United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.D., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Bellmawr, NJ, Employer

__________________________________________

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Docket No. 22-0405

Issued: October 5, 2022

Appearances: Case Submitted on the Record

Russell T. Uliase, 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 January 24, 2022 appellant, through counsel, filed a timely appeal from a July 28, 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 to consider 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 lumbar or thoracic 

conditions causally related to the accepted January 3, 2017 employment incident.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

in the Board’s prior orders are incorporated herein by reference. The relevant facts are as follows.

On January 3, 2017 appellant, then a 61-year-old mail handler, filed a notice of recurrence 

(Form CA-2a) alleging that she sustained a recurrence of disability on that date as a result of her 

previously accepted December 6, 2016 traumatic injury under OWCP File No. xxxxxx708.4 She 

alleged that she experienced lower back pain in the same location where she was previously 

injured. Following her December 6, 2016 employment injury, appellant returned to full-duty work 

until January 3, 2017. In an OWCP development questionnaire dated February 13, 2017, she 

explained that her recurrence occurred while she was driving and pulling equipment.

Medical reports from Dr. Michael S. Levy, an attending orthopedic surgeon, were 

submitted. In narrative reports dated December 22, 2016, January 5 and February 2, 16, and 23, 

2017, Dr. Levy noted that appellant presented for a follow-up evaluation of her December 6, 2016 

work-related lumbar sprain. He noted that she had previously attempted to return to work on 

January 3, 2017 and experienced a significant increase in pain. Appellant worked three hours and 

was unable to continue. Dr. Levy discussed his examination findings and diagnosed lumbar 

sprain/strain, back pain, and thoracic spine spondylosis. In a January 5, 2017 duty status report 

(Form CA-17), he noted a history of the accepted December 6, 2016 employment injury and 

diagnosed lumbar strain due to injury. Dr. Levy placed appellant off work. By letter dated 

January 26, 2017, he advised that she may resume work on February 3, 2017. In a February 2, 

2017 work capacity evaluation (Form OWCP-5c), Dr. Levy reiterated his diagnosis of lumbar 

sprain/strain and advised that appellant was totally disabled from work.

OWCP, by development letter dated March 13, 2017, provided a questionnaire for 

appellant’s completion regarding the circumstances surrounding her claimed injury and requested 

that she submit a narrative medical report from her physician. It afforded her 30 days to respond.

On March 20, 2017 appellant responded to OWCP’s development questionnaire, relating 

that on January 3, 2017 she was driving a tow motor and pulling empty hampers to her area when

her back started to hurt in the same area as her previous injury. She noted that she immediately

reported her injury to her supervisor.

3 Order Dismissing Appeal, Docket No. 19-0590 (issued June 25, 2019); Order Granting Petition for 

Reconsideration and Reinstating Appeal, Docket No. 19-0590 (issued May18, 2020); Order Remanding Case, Docket 

No. 19-0590 (issued August 28, 2020).

4 Appellantfiled a traumatic injury claim (Form CA-1) on December 6, 2016 alleging that on that dayshe sustained 

a back injury when a tow motor rear ended the tow motor she was operating while in the performance of duty. OWCP 

assigned File No. xxxxxx708 and accepted the claim for lumbar and thoracic sprains.
3

Appellant submitted additional medical evidence from Dr. Levy. In reports dated March 2 

and 16, 2017, Dr. Levy reiterated his prior diagnosis of lumbar sprain/strain. In prescriptions dated 

March 16 and 17, 2017, he ordered a pain management evaluation and continued physical therapy. 

In a March 23, 2017 prescription note, Dr. Levy noted that appellant was progressing with physical 

therapy and that she should not return to work until one month after completing such treatment.

Appellant also submitted a March 15, 2017 lumbar spine magnetic resonance imaging 

(MRI) scan report from Dr. Joel D. Swartz, a Board-certified diagnostic radiologist. Dr. Swartz

provided impressions of no evidence of fracture/dislocation, marrow replacing process or 

intraspinal/paraspinous mass; disc bulging at L1-2, disc desiccation with bilateral intraforaminal 

disc bulging right greater than left at L2-3; left far lateral/intraforaminal disc herniation at L3-4; 

disc degeneration with broad disc protrusion, marginal osteophytosis, facet joint degenerative joint 

disease, and degenerative offset at L4-5; and disc degeneration with broad disc protrusion more to 

the left at L5-S1.

By decision dated April 18, 2017, OWCP accepted that the January 3, 2017 employment 

incident occurred, as alleged. However, it denied appellant’s traumatic injury claim, finding that 

the medical evidence of record was insufficient to establish thatthe diagnosed lumbar and thoracic 

spine conditions were causally related to the accepted employment incident.

On April 27, 2017 appellant requested a telephonic hearing before a representative of 

OWCP’s Branch of Hearings and Review.

In support of her request, appellant submitted an April 6, 2017 letter from Dr. Levy.

Dr. Levy noted a history of his treatment of appellant beginning December 22, 2016 and his review 

of medical records. He opined that her diagnoses included disc and osteophyte changes and 

changes to the lumbar spine causally related to her December 6, 2016 employment injury. 

Dr. Levy noted that appellant was ordered back to work pending an evaluation by a pain 

management physician and review of an MRI scan, which revealed a bulging disc and degenerative 

joint disease.

OWCP subsequently received additional medical evidence. In prescriptions notes dated 

May 19, 2017, Dr. Robert T. Rinnier, a Board-certified anesthesiologist and pain medicine

specialist, diagnosed lumbago and lumbar herniated nucleus pulpous and ordered physical therapy 

to treat the diagnosed conditions and appellant’s core strength. He placed her off work for one 

month until her next evaluation.

In a June 15, 2017 prescription note, Dr. Uplekh S. Purewal, an attending Board-certified 

anesthesiologist and pain medicine specialist, placed appellant off work for four weeks due to 

medical issues.

Following a September 27, 2017 telephonic hearing, appellant submitted an October 5, 

2017 prescription note from Dr. Purewal who related that appellant returned to work on January 3, 

2017 and engaged in bending over while pulling hampers to a tow motor. Dr. Purewal opined that 

the work performed on that day aggravated her lumbar radiculopathy which caused her to stop 

work.
4

By decision dated November 7, 2017, an OWCP hearing representative affirmed the 

April 18, 2017 decision. He found that the medical evidence submitted was insufficient to 

establish that appellant’s diagnosed lumbar and thoracic spine conditions were causally related to 

the accepted January 3, 2017 employment incident.

On February 28, 2018 appellant, through counsel, requested reconsideration. She also 

submitted a statement describing her work duty of driving a tow motor. Appellant explained that 

the job not only required driving the tow motor, but also required bending over to hook up ca ges 

and hampers, and then connecting them to the tow motor. 

OWCP, by decision dated March 5, 2018, denied appellant’s request for reconsideration of 

the merits of her claim, pursuant to 5 U.S.C. § 8128(a), as the evidence submitted was irrelevant 

or immaterial.

On March 23, 2018 appellant, through counsel, again requested reconsideration. She 

submitted a March 16, 2018 report from Dr. Purewal who noted that appellant developed posttraumatic lumbago following her December 6, 2016 employment injury. Dr. Purewal advised that 

her condition was aggravated and exacerbated by her tow motor work and hooking up a hamper 

on January 3, 2017.

OWCP, by decision dated June 19, 2018, denied modification of the November 7, 2017 

decision affirming the denial of appellant’s traumatic injury claim. It found that the medical 

evidence submitted failed to provide a rationalized opinion explaining how the January 3, 2017 

employment incident contributed to or aggravated her diagnosed back conditions.

On July 31, 2018 appellant, through counsel, requested reconsideration.

OWCP, by decision dated October 29, 2018, denied modification of its June 19, 2018 

decision.

On January 21, 2019 appellant, through counsel, appealed the October 29, 2018 decision 

to the Board. By order dated June 25, 2019, the Board dismissed the appeal at appellant’s request.

5

 

On June 28, 2019 appellant, through counsel, filed a petition for reconsideration of the Board’s

June 25, 2019 order. Counsel contended that appellant’s appeal was mistakenly dismissed after

the Board received a dismissal request from a different appellant with the same name. By order 

dated May 18, 2020, the Board granted appellant’s petition for reconsideration and reinstated her

appeal.

6

A July 17, 2019 form report from a nurse practitioner with an illegible signature noted 

appellant’s work restrictions.

Form CA-17 reports dated June 27, 2019 and January 16, 2020 from a healthcare provider 

with an illegible signature noted that appellant had a lifting injury. The reports provided diagnoses 

5

Supra note 3.

6

Id.
5

of low back pain and other intervertebral disc displacement due to injury and indicated that 

appellant could work with restrictions.

By order dated August 28, 2020, the Board set aside the October 29, 2018 decision and 

remanded the case directing OWCP to combine appellant’s claims under File Nos. xxxxxx708 and 

xxxxxx562 and issue a de novo merit decision.

Thereafter, OWCP administratively combined the files with File No. xxxxxx708 serving 

as the master file.7

The relevant medical evidence in OWCP File No. xxxxxx708 included reports dated 

April 27, 2017 through May 24, 2018 from Dr. Purewal. In these reports, Dr. Purewal noted a 

history of the December 6, 2016 employment injury and discussed examination findings. He 

provided an assessment that appellant developed post-traumatic lumbago following her 

December 6, 2016 employment injury. Dr. Purewal addressed her work capacity and restrictions, 

noting that she returned to work on January 3, 2017, but was only able to work several hours due 

to back pain and she had subsequent intermittent periods of disability from work.

In OWCP File No. xxxxxx562, OWCP received a September 30, 2020 form report from 

Lisa A. Paul, an advanced practical nurse, who provided appellant’s work restrictions. In an 

October 1, 2020 prescription, Ms. Paul noted that appellant should be able to return to work within 

six months.

By decision dated January 25, 2021, OWCP denied appellant’s claims for a traumatic 

injury and recurrence of disability of his previously accepted December 6, 2016 employment 

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

or disability causally related to the January 3, 2017 employment incident.

On February 4, 2021 appellant, through counsel, requested an oral hearing before a

representative of OWCP’s Branch of Hearings and Review. A telephonic hearing was held on 

May 14, 2021.

OWCP received an additional form report dated July 22, 2021 from Ms. Paul, noting 

appellant’s work restrictions.

By decision dated July 28, 2021, an OWCP hearing representative affirmed the January 25, 

2021 decision, finding that the medical evidence of record was insufficient to establish that the 

January 3, 2017 employment incident caused or aggravated appellant’s diagnosed conditions.

LEGAL PRECEDENT

An employee seeking benefits under FECA8 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 

7 At the same time, OWCP also administratively combined File No. xxxxxx739 which was accepted for a lumbar 

strain on December 14, 2004.

8

Supra note 2.
6

States within the meaning of FECA, that the claim was timely filed within the applicable time 

limitation of FECA,9that 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.10 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.11

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 to be established 

is that the employee 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.12

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

condition and an employment incident is rationalized medical opinion evidence. 13 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.14

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship, therefore, involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.

15

9 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).

10 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).

11 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).

12 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). 

13 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); 

Robert G. Morris, 48 ECAB 238 (1996).

14 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).

15 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013);

A.C., Docket No. 21-1307 (issued March 22, 2022); M.B., Docket No. 20-1275 (issued January 29, 2021);see R.D., 

Docket No. 18-1551 (issued March 1, 2019).
7

ANALYSIS

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

thoracic conditions causally related to the accepted January 3, 2017 employment incident.

In support of her claim, appellant submitted medical evidence from Dr. Levy. In reports 

dated December 22, 2016 through March 16, 2017, Dr. Levy noted that, following her 

December 6, 2016 employment injury, appellant attempted to return to work on January 3, 2017. 

He noted, however, that she was only able to work three hours and sto pped work due to a 

significant increase in pain. Dr. Levy diagnosed the accepted condition of lumbar sprain. He also 

diagnosed lumbar strain. In a January 5, 2017 Form CA-17 report, Dr. Levy advised that 

appellant’s lumbar strain was due to her December 6, 2016 employment injury and he placed her 

off work. In an April 6, 2017 letter, he diagnosed disc and osteophyte changes and changes to the 

lumbar spine based on MRI scan findings and opined that the diagnosed conditions were causally 

related to the December 6, 2016 employment injury. While he noted appellant’s attempt to return 

to work on January 3, 2017, Dr. Levy did not provide a detailed history of injury pertaining to the 

accepted January 3, 2017 employment incident. Further, he did opine that the diagnosed lumbar 

conditions were causally related to the accepted employment incident. Rather, Dr. Levy attributed 

the diagnosed conditions to appellant’s previously accepted December 6, 2016 employment injury. 

His January 26, 2017 letter, February 2, 2017 Form OWCP-5c report, and March 23, 2017 

prescription note initially indicated that appellant could resume work on February 3, 2017, then 

found that she was totally disabled from work, and subsequently advised that she could not return 

to work until one month following completion of physical therapy treatments. Dr. Levy did not 

provide a history of injury, a firm medical diagnosis, or an opinion as to whether the January 3, 

2017 employment incident caused a diagnosed medical condition and disability from work.16 

Likewise, hisremaining prescriptions dated February 2 and March 16 and 17, 2017, which ordered 

physical therapy and a pain management evaluation did not provide a history of injury, a firm 

medical diagnosis, or an opinion on causal relationship.

17

 For these reasons, the Board finds that 

the medical evidence from Dr. Levy is insufficient to establish appellant’s burden of proof.

Appellant also submitted medical evidence from Dr. Purewal. In an October 5, 2017 

prescription note, Dr. Purewal opined that appellant’s lumbar radiculopathy was aggravated by the 

January 3, 2017 employment incident. In a March 16, 2018 report, he also opined that her posttraumatic lumbago, which she developed following the December 6, 2016 employment injury, was 

aggravated and exacerbated by the January 3, 2017 employment incident. While Dr. Purewal 

provided an affirmative opinion suggestive of causal relationship, he did not offer medical 

rationale sufficient to explain how the accepted January 3, 2017 employment incident would have 

aggravated or exacerbated appellant’s diagnosed conditions.18 The Board has previously held that 

conclusory statements lacking medical rationale are insufficient to establish causal relationship 

16 See D.L., Docket No. 19-1053 (issued January 8, 2020); C.C., Docket No. 18-1099 (issued December 21, 2018).

17 Id.

18 S.A.,Docket No. 21-0593 (issued February 3, 2022); T.W., Docket No. 20-0767 (issued January 13, 2021);see 

H.A., Docket No. 18-1466 (issued August23, 2019); L.R., Docket No. 16-0736 (issued September 2, 2016).
8

between employment factors and diagnosed conditions.19 In reports dated April 27, 2017 through 

May 24, 2018 and a prescription note dated June 15, 2017, Dr. Purewal placed appellant off work 

for intermittent periods of disability due to medical issues and set forth her work restrictions. He 

noted that she developed post-traumatic lumbago following the December 6, 2016 employment 

injury and that she was only able to work several hours when she returned to work on 

January 3, 2017. However, Dr. Purewal did not offer an opinion addressing whether appellant’s

diagnosed lumbar condition and disability status were caused or aggravated by the January 3, 2017 

employment incident. The Board has held that a medical report is of no probative value if it does 

not offer an opinion as to whether the accepted employment incident caused or aggravated the 

claimed condition.20 For these reasons, the Board finds that the medical evidence from

Dr. Purewal is insufficient to establish appellant’s claim.

Likewise, Dr. Rinnier’s May 19, 2017 prescriptions notes did not provide an opinion on 

causal relationship. He diagnosed lumbago and lumbar herniated pulpous, ordered physical 

therapy to treat the diagnosed conditions and appellant’s core strength, and placed her off work for 

one month until her next evaluation. Dr. Rinnier did not offer an opinion as to whether appellant’s 

diagnosed lumbar and thoracic spine conditions and disability status were causally related to the 

January 3, 2017 employment incident.

21

 Thus, this evidence is insufficient to meet appellant’s 

burden of proof.

Appellant submitted Dr. Swartz’ March 15, 2017 MRI scan of the lumbar spine. The 

Board has held, however, that diagnostic studies, standing alone, lack probative value as they do 

not address whether the employment incident caused any of the diagnosed conditions. 22 For this 

reason, Dr. Swartz’ MRI scan report is insufficient to establish appellant’s burden of proof.

Appellant also submitted July 17, 2019 and September 30, 2020 form reports and an 

October 1, 2020 prescription from nurse practitioners. However, certain healthcare providers such 

19 S.A., id.; K.O., Docket No. 18-1422 (issued March 19, 2019); see E.P., Docket No. 18-0194 (issued 

September 14, 2018).

20 G.J., Docket No. 21-0528 (issued February 1, 2022); L.E., Docket No. 19-0470 (issued August12, 2019); M.J., 

Docket No. 18-1114 (issued February 5, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket 

No. 17-1549 (issued July 6, 2018).

21 Id.

22 A.O., Docket No. 21-0968 (issued March 18, 2022); M.B., Docket No. 19-1638 (issued July 17, 2020); T.S., 

Docket No. 18-0150 (issued April12, 2019).
9

as nurse practitioners, are not considered physicians as defined under FECA.23 Consequently, 

these reports will not suffice for purposes of establishing entitlement to FECA benefits.24

The remaining medical evidence of record consists of reports dated December 11, 2016, 

June 27, 2019, and January 16, 2020 by unidentifiable health care providers. The Board has held 

that reports that are unsigned or bear an illegible signature lack proper identification and cannot 

be considered probative medical evidence as the author cannot be identified as a physician.25 Thus, 

these reports are also insufficient to establish appellant’s claim.

As appellant has not submitted rationalized medical evidence establishing that her lumbar 

or thoracic conditions causally related to the accepted January 3, 2017 employment incident, the 

Board finds that she has not met her burden of proof to establish her claim.

On appeal counsel contends that Dr. Purewal’s reports are sufficient to establish that the 

January 3, 2017 employment incident aggravated appellant’s previously accepted December 6, 

2016 employment-related conditions. As discussed above, however, appellant has not submitted 

rationalized medical evidence establishing that her previously accepted conditions were 

aggravated by the January 3, 2017 employment incident, and thus, 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 lumbar or 

thoracic conditions causally related to the accepted January 3, 2017 employment incident.

23 Section 8101(2) 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 also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013); M.F., Docket No. 19-1573 (issued March 16, 2020);N.B., Docket 

No. 19-0221 (issued July 15, 2019); DavidP. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (finding that lay individuals 

such as physician assistants, nurses, and physical therapists are not competent to render a medical opinion under 

FECA).

24 See M.O., Docket No. 21-1068 (issued March 1, 2022); M.T., Docket No. 21-0783 (issued December 27, 2021); 

R.M., Docket No. 21-0602 (issued March10, 2022); M.C., Docket No. 19-1074 (issued June 12, 2020) (nurse 

practitioners are not considered physicians under FECA).

25 R.O., Docket No. 21-0473 (issued January31, 2022); C.M., Docket No. 21-0004 (issued May24, 2021); T.D., 

Docket No. 20-0835 (issued February 2, 2021); Merton J. Sills, 39 ECAB 572, 575 (1988).
10

ORDER

IT IS HEREBY ORDERED THAT the July 28, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: October 5, 2022

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