United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.W., Appellant

and

U.S. POSTAL SERVICE, NATIONAL 

DISTRIBUTION CENTER, Jersey City, NJ, 

Employer

__________________________________________

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Docket No. 19-0003

Issued: June 18, 2019

Appearances: Case Submitted on the Record

James D. Muirhead, 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 October 1, 2018 appellant, through counsel, filed a timely appeal from a May 4, 2018 

merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

 

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 The Board notes that appellant submitted additional evidence on appeal. However, the Board’s Rules of Procedure

provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the 

time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.”

20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on 

appeal. Id.
2

Federal Employees’ Compensation Act3(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction to consider the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish a left wrist injury 

causally related to the accepted November 1, 2014 employment incident.

FACTUAL HISTORY

On November 1, 2014 appellant, then a 56-year-old maintenance mechanic, filed a 

traumatic injury claim (Form CA-1) alleging that he slipped and fell backwards when turning to 

get a hammer and fractured his left wrist on that date while in the performance of duty. On the 

reverse side of the claim form, the employing establishment disagreed with his description of 

events and noted that a witness reported that appellant’s face turned white and he fainted. On a 

November 1, 2014 incident report, it noted that appellant was in the process of standing up to go 

get tools, he started to turn, and then slipped and fell backwards landing on his back. 

On November 1, 2014 the employing establishment provided appellant with an 

authorization for examination and/or treatment (Form CA-16) diagnosing fracture of the wrist. On 

that day appellant sought treatment at the emergency room where Dr. Amir E. Estaphan, a Boardcertified emergency medicine physician, diagnosed syncope, hypotension, and left wrist fracture. 

Dr. Estaphan recommended left wrist surgery.

In a development letter dated November 18, 2014, OWCP advised appellant that initially 

his injury appeared to be minor, resulting in minimal or no lost time from work. It noted that 

payment of a limited amount of medical expenses was administratively approved and the merits 

of the claim had not been formally considered. OWCP determined that the factual portion of 

appellant’s traumatic injury claim had not been established. It requested that he complete a 

questionnaire as well as provide additional factual and medical evidence in support of his claim. 

OWCP afforded him 30 days for response.

In a note dated November 1, 2014, Dr. Estaphan reported that appellant had sudden onset 

of weakness, stood up, and experienced a sudden onset syncopal episode. He diagnosed markedly 

comminuted, distracted, and angulated fracture through the distal radius on the left. Dr. Estaphan 

recommended hospitalization for observation due to a probably syncopal episode and hypotension, 

but appellant refused to stay.

On November 3, 2014 Dr. Renata Weber, a Board-certified hand and plastic surgeon, 

examined appellant and noted that he had fallen twice in the past week. She diagnosed 

comminuted distal radius fracture based on x-rays. Dr. Weber recommended wrist surgery. On 

November 3, 2014 she completed part B of the Form CA-16, attending physician’s report, which 

listed October 27, 2014 as the date of injury and described the injury as distal radius fracture.

Dr. Weber diagnosed Colles’ fracture of the wrist and checked a box marked “no” that appellant’s 

 

3 5 U.S.C. § 8101 et seq.
3

diagnosed wrist fracture was not due to his employment activity. She noted that he had a 

concurrent condition of “dizziness.” 

On December 3, 4014 Dr. Peter H. Pham, an osteopath, admitted appellant to the hospital 

with diagnoses of anxiety, syncope, and left wrist fracture. Appellant noted that he had fallen the 

previous month at work when he tripped over machinery and had landed on his left wrist. On 

December 5, 2014 Dr. Weber examined him and noted that she had examined him four weeks 

earlier due to a distal radius fracture to the left hand. She noted that appellant reported that he had 

injured his wrist at work and that he had been falling more frequently lately. Dr. Weber diagnosed 

left distal radius fracture and new median nerve compression. She recommended surgery. On 

December 5, 2014 Dr. Weber performed an open reduction and internal fixation of four fragment 

distal radius fracture and left carpal tunnel release.

By decision dated January 5, 2015, OWCP denied appellant’s claim finding that he had not 

established the factual component of his traumatic injury claim. It explained that he failed to 

clarify the cause of his fall, i.e., whether he had a history of fainting spells, whether a hazardous 

condition was present, or whether he struck any object as he fell. OWCP therefore concluded that 

the requirements had not been met to establish an injury as defined by FECA. 

During his hospitalization on December 3, 2014, appellant reported that he tripped over 

machinery and fell onto his wrist. He denied dizziness, light headedness, or syncope at any time. 

In a note dated April 2, 2015, Dr. Weber reported that appellant fell the previous week 

injuring his left hand and index finger. On May 4, June 25, and July 30, 2015 she again noted that 

he had reinjured his hand in March 2015 and diagnosed a tendon rupture due to either his original 

fracture or possibly the March 2015 injury. On August 3, 2015 appellant underwent a second left 

carpal tunnel release. In a note dated September 30, 2015, Dr. Weber diagnosed carpal tunnel 

syndrome, rupture of the extensor tendons of the hand, wrist sprain, and lumbosacral root lesions.

On November 20, 2015 appellant, through counsel requested reconsideration of the 

January 5, 2015 decision contending that appellant had fallen at work on November 1, 2014, had 

felt an immediate problem with his left wrist, and sought medical attention on that date.

By decision dated February 16, 2016, OWCP denied modification of the January 5, 2015 

decision. It found that, according to a witness, appellant’s face turned white and he fainted. 

OWCP also noted two different descriptions of the alleged employment incident in the medical 

evidence, falling over machinery and slipping when he turned to get a hammer.

On March 2, 2016 appellant, through counsel, requested reconsideration and provided 

additional medical evidence arguing that appellant slipped and fell at work whether turning to get 

a hammer or falling over machinery. Appellant alleged that his job contributed to his fall.

In a report dated January 29, 2016, Dr. Weber noted that appellant had fallen twice in 

November 2014 and that he was evaluated for syncopal episodes. She opined, “One of these falls 

caused the wrist fracture and possibly a few other falls while the wrist was not properly protected 

with a splint or cast contributed to the severe comminution.” Dr. Weber performed appellant’s 

first wrist surgery on December 4, 2014 which included carpal tunnel release. Appellant fell again 

in April 2015 reinjuring the left thumb and wrist. In June 2015, Dr. Weber diagnosed attrition 
4

rupture of the extensor tendon to the left thumb, a known complication of distal radius fractures. 

She performed a second left wrist surgery in August 2015 rereleasing the carpal tunnel with 

internal neurolysis of the median nerve, removal of synovial tissue, and tendon transfer to restore 

thumb extension. Following the surgery, magnetic resonance imaging (MRI) scans demonstrated 

scapholunate ligament tear, and triangular fibrocartilage complex (TFCC) tear. Appellant also 

developed symptoms of severe pain consistent with a neuroma as well as laxity of the 

metacarpophalangeal (MCP) joint which disrupted the tendon transfer. In November 2015,

Dr. Weber performed a third left wrist surgery to repair the TFCC and remove a bone spur as well 

as transposing the ulnar sensory nerve. Four weeks later, she performed a fourth surgery to remove 

the volar plate and minimize synovitis and ulnar styloid bursitis. As a result of appellant’s medical 

course, Dr. Weber found that he was partially disabled.

By decision dated June 1, 2016, OWCP denied modification of its prior decisions. It found 

that appellant had not submitted factual statements clarifying the events of November 1, 2014.

On November 10, 2016 appellant, through counsel, requested reconsideration and 

submitted a factual statement. Appellant asserted that on November 1, 2014 he was at work 

replacing a machine shaft. As he was leaving the area to retrieve more tools, his left foot caught 

in a gap between a beam and the floor. Appellant fell and landed on his left wrist. He did not 

realize the exact cause of his fall until a few days later when he noticed the bruising on his toes. 

Appellant further noted that, although he had experienced syncopal episodes in the past, the fall 

on November 1, 2014 was not due to syncope, but due to tripping when his left foot was caught in 

a gap between the floor and a beam. He denied losing consciousness and asserted that he could 

not see his coworker’s face when he fell, disputing his coworker’s claim that appellant’s face 

turned pale before he fell. 

By decision dated February 27, 2017, OWCP modified and affirmed its prior decisions

finding that appellant had established that the incident occurred as alleged, but failed to provide 

medical evidence to establish causal relationship between his diagnosed condition and the accepted 

employment incident.

On February 5, 2018 appellant, through counsel, requested reconsideration and submitted 

a report from Dr. Weber dated January 29, 2018. In her January 29, 2018 report, Dr. Weber noted 

that she first examined appellant in November 2014 after an emergency room visit with low blood 

pressure and a left wrist fracture. Appellant reported that he fell at work one week prior to the 

emergency room visit, but did not immediately seek treatment as he believed that his wrist was 

sprained. Dr. Weber diagnosed severely comminuted fracture of the left distal radius and ulnar 

styloid known as a fall on outstretched hand. Appellant underwent surgery approximately one 

month after his injury. Dr. Weber opined that the severe comminution as well as the delay in care 

contributed to the complications he sustained and the need for multiple additional surgeries. She

opined that a fall on an outstretched wrist could cause the fracture pattern appellant sustained. 

Dr. Weber noted that most syncopal falls did not result in wrist fractures, but instead falling with 

the hand outstretched to prevent or break the fall that results in wrist fractures. She noted that most 

syncopal falls were the result of appellant’s losing consciousness and resulted in facial injuries and 

head lacerations. Dr. Weber found that he was partially disabled.
5

By decision dated May 4, 2018, OWCP denied modification of the February 27, 2017 

decision finding that appellant had not established that his injuries were causally related to his 

accepted November 1, 2014 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,4that 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.5 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.6

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

performance of duty it must first be determined whether fact of injury has been established.7 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.8 Second, the employee must 

submit sufficient evidence, generally only in the form of medical evidence, to establish that the 

employment incident caused a personal injury.9

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

causal relationship is rationalized medical opinion evidence.10 Rationalized medical opinion 

evidence is evidence which includes a physician’s opinion on the issue of whether there is a causal 

relationship between the claimant’s diagnosed condition and the implicated employment factors.11 

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 

 

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

153(1989).

5

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

ECAB 312 (1988).

6 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).

7 B.F., Docket No. 09-0060 (issued March 17, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

8 D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005).

9 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra 

note 7.

10 A.L., Docket No. 18-1465 (issued February 14, 2019); K.V., Docket No. 18-0306 (issued August 8, 2018);

Elizabeth H. Kramm, 57 ECAB 117, 123 (2005).

11 A.L., id.; I.J., 59 ECAB 408 (2008).
6

identified by the claimant.12 This medical opinion must include an accurate history of the 

employee’s employment injury and must explain how the condition is related to the injury. The 

weight of 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.13

ANALYSIS

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

condition was causally related to the accepted November 1, 2014 employment incident.

On November 1, 2014 Dr. Estaphan diagnosed syncope, hypotension, and left wrist 

fracture. While this report reflects immediate treatment following the employment incident, it fails 

to relate any opinion regarding the cause of appellant’s condition and is therefore insufficient to 

establish his traumatic injury claim.14 On December 3, 4014 Dr. Pham diagnosed anxiety, 

syncope, alcohol use, and left wrist fracture. Neither Dr. Estaphan nor Dr. Pham provided an 

opinion as to the cause of the diagnosed left wrist fracture. The record also contains multiple 

reports from Dr. Weber addressing appellant’s left wrist condition. Beginning on November 3, 

2014 she noted that he had fallen twice in the past week and diagnosed comminuted distal radius 

fracture based on x-rays. On November 3, 2013 Dr. Weber did not provide an opinion as to the 

cause of appellant’s wrist fracture. 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.15 Thus, these reports are insufficient to meet appellant’s burden of proof 

regarding causal relationship.

Dr. Weber completed the attending physician’s portion of a December 3, 2014 Form CA16 which listed October 27, 2014 as the date of injury and described the injury as distal radius 

fracture. She checked a box marked “no” that appellant’s diagnosed wrist fracture was not due to 

his employment activity. Dr. Weber noted that he had a concurrent condition of “dizziness.” This 

report does not support causal relationship between appellant’s diagnosed left wrist fracture and 

his accepted November 1, 2014 employment incident. It is based on a different history of injury 

than that offered by him and accepted by OWCP. Therefore, this report does not support 

appellant’s claim.16

On December 5, 2014 Dr. Weber noted that appellant reported he had injured his wrist at 

work and that he had been falling more frequently lately. She diagnosed left distal radius fracture 

 

12 Id.

13 A.L., supra note 10; D.H., Docket No. 17-1913 (issued December 13, 2018); K.V., Docket No. 18-0723 (issued 

November 9, 2018); James Mack, 43 ECAB 321 (1991).

14 T.M., Docket No. 18-0972 (issued December 13, 2018).

15 See M.C., Docket No. 18-0951 (issued January 7, 2019); J.L., Docket No. 18-0698 (issued November 5, 2018); 

R.A., Docket No. 17-1472 (issued December 6, 2017); Sedi L. Graham, 57 ECAB 494 (2006); Deborah L. Beatty, 54 

ECAB 340 (2003).

16 M.C., id.; M.B., Docket No. 18-0906 (issued November 21, 2018).
7

and new median nerve compression. Dr. Weber did not offer her own medical opinion as to the 

cause of appellant’s injury. An award of compensation may not be based on surmise, conjecture, 

speculation, or upon appellant’s own belief that there was a causal relationship between his 

condition and his employment.17 

In her January 29, 2016 report, Dr. Weber noted that appellant had fallen several times in 

November 2014 and that he was evaluated for syncopal episodes. She opined, “One of these falls 

caused the wrist fracture and possibly a few other falls while the wrist was not properly protected 

with a splint or cast contributed to the severe comminution.” In her January 29, 2018 report,

Dr. Weber reported that appellant informed her that he fell at work one week prior to the 

emergency room visit on November 1, 2014, but did not immediately seek treatment as he believed 

that his wrist was sprained. She opined that a fall on an outstretched wrist could cause the fracture 

pattern he sustained. These reports do not support appellant’s claim for a left wrist fracture due to 

the accepted November 1, 2014 employment incident. Instead, Dr. Weber attributed his left wrist 

fracture to either a series of falls or a sole earlier fall that has not been accepted as work related by 

OWCP. Furthermore, she did not clearly identify the November 1, 2014 employment incident as 

one of the falls which caused or contributed to appellant’s diagnosed condition and did not attribute 

his left wrist fracture to this accepted employment incident.18 Without an affirmative opinion that 

appellant’s diagnosed condition was causally related to his accepted employment incident, these 

reports are insufficient to meet his burden of proof.19

As appellant has not submitted rationalized medical evidence establishing that his left wrist 

condition was causally related to the accepted November 1, 2014 employment incident, he has not 

met his burden of proof.

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 left wrist 

condition was causally related to the accepted November 1, 2014 employment incident.20

 

17 A.L., supra note 10; A.W., Docket No. 17-0285 (issued May 25, 2018).

18 M.B., supra note 16.

19 M.C., supra note 15.

20 The Board notes that the employing establishment issued a Form CA-16. A properly completed CA-16 form 

authorization may constitute a contract for payment of medical expenses to a medical facility or physician, when 

properly executed. The form 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. See 20 C.F.R. § 10.300(c); 

M.C., supra note 15; Tracy P. Spillane, 54 ECAB 608 (2003).
8

ORDER

IT IS HEREBY ORDERED THAT the May 4, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 18, 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