United States Department of Labor

Employees’ Compensation Appeals Board

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K.V., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Carmel, NY, Employer

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Docket No. 21-1409

Issued: April 19, 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

JANICE B. ASKIN, Judge

JURISDICTION

On September 20, 2021 appellant filed a timely appeal from a July 1, 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 his burden of proof to establish a tooth injury

causally related to the accepted August 4, 2019 employment incident.

FACTUAL HISTORY

On August 19, 2019 appellant, then a 24-year-old city carrier assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on August 4, 2019 his two front teeth were “knocked out”

1

5 U.S.C. § 8101 et seq.
2

by a steel bar. On the reverse side of the claim form, appellant’s supervisor acknowledged that 

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

Appellant and his colleague, M.P., submitted statements dated August 4, 2019 attesting 

that appellant had picked up a package which consisted of a large steel bumper. The package was 

oddly shaped, it slipped, “clipped appellant’s face” and chipped his two front teeth. 

OWCP received a statement dated August 4, 2019 from appellant’s supervisor, G.R.

wherein she related that appellant had reported that he chipped his front tooth on a parcel. G.R. 

also noted that he initially stated that he did not require medical attention. 

OWCP also received a narrative statement from appellant dated April 19, 2021 wherein he 

explained that his injury required extensive dental work. Appellant advised that his claim was for 

reimbursement of $3,118.00 of dental expenses. 

In a development letter dated May 24, 2021, OWCP advised appellant that additional 

medical evidence was necessary to establish his claim. It afforded him 30 days to submit the 

necessary evidence. No additional evidence was received. 

By decision dated July 1, 2021, OWCP accepted that the August 4, 2019 employment 

incident occurred, as alleged, but denied appellant’s claim finding that he had not submitted 

medical evidence containing a medical diagnosis in connection with his accepted employment 

incident. It concluded, therefore, that the requirements had not been met to establish an injury as 

defined by FECA. 

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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 FECA, that the claim was timely filed within the applicable time 

limitation period of FECA,3that 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.4 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.5

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it must first be determined whether a fact of injury has been established. 

There are two components involved in establishing fact of injury. The first component is that the 

2

Id.

3 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).

4 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).

5 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).
3

employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time, place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury.6

ANALYSIS

The Board finds that appellant has established a tooth injury causally related to the accepted 

August 4, 2019 employment incident.

The evidence of record establishes that appellant’s coworker, M.P., was present and 

witnessed that on August 4, 2019 appellant lifted a package, containing a large metal bumper, 

which slipped in his hands, “clipped [appellants] face” and chipped his front teeth. Appellant’s 

supervisor, G.R., has corroborated that appellant immediately informed her of his injury on 

August 4, 2019. 

OWCP’s procedures provide that, if the condition reported is a minor one, which can be 

identified on visual inspection by a lay person, a case may be accepted without a medical report 

and no development of the case needs to be undertaken, if the injury was witnessed or reported 

promptly, and no dispute exists as to the occurrence of an injury, and no time was lost from work 

due to disability.

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The Board finds that appellant’s tooth injury is a visible injury, which was witnessed and 

identified by appellant’s lay person coworker. Appellant promptly reported the injury, no dispute 

exists as to the occurrence of the injury, and he lost no time from work. Therefore, no further 

development of the medical evidence is necessary for acceptance of the claim. 8

As appellant has established that he sustained a tooth injury from the August 4, 2019 

employmentincident, the Board will, therefore, reverse OWCP’s July 1, 2021 decision and remand 

the case for payment of medical expenses for appellant’s tooth injury, to be followed by a de novo 

decision regarding any attendant disability.

CONCLUSION

The Board finds that appellant has met his burden of proof to establish a tooth injury 

causally related to the accepted August 4, 2019 employment incident.

6 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).

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

(June 2011); id. at Chapter 2.805.3(c) (January 2013). See also A.J., Docket No. 19-1289 (issued December 31, 2019).

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Supra note 7. 
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ORDER

IT IS HEREBY ORDERED THAT the July 1, 2021 decision of the Office of Workers’

Compensation Programs is reversed.

Issued: April 19, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board