United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.M., Appellant

and

U.S. POSTAL SERVICE, CARDISS COLLINS 

POST OFFICE, Chicago, IL, Employer

__________________________________________

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Docket No. 22-0220

Issued: July 29, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 22, 2021 appellant filed a timely appeal from a September 20, 2021 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 her burden of proof to establish a diagnosed medical 

condition causally related to the accepted December 4, 2020 employment incident.

FACTUAL HISTORY

On December 9, 2020 appellant, then a 45-year-old city delivery specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on December 4, 2020 she a sustained a back 

injury when delivering large packages while in the performance of duty. She asserted that her 

1

5 U.S.C. § 8101 et seq.
2

back muscles began to tighten while working her delivery route, and that she experienced lower 

back pain. Appellant stopped work on the date of the claimed injury. She informed her supervisor 

of her condition the next morning. In a December 8, 2020 statement, appellant advised that she 

continued to experience back pain.

In notes dated December 8, 15, and 29, 2020, Dr. Zahra Ismail, a Board-certified internist, 

excused appellant from work for the period December 8 through 29, 2020 as she was 

“incapacitated from any work-related activities.” In the December 29, 2020 note, she advised that 

appellant could return to work on January 4, 2021 to “partial duties” with a restriction of lifting no 

more than 25 pounds for the first week.

In a December 23, 2020 attending physician’s report (Form CA-20), Dr. Ismail advised 

that appellant reported injuring her lower back when lifting packages at work on 

December 4, 2020. She listed physical examination findings of limited range of motion of the 

lower back due to pain and diagnosed acute lower back pain without sciatica. Dr. Ismail checked 

a box marked “Yes,” indicating that the diagnosed condition was caused or aggravated by the 

December 4, 2020 employment activity. She found that appellant was totally disabled from work 

for the period December 4 through 30, 2020.

In a December 20, 2020 letter, appellant’s immediate supervisor indicated that the 

employing establishment was challenging appellant’s claim. She acknowledged that appellant 

delivered packages on December 4, 2020, but asserted that none of them weighed more than 11 

pounds and 3 ounces.

In a January 4, 2021 development letter, OWCP notified appellant of the deficiencies of 

her claim. It advised her of the type of evidence needed and provided a questionnaire for her

completion. OWCP afforded appellant 30 days to submit the necessary evidence.

Appellant submitted a December 31, 2020 report from Vicki Lind, a nurse assigned to 

appellant by OWCP, who detailed her interactions with appellant. In a January 8, 2021 note,

Dr. Ismail indicated that, commencing January 4, 2021, appellant was restricted from lifting more 

than 25 pounds, and noted that she may return to activities on February 1, 2021.

By decision dated February 23, 2021, OWCP accepted that appellant delivered packages

in the performance of duty on December 4, 2020, as alleged. However, it denied her claim, finding 

that the medical evidence of record was insufficient to establish a medical diagnosis in connection 

with the accepted December 4, 2020 employment incident. OWCP concluded, therefore, that the 

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

On July 26, 2021 appellant requested reconsideration of the February 23, 2021 decision.

Appellant submitted an April 29, 2021 report from Dr. Sara Doss, a Board-certified 

internist, who indicated that appellant was seen on December 8, 2020 for acute low back pain that 

developed after lifting a heavy object at work. Dr. Doss noted that she diagnosed acute midline 

low back pain without sciatica and recommended rest from lifting and work. She advised that 

appellant underwent follow-up visits on December 15 and 29, 2020 and her pain improved 

significantly. Dr. Doss indicated that appellant was able to return to work on January 4, 2021.
3

In a May 28, 2021 Form CA-20, Dr. Doss indicated that appellant reported she was lifting 

a dresser and refrigerator at work on an unspecified date and developed acute low back pain. She 

advised that appellant had physical examination findings of tenderness of the paraspinal lumbar 

muscles at L2 through S1 without neurological deficits and diagnosed acute midline low back pain 

without sciatica. Dr. Doss checked a box marked “Yes” indicating that the diagnosed condition 

was caused or aggravated by the reported employment activity. She indicated that appellant was 

totally disabled, commencing December 4, 2020, and was able to resume regular duty on 

January 4, 2021.

In a July 16, 2021 report, Dr. Doss indicated that appellant was seen on December 8, 2020 

for acute low back pain that developed after lifting a dresser and small refrigerator at work. 

Appellant reported that she felt a pulling sensation and some pain while engaging in the moving 

activity and woke up the next day with significant lower pain such that she could not get out of 

bed without experiencing severe pain. Dr. Doss indicated, “[t]his appears to establish a causal 

relationship between the diagnosed condition and the event at work.” She indicated that she 

diagnosed acute midline low back pain without sciatica and recommended medication, a stretching 

regimen, and rest from lifting and work. Dr. Doss advised that appellant underwent follow-up 

visits on December 15 and 29, 2020 and her pain improved significantly. She indicated that 

appellant was able to return to work on January 4, 2021.

By decision dated September 20, 2021, OWCP denied modification of its February 23, 

2021 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA has the burden of proof to establish the 

essential elements of his or her claim, including that 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.2 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.3

To determine if an employee has sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred.4 The second component is whether the employment incident caused a personal injury.5 

2

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

ECAB 312 (1988).

3 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

4 B.P., Docket No. 16-1549 (issued January 18, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

5 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989). 
4

Rationalized medical opinion evidence is required to establish causal relationship. 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 incident.6 

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.7

ANALYSIS

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

medical condition causally related to the accepted December 4, 2020 employment incident.

In notes dated December 8, 15, and 29, 2020, Dr. Ismail excused appellant from work for 

the period December 8, 2020 through January 3, 2021as she was “incapacitated from any workrelated activities.” In the December 29, 2020 note, she advised that appellant could return to work 

on January 4, 2021 with restrictions. In a Form CA-20, Dr. Ismail advised that appellant reported 

injuring her lower back when lifting packages at work on December 4, 2020. She listed physical 

examination findings of limited range of motion of the lower back due to pain and diagnosed acute 

lower back pain without sciatica. Dr. Ismail checked a box marked “Yes” indicating that the 

diagnosed condition was caused or aggravated by the December 4, 2020 employment activity. She 

found that appellant was totally disabled from work for the period December 4 through 30, 2020. 

In a January 8, 2021 note, Dr. Ismail indicated that, commencing January 4, 2021, appellant was 

restricted from lifting more than 25 pounds, and noted that she may return to activities on 

February 1, 2021. While Dr. Ismail’s reports contain a diagnosis of acute midline low back pain 

without sciatica, the Board has held that pain alone is a symptom, not a medical diagnosis, and that 

findings of pain or discomfort alone do not satisfy the medical aspect of the fact of injury medical 

determination.8 Therefore, his reports are insufficient to establish a medical diagnosis in 

connection with the accepted employment incident.

9

Appellant also submitted an April 29, 2021 report from Dr. Doss, who indicated that 

appellant was seen on December 8, 2020 for acute low back pain that developed after lifting a 

heavy object at work. Dr. Doss noted that she diagnosed acute midline low back pain without 

sciatica and recommended rest from lifting and work. She noted that appellant was able to return 

to work on January 4, 2021. In a May 28, 2021 Form CA-20, Dr. Doss indicated that appellant 

reported that she was lifting a dresser and refrigerator at work on an unspecified date and developed 

acute low back pain. She advised that appellant had physical examination findings of tenderness 

of the paraspinal lumbar muscles at L2 through S1 without neurological deficits and diagnosed 

acute midline low back pain without sciatica. Dr. Doss checked a box marked “Yes” indicating 

6

S.S.,Docket No. 18-1488 (issued March 11, 2019). 

7

J.L., Docket No. 18-1804 (issued April12, 2019).

8

See F.U., Docket No. 18-0078 (issued June 6, 2018); Federal (FECA) Procedure Manual, Part 2 --Claims, Fact 

of Injury, Chapter 2.803.4a(6) (August 2012).

9

See supra notes 4 and 5.
5

that the diagnosed condition was caused or aggravated by the reported employment activity. She

noted that appellant was totally disabled, commencing December 4, 2020, and was able to resume 

regular duty on January 4, 2021. In a July 16, 2021 report, Dr. Doss indicated that appellant was 

seen on December 8, 2020 for acute low back pain that developed after lifting a dresser and small 

refrigerator at work. She discussed appellant’s reported course of low back symptoms and noted, 

“[t]his appears to establish a causal relationship between diagnosed condition and the event at 

work.” Dr. Doss diagnosed acute midline low back pain without sciatica. Her reports, however,

only contain a diagnosis of acute midline low back pain without sciatica. As noted above, pain 

alone is a symptom, not a medical diagnosis, and findings of pain or discomfort alone do not satisfy 

the medical aspect of the fact of injury medical determination.10 Therefore, this evidence is also 

insufficient to establish a medical diagnosis in connection with the accepted employment 

incident.

11

 

In a December 31, 2020 report, Ms. Lind, a nurse assigned to appellant by OWCP, detailed 

her interactions with appellant. The Board has held, however, that health care providers such as 

nurses, physician assistants, physical therapists are not considered physicians as defined under 

FECA and their reports do not constitute competent medical evidence. 12 Therefore, this report is 

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

As the medical evidence of record does not contain a medical report relating a diagnosed 

medical condition to the accepted December 4, 2020 employment incident, the Board finds that 

appellant has not met her 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 her burden of proof to establish a diagnosed 

medical condition, causally related to the accepted December 4, 2020 employment incident.

10 See supra note 8.

11 See supra notes 4 and 5.

12 Section 8101(2) of FECA 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). 5 

U.S.C. § 8101(2); 20 C.F.R. § 10.5(t); see Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship,

Chapter 2.805.3a(1) (January 2013); M.M., Docket No. 17-1641 (issued February 15, 2018); K.J., Docket No. 16-

1805 (issued February 23, 2018); P.S, Docket No. 17-0598 (issued June 23, 2017); 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).
6

ORDER

IT IS HEREBY ORDERED THAT the September 20, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 29, 2022

Washington, DC

Alec J. Koromilas, 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