United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.T., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Chula Vista, CA, Employer

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Docket No. 17-0265

Issued: May 25, 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

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On November 15, 2016 appellant filed a timely appeal from a June 16, 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 this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish that his diagnosed 

lumbar condition is causally related to the accepted December 16, 2015 employment incident.

FACTUAL HISTORY

On December 16, 2015 appellant, then a 41-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) for a lower back sprain he allegedly sustained earlier that same day. He 

 

1 5 U.S.C. § 8101 et seq.
2

recounted that he was in his vehicle on the street when he picked up a parcel, twisted his body, and 

“pulled” his lower back. Appellant stopped work on December 16, 2015. 

Appellant submitted an accident report and record notification from the employing 

establishment. It indicated that at 10:49 a.m. on December 16, 2015 appellant sprained his lower 

back when he picked up a parcel in his truck and twisted his body. 

The employing establishment provided an authorization for examination and/or treatment 

(Form CA-16) dated December 16, 2015.

In an attending physician’s report (Form CA-20) dated December 16, 2015, Raquel 

Knutson, a certified physician assistant, indicated that appellant felt a pull in his lower back when 

he lifted a package at work. She noted that appellant had a preexisting low back injury from 2014. 

Ms. Knutson diagnosed lumbosacral strain and muscle sprain. She checked a box marked “yes”

indicating that the condition was caused or aggravated by the above-described employment 

activity. Ms. Knutson authorized appellant to resume modified duty on December 17, 2015. She 

also provided a duty status report (Form CA-17) of the same date which provided work restrictions. 

Appellant submitted a First Report of Occupational Injury or Illness Form dated 

December 16, 2015 by Dr. Tiffany L. Shay Alexander, Board-certified in preventive medicine. 

She noted that appellant worked as a letter carrier and described that around 10:00 a.m. on 

December 16, 2015 appellant was inside his truck and bent down to pick up a package on the floor 

when he felt a pull in his left lower back. Dr. Alexander related that appellant currently 

complained of muscle tightness and pain in his left low back radiating to the left lateral thigh. She 

reviewed appellant’s history and noted that he had a lumbar strain the prior year, which had 

completely resolved. Upon physical examination of appellant’s lumbar spine, Dr. Alexander 

observed tenderness to palpation in bilateral lumbar paraspinals, L3-L5. Range of motion testing 

showed flexion to 70 degrees, extension to 10 degrees, rotation to 20 degrees bilaterally, and lateral 

side bending bilaterally to 25 degrees. Straight leg raise testing was positive bilaterally at 50 

degrees. Dr. Alexander diagnosed lumbosacral strain and lumbar paraspinal muscle spasm. She 

reported that appellant could return to modified duty on December 17, 2015 with restrictions of 

lifting, pulling up to 10 pounds, sitting, standing, or walking up to six to eight hours, climbing up 

to one hour, carrying, pushing, or pulling up to six to eight hours, and no kneeling, bending, 

stooping, or twisting. Dr. Alexander provided a Form CA-17 which outlined appellant’s work 

restrictions. 

On December 16, 2015 appellant underwent a lumbar spine x-ray examination by

Dr. Barry Lumkin, a Board-certified diagnostic radiologist, who reported mild levocurvature 

without acute findings and mild lower lumbar facet arthrosis of the lumbar spine.

By letter dated January 6, 2016, OWCP advised appellant that his claim was initially 

accepted as a minor injury, but was now being formally considered because he had not yet returned 

to work. It requested that he respond to an attached development questionnaire in order to 

substantiate the factual elements of his claim. Appellant was also requested to provide additional 

medical evidence to establish that he sustained a diagnosed condition as a result of the alleged 

employment incident. He was afforded 30 days to submit the necessary evidence.
3

Appellant continued to receive treatment from Dr. Alexander. In reports dated 

December 29, 2015 to January 27, 2016, Dr. Alexander related that appellant’s condition had 

improved, but he still complained of pain across the lower back radiating to his posterior thighs. 

She reviewed appellant’s history and conducted an examination of appellant’s lower back. 

Dr. Alexander reported tenderness to palpation midline in the area of L3-L5 and in the bilateral 

lumbar paravertebral musculature at the area of L5. She noted slightly restricted range of motion 

and intact sensation to both lower extremities. Straight leg raise testing was negative bilaterally. 

Dr. Alexander diagnosed lumbar strain and lumbar paraspinal muscle spasm. She recommended 

that appellant continue with his current work restrictions and provided duty status reports which 

outlined appellant’s restrictions. 

On January 29, 2016 appellant accepted a job offer as a modified city carrier. The duties 

of his assignment included casing mail, delivering express mail, and working the pick-up window 

for two to three hours. The physical requirements of the position required standing and walking 

for two to three hours. 

By decision dated February 9, 2016, OWCP denied appellant’s claim. It accepted that the 

December 16, 2015 incident occurred as alleged and that a back condition had been diagnosed, but 

it denied the claim because the medical evidence submitted failed to establish causal relationship 

between the diagnosed medical condition and the accepted employment incident.

On March 21, 2016 appellant requested reconsideration. He indicated that he spoke with 

his physician who informed him that all necessary documentation was sent to OWCP. Appellant 

noted that he was attaching an updated First Report of Occupational Injury or Illness Form and 

medical reports from his previous injury. 

OWCP also received appellant’s response to its development questionnaire. Appellant

indicated that on December 16, 2015 he was delivering mail on his route and had to drop off a 

medium size package weighing approximately 20 to 25 pounds. He related that when he lifted the 

package in his truck he felt a sharp pull in his lower back. Appellant noted that he previously had 

low back pain due to diagnosed lumbar facet arthropathy. 

Appellant submitted an amended December 16, 2015 First Report of Occupational Injury 

or Illness Form by Dr. Alexander. Dr. Alexander noted that appellant worked as a letter carrier 

and described that on December 16, 2015 he felt a pull in his left lower back when he twisted to 

pick up a package on the floor to be delivered. She provided examination findings and diagnosed 

lumbosacral strain and lumbar paraspinal muscle spasm. Dr. Alexander checked a box marked 

“yes” indicating that her findings and diagnosis were consistent with appellant’s account of injury. 

She recommended that appellant return to modified duty on December 17, 2015. 

In a February 24, 2016 report, Dr. Alexander indicated that appellant was evaluated for

follow-up evaluation of a lower back injury that occurred on December 16, 2015. She related that 

appellant still complained of intermittent pain in his lower back radiating down to his bilateral 

hamstrings. Dr. Alexander noted that appellant had worked modified duty for the past two weeks 

and appeared to be tolerating his work without any significant discomfort. She reviewed 

appellant’s history and conducted an examination. Dr. Alexander reported tenderness in the 

midline from L1-L5 and tenderness in the lower lumbar paravertebral musculature in appellant’s 
4

lumbar spine. She also noted mild restricted range of motion and intact sensation in the bilateral 

lower extremities. Straight leg raise testing was negative bilaterally. Dr. Alexander diagnosed 

lumbosacral strain and lumbar paraspinal muscle spasm. She recommended that appellant 

continue modified duty with his current work restrictions and provided a duty status report which 

outlined his work restrictions.

OWCP also received several other medical reports related to appellant’s 2014 back injury. 

Appellant submitted progress notes dated March 18, 2014 to February 11, 2015 by Dr. Hai Tien 

Tran, an osteopath, and Dr. James Youn, a Board-certified family practitioner, regarding treatment 

for chronic low back pain. He was diagnosed with arthropathy of lumbar facet. Appellant also 

provided a May 6, 2014 lumbar spine magnetic resonance imaging (MRI) scan report by Dr. Scott 

Rice, a Board-certified diagnostic radiologist, who noted diminished disc signal with moderate 

disc protrusion at L4-L5 and small right central disc protrusion at L5-S1.

By decision dated June 16, 2016, OWCP denied modification of the February 9, 2016 

decision. It found that the medical evidence of record was insufficient to establish that appellant’s 

lumbar condition was causally related to the December 16, 2015 employment incident. OWCP 

noted that Dr. Alexander’s reports did not contain a well-rationalized medical opinion explaining 

how appellant’s current lumbar condition resulted from the December 16, 2015 employment 

incident.

LEGAL PRECEDENT

A claimant seeking benefits under FECA2 has the burden of proof to establish the essential 

elements of his or her claim by the weight of the reliable, probative, and substantial evidence, 

including that an injury was sustained in the performance of duty as alleged, and that any specific 

condition or disability claimed is causally related to the employment injury.3

To determine if a claimant sustained a traumatic injury in the performance of duty, OWCP 

begins with an analysis of whether fact of injury has been established. Generally, fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred.4 The second component is whether the employment incident caused a personal injury.5 

An employee may establish that an injury occurred in the performance of duty as alleged, but fail 

to establish that the disability or specific condition for which compensation is being claimed is 

causally related to the injury.6

 

2

Id.

3 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

4 Elaine Pendleton, 40 ECAB 1143 (1989).

5

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

6 Shirley A. Temple, 48 ECAB 404, 407 (1997).
5

Causal relationship is a medical question that generally requires rationalized medical 

opinion evidence to resolve the issue.7 A physician’s opinion on whether there is causal 

relationship between the diagnosed condition and the implicated employment factor(s) must be 

based on a complete factual and medical background.8 Additionally, the physician’s opinion must 

be expressed in terms of a reasonable degree of medical certainty, and must be supported by 

medical rationale, explaining the nature of the relationship between the diagnosed condition and 

appellant’s specific employment factor(s).9

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.10

ANALYSIS

Appellant alleged that on December 16, 2015 he strained his lower back when he picked 

up a parcel and twisted his body at work. OWCP accepted that the December 16, 2015 

employment incident occurred as alleged and that he was diagnosed with a lumbar condition. 

However, it denied appellant’s claim, finding that the medical evidence of record was insufficient 

to establish that his diagnosed lumbar condition was causally related to the accepted employment 

incident. The Board finds that appellant failed to meet his burden of proof to establish causal 

relationship.

Appellant was treated by Dr. Alexander. In a First Report of Occupational Injury or Illness 

Form dated December 16, 2015, she related that on December 16, 2015 appellant bent down to 

pick up a package on the floor and felt a pull in his left lower back. Dr. Alexander reviewed 

appellant’s history and noted that he had a lumbar strain the year prior. Upon physical examination 

of appellant’s lumbar spine, she observed tenderness to palpation in bilateral lumbar paraspinals, 

L3-L5. Straight leg raise testing was positive bilaterally at 50 degrees. Dr. Alexander diagnosed 

lumbosacral strain and lumbar paraspinal muscle spasm. She recommended that appellant return 

to modified duty on December 17, 2015. In an amended form received on March 18, 2016,

Dr. Alexander checked a box marked “yes” indicating that her findings and diagnosis were 

consistent with appellant’s account of injury. 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.11 

Dr. Alexander continued to treat appellant and provided subsequent reports dated 

December 29, 2015 to February 24, 2016. She described the December 16, 2015 employment 

 

7 Robert G. Morris, 48 ECAB 238 (1996).

8 Victor J. Woodhams, 41 ECAB 345, 352 (1989).

9

Id.

10 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

11 D.D., 57 ECAB 734, 738 (2006); Deborah L. Beatty, 54 ECAB 340 (2003).
6

incident and noted appellant’s continued complaints of lower back pain radiating to his posterior 

thighs. Dr. Alexander provided examination findings and diagnosed lumbar strain and lumbar 

paraspinal muscle spasm. She recommended that appellant continue with his current work 

restrictions and provided duty status reports which outlined appellant’s restrictions. Although

Dr. Alexander accurately described the December 16, 2015 employment incident and diagnosed a 

back condition based on physical examination, she did not provide an affirmative opinion 

explaining that the described employment incident resulted in the diagnosed medical condition. 

The Board has found that a physician must provide a narrative description of the identified 

employment incident and a reasoned opinion on whether the employment incident described 

caused or contributed to appellant’s diagnosed medical condition.12 Because Dr. Alexander did 

not provide a reasoned opinion explaining how the December 16, 2015 employment incident 

caused or contributed to appellant’s lumbar condition, this report is insufficient to establish 

appellant’s claim. The need for rationalized medical opinion evidence is particularly important in 

this case since appellant had a preexisting back injury in 2014.13

The December 16, 2015 lumbar spine x-ray examination report by Dr. Lumkin is also 

insufficient to establish appellant’s claim. Although he noted diagnoses of mild levocurvature 

without acute findings and mild lower lumbar facet arthrosis of the lumbar spine, he did not 

provide any opinion on the cause of appellant’s diagnosed condition. The Board has held that 

diagnostic reports that do not offer any opinion regarding the cause of an employee’s condition is 

of limited probative value on the issue of causal relationship.14 

The December 16, 2015 attending physician’s report by Ms. Knutson, a physician 

assistant, also fails to establish appellant’s claim because evidence from a physician assistant or 

nurse does not constitute competent medical evidence under FECA as neither are considered 

physicians as defined under section 8102(2) of FECA.15

In order to obtain benefits under FECA an employee has the burden of proof to establish 

the essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence.16 Because appellant has failed to provide such evidence demonstrating that his lumbar 

condition was causally related to the December 16, 2015 employment incident, he has not met his 

burden of proof.

 

12 John W. Montoya, 54 ECAB 306 (2003).

13 See supra note 10.

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

15 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

V.C., Docket No. 16-0642 (issued April 19, 2016); L.C., Docket No. 16-1717 (issued March 2, 2017) (nurses); 

Allen C. Hundley, 53 ECAB 551, 554 (2002) (physician assistant).

16 Supra note 3.
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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 

diagnosed lumbar condition is causally related to the accepted December 16, 2015 employment 

incident.

ORDER

IT IS HEREBY ORDERED THAT the June 16, 2016 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: May 25, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board