United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.T., Appellant

and

U.S. POSTAL SERVICE, SANTA ANA 

PROCESSING & DISTRIBUTION CENTER, 

Santa Ana, CA, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 23-0248

Issued: August 14, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 2, 2022 appellant filed a timely appeal from a November 14, 2022 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 to consider the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish back, and neck

conditions causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On August 26, 2020 appellant, then a 55-year-old custodial laborer, filed an occupational 

disease claim (Form CA-2) alleging that he developed neck and low back pain due to factors of 

1

5 U.S.C. § 8101 et seq.
2

his federal employment including pushing, carrying lifting, twisting, bending, lifting over his 

shoulders, standing, moping, dumping trash, and moving heavy objects. He noted that he first 

became aware of his neck and back conditions and first realized the relation to his federal 

employment on June 29, 2020. Appellant stopped work on July 14, 2020 and returned to limited 

duty with restrictions of walking no more than two hours a day, bending, twisting, and stooping 

for 30 minutes each, and pushing and pulling no more than 25 pounds.

On July 13 and August 17 2020 Dr. Basimah Khulusi, a Board-certified physiatrist, 

completed duty status reports (Form CA-17) diagnosing cervical radiculopathy/stenosis and 

lumbar disc displacement. She also provided work restrictions.

In a September 4, 2020 development letter, OWCP informed appellant of the deficiencies 

of his claim. It advised him of the type of factual and medical evidence necessary to establish his 

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

respond.

In an August 17, 2020 narrative report, Dr. Khulusi recounted appellant’s 28-year 

employment history with the employing establishment. She described his current custodial duties 

including dumping heavy trash, sweeping, mopping, and cleaning offices and restrooms. 

Dr. Khulusi noted that these duties required continuous standing and repetitive lifting, turning, 

twisting, pushing, and pulling of heavy objects. She further described appellant’s clerk duties,

performed prior to 2017, which included frequent overhead reaching, stooping, bending, twisting, 

turning, gripping, and grasping. Dr. Khulusi recounted that appellant’s neck and low back pain 

had begun in 1999 while he was working as a clerk, that after treatment with medication the pain 

would resolve, and he could return to full-duty work. She also noted that he had sustained low 

back injuries in two motor vehicle accidents in 1988 and 2005. Dr. Khulusi reviewed magnetic 

resonance imaging (MRI) scan and electromyogram and nerve conduction velocity (EMG/NCV)

findings and diagnosed multiple cervical disc displacements and radiculopathies and multiple 

lumbar disc displacements. She explained that appellant’s repetitive lifting, carrying, pushing, and 

pulling had caused repetitive spraining and straining of the structures of his neck and low back or 

cumulative trauma disorder, in turn causing chronic inflammation and muscle weakness. 

Dr. Khulusi, opined that these processes resulted in increased pressure on the intradiscal spaces

and ultimately disc displacement. She concluded that disc displacement together with arthritic 

changes, caused by wear and tear, compromised the space for nerve roots at multiple levels in the 

lumbar and cervical spines resulting in cervical radiculopathies. Dr. Khulusi reviewed medical 

literature regarding neck/shoulder musculoskeletal and low back musculoskeletal disorders and

provided work restrictions.

On September 21, 2020 appellant responded to OWCP’s development questionnaire and 

described his job duties.

By decision dated October 14, 2020, OWCP denied appellant’s occupational disease claim 

finding that he had not established the factual component of his claim, as he did not sufficiently 

respond to the development questionnaire. Consequently, it found that he had not met the 

requirements to establish an injury as defined by FECA. 
3

On June 22, 2021 appellant requested reconsideration and provided additional factual 

statements and medical evidence. In a June 14, 2021 report, Dr. Khulusi attributed appellant’s 

diagnosed back conditions to the duties of both of his positions at the employing establishment 

including bending, twisting, pushing, pulling, carrying above the shoulder, and carrying heavy 

objects as a clerk. She advised that his treatment records indicated that he had intermittent periods 

of low back pain caused by sprain or strain. Dr. Khulusi repeated her prior diagnoses of multiple 

cervical disc displacements and radiculopathies and multiple lumbar disc displacements and again 

opined that these conditions were caused by his job duties as a clerk and as a custodian.

In an August 5, 2021 development letter, OWCP requested that appellant provide 2017 

diagnostic studies following his automobile accident. It afforded him 30 days to respond.

Dr. Khulusi completed a report on August 24, 2021 and observed that appellant had no 

lumbar or cervical spine x-rays in 2017.

By decision dated September 9, 2021, OWCP modified the October 14, 2020 decision to 

find that he had established the factual component of his claim. However, the claim remained 

denied as the medical evidence of record was insufficient to establish causal relationship between 

the diagnosed condition(s) and the accepted employment factors.

On October 28, 2021 appellant requested reconsideration. In an October 25, 2021 report,

Dr. Khulusi attributed appellant’s diagnosed cervical and lumbar spine conditions to his 

employment duties. She noted that his prior back conditions from 2017 had resolved and opined 

that his current cervical and lumbar disc displacement and cervical radiculopathy was caused by 

his job duties.

By decision dated January 26, 2022, OWCP denied modification of its prior decision.

On February 21, 2022 appellant requested reconsideration. Dr. Khulusi completed a 

February 15, 2022 report and advised that although appellant had experienced intermittent back 

and neck conditions that required sporadic medical treatment and, on occasion, a few days off 

work, he continued to work without restrictions until June 2020, when his back and neck 

conditions became disabling. She noted that appellant was previously diagnosed with sprains. 

Dr. Khulusi repeated her diagnoses of multiple cervical disc displacements and radiculopathies 

and multiple lumbar disc displacements and asserted that these additional conditions had not been 

established prior to June 2020.

By decision dated November 14, 2022, OWCP denied modification of its prior decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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, that the claim was timely filed within the applicable 
4

time limitation period of FECA,2that 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. 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.3

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or oc currence 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 identified employment factors.4

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.5 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.6 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 factors.7

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.8

ANALYSIS

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

Appellant submitted multiple reports from Dr. Khulusi including August 17, 2020 and 

June 14, 2021 reports, wherein she noted in detail appellant’s job duties including lifting, pushing, 

pulling, turning, and twisting and opined that these duties caused his multiple cervical disc 

2 T.M.,Docket No. 20-1460 (issued December 20, 2022); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P.,

59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

3 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).

4 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

5 T.M., supra note 2; T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

6 T.M., id.; M.V., Docket No. 18-0884 (issued December 28, 2018).

7

Id.; Victor J. Woodhams, supra note 4.

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

L.C., Docket No. 19-1301 (issued January 29, 2020); R.D., Docket No. 18-1551 (issued March 1, 2019).
5

displacements and radiculopathies and multiple lumbar disc displacements. She explained the job 

duties had caused repetitive spraining and straining of his neck and low back which in turn caused

chronic inflammation and muscle weakness resulting in increased pressure on the intradiscal 

spaces and disc displacement. These activities and events also resulted in arthritis which 

compromised the space for nerve roots resulting in cervical radiculopathies. Dr. Khulusi 

concluded that performing these duties directly caused appellant’s diagnosed cervical and lumbar 

conditions.

The Board finds that, while these reports from Dr. Khulusi are not fully rationalized, they 

did provide a pathophysiological explanation that appellant sustained cervical and lumbar 

conditions due to lifting, pushing, pulling, and twisting while performing his duties as both a clerk 

and a custodian. Although these reports are insufficient to meet appellant’s burden of proof to 

establish the claim, they are sufficient to require OWCP to further develop the medical evidence.9

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter. 

While it is appellant’s burden of proof to establish the claim, OWCP shares responsibility in the 

development of the evidence.10 It has the obligation to see that justice is done.11

The Board will, therefore, remand the case to OWCP for further development of the 

medical evidence. On remand it shall refer appellant, a statement of accepted facts, and the 

medical evidence of record to a physician in the appropriate field of medicine. The referral 

physician shall provide a rationalized opinion on whether the diagnosed cervical and lumbar spine

conditions are causally related to the accepted employment activities. If the physician opines that 

the diagnosed conditions are not causally related, he or she must explain with rationale how or 

why his or her opinion differs from that of Dr. Khulusi. Following this and other such further 

development as deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

9 C.A., Docket No. 22-0764 (issued November 30, 2022); M.R.,Docket No. 20-0101 (issued September 14, 2021), 

Richard E. Simpson, 55 ECAB 490, 500 (2004); John J. Carlone, 41 ECAB 354, 360 (1989).

10 Id.

11 Id.
6

ORDER

IT IS HEREBY ORDERED THAT the November 14, 2022 decision of the Office of 

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

consistent with this decision of the Board.

Issued: August 14, 2023

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board