United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.R., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

LOUIS STOKES CLEVELAND VETERANS 

AFFAIRS MEDICAL CENTER, Cleveland, OH, 

Employer

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Docket No. 19-1452

Issued: June 29, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 25, 2019 appellant, through counsel, filed a timely appeal from a June 3, 2019 

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.

 

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.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish a back injury 

causally related to the accepted July 21, 2018 employment incident.

FACTUAL HISTORY

On September 18, 2018 appellant, then a 55-year-old licensed practical nurse, filed a 

traumatic injury claim (Form CA-1) alleging that on July 21, 2018 she injured her low back when 

she fell out of her chair while in the performance of duty. She did not stop work.

In a development letter dated September 28, 2018, OWCP informed appellant that the 

evidence was currently insufficient to support her claim, noting that she had not submitted any 

medical evidence. It advised her of the type of factual and medical evidence needed to establish 

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

submit the necessary evidence.

OWCP subsequently received a report dated August 13, 2018 from an unidentified health 

care provider, who treated appellant for leg/thigh symptoms, insomnia, and acute pain. The health 

care provider prescribed pain medicine and referred her for physical therapy.

In an August 15, 2018 visit summary report, Dr. Andre Cassell, a Board-certified 

physiatrist, noted that he had treated appellant for a lumbar strain and radicular pain of the left 

lower extremity. He continued pain medication and recommended physical therapy and that 

appellant obtain a magnetic resonance imaging (MRI) scan of the lumbar spine. In an after visit 

summary dated September 5, 2018, Dr. Cassell evaluated appellant for left flank pain, 

degenerative arthritis of the lumbar spine, acute bilateral low back pain with left-sided sciatica, 

chronic pain of the left knee, lumbar nerve root disorder, and headache due to trauma. He 

prescribed medications for pain and headaches and recommended a lumbar injection. 

On September 18, 2018 Dr. Jeffrey C. Kirschman, Board-certified in family practice, 

evaluated appellant at the employing establishment’s clinic. He indicated that she had fallen 

backward from a chair on July 21, 2018, hitting a desk with her neck and low back and tangling 

her left leg in the chair. Appellant’s pain had increased on August 9, 2018. Dr. Kirschman noted 

that she had a history of problems with her low back, but was performing full duty at the time of 

the incident. He advised that an MRI scan demonstrated an L3-4 left foraminal disc extrusion 

impinging on the left L3 nerve root. Dr. Kirschman diagnosed a lower back and pelvis contusion, 

a contusion of an unspecified part of the neck, lumbar intervertebral disc disorders with 

radiculopathy, and a strain of the left hip. He asserted that the condition was “work-related per 

history.”

In a September 26, 2018 note, Dr. Cassell advised that appellant would be off work from 

September 26 to October 26, 2018. 

In an October 11, 2018 statement, appellant related that on July 21, 2018 she had stepped 

onto a chair to get a flashlight before making her rounds when she fell backward onto a desk. She 

showed the night nurse manager her bruises, but did not report the incident because she did not 
3

believe that it was serious. Appellant sought treatment from her primary care physician on 

July 31, 2018 and at the emergency room on August 10, 2018. She continued home treatments,

but the pain progressed and she developed left leg numbness. Appellant advised that she was in a 

motor vehicle accident in 2016, but that her injuries had resolved. 

In a narrative report dated October 24, 2018, Dr. Cassell indicated that he had initially 

evaluated appellant on August 15, 2018 for back pain that had begun on July 21, 2018 after a fall 

at work. He advised that she had a history of back pain from a prior June 26, 2018 accident. 

Dr. Cassell reviewed the result so diagnostic testing, including the MRI scan showing a left 

foraminal disc extrusion at L3-4 impinging upon the left L3 nerve. He related, “It is likely that the 

high energy trauma from [appellant’s] fall backwards and subsequent contusion ‘may have’ caused 

[or] precipitated an event that caused or aggravated a preexisting extruded disc in the lumbar spine. 

The extruded disc with compression of part of the dorsal root ganglion could be causing 

[appellant’s] symptoms, including weakness, loss of sensation, and difficult with ambulation.” 

By decision dated October 31, 2018, OWCP denied appellant’s traumatic injury claim,

finding that the medical evidence of record was insufficient to establish that the medical condition 

was causally related to the accepted employment incident. 

Subsequently, OWCP received an October 24, 2018 report from Dr. Jonathan E. Belding, 

a Board-certified orthopedic surgeon. Dr. Belding evaluated appellant for pain radiating into the 

left lower extremity. He recommended a knee injection to determine whether the pain was from 

knee arthritis or stemming from her back. Dr. Belding diagnosed acute bilateral low back pain 

with left sciatica and lumbar facet joint pain.

On November 8, 2018 appellant, through counsel, requested a telephonic hearing before 

an OWCP hearing representative. 

In a progress report dated November 22, 2018, Dr. Cassell discussed appellant’s 

complaints of low back pain radiating into the left leg. He noted that her pain improved with 

injections, but had returned after physical therapy. Dr. Cassell diagnosed lumbar radiculopathy 

due to disc disease. 

In a request for medical documentation form dated December 24, 2018, Dr. Cassell noted 

that appellant was unable to bend, lift, twist, carry objects, or walk for prolonged distances. He 

indicated that the MRI scan demonstrated an extruded disc at L3-4 on which was causing pain and 

weakness in the left leg. Dr. Cassell opined that appellant was moderately-to-severely impaired 

and that it was unclear how long she would be off work due to her injury. He recommended

physical therapy and interventional spinal procedures.

At the telephonic hearing, held on March 18, 2019, appellant described her employment 

history and the treatment received. Counsel advised that he was seeking a supplemental report 

from Dr. Cassell. No further evidence was received.

Thereafter, OWCP received an MRI scan of the lumbar spine dated May 15, 2017 which 

revealed mild multilevel degenerative facet arthrosis. An August 30, 2018 MRI scan of the lumbar 

spine revealed a left foraminal disc extrusion at L3-4 with impingement upon the left L3 nerve 

root.
4

By decision dated June 3, 2019, an OWCP hearing representative affirmed the October 31, 

2018 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 and that the claim was filed within the applicable time 

limitation period of FECA,4that an injury was sustained while in the performance of duty as 

alleged, and that any disability or specific 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 on a traumatic injury or an 

occupational disease.6

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

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

injury consists of two components, which must be considered in conjunction with one another. 

The first component to be established is that the employee actually experienced the employment 

incident which is alleged to have occurred.7 The second component is whether the employment 

incident caused a personal injury and generally can be established only by medical evidence.8

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 of the 

claimant, 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 factors identified by the claimant.9 Neither the mere fact that a disease or condition 

manifests itself during a period of employment, nor the belief that a disease or condition was 

caused or aggravated by employment factors or incidents is sufficient to establish causal 

relationship.10

 

3

Id.

4 See R.B., Docket No. 18-1327 (issued December 31, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 

ECAB 153 (1989).

5 Y.K., Docket No. 18-0806 (issued December 19, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

6 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).

7 R.E., Docket No. 17-0547 (issued November 13, 2018; Elaine Pendleton, 40 ECAB 1143 (1989).

8 D.C., Docket No. 18-1664 (issued April 1, 2019); John J. Carlone, 41 ECAB 354 (1989).

9 H.B., Docket No. 18-0781 (issued September 5, 2018).

10 D.H., Docket No. 18-1410 (issued March 21, 2019).
5

Pursuant to OWCP’s procedures, no development of a claim is necessary where the 

condition reported is a minor one which can be identified on visual inspection by a lay person (e.g.,

burn, laceration, insect sting or animal bite).11 No medical report is required to establish a minor 

condition such as a laceration.12

ANALYSIS

The Board finds that appellant has met her burden of proof to establish back contusions 

causally related to the accepted July 21, 2018 employment incident. The Board further finds, 

however, that appellant has not established that her additional claimed conditions were causally 

related to the accepted July 21, 2018 employment incident.

As a result of the accepted July 21, 2018 employment incident, appellant was treated by 

Drs. Cassell and Kirschman. Both physicians described appellant’s fall backwards from her chair 

and striking her back on that date while in the performance of duty, noted back pain, and diagnosed 

back contusions on physical examination. Both Drs. Cassell and Kirschman concluded that these 

contusions resulted from the July 21, 2018 employment incident.

The Board finds that the history of the accepted July 21, 2018 employment incident 

reported by Drs. Cassell and Kirschman was consistent with appellant’s account, and their 

respective diagnosis of back contusions was visible and consistent with the mechanism of injury. 

As such, the Board finds that this evidence is sufficient to establish that appellant sustained back 

contusions causally related to the accepted February 21, 2019 employment incident.13 Upon return 

of the case record OWCP shall make payment and/or reimbursement of medical expenses and 

wage-loss compensation for disability, if any, with regard to the accepted back contusions.

The Board further finds, however, that the evidence of record is insufficient to establish 

that appellant’s additionally claimed back conditions were causally related to the accepted July 21, 

2018 employment incident.

On October 24, 2018 Dr. Cassell discussed appellant’s history of back pain beginning on 

July 21, 2018 after a fall at work. He noted that she had a prior injury to her back. Dr. Cassell 

opined that appellant’s fall and contusion “may have” caused or aggravated a preexisting extruded 

disc due to impact from her backward fall. He indicated that the compressing of the dorsal root 

from the extruded disc could result in her symptoms of reduced sensation, difficulty walking, and 

weakness. Dr. Cassell’s finding that it was “likely” that appellant’s backward fall caused or 

aggravated the extruded lumbar disc is couched in speculative terms. The Board has held that,

 

11 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Initial Development of Claims, Chapter 2.800.6(a) 

(June 2011).

12 Id., see I.H., Docket No. 19-1678 (issued April 21, 2020) (the Board accepted abrasions as causally related to the 

accepted employment incident).

13 Supra notes 10 and 11. 
6

medical opinions that are speculative or equivocal are of diminished probative value and, thus, this 

report is insufficient to meet her burden of proof to establish her claim.

14

In a report dated September 18, 2018, Dr. Kirschman discussed appellant’s history of 

falling backward off a chair on July 21, 2017 striking her neck and low back on a desk. He 

diagnosed a lower back and pelvis contusion, a contusion of an unspecified part of the neck, lumbar 

intervertebral disc disorders with radiculopathy, and a strain of the left hip. Dr. Kirschman 

indicated that appellant’s condition was related to her employment by history. While he found 

that her condition was related to the incident by history, he failed to make an independent finding 

regarding causation.15 Without providing an independent opinion explaining how physiologically 

the movements involved in the accepted employment incident caused or contributed to the 

diagnosed condition, his opinion is of little probative value.16

The remaining medical evidence fails to address causal relationship. In an August 15, 2018 

visit summary report, Dr. Cassell noted treating appellant for a lumbar strain and radicular pain of 

the left lower extremity. In the September 5, 2018 after visit summary, he evaluated appellant for 

left flank pain, degenerative arthritis of the lumbar spine, acute bilateral low back pain with leftsided sciatica, chronic pain of the left knee, lumbar nerve root disorder, and headache due to 

trauma. On September 26, 2018 Dr. Cassell advised that appellant should not work from 

September 26 to October 26, 2018. On October 24, 2018 Dr. Belding diagnosed acute bilateral 

low back pain with left sciatica and lumbar facet joint pain. In a November 22, 2018 progress 

report, Dr. Cassell diagnosed lumbar radiculopathy due to disc disease. In a December 24, 2018 

form report, he found that appellant had an extruded L3-4 disc by MRI scan causing left leg pain 

and weakness. Dr. Cassell determined that she had a moderate-to-severe impairment. Although 

these physicians diagnosed various back conditions, neither physician, however, addressed the 

cause of the diagnosed conditions or disability. The Board has held that medical evidence that 

does not offer any opinion regarding the cause of an employee’s condition or disability is of no

probative value on the issue of causal relationship.17 As Drs. Cassell and Belding did not address 

the issue of causal relationship between the diagnosed back conditions and the accepted July 21, 

2018 employment incident, their reports are of no probative value and are, therefore, insufficient 

to establish appellant’s claim.

Appellant submitted MRI scans of the lumbar spine dated May 15, 2017 and 

August 30, 2018. The Board has explained that diagnostic studies, standing alone, lack probative 

value as they do not address whether the employment incident caused any of the diagnosed 

conditions.18 

 

14 V.W., Docket No. 19-1537 (issued May 13, 2020); K.M., Docket No. 19-1483 (issued February 6, 2020).

15 T.S., Docket No. 18-1501 (issued March 4, 2019).

16 Id.; see also A.B., Docket No. 18-0577 (issued October 10, 2018).

17 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018). 

18 N.B., Docket No. 19-0221 (issued July 15, 2019). 
7

As appellant has not submitted rationalized medical evidence establishing a causal 

relationship between her additional claimed back conditions and the accepted July 21, 2018

employment incident, the Board finds that she has not met her burden of proof to establish her 

claim.

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 met her burden of proof to establish back contusions 

causally related to the accepted July 21, 2018 employment incident. The Board further finds, 

however, that appellant has not established additional claimed back conditions causally related to 

the accepted February 21, 2019 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the June 3, 2019 decision of the Office of Workers’

Compensation Programs is reversed in part and affirmed in part.

Issued: June 29, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board