United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.S., Appellant

and

U.S. POSTAL SERVICE, NETWORK 

DISTRIBUTION CENTER, Atlanta, GA, 

Employer

__________________________________________

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Docket No. 18-1696

Issued: March 26, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 September 10, 2018 appellant, through counsel, filed a timely appeal from a May 9, 

2018 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 has met his burden of proof to establish that his cervical 

condition was causally related to the accepted September 6, 2016 employment incident.

FACTUAL HISTORY

On September 12, 2016 appellant, then a 67-year-old mail handler/equipment operator, 

filed a traumatic injury claim (Form CA-1) alleging that on September 6, 2016 he sustained a

skull/head injury while in the performance of duty. He stopped work on September 6, 2016. 

In a September 15, 2016 development letter, OWCP informed appellant that the evidence 

of record was insufficient to establish his claim. It advised him of the factual and medical evidence 

necessary to establish his claim and also provided a questionnaire for completion. OWCP afforded 

appellant 30 days to provide the necessary factual information and medical evidence.

OWCP subsequently received a September 6, 2016 employing establishment accident 

report, which described that on September 6, 2016 appellant was observed passed out on a forklift 

just before he hit a stationary concrete pillar. It indicated that appellant was not wearing his seat 

belt and fell off the forklift, hitting his head on the concrete floor. 

OWCP received various hospital records. In a report dated September 6, 2016,

Dr. David M. Bradberry, Jr., an osteopath specializing in physical medicine and rehabilitation, 

related that appellant was driving a forklift when he hit a concrete pole, fell from the forklift, and 

struck his head. He reported that diagnostic imaging testing was negative for signs of ischemia,

but showed severe spinal canal stenosis at C3-4. Dr. Bradberry diagnosed cervical stenosis of the 

spinal canal, central cord syndrome, bilateral arm weakness, and reactive depression.

On September 7, 2016 appellant underwent further diagnostic testing. A neurological 

spine computerized tomography (CT) report showed no findings of acute intracranial hemorrhage 

or large vascular territory infarction. A cervical spine magnetic resonance imaging (MRI) scan 

report showed mild congenital narrowing of the spinal canal, moderate to large disc osteophyte 

complex compressing the spinal cord at C3-4, mild-to-moderate posterior disc osteophyte complex 

at C4-5, mild posterior disc osteophyte at C5-6, and minimal disc osteophyte complex at C6-7.

In an examination report dated September 7, 2016, Dr. Antonio Wehbeh, an internist, 

indicated that appellant was seen as the hospital as a stroke alert. He related that, prior to his 

arrival, appellant was driving a fork lift, hit a tree, and fell to the ground. Dr. Wehbeh noted that 

appellant had positive medical history for strokes. He reviewed diagnostic testing and reported 

that sensory examination showed anterior sensory level at the C4 innervation area. Dr. Wehbeh 

reported that the etiology of appellant’s symptoms appeared most consistent with cord contusion 

after trauma due to severe stenosis, with cord edema and some degree of cord compression.

On September 12, 2016 appellant underwent unauthorized anterior cervical discectomy

and fusion at C3-4 and C4-5 surgery. The operative report noted a preoperative diagnosis of 

central cord syndrome with cervical stenosis.
3

Appellant remained in the hospital for continued postoperative treatment and 

rehabilitation. Hospital records dated September 7 to October 12, 2016 document appellant’s daily 

laboratory results, vitals, postoperative examination notes, and rehabilitation progress notes. The 

diagnoses listed were cervical stenosis of spinal canal, bilateral arm weakness, central cord 

syndrome, closed head injury, hyperglycemia, leukocytosis, and anemia. 

In an examination report dated September 15, 2016, Dr. Anuradha Subramanian, a critical 

care specialist, related that appellant had suffered an injury at C3-4 after a forklift crash. She 

described that on September 6, 2016 appellant was driving a forklift when it crashed into a pole. 

Dr. Subramanian reported a possible syncope episode and diagnosed C3-4 severe spinal canal 

stenosis with spinal cord compression, resulting in central cord syndrome. She provided an 

assessment that appellant “suffered an injury status post forklift crash with the following injuries: 

C3-4 severe spinal canal stenosis with spinal cord compression, resulting in central cord 

syndrome.” Dr. Subramanian continued to treat appellant and provided examination notes dated 

September 20 to October 12, 2016.

On October 13, 2016 OWCP received appellant’s response to its development letter. 

Appellant described that on September 6, 2016 he was operating his forklift and “crossing the 

loop.” He indicated that he looked left and right checking for mail and as he turned his head, his 

fork lift collided with a pole. Appellant related that the crash caused him to be ejected from his 

forklift and he landed on the concrete floor. He noted that he did not have any similar disabilities 

or symptoms before this injury. 

In an October 13, 2016 letter, T.G., a human resource specialist for the employing 

establishment, indicated that she was attaching a list of appellant’s prescriptions prior to his 

admission to the hospital. She alleged that the medications that appellant was taking may have 

contributed to his injury. T.G. noted that appellant had previously been diagnosed with diabetes. 

By decision dated October 21, 2016, OWCP denied appellant’s traumatic injury claim, 

finding that the factual evidence of record was insufficient to establish that the alleged incident 

occurred as described due to factual discrepancies. 

On November 28, 2016 appellant requested a hearing before an OWCP hearing 

representative. A hearing was held on June 20, 2017.

OWCP received hospital progress notes dated September 6 to October 24, 2016 regarding 

appellant’s medical treatment and rehabilitation after surgery to treat his diagnosed C3-4 severe 

spinal canal stenosis with spinal cord compression, resulting in central cord syndrome. 

In a progress note dated November 17, 2016, Renee L. Thomas, a physician assistant, 

related that appellant had a closed head injury status post trauma in September 2016, which 

resulted in extremity weakness, cervical stenosis of spinal canal, and central cord syndrome. 

By decision dated September 5, 2017, an OWCP hearing representative affirmed the 

October 21, 2016 decision with modification. He accepted that the September 6, 2016 

employment incident occurred as alleged, but denied appellant’s claim finding that the medical 

evidence of record failed to establish a diagnosed condition due to the accepted incident. The 

hearing representative also determined that the medical evidence was insufficient to establish that 
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appellant’s fall at work on September 6, 2016 was due to an idiopathic condition. He further found 

that because appellant was driving a tow motor at work at the time of the accepted incident, the 

incident occurred in the performance of duty.

On January 22, 2018 appellant, through counsel, requested reconsideration of the

September 5, 2017 decision.

In a letter dated November 9, 2017, Dr. Jonathan A. Grossberg, a Board-certified 

neurological surgeon, indicated that appellant was treated at a hospital for a traumatic injury that

occurred in early September. He related that appellant was involved in a forklift accident and 

subsequently complained of weakness in his upper and lower extremities. Dr. Grossberg reported 

that physical examination findings were consistent with central cord syndrome. He noted that 

appellant’s CT and MRI scans showed no acute fractures, but severe cervical stenosis with cord 

signal change “likely representing a contusion from the injury.” Dr. Grossberg opined: “It is likely 

that the trauma led to worsening of his cervical stenosis with a contusion of his spinal cord (central 

cord syndrome) which was responsible for his weakness.”

By decision dated May 9, 2018, OWCP denied modification of the September 5, 2017 

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

relationship between appellant’s diagnosed cervical condition and the accepted September 6, 2016 

employment incident. 

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 timely filed within the applicable 

time limitation period of FECA,3that an injury was sustained in the performance of duty as alleged, 

and that any disability or medical condition for which compensation is claimed is causally related 

to the employment injury.4 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.5 

In order to determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, OWCP must first determine whether fact of injury has been established.6 

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

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

 

3 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

4

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).

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

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish that his 

diagnosed cervical condition was causally related to the accepted September 6, 2016 employment 

incident.

Appellant submitted several hospital reports dated September 6 to October 24, 2016. In a 

September 6, 2016 report, Dr. Bradberry related that appellant was driving a forklift when he hit a 

concrete pole, fell down, and struck his head. He diagnosed cervical stenosis of the spinal canal, 

central cord syndrome, bilateral arm weakness, and reactive depression. Dr. Bradberry did not, 

however, specifically address the cause of appellant’s cervical stenosis, central cord syndrome, 

bilateral arm weakness, or depression nor provide an opinion on causal relationship. The Board 

has held that medical evidence that does not offer an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.13 

Likewise, the diagnostic examination reports, including the September 7, 2016 cervical 

spine CT and MRI scans also fail to establish appellant’s claim as they do not include an opinion 

on the causal relationship between appellant’s diagnosed cervical conditions and the accepted 

September 6, 2016 employment incident. The Board has held that reports of diagnostic tests are of 

 

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 345 (1989).

12 James Mack, 43 ECAB 321 (1991).

13 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
6

lack probative value as they fail to provide an opinion on the causal relationship between 

appellant’s employment duties and the diagnosed conditions.14 

In her reports dated September 15 to October 12, 2016, Dr. Subramanian accurately 

described the September 6, 2016 employment incident and noted diagnosis of C3-4 severe spinal 

canal stenosis with spinal cord compression, resulting in central cord syndrome. She provided an 

assessment that appellant “suffered an injury status post forklift crash with the following injuries:

C3-4 severe spinal canal stenosis with spinal cord compression, resulting in central cord 

syndrome.” Although Dr. Subramanian attributed appellant’s cervical conditions to the accepted 

September 6, 2016 employment incident, she did not provide an affirmative opinion explaining 

how the described forklift crash at work resulted in the diagnosed medical conditions. The Board 

has held that a report is of limited probative value regarding causal relationship if it does not 

contain medical rationale explaining how a given medical condition/disability was related to 

employment factors.15 Because Dr. Subramanian did not provide a reasoned opinion explaining 

how the September 6, 2016 employment incident caused or contributed to appellant’s cervical 

conditions, her reports are insufficient to establish his claim. 

In a November 9, 2017 letter, Dr. Grossberg related that appellant was involved in a forklift 

accident in early September and reported that physical examination findings were consistent with 

central cord syndrome. He opined: “It is likely that the trauma led to worsening of his cervical 

stenosis with a contusion of his spinal cord (central cord syndrome) which was responsible for his 

weakness.” The Board finds that Grossberg’s opinion is speculative in nature.16 He did not 

specifically describe the September 6, 2016 employment incident nor definitively opine that 

appellant’s employment caused or contributed to his cervical conditions.17 The Board has held 

that medical opinions that are speculative or equivocal in nature are of diminished probative 

value.18 

Similarly, Dr. Wehbeh’s opinion in his September 7, 2016 report that appellant’s 

symptoms appeared “most consistent” with cord contusion after trauma is speculative and 

equivocal and is also insufficient to establish causal relationship. An award of compensation may 

not be based on surmise, conjecture, speculation or upon appellant’s own belief that there is causal 

relationship between his claimed condition and his employment.19 

 

14 See A.B., Docket No. 17-0301 (issued May 19, 2017).

15 See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale describing the relation between work factors and 

a diagnosed condition/disability).

16 Roy L. Humphrey, 57 ECAB 238, 242 (2005); Michael E. Smith, 50 ECAB 313 (1999).

17 A physician’s opinion on causal relationship must be based on a complete factual and medical background. 

Victor J. Woodhams, supra note 13.

18 Z.B., Docket No. 17-1336 (issued January 10, 2019); D.D., 57 ECAB 734, 738 (2006); Kathy A. Kelley, 55 ECAB 

206 (2004).

19 Robert A. Boyle, 54 ECAB 381 (2003); Patricia J. Glenn, 53 ECAB 159 (2001).
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OWCP also received a November 17, 2016 report by Ms. Thomas, a physician assistant. 

This report does not constitute competent medical evidence because a physician assistant is not 

considered a “physician” as defined under FECA.20 As such, this evidence is also insufficient to 

meet appellant’s burden of proof.

On appeal, counsel contends that appellant’s claim should have been accepted for spinal 

cord contusion. For the reasons set forth above appellant has not met his burden of proof to 

establish his claim. 

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 his cervical 

condition was causally related to an accepted September 6, 2016 employment incident.

 

20 See M.M., Docket No. 17-1641 (issued February 15, 2018); K.J., Docket No. 16-1805 (issued February 23, 

2018); 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); 5 U.S.C. § 8101(2) (this subsection 

defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by state law).
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ORDER

IT IS HEREBY ORDERED THAT the May 9, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 26, 2019

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