United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.H., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SECURITY 

ADMINISTRATION, BWI THURGOOD 

MARSHALL AIRPORT, Linthicum, MD, 

Employer

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Docket No. 20-0639

Issued: November 10, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 29, 2020 appellant filed a timely appeal from an October 11, 2019 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 a medical condition 

causally related to the accepted July 25, 2018 employment incident.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On August 22, 2018 appellant, then a 62-year-old supervisory transportation security 

officer, filed a traumatic injury claim (Form CA-1) alleging that on July 25, 2018 he injured his 

neck, shoulders, knees, and back when he fell over a cart while in the performance of duty. On 

the reverse side of the claim form, appellant’s supervisor, W.B., acknowledged that the incident 

occurred in the performance of duty and that there was no willful misconduct involved. Appellant

stopped work on July 25, 2018 and returned on August 15, 2018. 

Appellant was treated by Dr. Eddye J. Bullock, a Board-certified internist, on July 25

and 31, 2018, for low back, right shoulder, and neck pain after he fell over a cart at work. 

Dr. Bullock diagnosed myalgia and opined that appellant “most likely” sustained a contusion from 

a fall. On October 30, 2018 appellant presented with worsening neck and shoulder pain and 

cracking in the right shoulder. Dr. Bullock diagnosed osteoarthritis of the right shoulder, neck 

pain, and cervical spondylosis. On November 21, 2018 he evaluated appellant for recurrent low 

back pain. Dr. Bullock diagnosed chronic low back pain and opined that the episode “maybe”

[sic] related to the fall over the summer; however, he noted that appellant had a history of back 

pain that predated the fall.

Appellant attended physical therapy treatment from July 31 to December 6, 2018.

Dr. Alireza P. Farsaii, a Board-certified orthopedist, evaluated appellant on November 16, 

2018, for bilateral shoulder pain, which began after a fall that occurred four months earlier. An 

x-ray of the left shoulder of even date revealed no acute fractures, no dislocation or bony lesions, 

and mild degenerative arthritis at the glenohumeral joint and acromioclavicular (AC) joints. 

Dr. Farsaii’s assessment was “right shoulder rule out rotator cuff tear.”

A November 21, 2018 magnetic resonance imaging (MRI) scan of the right shoulder 

revealed: full-thickness, full width tear of the supraspinatus tendon, retracted; high-grade partial 

tear of the distal subscapularis with tendinopathy; chronic tears along the superior labrum, 

posterior labrum and anterior labrum; moderate degenerative joint disease of the AC joint, and 

minimal joint arthritis with chondromalacia. An MRI scan of the left shoulder of even date 

revealed an articular surface tear along the anterior fibers of the distal supraspinatus, partial 

insertional tear of the distal subscapularis with tendinopathy, degenerative changes, partial tears 

along the anterior labrum, fragmentation, and advanced degenerative changes along the AC joint.

On November 30, 2018 Dr. Farsaii reviewed the MRI scan of the right shoulder and 

diagnosed traumatic, full-thickness right rotator cuff tear and biceps tendinitis and recommended 

right shoulder arthroscopic rotator cuff repair and open subpectoral biceps tenodesis. 

In a December 13, 2018 development letter, OWCP informed appellant that, when his 

claim was first received, it appeared to be a minor injury that resulted in minimal or no lost time 

for work, and therefore, payment of a limited amount of medical expenses was administratively 

approved without formal consideration of the merits of his claim. It had now reopened his claim 

for consideration of the merits. OWCP advised appellant of the deficiencies of his claim, requested 

additional factual and medical evidence, and provided a questionnaire for his completion. It 

afforded him 30 days to respond. 
3

In a July 24, 2018 statement, appellant indicated that while he was opening up a passenger 

lane he fell over a cart and injured his right side, neck, shoulders, buttocks, and knees. He 

experienced a nose bleed later that day and stopped work. 

An employing establishment incident report dated July 31, 2018, prepared by A.B., a 

fellow transportation security officer, noted that on July 24, 2018 appellant was on duty setting up 

lane four for checkpoint screening when he tripped and fell over a smart cart. He remained on the 

floor until being assisted up by a coworker and a passenger. 

In an August 10, 2018 authorization for examination and/or treatment (Form CA-16), the 

employing establishing authorized appellant to seek medical care. In Part B of the Form CA-16, 

attending physician’s report, of even date, Dr. Bullock reported that appellant fell over a cart at 

work and landed on his right side. He noted that appellant reported preexisting neck and back 

pain. Dr. Bullock diagnosed myalgia, and noted the cause of injury was a fall against an object. 

He checked a box marked “Yes” indicating that the diagnosed conditions were caused or 

aggravated by the described employment activity. Dr. Bullock further indicated that appellant was 

totally disabled from work from July 25 to August 14, 2019. 

In return to work slips dated July 25 and 30, 2018, Dr. Bullock noted that appellant was 

disabled from work from July 25 to August 5, 2018. In an August 10, 2018 attending physician’s 

report (Form CA-20), he noted that appellant was injured at work on July 25, 2018 when he fell 

over a cart and onto his side. Dr. Bullock diagnosed myalgia and checked a box marked “Yes”

indicating that appellant’s condition had been caused or aggravated by an employment activity. 

By decision dated January 30, 2019, OWCP denied appellant’s traumatic injury claim,

finding that the medical evidence submitted was insufficient to establish causal relationship 

between his diagnosed conditions and the accepted July 25, 2018 employment incident.

On February 25, 2019 appellant requested an oral hearing. He later requested that OWCP 

proceed with a review of the written record in lieu of an oral hearing. 

OWCP received additional evidence. In a January 9, 2019 response to OWCP’s

development questionnaire, appellant indicated that, on July 24, 2018, he was working at C pier

checkpoint opening the stanchions that blocked off an entrance way to two lanes. After opening 

the lane he tripped over a baggage cart and flipped upward about two or three feet and then fell on 

his backside. Appellant reported the accident to his supervisor A.B. He indicated that he had not 

sustained any injuries on or off duty since the accident. Appellant sought treatment from

Dr. Bullock on July 25, 2018 for pain in his knees, neck, shoulder, back, and right side. He related 

that he experienced chronic back pain from a past injury and had bilateral knee surgery in 2016,

but remained pain free until this accident.

In reports dated January 14 and February 5, 2019, Dr. Bullock summarized appellant’s 

July 25 and 31, and November 21, 2018 office visits. He diagnosed chronic lumbar back pain and 

lumbar osteoarthritis/spondylosis, which flared up after appellant’s fall at work on July 24, 2018, 

and opined that the fall against the cart exacerbated appellant’s chronic back and neck conditions.

In a February 26, 2019 operative report, Dr. Farsaii noted performing a right shoulder 

arthroscopic rotator cuff repair and open subpectoral biceps tenodesis. He diagnosed right 

shoulder massive rotator cuff tear, biceps tendinitis, and biceps tendon tear.
4

By decision dated October 11, 2019, OWCP’s hearing representative affirmed the 

January 30, 2019 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA2has the burden of proof to establish the 

essential elements of his or her claim, including 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 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

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. First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time and place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury.6

The medical evidence required to establish a causal relationship is rationalized medical 

opinion evidence.7 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 

specific employment incident identified by the employee.8

ANALYSIS

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

condition causally related to the accepted July 25, 2018 employment incident.

 

2 Supra note 1.

3 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989).

4 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

James E. Chadden, Sr., 40 ECAB 312 (1988).

5 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

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

6 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

7 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. 

Morris, 48 ECAB 238 (1996).

8 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).
5

In support of his claim appellant submitted medical reports from Dr. Bullock dated July 25

and 30, 2018, who diagnosed myalgia and advised that appellant “most likely” sustained a 

contusion from a fall. Similarly, on October 30 and November 21, 2018, Dr. Bullock diagnosed 

chronic low back pain and opined that the episode may be related to the fall over the summer. The 

Board has held that such medical opinions that suggest that a condition was most “likely” caused 

by work activities are speculative or equivocal in character and have limited probative value.9 As 

such, these medical notes by Dr. Bullock are insufficient to establish appellant’s claim.

In return to work slips dated July 25 and 30, 2018, Dr. Bullock noted that appellant was 

disabled from work from July 25 to August 5, 2018. As these notes do not address causation, they 

are of no probative value and insufficient to meet appellant’s burden of proof.10

In a Form CA-20 dated August 10, 2018, Dr. Bullock diagnosed myalgia and checked a 

box marked “Yes” indicating that the condition was caused or aggravated by the employment 

incident. The Board has held, however, that a report that addresses causal relationship with a 

checkmark, without medical rationale explaining how the employment incident caused or 

aggravated the diagnosed condition, is of diminished probative value and insufficient to establish 

causal relationship.11

Other reports from Dr. Bullock dated January 14 and February 5, 2019, diagnosed chronic 

lumbar back pain and lumbar osteoarthritis/spondylosis. He opined that appellant’s fall against a 

cart exacerbated his chronic back and neck conditions. Although his statement is supportive of a

causal relationship, he did not offer medical rationale explaining the basis of his conclusory 

opinion regarding the causal relationship between appellant’s back and neck conditions and the 

factors of his federal employment.12 The Board has held that a mere conclusion without the 

necessary rationale as to whether a given medical condition was related to an accepted employment 

incident is insufficient to meet a claimant’s burden of proof.13 As such, these notes are of limited 

probative value.

In reports dated November 16 and 30, 2018, Dr. Farsaii evaluated appellant for a fourmonth history of bilateral shoulder pain, which began after a fall at work. He diagnosed traumatic, 

full thickness right rotator cuff tear, and biceps tendinitis and performed right shoulder 

arthroscopic surgery on February 26, 2019. However, as Dr. Farsaii did not offer an opinion on 

causal relationship, his opinion is of no probative value.14 Therefore, his medical reports are 

insufficient to meet appellant’s burden of proof.

Appellant submitted physical therapy reports dated July 31 to December 6, 2018. 

However, certain healthcare providers such as physician assistants, nurses, nurse practitioners, 

 

9

J.W., Docket No. 18-0678 (issued March 3, 2020).

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

11 See K.R., Docket No. 19-0375 (issued July 3, 2019); Deborah L. Beatty, 54 ECAB 340 (2003).

12 P.L., Docket No. 19-1750 (issued March 26, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

13 A.T., Docket No. 19-0410 (issued August 13, 2019); E.L., Docket No. 17-1632 (issued January 3, 2018).

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

physical therapists, and social workers are not considered “physician[s]” as defined under FECA. 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.15 

Appellant also submitted MRI scans of the left and right shoulder dated November 21, 

2018, and an x-ray of the left shoulder dated November 22, 2017. The Board has explained that 

diagnostic studies, standing alone, lack probative value as they do not address whether the 

employment incident caused any of the diagnosed conditions.16

As the case record does not contain rationalized medical evidence sufficient to establish 

causal relationship between the accepted July 25, 2018 employment incident and his diagnosed 

conditions, the Board finds that appellant has not met his burden of proof.

On appeal appellant asserts that his supervisors and physicians concluded that the fall at 

work caused his rotator cuff tear and exacerbated his arthritis, and that OWCP ignored this 

evidence. He asserted that, if this evidence was insufficient, the claims examiner should have 

obtained additional medical evidence or referred him for a second opinion evaluation. Appellant 

referenced the case of Elizabeth Maypother.17 In that case, he asserted that the leukemia and 

subsequent infection, which caused her husband’s death was causally related to a slip and fall 

injury that occurred at work on March 7, 1950. Appellant submitted rationalized medical evidence 

sufficient to merit further development and OWCP referred him to two second opinion evaluations. 

However, as explained above, he has not submitted rationalized medical evidence sufficient 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.

 

15 Section 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims,

Causal Relationship, Chapter 2.805.3a(1) (January 2013); 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); see also J.R., Docket No. 20-0496 (issued August 13, 2020) (physical therapists are not considered 

physicians under FECA).; see also S.L., Docket No. 19-0603 (issued January 28, 2020) (a nurse is not considered a 

physician as defined under FECA).

16 R.C., Docket No. 19-0376 (issued July 15, 2019).

17 5 ECAB 604 (1953).
7

CONCLUSION

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

condition causally related to the accepted July 25, 2018 employment incident.18

ORDER

IT IS HEREBY ORDERED THAT the October 11, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 10, 2020

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

18 The Board notes that the employing establishment issued a Form CA-16. A completed Form CA-16 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. 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).