United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Pomona, CA, Employer

__________________________________________

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Docket No. 21-1431

Issued: May 2, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 30, 2021 appellant filed a timely appeal from an August 4, 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 her burden of proof to establish a cervical condition 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On May 14, 2019 appellant, then a 54-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained problems with her neck causally related to factors 

of her federal employment. She noted that she first became aware of her condition and realized 

1

5 U.S.C. § 8101 et seq.
2

its relation to her federal employment on March 13, 2019. Appellant attributed her condition to 

performing repetitive work for the past 28 years. 

In a statement dated May 1, 2019, appellant related that her neck symptoms had begun 

around 2011 and had progressively worsened since March 2019. She further related that returning 

to full-time employment and performing duties such as casing mail, driving, and delivering mail 

had aggravated her neck condition. 

In a December 19, 2016 work status report, Dr. Lisa Jung Sook Choi-Flores, Boardcertified in family practice, noted that appellant had a history of a cervical discectomy. She found 

that appellant should perform modified employment from December 27, 2016 through 

June 20, 2017.

In work status reports dated March 17, 2017, Dr. Choi-Flores provided restrictions. On 

March 31, 2017 she advised that appellant was unable to work from April 1 through 9, 2017.

In a work status report dated September 28, 2017, Dr. Choi-Flores diagnosed cervical 

radiculopathy, a cervical intervertebral disc herniation with radiculopathy, and bilateral rotator 

cuff syndrome. She provided work restrictions.

In an April 11, 2018 work status report, Dr. Choi-Flores indicated that appellant was off 

work from April 12 through 17, 2018 and could perform modified duties through 

October 11, 2018.

On May 21, 2019 the employing establishment advised that appellant had performed lightduty work for years due primarily to neck and shoulder conditions unrelated to her employment.

2

 

It indicated that she had undergone surgery in 2015 and subsequently worked light duty for a 

number of years. 

In a development letter dated May 30, 2019, OWCP requested that appellant submit 

additional factual and medical evidence in support of her claim, including a report from her 

attending physician addressing the causal relationship between any diagnosed condition and 

factors of her federal employment. It afforded her 30 days to submit the requested evidence. 

Thereafter, OWCP received a May 1, 2019 report from Dr. Basimah Khulusi, a Boardcertified physiatrist. Dr. Khulusi advised that appellant had worked at the employing 

establishment since 1991. She noted that she had undergone neck surgery in May 2015. Appellant

returned to work full time with restrictions in November 2015, but, in August 2018, her work hours 

were reduced to two hours per day until March 6, 2019, when she again returned to modified fulltime employment. Dr. Khulusi described appellant’s employment duties, including casing, sort, 

pulling, and delivering mail. She noted that appellant had experienced pain in her neck radiating 

into her hands around 2011 while performing her work duties. Dr. Khulusi reviewed the results 

of an April 5, 2019 magnetic resonance imaging (MRI) scan. She diagnosed cervical disc disease, 

2

In an employing establishment routing slip dated May 9, 2019, M.P., a supervisor, advised that appellant had 

provided medical evidence that she had limitations, but not that it was employment related. F.S., appellant’s 

supervisor since 2016, indicated that she worked in a light-duty status due to neck restrictions.
3

cervical radiculopathy, cervical disc displacement at C4-5, and a cervical fusion due to the disc 

displacement. Dr. Khulusi described appellant’s repetitive work duties and related, “All these 

repetitive activities done day-after-day have proven to be above what her body can take status post 

neck fusion surgery. The sustained contractions of her neck muscles have increased the stresses 

on the disc above the fusion level at the C4-5 level and caused displacement of that disc, which 

resulted in mild-to-moderate bilateral neural foraminal stenosis.” Dr. Khulusi further found mildto-moderate bilateral neural foraminal stenosis at C5-6 and severe bilateral neural foraminal 

stenosis at C6-7. She related, “That means the nerve roots coming out of [appellant’s] spine in the 

neck are running in a compromised space and any increased stresses on the structures of her neck 

lead to strain of these structures, which aggravates the neurological compromise of the cervical 

nerve roots that do not have much reserve.” Dr. Khulusi provided work restrictions.

In an undated statement received by OWCP on June 26, 2019, appellant related that she 

had worked full duty from 1991 until 2011 and that, subsequent to that time, had spent 

approximately two hours per day casing mail. She indicated that she had undergone neck surgery 

in 2015 and had attached records. Appellant attributed her condition to casing and loading mail.

By decision dated August 12, 2019, OWCP denied appellant’s occupational disease claim. 

It found that the medical evidence was insufficient to establish a medical condition causally related 

to the accepted employment factors.

Thereafter, OWCP received medical reports from various providers dated January 2017 

through March 2019.

An April 5, 2019 MRI scan of the cervical spine revealed a disc bulge, annular fissure, and 

hypertrophy causing mild-to-moderate bilateral neuroforminal stenosis at C4-5, an anterior fusion 

with mild-to-moderate bilateral neuroforminal stenosis at C5-6, and an anterior fusion with severe

bilateral neuroforaminal stenosis at C6-7.

In a report dated November 7, 2019, Dr. James T. Tran, a Board-certified neurosurgeon, 

described appellant’s work history and complaints of neck pain beginning in 2011 while 

performing her work duties. He noted that she underwent neck surgery in May 2015. Dr. Tran 

indicated that appellant had continued complaints of neck pain for which she received steroid 

injections. He diagnosed connective tissue stenosis, intervertebral disc stenosis, and osseous 

stenosis of the neural cervical canal region. Dr. Tran found that appellant had cervical 

radiculopathy from stenosis at C4-5 following a discectomy and fusion in 2015. He opined that 

the diagnosed conditions were employment related. Dr. Tran related that appellant’s turning and 

extending of her head lifting mail and retrieving satchels exerted force on her cervical spine 

causing annular tears at C4-5, which allowed protrusion of the nucleus pulposus into the spinal 

canal and compressed the nerve roots at C4-5. He further found that her frequent neck movements

sorting mail and retrieving satchels caused the “cervical superior and inferior facet joints at each 

cervical spinal level at C4-5 to disengage and separate” resulting in tears in the annulus fibrosus 

extruding into the C4-5 cervical canal at C4-5.

On January 30, 2020 Dr. Khulusi advised that she had reviewed OWCP’s August 12, 2019 

decision. She opined that OWCP should have accepted as employment-related connective tissue 

stenosis, intervertebral disc stenosis, and osseous stenosis of the neural canal of the c ervical region.
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On March 3, 2020 appellant requested reconsideration.

By decision dated June 1, 2020, OWCP denied modification of its August 12, 2019 

decision.

In a report dated November 15, 2020, Dr. Khulusi indicated that she had reviewed OWCP’s 

June 1, 2020 decision. She denied finding that appellant’s condition resulted from work duties 

performed beginning March 19, 2019 or that employment after that date caused her condition. 

Dr. Khulusi advised that her work duties, including casing mail for two hours per day, had 

aggravated her neck condition. She noted that appellant’s condition had significantly worsened 

from November 2016 until April 2019, as shown by MRI scan. Dr. Khulusi asserted that the 

diagnoses of cervical disc disease, cervical disc displacement, cervical radiculopathy, and status 

post neck fusion should be accepted as employment related.

On November 19, 2020 appellant requested reconsideration.

By decision dated February 16, 2021, OWCP denied modification of its June 1, 2020 

decision.

Thereafter, OWCP received medical reports dated from 2017 onward, which documented

appellant’s treatment for a variety of conditions. On September 28, 2017 Dr. Choi-Flores 

evaluated appellant for pain in her neck, back, and left shoulder. She diagnosed cervical 

radiculopathy and disc disease, bilateral rotator cuff syndrome, and arthritis of the bilateral 

sacroiliac joints. In a progress report dated August 18, 2018, Dr. Mohamed Asjam Simjee, who 

specializes in family medicine, diagnosed cervical disc disease and chronic neck pain.

In a report dated June 24, 2021, Dr. Khulusi advised that she had provided medical records 

from 2011 to 2016. She indicated that a neck fusion caused a change in the distribution of forces 

in the vertebrae. Dr. Khulusi related that appellant’s full-time work was “detrimental to her neck 

condition after fusion and caused excessive forces to concentrate on the disc levels above and 

below her fusion and that caused her discs to be displaced as per the results of the MRI [scan] 

dated April 5, 2019 causing her to suffer significant neural foraminal stenosis that happened very 

quickly within a period of two and a half years.” She again asked that OWCP accepted as 

employment related cervical disc disease, cervical disc displacement, cervical radiculopathy, and 

status post neck fusion.

On June 22, 2021 appellant requested reconsideration.

By decision dated August 4, 2021, OWCP denied modification of its February 16, 2021 

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 that the individual is an employee of the United 

3

Supra note 2.
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States within the meaning of FECA, 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 upon a traumatic injury or an occupational disease.6

In an occupational disease claim, appellant’s burden of proof requires submission of the 

following: (1) a factual statement identifying employment factors alleged to have caused or 

contributed to the presence or occurrence of the disease or condition; (2) medical evidence 

establishing the presence or existence of the disease or condition for which compensation is 

claimed; and (3) medical evidence establishing that the diagnosed condition is causally related to 

the employment factors identified by the employee.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.

9

 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).10

ANALYSIS

The Board finds that this case is not in posture for decision.

In a May 1, 2019 report, Dr. Khulusi discussed appellant’s employment history and her 

history of neck surgery in May 2015. She described in detail appellant’s work duties and reviewed 

the results of an April 5, 2019 MRI scan. Dr. Khulusi diagnosed cervical disc disease, cervical 

radiculopathy, status post-neck fusion, cervical disc displacement at C4-5, and a cervical fusion 

due to the disc displacement. She opined that appellant’s work duties after her cervical fusion had 

caused increased stress above the fusion level resulting in bilateral neural foraminal cervical 

4 F.H., Docket No. 18-0869 (issued January 29, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); JoeD. 

Cameron, 41 ECAB 153 (1989).

5 L.C., Docket No. 19-1301 (issued January 29, 2020); J.M., Docket No. 17-0284 (issued February 7, 2018); 

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).

7 T.W., Docket No. 20-0767 (issued January 13, 2021); S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 

59 ECAB 382 (2008).

8 W.M., Docket No. 14-1853 (issued May 13, 2020); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 M.G., Docket No. 21-0879 (issued November 19, 2021); M.V., Docket No. 18-0884 (issued December 28, 2018).

10 Id.
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stenosis. In a November 15, 2020 report, she related that MRI scans supported that appellant’s 

condition had significantly deteriorated between November 2016 and April 2019. Dr. Khulusi 

opined that appellant’s work duties, including two hours per day of casing mail, had aggravated 

her neck condition. On June 24, 2021 she explained that her neck fusion had changed the 

distribution of forces in the vertebrae, and that her work duties had caused excessive force above 

and below the area of the fusion, resulting in neural foraminal stenosis. Dr. Khulusi diagnosed 

cervical disc disease, cervical disc displacement, cervical radiculopathy, and status post neck 

fusion and found that the diagnosed conditions were employment related.

In a report dated November 7, 2019, Dr. Tran discussed appellant’s history of neck pain 

beginning in 2011 and neck surgery in May 2015. He diagnosed connective tissue stenosis, 

intervertebral disc stenosis, and osseous stenosis of the neural cervical canal region , which he 

found were related to her employment. Dr. Tran explained that appellant’s turning and extending 

of her head lifting mail and retrieving satchels exerted force on her cervical spine causing annular 

tears at C4-5, which allowed protrusion of the nucleus pulposus into the spinal canal and 

compressed the nerve roots at C4-5. He further found that frequent neck movement sorting mail 

and retrieving satchels resulted in tears in the annulus fibrosus due to cervical facet joint force. 

It is well established that proceedings under FECA are not adversarial in nature and, while 

appellant has the burden of proof to establish entitlement to compensation, OWCP shares 

responsibility in the development of the evidence.11 OWCP has an obligation to see that justice is 

done.12

The Board finds that, while the reports from Dr. Khulusi and Dr. Tran are insufficient to 

meet appellant’s burden of proof, they raise an uncontroverted inference of causal relation between 

her claimed cervical conditions and the accepted factors of her federal employment. Both 

physicians provided a comprehensive understanding of the medical record and appellant’s work 

duties, and a pathophysiological explanation as to how the mechanism of the accepted employment 

factors were sufficient to cause the diagnosed conditions. The opinions of Dr. Khulusi and

Dr. Tran are not contradicted by any substantial medical factual evidence of record. The Board 

has long held that it is unnecessary that the evidence of record in a case be so conclusive as to 

suggest causal connection beyond all possible doubt. Rather, the evidence required is only that 

necessary to convince the adjudicator that the conclusion drawn is rational, sound, and logical. 13 

Dr. Khulusi and Dr. Tran’s opinions are rationalized and are, therefore,sufficient to require further 

development to determine whether appellant sustained a cervical condition caused or aggravated 

by the accepted employment factors.14 

11 E.G., Docket No. 19-1296 (issued December 19, 2019); A.P., Docket No. 17-813 (issued January 3, 2018);

Jimmy A. Hammons, 51 ECAB 219 (1999).

12 J.N., Docket No. 20-1287 (issued October 26, 2021).

13 L.P., Docket No. 20-0434 (issued February 2, 2021); W.M., Docket No. 17-1244 (issued November 7, 2017).

14 See E.G., Docket No. 20-1184 (issued March 1, 2021); C.M., Docket No. 17-1977 (issued January 29, 2019);

John J. Carlone, 41 ECAB 354 (1989).
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On remand, OWCP shall refer appellant, along with the case record, and a statement of 

accepted facts to a specialist in the appropriate field of medicine for a second opinion examination 

and an evaluation regarding whether she sustained a cervical condition caused or aggravated by 

the accepted factors of her employment. If the physician opines that the diagnosed conditions are 

not causally related, he or she must explain with rationale how or why the opinion differs from 

that of Dr. Khulusi and Dr. Tran. Following this and other such further development as deemed 

necessary, OWCP shall issue a de novo decision regarding appellant’s claim.

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the August 4, 2021 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: May 2, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board