United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.R., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Decatur, IL, Employer

__________________________________________

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Docket No. 18-1408

Issued: March 1, 2019

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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 12, 2018 appellant filed a timely appeal from a June 6, 2018 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 to 

consider the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish a right hand and 

wrist injury and right-sided rib contusion causally related to the accepted April 26, 2018 

employment incident.

FACTUAL HISTORY

On April 27, 2018 appellant, then a 60-year-old rural carrier associate, filed a traumatic 

injury claim (Form CA-1) alleging that, when stepping from his delivery vehicle on April 26, 2018

 

1 5 U.S.C. § 8101 et seq. 
2

while in the performance of duty, he lost his footing and fell onto concrete, causing a right wrist 

fracture and right-sided rib contusion. He stopped work on April 27, 2018.

In support of his claim, appellant submitted two form reports dated April 27, 2018 from

Antoniannette Pate, a nurse practitioner, who diagnosed a possible right wrist fracture and rightsided rib contusion. Ms. Pate noted work restrictions. 

In a referral form dated April 27, 2018, Ms. Pate and Dr. Keith Fabrique, an attending 

family practitioner, referred appellant to an orthopedic surgeon to evaluate right hand and wrist 

pain for a possible fracture. 

By development letter dated May 2, 2018, OWCP informed appellant that the evidence 

submitted was insufficient to establish the claim. It advised him of the type of medical and factual 

evidence needed, including a detailed description of the April 26, 2018 employment incident, and 

a narrative report from his physician explaining how and why that event would cause the claimed 

right hand and wrist condition. OWCP afforded appellant 30 days to submit the necessary 

evidence.

In response, appellant submitted a chart note dated April 27, 2018 from Ms. Pate. He also 

submitted a duty status report (Form CA-17) dated May 2, 2018 that does not bear a legible 

signature.

By decision dated June 6, 2018, OWCP accepted that the April 26, 2018 incident occurred 

as alleged. It denied the claim, however, finding that causal relationship had not been established.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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, that an injury was sustained while in the performance of duty as alleged, and that any 

disability or specific condition for which compensation is claimed is causally related to the 

employment injury.3 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.4

In order to determine whether an employee 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, which must be considered in conjunction with one 

another. The first component to be established is that the employee actually experienced the

 

2 Supra note 1.

3 Alvin V. Gadd, 57 ECAB 172 (2005); Anthony P. Silva, 55 ECAB 179 (2003). 

4 See Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117 (2005); Ellen L. Noble, 55 ECAB 530 (2004).
3

employment incident which is alleged to have occurred.5 The second component is whether the 

employment incident caused a personal injury and generally can be established only by medical 

evidence.6 

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

relationship is rationalized medical evidence.7 The opinion of the physician must be based on a 

complete factual and medical background of the claimant, 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.8 

Neither the mere fact that a disease or condition manifests itself during a period of employment, 

nor the belief that the disease or condition was caused or aggravated by employment factors or 

incidents is sufficient to establish causal relationship.9

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right hand and 

wrist injury and right-sided rib contusion causally related to the accepted April 26, 2018 

employment incident.

Dr. Fabrique diagnosed right hand and wrist pain in a report dated April 27, 2018. 

However, pain is a description of a symptom rather than a clear diagnosis of a medical condition.10 

Dr. Fabrique also diagnosed a possible wrist fracture. However, medical opinions that are 

speculative or equivocal are of diminished probative value.11 Therefore, the April 27, 2018 report 

of Dr. Fabrique is of limited probative value and insufficient to establish a firm medical 

diagnosis.12

Appellant also submitted reports from Ms. Pate, a nurse practitioner. The Board has held 

that medical reports signed solely by a nurse practitioner are of no probative value as nurse 

 

5 R.E., Docket No. 17-0547 (issued November 13, 2018); David Apgar, 57 ECAB 137 (2005); Delphyne L. Glover, 

51 ECAB 146 (1999). 

6 R.E., id.

7 G.N., Docket No. 18-0403 (issued September 13, 2018); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

8 K.V., Docket No. 18-0723 (issued November 9, 2018); Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 

45 ECAB 365 (1994).

9 Dennis M. Mascarenas, 49 ECAB 215 (1997).

10 D.A., Docket No. 18-0783 (issued November 8, 2018); C.B., Docket No. 09-2027 (issued May 12, 2010); Robert

Broome, 55 ECAB 339 (2004) (the Board has consistently held that pain is a symptom, not a compensable medical 

diagnosis).

11 T.O., Docket No. 18-0139 (issued May 24, 2018); Lourdes Harris, 45 ECAB 545, 547 (1994).

12 Id.
4

practitioners are not considered physicians as defined under FECA and therefore are not competent 

to provide a medical opinion.13

Appellant also provided a duty status report (Form CA-17) dated May 2, 2018 that does 

not bear a legible signature. Reports bearing no signature or an illegible signature cannot be 

identified as having been prepared by a physician and therefore, they do not constitute competent 

medical opinion evidence.14

As appellant has not submitted rationalized medical evidence to establish an injury causally 

related to the accepted employment incident, he has not met his burden of proof. 

On appeal, appellant contends that OWCP should reimburse his medical expenses as the 

employing establishment sent him to a “company doctor” who referred him to a specialist. As 

explained above, he is not entitled to wage-loss compensation or medical benefits as the medical 

evidence of record is insufficient to establish his claim. Also, the record does not contain an

authorization for medical treatment (Form CA-16), which would create a contractual obligation to 

pay for the cost of examination or treatment.

15

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 a right hand and 

wrist injury and right-sided rib contusion causally related to the accepted April 26, 2018 

employment incident.

 

13 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); 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). S.J., Docket No. 17-0783, n.2 

(issued April 9, 2018) (nurse practitioners are not considered physicians under FECA).

14 A medical report may not be considered as probative medical evidence if there is no indication that the person

completing the report qualifies as a physician as defined in 5 U.S.C. § 8101(2); L.F., Docket No. 18-0327 (issued

August 17, 2018); Merton J. Sills, 39 ECAB 572 (1988).

15 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. The period for which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, 

unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c); P.R., Docket No. 18-0737 (issued November 2, 2018); 

N.M., Docket No. 17-1655 (issued January 24, 2018), Tracy P. Spillane, 54 ECAB 608 (2003). 
5

ORDER

IT IS HEREBY ORDERED THAT the June 6, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 1, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board