United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.R., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Grand Rapids, MI, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 22-0471

Issued: June 27, 2022

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the Appellant1

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 February 9, 2022 appellant, through counsel, filed a timely appeal from a January 27,

2022 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 over 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 a medical condition 

causally related to the accepted October 30, 2020 employment incident. 

FACTUAL HISTORY

On December 2, 2020 appellant, then a 64-year-old rural delivery specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on October 30, 2020 she strained her right knee 

when she tripped over a package while in the performance of duty. She did not stop work.

In an undated statement, appellant related that she overextended her knee when she tripped 

and caught her foot on a panel while carrying mail flats. She indicated that she developed right

hip and leg pain as a result of the alleged incident. 

A return-to-work note dated November 17, 2020 from Dr. Adam Stefaniak, a Boardcertified orthopedist, held appellant off work November 17 through 25, 2020. 

A Family and Medical Leave Act medical form dated December 2, 2020 was completed 

by Dr. Hina Humeera, a Board-certified family medicine specialist. Dr. Humeera related that on 

October 30, 2020 appellant tripped over a package while carrying mail, which caused lower back 

pain radiating down into her leg. She also noted that she had a history of radiculopathy of the right 

leg. 

In a duty status report (Form CA-17) dated December 23, 2020, Dr. Humeera provided a 

description of injury that on October 30, 2020 appellant tripped and injured her knee, hip, and leg.

She repeated her earlier medical findings and diagnoses. 

On December 24, 2020 the employing establishment controverted appellant’s claim, 

contending that she did not submit medical evidence sufficient to establish a diagnosed condition 

causally related to the alleged employment incident. 

A Form CA-17 from Dr. Humeera dated December 30, 2020 reiterated the alleged 

mechanism of injury on October 30, 2020. Dr. Humeera noted that appellant’s lower back pain 

was radiating down appellant’s leg and that her right knee pain caused weakness and difficulty 

walking. She diagnosed lumbosacral radiculopathy and right knee pain. 

In a development letter dated January 19, 2021, OWCP informed appellant of the 

deficiencies of her claim. It advised her of the type of factual and medical evidence necessary to 

establish her claim and provided a questionnaire for her completion. OWCP afforded appellant

30 days to submit the necessary evidence. 

A Form CA-17 dated January 11, 2021 from Dr. Paula Kilmer, a Board-certified 

physiatrist, related that appellant was experiencing weakness in the right leg. Dr. Kilmer

diagnosed lumbar radiculopathy and indicated that she was to undergo a magnetic resonance 

imaging (MRI) scan. In a return-to-work note of even date, she held appellant off work from 

January 11 through February 11, 2021. 
3

In a diagnostic report dated February 2, 2021, Dr. Charles Swallow, a Board-certified 

radiologist, performed an MRI scan of appellant’s lumbar spine, which revealed multilevel lumbar 

spondylosis with spinal and foraminal stenosis, right foraminal disc extrusion, and an associated 

hemorrhage. In a medical report of even date, he reiterated his findings from the MRI scan. 

A February 9, 2021 medical report from Dr. Kilmer noted that an MRI scan revealed 

spondylolisthesis of the lumbar region and lumbosacral radiculopathy. 

In a medical report dated February 17, 2021, Dr. Alain Fabi, a Board-certified 

neurosurgeon, reviewed appellant’s physical examinations and medical history. He diagnosed 

lumbar spondylosis and osteoporosis without a pathological fracture. In a Form CA-17 of even 

date, Dr. Fabi reiterated his clinical findings and also diagnosed lumbar radiculopathy. 

By decision dated February 25, 2021, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence of record was insufficient to establish medical conditions

causally related to the accepted October 30, 2020 employment incident. It concluded, therefore, 

that the requirements had not been met to establish an injury or medical condition causally related 

to the accepted employment incident. 

On January 11, 2021 appellant was seen by Dr. Kilmer, who related that on October 30, 

2020 appellant tripped and fell over a package, which caused her to develop back pain. She noted 

that appellant received physical therapy, but that it did not significantly improve radicular pain and 

numbness that had developed in the lower leg. Dr. Kilmer indicated that x-rays revealed

underlying radiculopathy and spondylosis. She opined that the October 30, 2020 employment 

incident aggravated appellant’s underlying lumbar conditions. 

In a diagnostic report dated February 17, 2021, Dr. Alexander Serra, a Board-certified 

radiologist, performed an x-ray of appellant’s lumbar spine, which revealed mild spondylosis and 

bilateral degenerative facet arthrosis. In a medical report of even date he additionally diagnosed 

lumbosacral radiculopathy.

A diagnostic report dated March 11, 2021 from Dr. Roman Hyszczak, a Board-certified 

radiologist, noted that an x-ray of appellant’s lumbar spine revealed lumbosacral radiculopathy. 

On April 8, 2021 appellant requested reconsideration of OWCP’s February 25, 2021 

decision. 

OWCP received additional evidence. In a Form CA-17 dated April 20, 2021, Dr. Fabi 

reiterated his previous diagnoses and medical findings. In a report of even date, he noted that 

appellant’s x-rays revealed a posterior fusion at L4-5, but reported that her lateral alignment was 

unchanged. In a diagnostic report also dated April 20, 2021, Dr. Robert Zick, a Board-certified 

radiologist, noted that there were no unexpected postoperative findings.

On June 2, 2021 appellant was seen by Dr. Zick for a follow-up appointment. Dr. Zick 

noted a stable lateral alignment. 
4

In a return to work note dated June 8, 2021, Dr. Fabi released appellant to work on 

July 12, 2021. By decision dated July 7, 2021, OWCP denied modification of its February 25, 

2021 decision.

OWCP subsequently received a diagnostic report dated June 2, 2021, from Dr. Zick who

indicated that appellant’s postoperative lumbar spine was stable. 

On August 17, 2021 appellant appealed OWCP’s July 7, 2021 decision to the Board. In a 

November 1, 2021 letter, counsel requested dismissal of the appeal to the Board3 and requested 

reconsideration of this decision before OWCP. 

In an October 26, 2021 narrative report, Dr. Sami Moufawad, a Board-certified physiatrist 

conducted an audio visual visit from which he recounted appellant’s medical history as given, and 

conducted a physical examination. He related that on October 30, 2020 she sustained a knee sprain 

when she tripped over a stack of mail while her view was blocked. In the process of breaking the 

fall, appellant lifted her back upwards, which caused her right knee to extend backwards. 

Dr. Moufawad explained that the mechanism of injury was a sudden pull of the knee ligaments 

and the forceful movement of falling forward, which resulted in a hyperextension of the knee. He

indicated that, after the incident, appellant’s pain began to radiate down to her right lower limb 

and lumbar region, causing numbness in the right lower back, buttocks, and right thigh. 

Dr. Moufawad opined that her lumbar conditions were also caused or aggravated by falling 

forward. As appellant prevented the fall, her spine thrusted backwards, contracting the muscles at 

high speed, squeezing the vertebra together, and eventually increasing pressure in the 

intervertebral disc. Dr. Moufawad explained that this impacted her ability to stand, walk, and lift 

heavy objects. He opined that this increased sudden pressure and appellant attempt to pull herself 

up from falling injured multiple lumbar spinalstructures and aggravated a preexisting dehydrated 

disc, which caused the disc protrusion thatled to her right radiculopathy condition. Dr. Moufawad 

noted that the pressure also impacted a dehydrated disc, which aggravated her preexisting 

anterolisthesis by decreasing the height and reducing the walls of the discs, and, therefore,

decreasing support for the vertebra. He diagnosed a right knee sprain, aggravation of 

anterolisthesis, disc protrusion, and right lumbar radiculopathy. 

By decision dated January 27, 2022, OWCP denied modification of its July 7, 2021

decision, finding that Dr. Moufawad’s October 26, 2021 narrative report did not create an 

inference of causal relationship. It concluded that appellant had not established that her right knee 

and lumbar spine conditions were causally related to the accepted October 30, 2020 employment 

incident. 

LEGAL PRECEDENT

A claimant seeking benefits under FECA4 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 limitation 

3 Order Dismissing Appeal, Docket No. 21-1247 (issued November 29, 2021).

4

Supra note 2.
5

of FECA,5that 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.6 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.7

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, place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury.8

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence.

9

 Rationalized medical opinion evidence is medical evidence which includes a 

physician’s rationalized opinion on the issue of whether there is a causal relationship between the 

claimant’s diagnosed condition and the implicated employment factors. The opinion of the 

physician must be based on a complete factual and medical background of the claimant, 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 claimant.

10

ANALYSIS

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

In his October 26, 2021 narrative report, Dr. Moufawad conducted an audio visual visit 

from which he recounted appellant’s medical history as given, conducted a physical examination 

and diagnosed a right knee sprain, aggravation of anterolisthesis, disc protrusion, and right lumbar 

radiculopathy. He opined that the accepted October 30, 2020 employment incident caused 

appellant’s right knee sprain when she tripped over a stack of mail while her view was blocked. 

Dr. Moufawad explained that the mechanism of injury, a hyperextension of the knee, was caused 

by a sudden pull and undue pressure on the right knee ligaments in conjunction with the forceful 

5 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). 

6 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).

7 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).

8 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).

9

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

10 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).
6

movement of falling over. He further opined that both radiated pain from the incident’s impact 

and the process of falling forward contributed to or aggravated her diagnosed lumbar conditions.

Dr. Moufawad explained that the process of falling forward thrusted her spine backwards. This

resulted in the lumbar spine muscles to contract at high speed and squeeze the vertebra together, 

eventually building pressure in the intervertebral disc. He found that this pressure impacted a

preexisting dehydrated disc, which then aggravated the preexisting anterolisthesis by reducing 

support for the vertebra. Dr. Moufawad also concluded that the pressure in the intervertebral disc 

caused a degenerative disc protrusion, which contributed to right radiculopathy, as x-rays 

following the employment incident revealed nerve roots pushing past the degenerative disc.

The Board finds thatDr. Moufawad provided an affirmative opinion on causal relationship. 

Further, Dr. Moufawad’s opinion is based upon a complete factual history from the appellant and 

medical background.11 While his report is not completely rationalized to meet appellant’s burden 

of proof to establish her claim, it raises an uncontroverted inference between her diagnosed 

medical conditions and the accepted employment incident and, therefore, is sufficient to require 

OWCP to further develop the medical evidence and the case record.

12

The Board notes that 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.13 It has an obligation to see that justice is done.14

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

medical evidence. On remand, OWCP shall refer appellant, a statement of accepted facts (SOAF)

and the medical evidence of record to a specialist in the appropriate field of medicine. The chosen 

physician shall provide a rationalized opinion on whether the diagnosed conditions are causally 

related to the accepted employment incident. 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. Moufawad. Following this and any further development as deemed necessary, 

OWCP shall issue a de novo decision on appellant’s claim.

CONCLUSION

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

11 E.P., Docket No. 20-0898 (issued February 17, 2021); S.C., Docket No. 19-0920 (issued September 25, 2019).

12 D.V., Docket No. 21-0383 (issued October 4, 2021); K.S., Docket No. 19-0506 (issued July 23, 2019); H.T., 

Docket No. 18-0979 (issued February 4, 2019); D.W., Docket No. 17-1884 (issued November 8, 2018). John J. 

Carlone, 41 ECAB 354, 358-60 (1989).

13 Id.

14 Id.
7

ORDER

IT IS HEREBY ORDERED THAT the January 27, 2022 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: June 27, 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