagnostic radiologist, reported that x-rays of the lumbosacral spine revealed degenerative 

changes. An x-ray of the right elbow revealed no acute fracture. 

In a January 18, 2016 medical report, Dr. Suarez reported that physical examination of the 

right elbow and lumbar spine revealed normal findings. He noted that appellant’s pain had 

resolved and she had reached maximum medical improvement (MMI). Dr. Suarez discharged her 

to full-duty work without restrictions.

On September 10, 2016 appellant filed a notice of recurrence (Form CA-2a). She did not 

stop work, but did not indicate on the form whether she was alleging a recurrence of disability or 

of medical treatment. On the reverse side of the form, appellant’s supervisor indicated that 

following her original injury, the employing establishment accommodated her modified duties

until she was released to full-duty work on January 18, 2016. 

By decision dated October 7, 2016, OWCP accepted appellant’s claim for low back 

contusion, right elbow contusion, and right elbow abrasion. It noted that when the claim had been 

received, it appeared to be a minor injury, which resulted in minimal or no lost time from work, 

and payment of a limited amount of medical expenses was administratively approved. OWCP

reopened the claim for consideration because appellant had filed a claim for a recurrence. 

By development letter dated October 7, 2016, OWCP informed appellant that the evidence 

of record was insufficient to support her recurrence claim. Appellant was advised of the medical 

and factual evidence needed and provided a questionnaire for completion. She was directed to 

respond within 30 days. 
3

In support of her claim, appellant submitted a September 30, 2016 progress note from 

Suren Meliksetyan, a physical therapist (PT), documenting physical therapy treatment after she

tweaked her back muscle. 

By decision dated November 7, 2016, OWCP denied appellant’s recurrence claim finding

that the medical evidence of record failed to establish that her need for additional medical treatment 

was due to a material change/worsening of her accepted work-related condition, without 

intervening cause. 

On October 11, 2017 appellant requested reconsideration of OWCP’s decision. In an 

accompanying narrative statement, she reported that her back was painful and she needed 

additional medical treatment.

In a September 15, 2016 medical report, Dr. Taha Mansoor Ahmad, Board-certified in 

internal medicine, reported that appellant complained of low back pain. She noted a history of 

injury when she fell and hit her back after slipping and falling on stairs when she was delivering 

mail. Dr. Ahmad also noted bilateral knee and right shoulder complaints under a different 

workers’ compensation claim. She reported that x-rays revealed degenerative changes and an 

August 31, 2016 magnetic resonance imaging (MRI) scan of the lumbar spine revealed multilevel 

mild degenerative disc disease, mild spinal canal stenosis at T11-12, T12-L1, and L3-4, and mild 

right neural foraminal narrowing at L5-S1. Dr. Ahmad noted a clinical history of low back pain 

with intermittent pain and paresthesias in the lower extremity, ruling out lumbar disc diseases. She

diagnosed low back contusion and lumbar spondylosis. Dr. Ahmad ordered eight physical therapy 

visits and reported that appellant could return to full-duty work.

In a November 1, 2016 work status report, Dr. Wilfred Anthony Williams, Board-certified 

in family medicine, released appellant to full-duty work on that date. An offer of a modified 

assignment (limited duty) was also submitted from the employing establishment for a modified 

carrier technician, which appellant accepted on December 21, 2016. 

By decision dated October 18, 2017, OWCP denied modification of the November 7, 2016 

decision denying appellant’s recurrence claim finding that the medical evidence failed to establish 

that her need for additional medical treatment was due to a material change/worsening of her 

accepted work-related condition. 

LEGAL PRECEDENT

The United States shall furnish to an employee who is injured while in the performance of 

duty the services, appliances, and supplies prescribed or recommended by a qualified physician 

that the Secretary of Labor considers likely to cure, give relief, reduce the degree or the period of 

any disability, or aid in lessening the amount of any monthly compensation.3

A recurrence of medical condition means a documented need for further medical treatment

after release from treatment for the accepted condition or injury when there is no accompanying 

work stoppage. Continuous treatment for the original condition or injury is not considered a need 

 

3 5 U.S.C. § 8103(a).
4

for further medical treatment after release from treatment, nor is an examination without 

treatment.4

If a claim for a recurrence of medical condition is made more than 90 days after release 

from medical care, a claimant is responsible for submitting a medical report supporting causal 

relationship between the employee’s current condition and the original injury in order to meet his 

burden.5

An employee has the burden of proof to establish that he or she sustained a recurrence of a 

medical condition that is causally related to his or her accepted employment injury. To meet this 

burden, the employee must submit medical evidence from a physician who, on the basis of a 

complete and accurate factual and medical history, supports that the condition is causally related 

and supports his or her conclusion with sound medical rationale.6

Where no such rationale is present, medical evidence is of diminished probative value.7

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a recurrence of 

medical condition on or after September 10, 2016 causally related to her accepted December 22, 

2015 employment injuries.8 

Appellant has not alleged disability as a result of the December 22, 2015 employment 

injury. Instead, she attributes her recurrence due to the need for medical treatment to a change in 

the nature and extent of her employment-related low back condition, requiring physical therapy. 

Appellant, therefore, has the burden of proof to provide medical evidence to establish that her 

lower back injury is due to a worsening of her accepted work-related conditions.9 

The medical evidence received in support of appellant’s claim was Dr. Ahmad’s 

September 15, 2017 report. Dr. Ahmad noted appellant’s complaints of low back pain and 

diagnosed low back contusion and lumbar spondylosis. She ordered eight physical therapy visits 

and reported that appellant could return to full-duty work. While Dr. Ahmad provided a diagnosis 

of low back contusion and lumbar spondylosis, she failed to provide any opinion on the cause of 

appellant’s need for continued medical treatment.10 Nor did she provide adequate bridging 

 

4 20 C.F.R. § 10.5(y).

5 Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4(b) (June 2013); see also 

J.M., Docket No. 09-2041 (issued May 6, 2010).

6 A.C., Docket No. 17-0521 (issued April 24, 2018); O.H., Docket No. 15-0778 (issued June 25, 2015).

7 Michael Stockert, 39 ECAB 1186, 1187-88 (1988); see Ronald C. Hand, 49 ECAB 113 (1957).

8 L.G., Docket No. 11-0142 (issued August 12, 2011).

9 D.L., Docket No. 13-1653 (issued November 22, 2013).

10 Cecilia M. Corley, 56 ECAB 662 (2005).
5

evidence to show a spontaneous worsening of the accepted condition.11 Dr. Ahmed further 

reported that a lumbar spine MRI scan revealed multilevel mild degenerative disc disease, mild 

spinal canal stenosis at T11-12, T12-L1, and L3-4, and mild right neural foraminal narrowing at 

L5-S1. It remains unclear if appellant’s need for continued medical treatment is due to the

December 22, 2015 employment injury or a result of an unrelated preexisting degenerative 

condition.12 A physician must provide an opinion on whether the accepted employment conditions 

caused or contributed to the claimant’s diagnosed medical condition and supports that opinion with 

medical reasoning to demonstrate that the conclusion reached is sound, logical, and rationale. The 

Board finds that Dr. Ahmad failed to provide a rationalized medical opinion.13 As her report 

contains no rationale explaining why appellant required continued treatment due to her accepted 

December 22, 2015 conditions on or after September 10, 2016, her opinion is insufficient to 

support that appellant sustained a worsening of her work-related conditions.14

The remaining medical evidence is insufficient to establish appellant’s claim. The 

September 30, 2016 physical therapy note is of no probative value as registered nurses, physical 

therapists, and physician assistants are not considered physicians as defined under FECA.15 

Dr. William’s November 1, 2016 work status report is also of no probative value as he

released appellant to full-duty work with no information pertaining to her medical condition.16 

Appellant did not submit any medical reports from a physician who, on the basis of a 

complete and accurate factual and medical history, concluded that appellant required further 

medical treatment for her accepted conditions on or after September 10, 2016 as a result of her

accepted December 22, 2015 employment injury.17 She has failed to establish by the weight of 

the reliable, probative and substantial evidence, a change in the nature and extent of the injuryrelated condition resulting in required continued medical treatment. As appellant has not 

submitted any medical evidence showing that she sustained a recurrence of medical condition due 

to her accepted employment injury, the Board finds that she has not met her burden of proof.

18

 

11 Ceferino L. Gonzales, 32 ECAB 1591 (1981).

12 R.E., Docket No. 14-868 (issued September 24, 2014).

13 See A.C., supra note 6. 

14 See Sedi L. Graham, 57 ECAB 494 (2006) (medical form reports and narrative statements merely asserting causal 

relationship generally do not discharge a claimant’s burden of proof).

15 5 U.S.C. § 8102(2) of FECA provides as follows: (2) ‘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 Roy L. Humphrey, 57 ECAB 238 (2005); 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).

16 S.W., Docket 08-2538 (issued May 21, 2009).

17 K.P., Docket No. 15-1711 (issued January 14, 2016).

18 L.L., Docket No. 13-2146 (issued March 12, 2014). See also William A. Archer 55 ECAB 674, 679 (2004).
6

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 10.607.19

CONCLUSION

The Board finds that appellant did not meet her burden of proof to establish a recurrence 

of medical condition on or after January 10, 2016 causally related to her accepted December 22, 

2015 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the October 18, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 5, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

19 The Board notes that a Form CA-16, authorization for examination and/or treatment, was issued by the employing 

establishment on December 22, 2015. When the 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. The period for which treatment is authorized by a Form CA16 is limited to 60 days from the date of issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c);

Tracy P. Spillane, 54 ECAB 608, 610 (2003).