United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

W.O., Appellant

and

DEPARTMENT OF THE TREASURY, 

INTERNAL REVENUE SERVICE, Ogden, UT, 

Employer

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Docket No. 22-0418

Issued: February 15, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

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 27, 2022 appellant filed a timely appeal from a December 13, 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.2

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 13, 2021 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record 

that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the 

Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish a diagnosed medical 

condition in connection with the accepted September 10, 2021 employment incident.

FACTUAL HISTORY

On October 29, 2021 appellant, then a 59-year-old computer clerk and assistant, filed a 

traumatic injury claim (Form CA-1) alleging that on September 10, 2021 she injured her back 

when she fell onto a pallet as she was pushing a roll of paper while in the performance of 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. 

In support of her claim, appellant submitted a prescription note dated September 20, 2021 

from Dr. Jeffery L. Degrauw, a Board-certified family practice specialist. Dr. Degrauw advised 

that she was seen for a fall at work on September 10, 2021 during which time she struck her back 

and the back of her head. 

In a development letter dated November 4, 2021, OWCP advised appellant of the 

deficiencies of her claim and further advised her that additional factual and medical evidence was 

necessary to establish her claim. It noted the type of factual and medical evidence needed and 

provided her with a questionnaire. OWCP afforded appellant 30 days to submit the necessary 

evidence. Appellant did not respond. 

By decision dated December 13, 2021, OWCP accepted that the September 10, 2021

employment incident occurred, as alleged, but denied appellant’s claim finding that she had not 

submitted medical evidence containing a medical diagnosis in connection with her 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 FECA3 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,4that 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 

3 Supra note 1.

4 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989).
3

to the employment injury.5 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.6

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

performance of duty, it must first 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 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 and can be established only by medical 

evidence.7

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

condition and an employment incident is rationalized medical opinion evidence.8 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.9

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a diagnosed 

medical condition in connection with the accepted September 10, 2021 employment incident.

OWCP received a prescription note dated September 20, 2021 from Dr. Degrauw. While

Dr. Degrauw noted that appellant struck her back and head during a fall on September 10, 2021 he 

neither provided a diagnosis of her medical condition, nor an opinion on causal relationship. The 

Board has held that a medical report is of no probative value if it does not provide a firm diagnosis 

of a particular medical condition, and a rationalized medical opinion that the accepted employment 

incident or events caused or aggravated the diagnosed condition.10

5 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).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990).

7 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).

8 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).

9 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).

10 L.E., Docket No. 19-0470 (issued August 12, 2019); M.J., Docket No. 18-1114 (issued February 5, 2019); see 

also L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
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As there is no medical evidence of record establishing a firm diagnosis of a medical 

condition, and rationalized medical opinion in connection with the accepted September 10, 2021 

employment incident, the Board finds that appellant 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 a diagnosed 

medical condition in connection with the accepted September 10, 2021 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the December 13, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 15, 2023

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