United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

F.H., Appellant 

and 

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Sarasota, FL, 

Employer 

__________________________________________ 

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Docket No. 16-1245 

Issued: March 3, 2017 

Appearances: 

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 May 25, 2016 appellant filed a timely appeal from a February 4, 2016 merit 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 the case.2

ISSUE 

The issue is whether appellant has met his burden of proof to establish a lower back and 

leg injury causally related to a January 13, 2015 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 

2

 Appellant filed a timely request for oral argument. By order dated November 9, 2016, the Board denied his 

request because his arguments could be adequately addressed in a decision based on a review of the case record. 

Order Denying Request for Oral Argument, Docket No. 16-1245 (issued November 9, 2016). 
2

FACTUAL HISTORY 

On January 13, 2015 appellant, then a 56-year-old laborer custodian, filed a traumatic 

injury claim (Form CA-1), alleging that on the same date he was sweeping his area when a 

poorly stacked pallet fell over dumping letter trays onto his lower back and legs causing him to 

fall. He stopped work on January 13, 2016. 

Appellant was treated in the Department of Veterans Affairs Medical Center on 

January 13, 2015 by a healthcare provider with an illegible signature, who returned appellant to 

work on January 14, 2015. 

On January 14, 2015 appellant came under the treatment of Dr. Ismet Saifullah, a Boardcertified family practitioner, who prescribed bedrest and returned appellant to regular duty on 

January 22, 2015. In a January 26, 2015 report, Dr. Saifullah indicated that appellant’s condition 

had not improved and he placed appellant on part-time limited duty four hours a day from 

January 26 to February 28, 2015. 

In an authorization for examination and treatment (Form CA-16) dated January 13, 2015, 

the employing establishment authorized appellant to seek medical care. 

On January 26, 2015 the employing establishment offered appellant a part-time job, four 

hours a day, as a custodian, starting that same day. 

By letter dated February 3, 2015, OWCP advised appellant that his claim was originally 

received as a simple, uncontroverted case which resulted in minimal or no time loss from work. 

It indicated that his claim was administratively handled to allow medical payments up to 

$1,500.00. However, the merits of the claim had not been formally adjudicated. OWCP advised 

that, because appellant had not returned to work in a full-time capacity, his claim would be 

formally adjudicated. It requested that he submit additional information including a 

comprehensive medical report from his treating physician explaining how the specific work 

incidents contributed to his claimed low back and legs injuries. 

In an undated statement, appellant indicated that on January 13, 2015, while cleaning area 

C, boxes of mail fell on his left leg and left foot causing him to fall onto his back and arms. He 

experienced back, right shoulder, and left leg pain. Appellant submitted a January 13, 2015 

witness statement from a person whose signature was illegible who indicated that he observed 

appellant sweep the left side of the conveyor when a mail pallet with trays fell and struck 

appellant causing him to fall. The witness saw appellant limping and holding his back. 

In an attending physician’s report (Form CA-20) dated February 12, 2015, Dr. Saifullah 

noted that appellant reported that bins containing mail fell off a pallet and hit his leg causing him 

to fall on his back and left shoulder. She noted that he had service-connected preexisting injuries 

to his low back, shoulder, and neck. Dr. Saifullah diagnosed back pain, shoulder pain and 

lumbar radiculopathy. She checked a box marked “yes,” that appellant’s condition was caused 

or aggravated by an employment incident. Dr. Saifullah returned him to work light duty four 

hours per day. In a report of even date, she indicated that appellant’s condition did not improve 

and she continued light-duty work four hours a day from February 12 to March 30, 2015. 
3

In a decision dated March 13, 2015, OWCP denied appellant’s claim finding that he did 

not submit any medical evidence containing a medical diagnosis in connection with the 

employment incident. 

On April 1, 2015 appellant requested an oral hearing which was held before a hearing 

representative on October 14, 2015. He submitted a March 10, 2015 magnetic resonance 

imaging (MRI) scan of the lumbar spine with contrast which revealed multilevel discogenic 

degenerative changes at L5-S1 and paracentral disc protrusion in contact with S1 nerve root. A 

March 16, 2015 left shoulder MRI scan revealed interval development of a full-thickness rotator 

cuff tear of supraspinatus tendon, partial undersurface tear of supraspinatus tendon, and minimal 

progressive degenerative arthrosis at the acromioclavicular joint. 

In reports dated March 26 and November 20, 2015, Dr. Saifullah indicated that appellant 

was injured at work on January 13, 2015. Appellant reported that a container of mail fell off a 

pallet and hit his left leg causing him to fall on his back and left shoulder. He was treated in the 

emergency room on January 13, 2015. Dr. Saifullah noted findings of positive straight leg 

testing, decreased range of motion of the left hip and knee, left lower extremity tenderness 

secondary to muscle strain, and decreased range of motion of the left shoulder. She noted the 

results of the MRI scan of the lumbar spine and left shoulder and treated appellant conservatively 

with anti-inflammatories and Ibuprofen. Dr. Saifullah diagnosed acute exacerbation of chronic 

neck, back, and shoulder pain and advised that he sustained soft tissue injuries from the fall and 

boxes landing on his back and shoulder. 

In a decision dated February 4, 2016, OWCP’s hearing representative affirmed the 

decision dated March 13, 2015. 

LEGAL PRECEDENT 

 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 FECA, that the claim was filed within the applicable time 

limitation 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. These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.3

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. 

There are two components involved in establishing 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. Second, the employee must submit medical evidence 

to establish that the employment incident caused a personal injury.4

 3 Gary J. Watling, 52 ECAB 357 (2001). 

4

 T.H., 59 ECAB 388 (2008). 
4

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on a complete factual and medical 

background, 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 claimant.5

ANALYSIS 

It is undisputed that on January 13, 2015 while performing his duties as a laborer 

custodian a stacked pallet fell over dumping letter trays onto his back and legs causing him to 

fall. However, the Board finds that appellant failed to submit sufficient medical evidence to 

establish that this work incident caused or aggravated his low back and leg condition. 

On March 26 and November 20, 2015 Dr. Saifullah indicated that appellant was injured 

from a fall at work on January 13, 2015. Appellant reported that a container of mail fell off a 

pallet and hit his left leg causing him to fall on his back, and left shoulder. Dr. Saifullah 

diagnosed acute exacerbation of chronic neck, back, and shoulder pain and advised that appellant 

sustained soft tissue injuries, resulting from the fall and boxes landing on his back and shoulder. 

The Board finds that, although Dr. Saifullah supported causal relationship, she did not provide 

medical rationale explaining the basis of her conclusory opinion regarding the causal relationship 

between appellant’s back, neck, and shoulder conditions and the accepted work incident.6 

Therefore, these reports are insufficient to meet appellant’s burden of proof. 

In a February 12, 2015 attending physician’s report, Dr. Saifullah noted appellant 

sustained a back and left shoulder injury when bins containing mail fell off a pallet and hit his 

leg causing him to fall. She diagnosed back pain, shoulder pain, and lumbar radiculopathy. 

Dr. Saifullah checked a box marked “yes” that appellant’s condition was caused or aggravated 

by an employment incident. The Board has held that an opinion on causal relationship which 

consists only of a physician checking “yes” to a medical form report question on whether the 

claimant’s condition was related to the history given is of little probative value. Without any 

explanation or rationale for the conclusion reached, such report is insufficient to establish causal 

relationship.7

On January 14, 2015 Dr. Saifullah prescribed appellant bedrest and advised that he could 

resume usual work on January 22, 2015. In reports dated January 26 and February 12, 2015, she 

noted no improvement in appellant’s condition and recommended that he work light duty four 

hours a day. Dr. Saifullah’s reports are insufficient to establish the claim as the physician did not 

 5 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 

6 See T.M., Docket No. 08-975 (issued February 6, 2009) (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). 

7

 The Board has held that when a physician’s opinion on causal relationship consists only of checking “yes” to a 

form question, without explanation or rationale, that opinion is of diminished probative value and is insufficient to 

establish a claim. Sedi L. Graham, 57 ECAB 494 (2006); D.D., 57 ECAB 734 (2006). 
5

provide a history of injury8 or specifically address whether appellant’s employment activities had 

caused or aggravated a diagnosed medical condition.9

 

Appellant submitted a note dated January 13, 2015 from a healthcare provider whose 

signature was illegible, who noted that appellant was treated as an outpatient and could return to 

work on January 14, 2015. However, this person’s signature is illegible and there is no 

indication of who signed this report. The Board has held that medical reports lacking proper 

identification do not constitute probative medical evidence.10

The remainder of the medical evidence, including diagnostic test reports, is of limited 

probative value as it does not provide an opinion on the causal relationship between the 

January 13, 2015 work incident and appellant’s diagnosed medical conditions.11

Consequently, appellant has failed to submit sufficient medical evidence to establish that 

appellant’s work incident on January 13, 2015 caused or aggravated a diagnosed medical 

condition. 

The Board notes that the record contains a January 13, 2015 CA-16 in which the 

employing establishment authorized medical treatment. Ordinarily, where the employing 

establishment authorizes treatment of a job-related injury by providing the employee a properly 

executed CA-16 form,12 OWCP is under contractual obligation to pay for the medical 

expenses.13 The record does not indicate whether the issue of appellant’s incurred medical 

expenses pursuant to this form has been addressed. The Board finds that upon return of the case 

record, this matter should be addressed. 

On appeal appellant asserts that the medical evidence of record supported that he 

sustained a lower back injury at work when a poorly stacked pallet fell over dumping letter trays 

onto his back and legs. He further asserted that his doctor was a qualified physician and the 

medical records provided a specific diagnosis of his condition. As found above, the medical 

evidence does not establish that appellant’s diagnosed conditions are causally related to the 

accepted conditions. Appellant has failed to meet his burden of proof. 

 8 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 

9 A.D., 58 ECAB 149 (2006) (medical evidence which does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship). 

10 See R.M., 59 ECAB 690 (2008); D.D., 57 ECAB 734 (2006). 

11 Supra note 9. 

12 See Val D. Wynn, 40 ECAB 666 (1989); see also Federal (FECA) Procedure Manual, Part 3 -- Medical, 

Authorizing Examination and Treatment, Chapter 3.300.3(a)(3) (February 2012). 

13 5 U.S.C. § 8103; 20 C.F.R. § 10.304. See L.B., Docket No. 10-469 (issued June 2, 2010); see also Federal 

(FECA) Procedure Manual, Part 3 -- Medical, Authorizing Examination and Treatment, Chapter 3.300.3(a)(3) 

(February 2012).
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. 

CONCLUSION 

The Board finds that appellant did not meet his burden of proof to establish a back and 

leg injury was causally related to a January 13, 2015 employment incident. 

ORDER 

IT IS HEREBY ORDERED THAT the February 4, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 3, 2017 

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