United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.M., Appellant

and

U.S. POSTAL SERVICE, BELOIT POST 

OFFICE, Beloit WI, Employer

__________________________________________

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Docket No. 20-0678

Issued: January 11, 2021

Appearances: Case Submitted on the Record

Larrissa Ann Parde, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 7, 2020 appellant, through counsel, filed a timely appeal from an August 19,

2019 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 his burden of proof to establish a lumbar condition 

causally related to the accepted February 10, 2018 employment incident.

FACTUAL HISTORY

On February 10, 2018 appellant, then a 39-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that date he injured his back when he slipped and fell on ice 

while in the performance of duty. He did not stop work. 

In a February 10, 2018 medical report, Dr. Tejesh N. Patel, Board-certified in family 

practice, reported that appellant injured his back when he slipped and fell on ice. He diagnosed 

left low back pain. In a medical note of even date, Dr. Patel released appellant to work on 

February 11, 2018 with restrictions for no pulling, pushing, or lifting over 10 pounds. He further 

noted that appellant could return to work without restrictions on February 19, 2018.

A lumbosacral spine x-ray read by Dr. George Cherian, Board-certified in diagnostic 

radiology, dated February 10, 2018 demonstrated suspected bilateral L5 spondylolysis. 

In a February 10, 2018 duty status report (Form CA-17) Dr. Patel diagnosed left low back 

pain as a result of a slip and fall on ice and provided work restrictions. 

In a February 13, 2018 medical note, Dr. Patel excused appellant from work beginning 

February 10, 2018, until further notice.

A February 16, 2018 lumbosacral spine x-ray read by Dr. Philip Budihardjo, an osteopath 

Board-certified in diagnostic radiology, again demonstrated suspected bilateral L5 spondylolysis 

without associated spondylolisthesis. 

In a February 16, 2018 report, Dr. Kenneth L. Klein, Board-certified in physical medicine 

and rehabilitation, provided examination findings and diagnosed left lumbar radiculopathy, low 

back pain, lumbar herniated nucleus pulposus (HNP), and spondylolysis.3In a work excuse note 

of even date, he indicated that appellant may return to work with restrictions. 

A February 27, 2018 lumbar spine magnetic resonance imaging (MRI) scan read by

Dr. Eric Goth, Board-certified in diagnostic radiology, demonstrated L5 spondylolysis and mild 

degenerative changes at L5-S1, but no significant canal or foraminal stenosis. 

In medical reports dated March 6 and 20, 2018, Dr. Klein reiterated examination findings 

and diagnosed left lumbar radiculopathy, low back pain, contusion, lumbar HNP, and 

 

3 The reports of Dr. Klein of record also note that examination was also performed by Brian Mulder, an advanced 

practice nurse,
3

spondylolysis. In a series of work excuse notes dated March 6 through April 10, 2018, Dr. Klein

released appellant to work with restrictions.4

In a development letter dated April 18, 2018, OWCP informed appellant of the type of 

factual and medical evidence necessary to establish his claim and provided a questionnaire for his 

completion. It afforded him 30 days to submit the necessary evidence. 

Appellant resubmitted a March 6, 2018 medical report, by Dr. Klein. 

Appellant underwent physical therapy treatment on April 24, 2018. 

In an April 24, 2018 response to OWCP’s questionnaire, appellant asserted that on 

February 10, 2018 he slipped on ice and fell down approximately four stairs, landing on the edge 

of the last step on his back. He indicated that he had no similar disability or symptoms before the 

February 10, 2018 employment incident. 

In a May 4, 2018 medical report, Dr. Klein reported that appellant was doing better and 

undergoing physical therapy treatment, which was helping. He reiterated his diagnoses. In a work 

excuse note of even date, Dr. Klein again indicated that appellant could return to work with 

restrictions.5

By decision dated May 22, 2018, OWCP accepted that the February 10, 2018 employment 

incident had occurred, as alleged, but found that the evidence of record did not establish a 

diagnosed medical condition in connection to the accepted employment incident and, thus, the 

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

In a May 18, 2018 medical report, Dr. Klein noted that appellant’s pain worsened since the 

last examination and reiterated his diagnoses. In a work excuse note of even date, he again 

indicated that appellant may return to work with restrictions. A lumbosacral spine x-ray of even 

date revealed no acute findings.

Appellant continued to receive physical therapy treatment through May 29, 2018. 

In an August 31, 2018 medical report, Dr. Klein reiterated his diagnoses. In a work excuse 

note of even date, he indicated that appellant may return to work without restrictions. 

In October 17, 2018 progress notes, Dr. James W. Leonard, Board-certified in physical 

medicine and rehabilitation, noted that on February 10, 2018 appellant slipped and fell on ice, 

striking his lower back on the edge of steps, while at work. He indicated that appellant underwent 

physical therapy without relief. Dr. Leonard conducted a physical examination and reviewed 

appellant’s medical history and diagnostic studies, which demonstrated L5 spondylolysis and disc

degeneration at L5-S1. He diagnosed underlying L5 spondylolysis. Dr. Leonard opined that “the 

fall at work aggravated this underlying L5 spondylolysis beyond its normal progression.” He 

 

4 On April 14, 2018 appellant filed a claim for wage-loss compensation (Form CA-7) for the period March 31 

through April 13, 2018.

5 On May 15, 2018 appellant filed a Form CA-7 for the period April 14 through May 7, 2018. 
4

concluded that appellant’s symptoms were directly due to the accepted February 10, 2018 

employment incident. 

Appellant continued with physical therapy treatment. 

On November 27, 2018 appellant requested reconsideration. 

In December 17, 2018 progress notes, Dr. Leonard noted that appellant returned with 

persistent pain and noted that his symptoms were not improving. He reported that appellant’s MRI 

scan revealed bilateral L5 spondylolysis and minimal spondylolisthesis.

By decision dated February 1, 2019, OWCP modified its May 22, 2018 decision, finding 

that the evidence of record was sufficient to establish a diagnosed condition. However, the claim

remained denied, as the evidence of record was insufficient to establish causal relationship 

between appellant’s diagnosed condition and the accepted February 10, 2018 employment 

incident.

In a March 19, 2019 narrative report, Dr. Leonard indicated that appellant was initially

seen by him on October 17, 2018. He noted that appellant slipped on ice and fell down some steps 

on February 10, 2018 while at work. Dr. Leonard indicated that appellant was seen again on 

December 17, 2018 with persisting pain and was referred to Dr. Seth K. Williams, a Boardcertified orthopedic surgeon, for surgical consultation. He noted that appellant’s diagnostic studies 

demonstrated bilateral L5 spondylolysis with minimal spondylolisthesis at L5-S1. Dr. Leonard

reiterated that prior to his fall on February 10, 2018, appellant experienced no pain. He again 

opined that the fall at work aggravated appellant’s underlying L5 spondylolysis beyond its normal 

progression. Dr. Leonard concluded, with a reasonable degree of medical certainty, that the 

accepted February 10, 2018 employment incident was the direct cause of appellant’s symptoms. 

In an April 17, 2019 narrative report, Dr. Williams noted that appellant was evaluated on 

March 2, 2019 and was diagnosed with L5 spondylolysis. He further indicated that appellant was 

previously evaluated on January 16, 2019 when he referred appellant for L5 pars injections to 

confirm L5 spondylolysis as the primary pain generator. Dr. Williams noted that appellant was

highly functional and performing well at his job prior to the accepted February 10, 2018 

employment incident. He explained that appellant’s L5 spondylolysis was “likely” preexisting, as 

the condition was present in up to five percent of the population and typically occurred during 

childhood or adolescence. Dr. Williams further explained that the majority of people with L5 

spondylolysis typically are without significant symptoms but, in some cases, they become 

symptomatic and require surgery. He opined that appellant was functioning well until his fall, 

which produced significant back pain that was persistent despite ongoing efforts with conservative 

treatment. Dr. Williams, therefore, concluded, within a reasonable degree of medical certainty, 

that the fall itself exacerbated appellant’s preexisting L5 spondylolysis. He recommended surgery.

On May 24, 2019 appellant requested reconsideration.

By decision dated August 19, 2019, OWCP denied modification of its February 1, 2019 

decision.
5

LEGAL PRECEDENT

An employee seeking benefits under FECA6 has 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,7that 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.8 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.9

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. There 

are two components involved in establishing fact of injury. 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. The second component is whether the employment incident 

caused a personal injury and can be established only by medical evidence.10 

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence.11 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 factors 

identified by the employee.12

In a case in which a preexisting condition involving the same part of the body is present 

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

 

6 Supra note 2.

7 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). 

8 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).

9 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).

10 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

11 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).

12 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).
6

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

of the work-related injury or disease and the preexisting condition.13

ANALYSIS

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

condition causally related to his accepted February 10, 2018 employment incident.

Dr. Williams, in his April 17, 2019 narrative report, opined with a reasonable degree of 

medical certainty that the accepted February 10, 2018 employment incident exacerbated 

appellant’s preexisting L5 spondylolysis. He noted that appellant’s diagnosed L5 spondylolysis 

was “likely” preexisting, as the condition was present in up to five percent of the population, most 

of which lived without any significant symptoms. While Dr. Williams supported causal 

relationship, his report does not contain rationale explaining how the accepted employment 

incident of slipping on ice and falling on the edge of stairs caused or aggravated appellant’s 

preexisting lumbar condition. The Board has held that a medical report is of limited probative 

value on a given medical issue if it contains an opinion which is unsupported by medical 

rationale.14 Further, the Board has consistently held that complete medical rationalization is 

particularly necessary when there is a preexisting condition involving the same body part,15 and 

has required medical rationale differentiating between the effects of the work-related injury and 

the preexisting condition in such cases.16 Therefore, Dr. Williams’ April 17, 2019 report is 

insufficient to establish appellant’s claim.

In October 17, 2018 progress notes and a March 19, 2019 narrative report, Dr. Leonard 

noted that appellant experienced no pain prior to the accepted February 10, 2018 employment 

incident and therefore he concluded that the incident aggravated appellant’s underlying L5 

spondylolysis beyond its normal progression. The Board has held that the mere fact that symptoms 

arise during a period of employment or produce symptoms revelatory of an underlying condition 

does not establish a causal relationship between a diagnosed condition and employment factors.17 

A medical opinion must provide an explanation of how the specific employment incident or 

employment factors physiologically caused or aggravated the diagnosed conditions.18 As such, 

these notes and report are insufficient to establish appellant’s burden of proof.

 

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

V.W., Docket No. 19-1537 (issued May 13, 2020); N.C., Docket No. 19-1191 (issued December 19, 2019); R.D., 

Docket No. 18-1551 (issued March 1, 2019).

14 B.M., Docket No. 19-1341 (issued August 12, 2020).

15 Supra note 11.

16 Id.; see also A.J., Docket No. 18-1116 (issued January 23, 2019); M.F., Docket No. 17-1973 (issued 

December 31, 2018); J.B., Docket No. 17-1870 (issued April 11, 2018).

17 A.S., Docket No. 19-1955 (issued April 9, 2020).

18 G.L., Docket No. 18-1057 (issued April 14, 2020).
7

In December 17, 2018 progress notes, Dr. Leonard diagnosed bilateral L5 spondylolysis 

and minimal spondylolisthesis, but did not offer an opinion as to whether appellant’s employment 

incident caused or aggravated his diagnosed conditions. Likewise, Dr. Klein, in his series of

reports, diagnosed left lumbar radiculopathy, low back pain, contusion, lumbar herniated nucleus 

pulposus (HNP), and spondylolysis. However, he also did not address whether appellant’s 

employment incident caused or aggravated his diagnosed condition. 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.19 For this reason, these reports are also 

insufficient to establish appellant’s claim. 

In a form report and note dated February 10, 2018, Dr. Patel diagnosed left low back pain 

and provided work restrictions. The Board has held, however, that pain is a symptom and not a 

compensable medical diagnosis.20 These reports are, therefore, insufficient to meet appellant’s 

burden of proof.

Dr. Patel excused appellant from work until further notice in his February 13, 2018 note. 

However, he did not provide a specific diagnosis of an injury or medical condition or an opinion 

on causation. The Board has held that a medical report lacking a firm diagnosis and a rationalized 

medical opinion regarding causal relationship is of no probative value.21 As such, Dr. Patel’s 

February 13, 2018 note is insufficient to meet appellant’s burden of proof.

Finally, the record contains diagnostic reports dated February 10, 16, 27, and 

May 18, 2018. The Board has held, however, that diagnostic test reports standing alone lack 

probative value on the issue of causal relationship as they do not provide an opinion on causal 

relationship between an employment incident and a diagnosed condition.22 For this reason, these 

diagnostic reports are insufficient to meet appellant’s burden of proof.

As there is no rationalized medical evidence of record explaining how appellant’s accepted 

February 10, 2018 employment incident caused or aggravated his diagnosed conditions, the Board 

finds that 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.

 

19 S.J., Docket No. 19-0696 (issued August 23, 2019); M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., 

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

20 T.S., Docket No. 20-0343 (issued July 15, 2020); J.P., 59 ECAB 178 (2007).

21 J.P., Docket No. 20-0381 (issued July 28, 2020); R.L., Docket No. 20-0284 (issued June 30, 2020).

22 L.F., Docket No. 19-1905 (issued April 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).
8

CONCLUSION

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

condition causally related to the accepted February 10, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the August 19, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 11, 2021

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board