United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.R., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Harrisburg, PA, Employer

__________________________________________

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Docket No. 22-0921

Issued: December 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

JANICE B. ASKIN, Judge

JURISDICTION

On May 26, 2022 appellant filed a timely appeal from a March 9, 2022 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.2

ISSUE

The issue is whether appellant has met her burden of proof to establish a medical condition 

causally related to the accepted February 24, 2021 employment incident.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the March 9, 2022 decision, OWCP received additional evidence. However, the 

Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that 

was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board 

for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional 

evidence for the first time on appeal. Id.
2

FACTUAL HISTORY

On March 3, 2021 appellant, then a 59-year-old letter carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on February 24, 2021 she injured her right leg, knee, shoulders, back 

and neck when she slipped and fell, while delivering a parcel in the performance of duty. 

In a February 26, 2021 return-to-work note, Shannon Bocchino, a physician assistant, 

noted a February 24, 2021 date of injury and provided work restrictions of no work over eight

hours and no overtime work.

In a March 10, 2021 development letter, OWCP notified appellant of the deficiencies of 

her claim. It advised her of the type of additional factual and medical evidence needed and 

provided a questionnaire for her completion. OWCP afforded appellant 30 days to submit the 

necessary evidence.

OWCP received February 26, 2021 progress notes from Ms. Bocchino, who noted 

appellant’s complaints of right leg pain, right hip pain, and lumbar pain. Ms. Bocchino reviewed 

February 26, 2021 x-rays of appellant’sright femur and right hip and found no evidence of fracture 

or other acute osseous abnormality. 

OWCP also received February 26, 2021 x-rays of the lumbar spine, read by Dr. Matthew 

Winfield, a Board-certified diagnostic radiologist, which revealed multilevel degenerative 

changes.

In a March 15, 2021 response to OWCP’s development questionnaire, appellant related 

that on the date of injury she exited her mail truck, started to walk, and slipped on ice which was 

under snow in a driveway. She noted that she had on proper snowshoes. Appellant asserted that 

she had reported her injury to her postmaster and continued to work until she had x-rays taken two 

days later. She noted that she had no symptoms prior to this accident.

In a March 25, 2021 report, Dr. Colin C. Heinle, a Board-certified orthopedic surgeon, 

indicated that appellant could return to work on March 26, 2021 with shifts limited to eight hours

per day. 

In progress notes dated March 25, 2021, Dr. Heinle noted that appellant presented with 

right lumbar, hip, and thigh pain, with a February 24, 2021 date of onset. He noted appellant’s 

history of primary osteoarthritis involving multiple joints; rotator cuff tendonitis on the left;

primary osteoarthritis of the left knee; left medial knee pain; history of total left knee arthroplasty;

traumatic complete tear of right rotator cuff, subsequent encounter;S/P(supraspinatus)rotator cuff 

repair; complete tear of right rotator cuff; biceps tendinitis of right shoulder;shoulder stiffness,

right; shoulder effusion, right; orthopedic aftercare; tear of right supraspinatus tendon; chronic left 

shoulder pain; biceps tendinitis of left upper extremity; and primary osteoarthritis of right knee.

Dr. Heinle related that appellant was approximately one month status post fall at work, with lower 

back pain and sacroiliac joint pain. He recommended physical therapy.

In a March 25, 2021 attending physician’s report (Form CA-20), Dr. Heinle noted that 

appellant had significant pain at the right sacroiliac joint and diagnosed right sacroiliac 

dysfunction. He checked a box marked “Yes” to indicate that the condition was caused or 
3

aggravated by an employment activity and checked a box “No” to indicate that appellant did not 

have a preexisting injury or disease.

In an April 7, 2021 report, Dr. Brandon Eck, an osteopath Board-certified in family 

practice, noted that appellant was seen for right sacroiliac joint and ligaments complaints. He 

administered an injection.

By decision dated April 14, 2021, OWCP denied appellant’s claim. OWCP found that the 

medical evidence of record was insufficient to establish a medical condition causally related to the 

accepted work incident. 

OWCP received a copy of an April 7, 2021 disability certificate from Dr. Eck who advised 

that appellant was unable to return to work until April 9, 2021. Dr. Eck noted that appellant had 

undergone a guided-needle placement procedure. 

In an April 22, 2021 Form CA-20, Dr. Heinle provided a history of injury as a fall on ice 

at work. He diagnosed right sacroiliac joint dysfunction and checked a box marked “Yes”

indicating that the condition was caused or aggravated by an employment activity. Dr. Heinle

noted that “[t]he condition was a direct result of injury sustained at work February 24, 2021.”

On April 23, 2021 appellant requested a review of the written record by a representative of 

OWCP’s Branch of Hearings and Review.

OWCP received April 21, May 5, 12, and 25, and June 2, 2021 physical therapy notes and 

an April 21, 2021 note from a physician assistant.

In a May 5, 2021 report, Dr. Matthew Culp, Board-certified in family practice, noted that 

he administered an injection to the right hip. He also saw appellant on June 8, 2021 and

recommended a magnetic resonance imaging (MRI) scan of the lumbar spine.

A June 22, 2021 MRI scan of the lumbar spine read by Dr. Alex Feinstein, a Boardcertified diagnostic radiologist, revealed multilevel degenerative changes, mild-to-moderate 

central canal stenosis at L4-L5, borderline central canal narrowing at L3-L4, annular bulges at L2-

L3 through L4-L5, and a small disc protrusion on the right at T12-L1. 

By decision dated July 16, 2021, OWCP’s hearing representative modified the April 14, 

2021 decision to find that the claim was denied as the medical evidence of record was insufficient 

to establish a medical diagnosis in connection with the accepted employment incident, rather than 

causal relationship. 

On January 4, 2022 appellant requested reconsideration. She noted that she requested 

“heartfelt” consideration, as she suffered an on-the-job fall in February 2021 and extreme,

excruciating back pain. Appellant denied having a history of back problems. 

A July 26, 2021 bone scan of the lumbar spine demonstrated moderate degenerative facet 

uptake on the right at L4-L5 and mild degenerative facet uptake on the right at L3-L4 and on the 

left at L5-S1.
4

OWCP received reports dated July 20, September 21, and October 26, 2021, and 

January 26, 2022 from Dr. Jackson Liu, Board-certified in physical medicine and rehabilitation. 

Dr. Liu noted a history of a fall on ice on February 24, 2021 and opined that this was work related.

He also noted that appellant had no prior symptoms or treatment and provided diagnoses of 

osteoarthritis of the lumbar spine with radiculopathy, spinal stenosis of the lumbar region with 

neurogenic claudication, displacement of the lumbar disc with radiculopathy, and spondylosis of 

the lumbar region without myelopathy or radiculopathy.

August 16, 2021 hospital records indicated appellant’s diagnoses as osteoarthritis of the 

spine with radiculopathy of the lumbar region and lumbar spondylosis. 

October 7, 2021 hospital records noted that appellant underwent an epidural injection for 

lumbar disc disorder with radiculopathy of the lumbar region.

OWCP received November 11, 2021 hospital records, noting that appellant underwent a 

lumbar facet injection for spondylosis without myelopathy or radiculopathy of the lumbosacral 

region.

By decision dated March 9, 2022, OWCP modified the July 16, 2021 decision to find that

the medical evidence of record was sufficient to establish a medical diagnosis in connection with 

the accepted employment incident. However, the claim remained denied as the medical evidence 

of record was insufficient to establish causal relationship between the diagnosed condition(s) and 

the accepted employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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,4that 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.5 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.6

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. The first component is that the 

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

3

Supra note 1.

4

See R.P., Docket No. 21-0477 (issued July 19, 2022); F.H., Docket No.18-0869 (issued January 29, 2020); J.P., 

Docket No. 19-0129 (issued April26, 2019); Joe D. Cameron, 41 ECAB 153 (1989).

5 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).

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

DeloresC. Ellyett, 41 ECAB 992 (1990).
5

employment incident at the time and 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.7

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

condition and an employment incident is rationalized medical opinion evidence. 8 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.9

In any 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.10

ANALYSIS

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

condition causally related to the accepted February 24, 2021 employment incident.

In support of her claim, appellant submitted several medical reports from Dr. Heinle. In a 

March 25, 2021 report, he indicated that appellant could return to work on March 26, 2021 with 

restrictions of shifts limited to eight hours. In progress notes dated March 25, 2021, Dr. Heinle 

noted that appellant presented with right lumbar, hip, and thigh pain, with a February 24, 2021 

date of onset. He also related that appellant was approximately one month status post fall at work, 

with lower back pain and sacroiliac joint pain. However, Dr. Heinle did not provide an opinion

on causal relationship. The Board has held that reports that do not provide an opinion on causal 

relationship are of no probative value.

11

 Therefore, this evidence is insufficient to establish this 

claim.

In a March 25, 2021 Form CA-20 attending physician’s report, Dr. Heinle noted that 

appellant had significant pain at the right sacroiliac joint and diagnosed right sacroiliac 

dysfunction. He checked the box “Yes” to indicate that the condition was caused or aggravated 

by an employment activity. The Board has held that a physician’s opinion on causal relationship 

7 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).

8

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

9 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).

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

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

11L.B., Docket No. 18-0533 (issued August27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
6

that consists only of checking a box marked “Yes”in response to a form question, without rationale 

explaining causal relationship, has limited probative value and is insufficient to establish a claim.12 

Therefore, his report is insufficient to establish the claim.

In an April 22, 2021 Form CA-20, Dr. Heinle diagnosed right sacroiliac joint dysfunction 

and checked a box marked “Yes” to indicate that the condition was caused or aggravated by 

appellant’s federal employment. He provided a history of injury as a fall on ice at work and 

explained “[t]he condition was a direct result of injury sustained at work February 24, 2021.” 

While Dr. Heinle opined that appellant’s right sacroiliac joint dysfunction condition was caused 

by the work incident, he failed to provide a rationalized medical opinion supporting causation. 

The Board has held that a medical opinion should offer a medically-sound and rationalized 

explanation by the physician of how the specific employment incident physiologically caused or 

aggravated the diagnosed conditions.13 Medical evidence which does not explain the nature of the 

relationship between the diagnosed condition and the specific employment incident is insufficient 

to meet the claimant’s burden of proof.14 As such, this report from Dr. Heinle are insufficient to 

meet appellant’s burden of proof.

Appellant also submitted reports from Dr. Liu dated July 20, September 21, and 

October 26, 2021 and January 26, 2022. Dr. Liu noted a history of a fall on ice on February 24, 

2021 and opined that it was work related. However, he did not provide rationale explaining his 

conclusory opinion. The Board has held that a medical opinion is of limited probative value if it 

is conclusory in nature.15 Additionally, the Board has held that a well-rationalized opinion is 

particularly warranted when there is a history of preexisting conditions, as in this case.16 

Consequently, Dr. Liu’s reports are insufficient to establish appellant’s claim.

In an April 7, 2021 report, Dr. Eck noted that appellant was seen for right sacroiliac joint 

and ligaments and provided an injection under local anesthesia. An April 7, 2021 disability 

certificate from Dr. Eck advised that appellant was unable to return to work until April 9, 2021, 

and noted that he provided a guided-needle placement procedure. Dr. Eck, however, did not 

provide an opinion on causation. As previously noted, a report which does not offer an opinion 

regarding causal relationship is insufficient to establish the claim.17

12 J.K., Docket No. 20-0527 (issued May 24, 2022); J.K., Docket No. 20-0590 (issued July 17, 2020); J.A., Docket 

No. 17-1936 (issued August 13, 2018); DonaldW. Long, 41 ECAB 142 (1989); LillianM. Jones, 34 ECAB 379, 

381 (1982).

13 See V.D., Docket No. 20-0884 (issued February 12, 2021); Y.D., Docket No. 16-1896 (issued February10, 2017).

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

Victor J. Woodhams, supra note 9.

15 See R.B., Docket No. 19-1527 (issued July 20, 2020); R.S., Docket No. 19-1774 (issued April3, 2020).

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

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

17 Supra note 11. 
7

A May 5, 2021 report from Dr. Culp noted that he had provided appellant with a right hip 

injection and recommended an MRI scan of the lumbar spine; however, he did not provide a 

diagnosis or opinion on causation. Dr. Culp’s report is, therefore, insufficient to establish causal 

relationship.18

OWCP received August 16, 2021 hospital records with diagnoses of osteoarthritis of the 

spine with radiculopathy of the lumbar region and lumbar spondylosis; October 7, 2021 hospital 

records noting that appellant underwent an epidural injection for lumbar disc disorder with 

radiculopathy of the lumbar region; and November 11, 2021 hospital records noting that appellant 

underwent a lumbar facet injection for spondylosis without myelopathy or radiculopathy of the 

lumbosacral region. As noted above, medical reports which do not offer an opinion on causal 

relationship are of no probative value and, thus, are insufficient to establish appellant’s claim.19

OWCP received February 26 and April 21, 2021 physician assistant notes and April 21, 

May 5, 12, and 25, and June 2, 2021 physical therapy notes. Physician assistants and physical 

therapists, however, are not considered physicians as defined under FECA.20 Consequently, their 

medical findings and/or opinions will not suffice for purposes of establishing entitlement to FECA 

benefits.21

The record also contains diagnostic studies including February 26, 2021 x-rays of the right 

femur and right hip, a June 22, 2021 MRI of the lumbar spine, and a July 26, 2021 bone scan of 

the lumbar spine. The Board has held that diagnostic studies, standing alone, lack probative value 

as they do not address whether the employment incident caused any of the diagnosed conditions.22

As the medical evidence of record is insufficient to establish causal relationship between 

her diagnosed medical conditions and the accepted February 24, 2021 employment incident, the 

Board finds that she 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.

18 Id. 

19 Id.

20 Section 8101(2) of FECA provides that 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). SeeFederal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship,Chapter 2.805.3a(1) 

(January2013); DavidP. 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 P.D., Docket 

No. 21-0920 (issued January 12, 2022).

21 Id.

22 R.O., Docket No. 20-1243 (issued May 28, 2021); V.L., Docket No. 20-0884 (issued February 12, 2021).
8

CONCLUSION

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

condition causally related to the accepted February 24, 2021 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the March 9, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: December 29, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board