United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.P., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Highland, NY, Employer

__________________________________________

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Docket No. 21-0936

Issued: April 12, 2022

Appearances: Case Submitted on the Record

Thomas S. Harkins, Esq., for the appellant1

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 June 7, 2021 appellant, through counsel, filed a timely appeal from a January 21, 2021 

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.3

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.

3 The Board notes that, following the January 21, 2021 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidencein 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

ISSUE

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

causally related to the accepted October 27, 2019 employment incident.

FACTUAL HISTORY

On October 27, 2019 appellant, then a 58-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that, on that day, she injured her low back when she lifted a 

package while in the performance of duty. She stopped work at the time of the alleged injury.

W.F., appellant’s supervisor, completed and signed an authorization for examination 

and/or treatment (Form CA-16) on October 27, 2019. OWCP also received an official position 

description, noting that appellant’s duties required loading and sorting mail.

In a development letter dated November 5, 2019, OWCP advised appellant of the 

deficiencies of her claim. It advised her as to the type of additional factual and medical evidence 

required and provided a questionnaire for her completion. OWCP afforded appellant 30 days to 

respond.

In response, appellant submitted a completed development questionnaire signed on 

November 8, 2019. She explained that on October 27, 2019 she had unloaded pallets of parcels 

from an online retailer. While sorting the packages, appellant lifted a large, heavy box and felt a 

stabbing pain in her spine. She could no longer bend her back or knees. Appellant reported the 

incident to her supervisor, who called an ambulance to transport appellant to a hospital. At the 

hospital, she was given an analgesic injection, oral medication, and lidocaine patches. A physician 

held appellant off work for three days. Appellant obtained a November 5, 2019 appointment with

Dr. Karl Ziermann, an osteopathic physician Board-certified in internal medicine, who obtained 

x-rays and held her off work for one month to undergo physical therapy and pain management. 

She noted that she had no history of back problems prior to the October 27, 2019 incident. 

Appellant submitted additional evidence. 

In an October 27, 2019 report, Dr. Matthew Stupple, Board-certified in emergency 

medicine, held appellant off work for three days. Hospital emergency department discharge 

instructions indicated a provisional diagnosis of sciatica. 

In a December 6, 2019 report, Dr. Richard Dentico, Board-certified in sports medicine, 

provided a history of the October 27, 2019 employment incident. On examination, he observed 

limited lumbar range of motion, and tenderness to palpation of the lumbar paraspinals. Dr. Dentico 

diagnosed acute low back pain, lumbar spondylosis, and sacroiliac joint dysfunction. He 

prescribed medication and physical therapy. 

By decision dated December 11, 2019, OWCP accepted that the October 27, 2019 

employment incident occurred, as alleged, but denied appellant’s claim as causal relationship had 

not been established between the diagnosed medical conditions and the accepted employment 

incident. It concluded, therefore, that the requirements had not been met to establish an injury or 

condition causally related to the accepted October 27, 2019 employment incident. 
3

On November 18, 2020 appellant, through counsel, requested reconsideration. Counsel

submitted additional medical evidence that he contended was sufficient to establish causal 

relationship between the accepted October 27, 2019 employment incident and the diagnosed 

lumbar conditions. 

In an October 27, 2019 report, Alison Marques, a paramedic, noted that appellant related 

that she experienced severe, sudden sacral pain while at work after lifting a package then bending 

forward. Appellant was transported to a hospital emergency department. 

In reports dated October 27, 2019, Dr. Stupple related appellant’s account of the onset of 

severe, sudden low back pain with radiation to the sacrum/coccyx and right posterior leg after 

bending to lift something while at work. On examination, he observed pain originating in her

back, reproducible with motion. Dr. Stupple stated an impression of right-sided sciatica, and a 

strain of the muscle, fascia, and tendons of the lower back. 

In November 5, 2019 reports, Dr. Ziermann provided a history of the October 27, 2019 

employment incident and treatment. On examination, he observed limited lumbar motion, 

bilaterally limited hip motion, and back pain with straight leg testing. Dr. Ziermann obtained 

x-rays of the lumbar spine, which demonstrated slight scoliosis with degenerative disc disease. He 

diagnosed acute back pain, lumbar spondylosis, and sacroiliac joint dysfunction. Dr. Ziermann

prescribed medication and physical therapy.

In a November 22, 2019 report, on the attending physician’s report, Part B of Form CA16, Dr. Ziermann diagnosed lumbar spondylosis causally related to the October 27, 2019 

employment incident. He checked a box indicating his support for causal relationship, and noted 

that appellant had “bent down to lift up a package and developed acute onset pain” requiring 

hospital treatment. Dr. Ziermann held her off work. 

In a December 10, 2019 work capacity evaluation for musculoskeletal conditions (Form 

OWCP-5c), Dr. Dentico diagnosed sacroiliac joint dysfunction. He held appellant off work until 

January 15, 2020. 

In a report dated August 6, 2020, Dr. Ziermann diagnosed acute low back pain, lumbar 

spondylosis, and sacroiliac joint dysfunction. He opined that it was reasonable thatthe October 27, 

2019 employment incident “could cause” acute low back pain and sacroiliac joint dysfunction.

Dr. Dentico, in an August 17, 2020 report, noted that appellant reported symptomatic relief 

after a lumbar medial branch block injection. He diagnosed lumbar degenerative disc disease, 

lumbar foraminal stenosis, and lumbar spondylosis. 

In an October 22, 2020 report, Dr. Dentico noted that appellant’s lumbar condition was 

related to the October 27, 2019 employment incident. He returned her to full duty as she was 

asymptomatic and her lumbar pain was managed with activity modification. 

By decision dated January 21, 2021, OWCPdenied modification of the December 11, 2019 

decision.
4

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 FECA, that the claim was timely filed within the applicable time 

limitation period of FECA,5that 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.6 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.7

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it must first be determined whether a 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 

employment incident at the time and place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury.8

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

condition and an employment incident is rationalized medical opinion evidence.9 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.10

ANALYSIS

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

condition causally related to the accepted October 27, 2019 employment incident.

In reports dated October 27, 2019, Dr. Stupple related appellant’s account of the onset of 

severe, sudden low back pain with sacral and right lower extremity radicular symptoms after 

4

Supra note 2.

5 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).

6 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).

7 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).

8 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).

9

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).

10 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).
5

bending to lift something while at work. He noted findings on examination and stated an 

impression of right-sided sciatica, and a strain of the muscle, fascia, and tendons of the lower back. 

However, Dr. Stupple offered no opinion on causal relationship in these reports. Medical evidence 

that fails to address causation is of no probative value on that issue.11 Therefore, the Board finds 

that the October 27, 2019 medical reports from Dr. Stupple are insufficient to establish causal 

relationship.

Appellant submitted an October 27, 2019 report by Ms. Marques, a paramedic, who related 

appellant’s account of severe, sudden sacral pain after lifting a package and bending forward while 

at work. This report is insufficient to establish appellant’s entitlement to FECA benefits. The 

Board has held that certain healthcare providers such as physician assistants and paramedics are 

not considered physicians as defined under FECA and, thus, are not competent to render medical 

opinions.12 Consequently, their medical findings and/or opinions will not suffice for purposes of 

establishing entitlements to FECA benefits. 

Dr. Ziermann treated appellant beginning on November 5, 2019. He provided a consistent 

history of injury in his reports through August 6, 2020. In his November 22, 2019 report,

Dr. Ziermann attributed appellant’s lumbar spondylosis and sacroiliac joint dysfunction to bending 

to lift a package on October 27, 2019. He opined in an August 6, 2020 report that it was reasonable 

that the October 27, 2019 employment incident “could cause” sacroiliac joint dysfunction and the 

onset of acute low back pain. An opinion that it is reasonable that the October 27, 2019 

employment incident could cause the diagnosed lumbar spondylosis and sacroiliac joint 

dysfunction is speculative in nature. The Board has held that medical opinions that are speculative 

and equivocal are of diminished probative value.13 Dr. Ziermann’s reports, therefore, are 

insufficient to meet appellant’s burden of proof.

Dr. Dentico, in reports dated from December 6, 2019 through October 22, 2020, provided 

an accurate history of the October 27, 2019 employment injury. He diagnosed sacroiliac joint 

dysfunction and lumbar degenerative disc disease. Dr. Dentico opined in his October 22, 2020 

report that appellant’s lumbar condition was attributable to the October 27, 2019 employment 

incident. While he discussed the October 27, 2019 employment incident, he did not offer a 

rationalized medical opinion explaining how that incident caused appellant’s diagnosed 

conditions.14 Dr. Dentico did not explain how lifting a package then bending forward while at 

11 C.G., Docket No. 20-0957 (issued January27, 2021); L.G., Docket No. 20-0433 (issued August6, 2020); S.D., 

Docket No. 20-0413 (July 28, 2020); S.K., Docket No. 20-0102 (issued June12, 2020); L.B., Docket No. 18-0533 

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

12 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); 20 C.F.R. § 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013);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 J.S., Docket No. 18-1085 (issued, February 12, 2019).

13 C.M., Docket No. 21-0435 (issued October 22, 2021); S.O., Docket No. 21-0002 (issued April29, 2021); H.A., 

Docket No. 18-1455 (issued August23, 2019); Samuel Senkow, 50 ECAB370(1999).

14 J.N., Docket No. 21-0606 (issued November 23, 2021); T.W., Docket No. 20-0767 (issued January 13, 2021);

see H.A., Docket No. 18-1466 (issued August 23, 2019); L.R., Docket No. 16-0736 (issued September 2, 2016).
6

work would have caused or contributed to sacroiliac joint dysfunction and lumbar degenerative 

disc disease. The Board has held that a medical opinion should reflect a correct history and offer 

a rationalized explanation by the physician of how the specific employment incident 

physiologically caused or aggravated the diagnosed conditions. 15 Dr. Dentico’s reports are, 

therefore, of limited probative value and insufficient to establish causal relationship. 16

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

appellant’s diagnosed medical conditions and the accepted factors of her federal employment, 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.

CONCLUSION

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

condition causally related to the accepted October 27, 2019 employment incident.17

15 T.G., Docket No. 21-0175 (issued June 23, 2021); J.D.,Docket No. 19-1953 (issued January 11, 2021); see K.W.,

Docket No. 19-1906 (issued April1, 2020).

16 Id.

17 The Board notes that the employing establishment issued a Form CA-16, dated October 27, 2019. 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); V.S.,Docket No. 20-1034 (issued November 25, 2020); J.G.,Docket No. 17-1062 (issued February 13, 

2018); Tracy P. Spillane, 54 ECAB 608 (2003).
7

ORDER

IT IS HEREBY ORDERED THAT the January 21, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: April 12, 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