United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.B., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

BALTIMORE VETERANS ADMINISTRATION 

MEDICAL CENTER, Baltimore, MD, Employer

__________________________________________

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Docket No. 19-0643

Issued: September 6, 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

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On January 28, 2019 appellant filed a timely appeal from a January 7, 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 her burden of proof to establish a diagnosed medical 

condition causally related to the accepted October 29, 2018 employment incident.

FACTUAL HISTORY

On November 1, 2018 appellant, then a 37-year-old food service worker, filed a traumatic 

injury claim (Form CA-1) alleging that, on October 29, 2018, she injured her back when she 

 

1 5 U.S.C. § 8101 et seq.
2

slipped and fell on a sticky grease mat while in the performance of duty. On the reverse side of 

the claim form the employing establishment indicated that appellant stopped work on that day and 

returned to work on October 30, 2018. It also checked the box marked “No” when asked whether 

appellant was injured in the performance of duty. 

In a development letter dated November 26, 2018, OWCP informed appellant that 

additional factual and medical evidence was necessary to establish her claim, and provided a 

questionnaire for her completion. It afforded her 30 days to submit the necessary evidence. In a 

separate development letter of even date, OWCP advised the employing establishment of 

appellant’s claim, and requested additional information regarding the circumstances surrounding 

appellant’s alleged injury. It afforded the employing establishment 30 days to submit the requested 

information. 

In a supplemental statement dated December 4, 2018, appellant recounted that she was 

walking in the employing establishment kitchen near the fryers when a mat stuck to her shoe, she 

fell forward on the mat, and landed on her knees and stomach. She indicated that a coworker 

helped her off the floor and she returned to work, but she then felt pain in her knees and in the

lower right part of her back and she sought medical treatment. 

In a report dated December 7, 2018, Dr. Joyce Evans, Board-certified in family medicine, 

noted that she examined appellant on November 6 and 20, 2018. She also noted that x-rays of 

appellant’s lumbar spine and right knee dated November 30, 2018 revealed minimal spondylosis 

and some degenerative changes to her right knee, but no evidence of fracture. Dr. Evans further 

related that appellant’s knee pain resolved by her November 6, 2018 encounter, but she still 

continued to experience significant back pain. She diagnosed back spasm and ongoing back pain, 

and opined that appellant’s fall at work caused her back injury. 

By decision dated January 7, 2019, OWCP denied appellant’s claim finding that she had 

not submitted medical evidence containing a medical diagnosis in connection with the accepted 

October 29, 2018 employment incident. 

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 timely filed within the applicable 

time limitation period 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 

 

2

Id.

3 See M.C., Docket No. 18-1278 (issued March 7, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P.,

59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
3

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

In order to determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, OWCP must first determine whether fact of injury has been established.6 

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.7 Second, the employee must submit evidence to establish 

that the employment incident caused a personal injury.8

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

relationship is rationalized medical evidence.9 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.10

ANALYSIS

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

medical condition causally related to the accepted October 29, 2018 employment incident.

In support of her claim, appellant submitted a report dated December 7, 2018 from

Dr. Evans who indicated that appellant had back spasms and ongoing back pain. The Board has 

held that a muscle spasm is a symptom and not a compensable medical diagnosis.11 Likewise, the 

Board has held that pain is a symptom, not a diagnosis.12 A medical report is of no probative value 

if it does not provide a firm diagnosis of a particular medical condition, or offer a specific opinion 

as to whether the accepted employment incident caused or aggravated the claimed condition.13 As

 

4

J.P., Docket No. 19-0197 (issued June 21, 2019); J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 

ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).

5

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

2014); Delores C. Ellyett, 41 ECAB 992 (1990).

6 D.B., Docket No. 18-1359 (issued May 14, 2019); S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 

172 (2005).

7 D.B., id.; Elaine Pendleton, 40 ECAB 1143 (1989).

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

9 C.W., Docket No. 19-0231 (issued July 15, 2019).

10 D.B., supra note 6; S.S., Docket No. 18-1488 (issued March 11, 2019).

11 See T.J., Docket No. 18-1500 (issued May 1, 2019); see also J.G., Docket No. 17-1382 (issued October 18, 2017).

12 D.B., supra note 6; E.M., Docket No. 18-1599 (issued March 7, 2019).

13 T.J., supra note 11; C.M., Docket No. 18-0146 (issued August 16, 2018).
4

Dr. Evans did not diagnose an actual medical condition causing appellant’s symptoms, her report 

lacks probative value and is insufficient to establish appellant’s claim.14

The Board finds that appellant has not submitted rationalized, probative medical evidence 

sufficient to establish a diagnosed medical condition causally related to her accepted employment 

incident of October 29, 2018.15 Appellant, therefore, 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 October 28, 2019 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the January 7, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 6, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

 

14 T.J., supra note 11; see D.K., Docket No. 17-1186 (issued June 11, 2018).

15 Supra note 10.