United States Department of Labor

Employees’ Compensation Appeals Board

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A.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

EDITH NOURSE ROGERS MEMORIAL 

VETERANS HOSPITAL, Bedford, MA, 

Employer

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Docket No. 19-1277

Issued: January 3, 2020

Appearances: Case Submitted on the Record

Brett Elliot Blumstein, Esq., for the appellant1

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 May 20, 2019 appellant, through counsel, filed a timely appeal from a December 7, 

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 her burden of proof to establish lumbar conditions 

causally related to accepted factors of her federal employment.

FACTUAL HISTORY

On August 7, 2017 appellant, then a 62-year-old medical assistant, filed an occupational 

disease claim (Form CA-2) alleging that her lumbar conditions had been aggravated by factors of 

her federal employment, including continuous walking and standing and various patient care 

duties.3 She noted that she first became aware of her condition and its relationship to her federal 

employment on November 4, 2013. Appellant did not stop work.

In a development letter dated August 29, 2017, OWCP informed appellant that the 

evidence of record was insufficient to establish her claim. It advised her regarding the medical 

and factual evidence required to establish her claim. OWCP afforded appellant 30 days to provide 

the requested information.

OWCP thereafter received a May 16, 2017 report from Dr. John W. Ellis, a Board-certified 

family medicine physician. Dr. Ellis detailed appellant’s history of injury on November 4, 2013 

summarized medical reports and diagnostic tests he had reviewed, and provided examination 

findings. He reported that on November 4, 2013 her right foot was caught in a nursing monitor 

strip, which caused her to fall on both hands and knees. Dr. Ellis noted that appellant’s current 

symptoms included difficulty walking and that she was stiff in the morning. Appellant’s physical 

examination revealed decreased L5 and S1 sensation to light touch and pin prick, right foot 

dorsiflexion weakness, straight leg raising and Bragard’s sign positive in the right leg and negative 

in the left leg, mild bilateral patella crepitation, restricted bilateral hip range of motion, mild right 

ankle lateral talofibular ligament swelling, and weakness on toe and heel walking. Dr. Ellis 

diagnosed sciatica, right L5 and S1 nerve impingement, lumbar intervertebral disc degeneration, 

spondylolisthesis, and lumbar stenosis. He concluded that appellant’s employment caused, 

contributed to, and/or aggravated the diagnosed conditions. In support of his opinion, Dr. Ellis 

explained that she tripped and fell forward which caused her low back sprain and that the jerking 

caused a slippage of her lower back vertebrae resulting in spondylolisthesis and impingement of 

the spinal nerves down the legs. He also opined that appellant’s continued employment following 

her November 4, 2013 fall aggravated her low back. 

By decision dated November 20, 2017, OWCP denied appellant’s claim finding that the 

medical evidence submitted was insufficient to establish causal relationship between the diagnosed 

 

3 OWCP assigned the current claim assigned OWCP File No. xxxxxx132. On November 4, 2013 appellant filed a 

traumatic injury claim (Form CA-1) alleging that on that date she sustained left leg, hip, and elbow pain when she fell 

on her left side after her right foot got caught in a strip cord and she fell on her left side. OWCP assigned OWCP File 

No. xxxxxx800 to this claim, which was denied by decision dated February 14, 2014 as no medical evidence with a 

diagnosis had been submitted. By decision dated February 13, 2015, it modified its prior decision finding the medical 

evidence submitted contained a diagnosis, but affirmed as modified as causal relationship between the accepted 

November 4, 2013 employment incident and the diagnosed conditions had not been established. OWCP 

administratively combined OWCP File Nos. xxxxxx132 and xxxxxx800, with the latter designated as the master file. 
3

low back conditions and the identified employment duties. It concluded that she had not met the 

requirements to establish an employment-related injury or condition. 

On October 16, 2018 appellant, through counsel, requested reconsideration and submitted 

an October 3, 2018 report from Dr. Ellis. 

In the October 3, 2018 report, Dr. Ellis again described appellant’s November 4, 2013 

employment incident, summarized medical reports and diagnostic tests he reviewed, and provided 

examination findings. He noted that her back pain was aggravated by lifting patients and bending 

and twisting while filing charts. Dr. Ellis noted that appellant’s job duties included lifting patients, 

making beds, helping patients to shower, and bending. He indicated that each time she performed 

her job duties she sustained repetitive strains of her lower back ligaments and muscles. Dr. Ellis 

diagnosed back muscle tendon unit strain, back deranged discs, spondylolisthesis, and bilateral L5 

and S1 spinal nerve impingement. He indicated that appellant’s hip pain was in the sacroiliac joint 

rather than the hip joint. Dr. Ellis indicated that she had physical impairments prior to starting 

work for the employing establishment, including back problems and radiculopathy from a 2009 

injury. Dr. Ellis concluded that appellant’s employment duties aggravated her preexisting low 

back condition. 

By decision dated December 7, 2018, OWCP denied modification. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 of FECA,5that 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.6 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.7

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit: (1) a factual statement identifying employment factors 

alleged to have caused or contributed to the presence or occurrence of the disease or condition;8

(2) medical evidence establishing the presence or existence of the disease or condition for which 

 

4 Supra note 2.

5 S.H., Docket No, 19-0631 (issued September 5, 2019); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989).

6 A.P., Docket No. 19-1158 (issued October 29, 2019); C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine 

Pendleton, 40 ECAB 1143 (1989).

7 S.C., Docket No. 18-1242 (issued March 13, 2019); S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 

345 (1989).

8 S.C., id.; Marlon Vera, 54 ECAB 834 (2003); Roger Williams, 52 ECAB 468 (2001).
4

compensation is claimed;9and (3) medical evidence establishing that the diagnosed condition is 

causally related to the identified employment factors.10

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

relationship is rationalized medical evidence.11 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.12 

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.13

In a 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.14

ANALYSIS

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

conditions causally related to the accepted factors of her federal employment.

Appellant submitted reports by Dr. Ellis in support of his claim. In his May 16, 2017 and 

October 3, 2018 reports, Dr. Ellis noted her employment history, her claimed November 4, 2013 

employment-related injury under OWCP File No. xxxxxx800, and her preexisting conditions, and 

he reviewed medical records and presented examination findings. In his May 16, 2017 report, he 

diagnosed sciatica, right L5 and S1 nerve impingement, lumbar intervertebral disc degeneration, 

spondylolisthesis, and lumbar stenosis, all of which he attributed to appellant’s November 4, 2013 

employment incident and to her employment duties. In his October 3, 2018 report, Dr. Ellis 

diagnosed back muscle unit tendon strain, deranged back discs, bilateral L5 and S1 spinal nerve 

impingement, and spondylolisthesis, all of which he opined had been aggravated by her 

employment duties.

 

9 B.K., Docket No. 19-0829 (issued September 25, 2019); Michael R. Shaffer, 55 ECAB 386 (2004).

10 V.G., Docket No. 19-0908 (issued October 25, 2019); C.M., Docket No. 18-1516 (issued May 8, 

2019); P.D., Docket No. 17-1885 (issued September 17, 2018); Beverly A. Spencer, 55 ECAB 501 (2004). 

11 V.G., id.; L.D., Docket No. 17-1581 (issued January 23, 2018); Jacqueline M. Nixon-Steward, 52 ECAB 

140 (2000).

12 V.G., supra note 10; L.D., id.; see also Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 

365 (1994).

13 Id. 

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

P.J., Docket No. 18-1738 (issued May 17, 2019); G.G., Docket No. 18-0550 (issued October 1, 2018).
5

In his May 16, 2017 report, Dr. Ellis explained that the jerking caused by appellant’s 

November 4, 2013 trip and falling forward caused a slippage of her lower back, resulting in spinal 

nerve impingement down her legs and spondylolisthesis. He opined that the diagnosed conditions 

had been aggravated by her employment following her slip and fall on November 4, 2013. In his 

October 3, 2018 report, Dr. Ellis opined that appellant’s preexisting back conditions had been 

aggravated by both her prior November 4, 2013 employment incident and her work duties. 

Specifically, he explained that her duties of lifting patients and bending and twisting while filing 

charts aggravated her back pain, shoulders, caused her lower back muscles, and ligaments to be 

repetitively strained. While Dr. Ellis generally supported causal relationship, his opinion was 

insufficiently rationalized. The Board has previously held that mere conclusory statements, not 

fortified by explanation, are insufficient to establish causal relationship between employment 

factors and diagnosed conditions.15 Without further explanation as to how, physiologically, the 

movements involved in appellant’s employment duties caused or contributed to the diagnosed

lumbar conditions, these opinions on causal relationship are of limited probative value.16 A

rationalized medical opinion is especially necessary in light of appellant’s preexisting lumbar 

conditions.17 Without medical rationale explaining how the accepted employment factors caused, 

contributed to, or aggravated the diagnosed conditions, Dr. Ellis’ reports are insufficient to 

establish her claim.18

On appeal counsel asserts that Dr. Ellis’ reports are sufficient to establish entitlement or to 

require referral to a second opinion physician. For the reasons set forth above, the Board finds the 

reports of Dr. Ellis are insufficiently rationalized to warrant either acceptance of her claim or 

further development of the medical opinion evidence by referral for a second opinion.

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 her burden of proof to establish lumbar 

conditions causally related to accepted factors of her federal employment. 

 

15 V.S., Docket No. 19-0936 (issued October 7, 2019); M.S., Docket No. 19-0587 (issued July 22, 2019); B.C.,

Docket No. 18-1735 (issued April 23, 2019); N.M., Docket No. 010-0283 (issued August 19, 2010).

16 Id. 

17 J.H., Docket No. 19-0838 (issued October 1, 2019); D.M., Docket No. 19-0389 (issued July 16, 2019).

18 Id. 
6

ORDER

IT IS HEREBY ORDERED THAT the December 7, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 3, 2020

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