United States Department of Labor

Employees’ Compensation Appeals Board

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G.D., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

U.S. IMMIGRATION AND CUSTOMS 

ENFORCEMENT, Broadview, IL, Employer

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Docket No. 22-0555

Issued: November 18, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 4, 2022 appellant filed a timely appeal from a December 8, 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 his burden of proof to establish a medical condition 

causally related to the accepted October 25, 2021 employment incident.

FACTUAL HISTORY

On October 27, 2021 appellant, then a 46-year-old general inspection, investigation, and 

compliance officer, filed a traumatic injury claim (Form CA-1) alleging that on October 25, 2021 

1

5 U.S.C. § 8101 et seq.
2

he sustained neck and back injuries after his vehicle was struck on the driver’s side door by another 

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

In a development letter dated November 4, 2021, OWCP advised appellant of the type of 

factual and medical evidence needed and provided a questionnaire for his completion. By separate 

letter of the same date, OWCP also requested additional information from the employing 

establishment. It afforded both parties 30 days to respond.

OWCP subsequently received an October 25, 2021 authorization for examination and/or 

treatment (Form CA-16), wherein the employing establishment authorized appellant to seek 

medical care. In Part B of that Form CA-16, attending physician’s report, a healthcare provider

with an illegible signature reported that appellant sustained a whiplash injury as a result of an 

automobile accident at work. The healthcare provider diagnosed whiplash. The healthcare 

provider also checked a box marked “No” indicating that the diagnosed condition was not caused 

or aggravated by the October 25, 2021 employment activity. Appellant was returned to regular 

duty on October 26, 2021.

OWCP also received additional factual evidence.

By decision dated December 8, 2021, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence submitted was insufficient to establish causal relationship 

between his diagnosed condition and the accepted October 25, 2021 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 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,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 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

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. First, 

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

2

Id.

3 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989).

4 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).

5 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).
3

employment incident at the time and place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 6

The medical evidence required to establish a causal relationship is rationalized medical 

opinion evidence.7 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 incident identified by the employee.8

ANALYSIS

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

condition causally related to the accepted October 25, 2021 employment incident.

In support of his claim, appellant submitted Part B of a Form CA-16, which contained an 

illegible signature and a diagnosis of whiplash. The Board has held that medical evidence 

containing an illegible signature, or which is unsigned has no probative value, as it is not 

established that the author is a physician.9 As such, this evidence is insufficient to establish the 

claim.

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

medical condition and the accepted October 25, 2021 employment incident, the Board finds that 

appellant 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.

6 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

7

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).

8 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).

9

See T.C., Docket No. 21-1123 (issued April5, 2022); Z.G., 19-0967 (issued October 21, 2019); see R.M., 59 

ECAB 690 (2008); MertonJ. Sills, 39 ECAB 572, 575 (1988); Bradford L. Sullivan, 33 ECAB 1568 (1982).
4

CONCLUSION

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

condition causally related to the accepted October 25, 2021 employment incident.10

ORDER

IT IS HEREBY ORDERED THAT the December 8, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 18, 2022

Washington, DC

Patricia H. Fitzgerald, 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

10 The Board notes that the employing establishment issued a Form CA-16. A completed Form CA-16 authorization 

may constitute a contract for payment of medical expenses to a medical facility or physician, when properly executed.

The form creates a contractual obligation, which does not involve the employee directly, to pay for the cost of the 

examination or treatment regardless of the action taken on the claim. See 20 C.F.R. § 10.300(c); J.G.,Docket No. 17-

1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB 608 (2003).