United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.D., Appellant

and

DEPARTMENT OF AGRICULTURE, FOOD 

SAFETY & INSPECTION SERVICE,

Minneapolis, MN, Employer

__________________________________________

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Docket No. 22-0286

Issued: June 15, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 15, 2021 appellant filed a timely appeal from an October 12, 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.

2

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the October 12, 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 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

ISSUE

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

in the performance of duty on May 27, 2021, as alleged.

FACTUAL HISTORY

On June 10, 2021 appellant, then a 48-year-old consumer safetyinspector,filed a traumatic 

injury claim (Form CA-1) alleging that on May 27, 2021 she sustained right elbow and wrist pain 

when she slipped on a wet floor causing her to fall on her right elbow and back while in the 

performance of duty. On the reverse side of the form the employing establishment acknowledged 

that she was injured in the performance of duty. Appellant did not stop work.

In an attending physician’s report, Part B of an authorization of examination and/or 

treatment (Form CA-16) dated June 10, 2021, Audrey Hubler, a nurse practitioner, related that she

fell at work after slipping on a wet floor and noted that x-rays revealed tenderness of the sacroiliac

joint and a decreased range of motion of the shoulder.

A June 10, 2021 return-to-work note from Dr. Robert Hill, a Board-certified family 

medicine specialist, indicated that appellant could return to work on June 27, 2021. Subsequently, 

on June 27, 2021 he held appellant off work through July 2, 2021. In a return-to-work note dated 

July 2, 2021, Dr. Hill indicated that appellant was unable to return to work until cleared by a 

physical therapist. 

In notes dated August 9 through 23, 2021, Toni Santos, a physical therapist, related that 

appellant injured herself on May 27, 2021 after slipping on a floor and landing on her right hip. 

In a September 8, 2021 development letter, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence required and provided a 

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

evidence. No additional evidence was received.

OWCP received progress notes dated June 10, 25, and July 2, 2021 from Ms. Hubler, who 

related the May 27, 2021 workplace incident. Ms. Hubler examined appellant for a lumbar back 

and shoulder strain and administered a steroid injection. 

By decision dated October 12, 2021, OWCP denied appellant’s claim, finding that the 

medical evidence of record was insufficient to establish that a traumatic injury occurred in the 

performance of duty on May 27, 2021, as alleged. Consequently, it found that she had not met the 

requirements to establish an injury as defined by FECA.

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 

3

Supra note 1.
3

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 

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 

To establish that an injury occurred as alleged, the injury need not be confirmed by 

eyewitnesses, but the employee’s statements must be consistent with the surrounding facts and 

circumstances and his or her subsequent course of action. The employee has not met his or her 

burden when there are such inconsistencies in the evidence as to cast serious doubt on the validity 

of the claim. Such circumstances as late notification of injury, lack of confirmation of injury, 

continuing to work without apparent difficulty following the alleged injury, and failure to obtain 

medical treatment may, if otherwise unexplained, cast sufficient doubt on the employee’s 

statements in determining whether a prima facie case has been established.8 An employee’s 

statement alleging that an injury occurred at a given time and in a given manner is of great 

probative value and will stand unless refuted by strong or persuasive evidence.9

ANALYSIS

The Board finds that appellant has not met her burden to establish a traumatic injury in the 

performance of duty on May 27, 2021, as alleged.

Appellant has not established the factual component of her claim as she has insufficiently 

explained how and where the claimed injury occurred.10 In her June 10, 2021 Form CA-1, she 

indicated that on May 27, 2021 she sustained right elbow and back pain when she slipped and fell

on a wet floor. Appellant, however, did not submit a detailed account of the alleged injury or any 

4 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued December 13, 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).

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 C.M., Docket No. 20-1519 (issued March 22, 2021); Betty J. Smith, 54 ECAB 174 (2002).

9

See M.C., Docket No. 18-1278 (issued March 7, 2019); D.B., 58 ECAB 464, 466-67 (2007).

10 See E.C., Docket No. 19-0943 (issued September 23, 2019).
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additional corroborating factual evidence describing how and where she sustained an injury on 

May 27, 2021. The Board has held that such a vague recitation of facts does not support a 

claimant’s allegation that a specific event occurred to cause a work-related injury.11

OWCP, in its September 8, 2021 development letter, informed appellant of the type of 

factual and medical evidence needed to establish her traumatic injury claim. It requested that she 

complete an attached questionnaire and provide a detailed factual description of the alleged 

employment incident. Appellant, however, did not respond.12

Appellant has not provided a sufficient description of the alleged employment incident and 

the mechanism by which she sustained an injury. The Board, therefore, finds that she has not met 

her burden of proof.13 As appellant has not met her burden of proof to establish that an incident 

occurred in the performance of duty, as alleged, it is unnecessary to address the medical evidence 

of record regarding causal relationship.14

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 traumatic 

injury in the performance of duty on May 27, 2021, as alleged.15

11 M.C., supra note 9; M.B., Docket No. 11-1785 (issued February 15, 2012).

12 M.F., Docket No. 18-1162 (issued April9, 2019).

13 H.D., Docket No. 15-1698 (issued May 4, 2016).

14 J.C., Docket No. 19-0542 (issued August 14, 2019); see M.P., Docket No. 15-0952 (issued July 23, 2015); 

Alvin V. Gadd, 57 ECAB 172 (2005).

15 The Board notes that the employing establishment issued a Form CA-16, dated June 10, 2021. 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).
5

ORDER

IT IS HEREBY ORDERED THAT the October 12, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 15, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board