United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

N.M., Appellant

and

U.S. POSTAL SERVICE, LARCHMONT POST 

OFFICE, Albany, NY, Employer

__________________________________________

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Docket No. 22-1049

Issued: October 27, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On July 6, 2022 appellant filed a timely appeal from a May 18, 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 over 

the merits of this case.2

ISSUE

The issue is whether appellant has met his burden of proof to establish a left hip condition 

causally related to the accepted March 22, 2022 employment incident.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the issuance of OWCP’s May18, 2022 decision, OWCP received additional

evidence. However, the Board’s Rules of Procedure provides: “The Board’sreview of a case is limited to the evidence 

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.” See 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

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

FACTUAL HISTORY

On March 22, 2022 appellant, then a 58-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that he injured his left hip in the performance of duty on March 22, 2022. 

He explained that he was attacked by four dogs who charged at him, and that he sustained injury 

while stepping backward and placing weight on his left hip. Appellant stopped work on 

March 22, 2022.

On March 24, 2022 appellant was seen by Dr. Christine Yang-Kauh, a Board-certified 

emergency medicine physician. Dr. Yang-Kauh noted appellant’s March 22, 2022 history of 

injury and his unspecified hip pain. She opined that the incident was the probable medical cause

of his condition. Dr. Yang-Kauh advised appellant to return to work on light duty with restrictions.

Dr. Yang-Kauh completed an attending physician’s report, Part B of an authorization for 

examination and/or treatment (Form CA-16) on March 24, 2022. She indicated that appellant 

could return to work as of March 25, 2022 on light duty with restrictions. Dr. Yang-Kauh noted 

diagnoses of left hip pain and possible bursitis. She further indicated by marking the form that the

diagnosed condition was caused or aggravated by the employment activity described.

On March 25, 2022 the employing establishment issued a completed Form CA-16.

By development letter dated April 12, 2022, OWCP informed appellant of the deficiencies

of his claim. It advised him of the type of factual and medical evidence needed and provided a 

questionnaire for his completion. OWCP afforded appellant 30 days to respond.

On April 5, 2022 appellant was seen by Dr. Stephen Wade, Board-certified in pain 

medicine. Appellant related to Dr. Wade that on March 22, 2022 he twisted his left hip while

trying to move away from multiple dogs attacking him on his mail route. He indicated that he

previously had a left total hip replacement performed on June 26, 2020 by Dr. Steven Zelicof, a 

Board-certified orthopedic surgeon. Dr. Wade’s assessment found specific joint derangements of 

the left hip, as well as left hip pain. He opined that the alleged work incident was the medical 

cause of appellant’s conditions. Dr. Wade also found that appellant’s history of injury was

consistent with his objective findings. He further noted that appellant was totally disabled from 

work.

An x-ray report signed by Dr. Wade on April 5, 2022 indicated that no dislocation was 

noted in appellant’s left hip.

On April 21, 2022 appellant was seen by Dr. Zelicof. Dr. Zelicof noted appellant’s history 

of injury. He diagnosed iliotibial band syndrome in the left leg, and strain of unspecified muscles

and fascia and tendons at thigh level in left thigh. Dr. Zelicof further related that appellant’s 

radiographs demonstrated good position and alignment of his previous left hip replacement. He

indicated that appellant could likely return to work on May 4, 2022 with restrictions.

By decision dated May 18, 2022, OWCP accepted that the March 22, 2022 employment 

incident occurred as alleged and that a medical condition was diagnosed in connection with the 

incident. However, it denied appellant’s claim, finding that the medical evidence of record was 
3

insufficient to establish causal relationship between his diagnosed left hip conditions and the 

accepted March 22, 2022 employment incident.

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 of FECA, that the claim was timely filed within the applicable time 

limitation of FECA, that 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 an employee 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 is whether the employee actually 

experienced the employment incident that allegedly occurred. The second component is whether 

the employment incident caused a personal injury. An employee may establish that an injury 

occurred in the performance of duty as alleged but fail to establish that the disability or specific 

condition for which compensation is being claimed is causally related to the injury.6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the employment injury must be based on a complete factual 

and medical background.

8

 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 employment injury.

9

 

Neither the mere fact that a disease or condition manifests itself during a period of employment, 

3

5 U.S.C. § 8101.

4

J.M., Docket No. 17-0284 (issued February 7, 2018);R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 B.H., Docket No. 20-0777 (issued October 21, 2020). K.M., Docket No. 15-1660 (issued September 16, 2016);

L.M., Docket No. 13-1402 (issued February 7, 2014);DeloresC. Ellyett, 41 ECAB 992 (1990).

6 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989).

7 R.P., Docket No. 21-1189 (issued July 29, 2022); E.M., Docket No. 18-1599 (issued March 7, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

8 R.P., id.; F.A., Docket No. 20-1652 (issued May 21, 2021); M.V., Docket No. 18-0884 (issued December 28, 

2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

9

Id.
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nor the belief that the disease or condition was caused or aggravated by employment factors or

incidents is sufficient to establish causal relationship.

10

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.11

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a left hip 

condition causally related to the accepted March 22, 2022 employment incident.

Appellant submitted a medical report from Dr. Yang-Kauh dated March 24, 2022 wherein 

she noted appellant’s history of injury on March 22, 2022 and related a diagnosis of unspecified 

hip pain. Dr. Yang-Kauh indicated that the accepted incident was the probable medical cause. 

The Board has held that pain alone is a symptom, not a medical diagnosis, and that findings of 

pain or discomfort alone do not satisfy the medical aspect of the fact of injury medical 

determination.12

OWCP also received Part B of a Form CA-16 from Dr. Yang-Kauh wherein she noted 

appellant’s left hip pain, indicated his work restrictions, and diagnosed possible bursitis.

Dr. Yang-Kauh marked the form indicating her belief that the condition was caused or aggravated 

by the employment activity described. This opinion is speculative in nature as she only identified 

a possible diagnosis. The Board has held that medical opinions that are speculative or equivocal 

are of diminished probative value.13

Dr. Wade, in his medical report dated April 5, 2022, opined that the accepted employment 

incident was the medical cause of appellant’s hip pain and specific joint derangements of the left 

hip. He did not, however, provide a rationalized medical opinion regarding causal relationship. 

Dr. Wade did not specifically explain how the employment incident physiologically caused the 

specific joint derangements. Medical opinion evidence should offer a medically-sound 

explanation of how the specific employment incident or work factors, physiologically caused

injury.14 Further, appellant related to Dr. Wade that he previously had a left total hip replacement 

on June 26, 2020. If work-related exposures caused, aggravated, or accelerated appellant’s 

10 T.M., Docket No. 22-0220 (issued July 29, 2022); S.S., Docket No. 18-1488 (issued March 11, 2019); see also

J.L., Docket No. 18-1804 (issued April12, 2019).

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

M.B., Docket No. 20-1275 (issued January 29, 2021); see R.D., Docket No. 18-1551 (issued March 1, 2019).

12 T.M., Docket No. 22-0220 (issued July 29, 2022); see F.U., Docket No. 18-0078 (issued June 6, 2018); Federal 

(FECA) Procedure Manual, Part 2 --Claims, Fact of Injury, Chapter 2.803.4a(6) (August 2012).

13 N.H., Docket No. 21-1133 (issued February 25, 2022);see D.B., Docket No. 20-0775 (issued July 28, 2021).

14 O.E., Docket No. 20-0554 (issued October 16, 2020); L.R., Docket No. 16-0736 (issued September 2, 2016).
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condition, he could be entitled to compensation.15 However, a well-rationalized opinion is 

particularly warranted when there is a history of a preexisting condition.16 As such, Dr. Wade’s 

report lacks the specificity and detail needed to establish that appellant’s diagnosed left hip 

condition was a result of the accepted employment incident.17 This report is, therefore, of limited 

probative value and insufficient to establish causal relationship.18

Appellant also submitted a report from Dr. Zelicof dated April 21, 2022 wherein he 

diagnosed iliotibial band syndrome in the left leg, and strain of unspecified muscles and fascia and 

tendons at thigh level in left thigh. Dr. Zelicof did not provide an opinion regarding causal 

relationship. The Board has held that medical evidence that does not offer an opinion regarding 

the cause of an employee’s condition is of no probative value on the issue of causal relationship.19

OWCP additionally received an x-ray report of appellant’s left hip. However, diagnostic 

studies standing alone lack probative value, as they do not address whether the employment 

incident caused a diagnosed condition.20

As appellant the medical evidence of record is insufficient to establish causal relationship 

between his diagnosed medical conditions and the accepted March 22, 2022 employment incident, 

the Board finds that he has not met his burden of proof to establish his claim.21

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 his burden of proof to establish a left hip 

condition causally related to the accepted March 22, 2022 employment incident.

15 P.G., Docket No. 19-1827 (issued May 15, 2020); M.E., Docket No. 18-1135 (issued January 4, 2019).

16 J.H., Docket No. 20-1645 (issued August 11, 2021); T.M.,Docket No. 08-0975 (issued February 6, 2009).

17 Id.; see also T.C., Docket No. 19-0227 (issued July 11, 2019).

18 J.N., Docket No. 21-0606 (issued November 23, 2021); T.W., Docket No. 20-0767 (issued January 13, 2021); 

see H.A., Docket No. 18-1466 (issued August 23, 2019).

19 L.B., Docket No. 18-0533 (issued August 27, 2018); D.K.,Docket No. 17-1549 (issued July 6, 2018).

20 A.O., Docket No. 21-0968 (issued March 18, 2022); see M.S.,Docket No. 19-0587 (issued July 22, 2019).

21 The Board notes that the employing establishment issued a Form CA-16, dated March25, 2022. 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 forthe 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 May 18, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: October 27, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board