United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.W., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Savannah, GA, Employer

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Docket No. 22-0134

Issued: May 24, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 4, 2021 appellant filed a timely appeal from an October 18, 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 lower 

back/buttocks contusion causally related to the accepted August 23, 2021 employment incident. 

FACTUAL HISTORY

On September 10, 2021 appellant, then a 60-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that he sustained a buttocks contusion on August 23, 2021 when he 

was attacked by a dog and fell backwards in an attempt to get away while in the performance of 

1

5 U.S.C. § 8101 et seq.
2

duty. 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.

On August 23, 2021 the employing establishment issued an authorization for examination 

and/or treatment (Form CA-16). The description of the injury was that appellant “[f]ell onto back 

while escaping dog attack.” In an accompanying attending physician’s report, Part B of the Form 

CA-16, a health provider, whose signature is illegible, diagnosed “contusion buttocks,” and 

indicated by checking a box marked “Yes”that it was related to the employment activity described. 

The description of the employment activity was that appellant was “kicking at a dog and walking 

backwards. He lost his footing and fell onto his buttocks.” Appellant was treated and discharged 

from treatment on August 24, 2021.

OWCP also received a duty status report (Form CA-17) dated August 28, 2021, which

listed appellant’s diagnosis as a contusion to the lower back/buttocks. The signature on the form 

add was illegible.

In a development letter dated September 13, 2021, OWCP informed appellant of the 

deficiencies in his claim. It advised him of the type of factual and medical evidence needed and 

afforded him 30 days to submit the necessary evidence.

By decision dated October 18, 2021, OWCP accepted that the August 23, 2021

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 f act of injury has been established. 

2

Id.

3 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); Joe D. 

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

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.6

Pursuant to OWCP’s procedures, no development of a claim is necessary where the 

condition reported is a minor one, which can be identified on visual inspection by a lay person 

(e.g., burn, laceration, insect sting, or animal bite).7 No medical report is required to establish a 

minor condition such as a contusion.

8

ANALYSIS

The Board finds that appellant has met his burden of proof to establish a contusion to the 

lower back and buttocks causally related to the August 23, 2021 employment incident. 

On August 23, 2021 appellant was attacked by a dog and he fell on his buttocks. The duty 

status report dated August 28, 2021 diagnosed a contusion to the lower back/buttocks. This 

diagnosis of a lower back/buttocks contusion was consistent with appellant’s physical examination 

and the mechanism of injury. As appellant has established that he sustained a visible injury from 

the August 23, 2021 employment incident,9the Board will, therefore, reverse OWCP’s October 18, 

2021 decision and remand the case for payment of medical expenses for appellant’s injury, to be 

followed by a de novo decision regarding any attendant disability.10

CONCLUSION

The Board finds that appellant has met his burden of proof to establish a lower back and 

buttocks contusion causally related to the accepted August 23, 2021 employment incident.11

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, Causal Relationship, Chapter 2.800.6(a) (June 2011). See 

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

8

Id.; see B.C., Docket No. 20-0498 (issued August27, 2020) (the Board accepted lumbar contusion as causally 

related to the accepted employment incident); S.H., Docket No. 20-0113 (issued June 24, 2020) (the Board accepted 

a right ankle contusion as causally related to the accepted employment incident); M.A., Docket No. 13-1630 (issued 

June 18, 2014).

9

Supra notes 7 and 8.

10 K.V., Docket No. 21-1409 (issued April19, 2022).

11 The Board notes that the employing establishment issued a Form CA-16, dated February 11, 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).
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ORDER

IT IS HEREBY ORDERED THAT the October 18, 2021 decision of the Office of 

Workers’ Compensation Programs is reversed. 

Issued: May 24, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board