United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.A., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, East Orange, NJ, Employer

__________________________________________

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Docket No. 20-1201

Issued: April 26, 2021

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, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 26, 2020 appellant filed a timely appeal from a May 20, 2020 merit decision of 

the Office of Workers’ Compensation Programs (OWCP).1 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 Appellant submitted a timely request for oral argument before the Board. 20 C.F.R. § 501.5(b). Pursuant to the 

Board’s Rules of Procedure, oral argument may be held in the discretion of the Board. 20 C.F.R. § 501.5(a). In 

support of appellant’s oral argument request, she asserted that oral argument should be granted because the evidence 

of record supports that her diagnosed medical conditions are causally related to the accepted August 21, 2017 

employment incident. The Board, in exercising its discretion, denies appellant’s request for oral argument because 

this matter requires an evaluation of the medical evidence presented. As such, the arguments on appeal can adequately 

be addressed in a decision based on a review of the case record. Oral argument in this appeal would further delay 

issuance of a Board decision and not serve a useful purpose. As such, the oral argument request is denied and this 

decision is based on the case record as submitted to the Board.

2 5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish a back or right leg 

condition causally related to the accepted August 21, 2017 employment incident.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows. 

On August 29, 2017 appellant, then a 28-year-old nursing assistant, filed a traumatic injury 

claim (Form CA-1) alleging that on August 21, 2017 she sustained injuries to her low back and 

right lower leg while in the performance of duty. She explained that she was guiding a resident in 

the bathroom who fell backward and that she caught him to prevent him from falling.4

The employing establishment controverted the claim, indicating that the incident did not 

occur as alleged. After initial development of the evidence, by decision dated January 4, 2018, 

OWCP denied appellant’s claim, finding that the factual component of fact of injury had not been 

met. It found that the evidence was insufficient to establish that an employment incident occurred 

as alleged.

On January 30, 2018 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. By decision dated July 20, 2018, OWCP’s hearing 

representative affirmed OWCP’s January 4, 2018 decision.

Appellant appealed to the Board. By decision dated April 10, 2020, the Board set aside 

the July 20, 2018 decision, finding that appellant had met her burden of proof to establish that the 

employment incident occurred as alleged. The Board found that it was undisputed that appellant

was in a limited-duty status and that she worked on a ward where the residents had dementia or 

long-term memory loss issues. It was also undisputed that she was assigned to transport a male 

resident to the employing establishment’s eye clinic for an examination. The Board found 

appellant’s consistent description of the incident was sufficient to establish that it occurred at the 

time, place, and in the manner alleged. The Board remanded the case for a de novo decision 

addressing whether appellant has met her burden of proof to establish an injury or condition 

causally related to the accepted employment incident. 

The evidence of record reflects that on August 25 and 28, 2017 appellant sought urgent 

care treatment following the August 21, 2017 incident. In an August 25, 2017 note, Dr. Kasnif 

Ramzan, a Board-certified family practitioner, in a post-injury evaluation form, diagnosed leg 

sprain and placed her off work. In an August 28, 2017 note, Dr. Michael Tafoya, a Board-certified 

 

3 Docket No. 19-0616 (issued April 10, 2020). 

4 Under OWCP file number xxxxxx356, OWCP accepted appellant’s claim for a June 30, 2016 lumbar strain. 

Appellant retuned to work in a full-time limited-duty position on July 5, 2016. Her claims have not been 

administratively combined by OWCP.
3

emergency medical practitioner, diagnosed right calf strain and right gluteal strain. He advised 

that appellant could work with restrictions.

In September 13 and 27, 2017 attending physician’s reports (Form CA-20), Dr. Joe 

VonGvorachoti, a Board-certified in physical and sports medicine, reported a history of a heavy 

male patient falling on appellant, who was reported as being six months pregnant, on 

August 21, 2017. He related diagnosis of displacement of lumbar intervertebral disc, and checked

a box “Yes,” indicating that the diagnosed condition was causally related to the employment 

activity. In corresponding reports, Dr. VonGvorachoti diagnosed S1 joint inflammation and 

lumbar disc displacement based on the magnetic resonance imaging (MRI) scan study. He

requested physical therapy and found appellant totally disabled from work until October 11, 2017. 

An October 17, 2016 MRI scan of appellant’s lumbar spine was submitted, which noted 

minimal disc bulging at L3-4 through L5-S1.

Dr. VonGvorachoti completed return-to-work forms indicating that appellant remained 

totally disabled on October 11 and November 10, 2017.5

In a November 8, 2017 report, Dr. VonGvorachoti noted that on September 13, 2017 

appellant presented for an initial examination and evaluation from an August 21, 2017 

employment-related injury, which occurred when she was moving an obese patient who fell onto 

her. He diagnosed displacement of lumbar intervertebral disc and inflammation of sacroiliac 

joint.6 Dr. VonGvorachoti noted that appellant’s prior work injury in June 20167 predisposed her 

to future back injuries and that she was pregnant, which put extra strain on her back. He indicated 

that a heavy patient falling on her was a potential mechanism for back injuries. Dr. VonGvorachoti 

opined that the August 21, 2017 work incident aggravated conditions caused by the June 30, 2016 

injury as well as any new low back pain.

Dr. VonGvorachoti continued to submit progress reports and disability slips opining that 

appellant was totally disabled. In a January 24, 2018 narrative report, he noted that a heavy/obese 

male patient fell on appellant in the bathroom. Dr. VonGvorachoti indicated that the incident 

caused injury to her lumbar discs and repeated his assessment of lumbar disc displacement and 

inflammation of sacroiliac joint. He opined that appellant’s back pain was causally related to her 

August 21, 2017 employment injury, which also exacerbated her previous employment injury of 

June 2016. Dr. VonGvorachoti explained that a heavy patient falling on appellant was a potential 

mechanism for a back injury.

OWCP also received a copy of a September 1, 2016 lumbar spine MRI scan, which

indicated minimal disc bulging L3-4 through L5-S1. 

 

5 OWCP received claims for compensation (Form CA-7) for disability for the period October 6, 2017 onward.

6 A September 1, 2016 lumbar MRI scan revealed disc bulges at L3-4 and L5-S1 and electromyogram/nerve 

conduction velocity tests conducted on March 29, 2017 were normal.

7 See supra note 4. 
4

By decision dated May 20, 2020, OWCP denied the claim, finding that the medical 

evidence of record was insufficient to establish that the diagnosed medical conditions were 

causally related to the accepted August 21, 2017 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA8 has the burden of establishing the essential 

elements of his or her claim, including the fact 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,9that 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.10 These are the essential elements of each and every claim, regardless of 

whether it is predicated upon a traumatic injury or an occupational disease.11

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether “fact of injury” has been established.12 Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred.13 The second component is whether the employment incident caused a personal injury.14 

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.15

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

condition and an employment incident is rationalized medical opinion evidence.16 A physician’s

opinion on whether there is causal relationship between the diagnosed condition and the implicated 

employment factor(s) must be based on a complete factual and medical background. Additionally, 

 

8 Supra note 2.

9 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); S.B.,

Docket No. 17-1779 (issued February 7, 2018); Joe D. Cameron, 41 ECAB 153 (1989).

10 L.C., Docket No. 19-1301 (issued January 29, 2020); J.M., Docket No. 17-0284 (issued February 7, 2018); R.C.,

59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).

11 P.A., Docket No. 18-0559 (issued January 29, 2020); G.D., Docket No. 19-0256 (issued May 20, 2019); L.M.,

Docket No. 13-1402 (issued February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

12 G.B., Docket No. 19-0773 (issued August 19, 2019); E.M., Docket No. 18-1599 (issued March 7, 2019); T.H.,

59 ECAB 388, 393-94 (2008).

13 L.T., Docket No. 18-1603 (issued February 21, 2019); Elaine Pendleton, 40 ECAB 1143 (1989).

14 T.H., Docket No. 19-0599 (issued January 28, 2020); B.M., Docket No. 17-0796 (issued July 5, 2018); John J. 

Carlone, 41 ECAB 354 (1989).

15 G.B., supra note 12; Shirley A. Temple, 48 ECAB 404, 407 (1997).

16 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).
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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 specific employment factor(s).17

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a back or right 

leg condition causally related to the accepted August 21, 2017 employment incident.

In support of her claim, appellant submitted a series of disability notes and reports from

Dr. VonGvorachoti. In his September 13 and 27, 2017 Form CA-20 reports, Dr. VonGvorachoti

reported a history that on August 21, 2017 a heavy male patient fell on appellant, who was reported 

as being six months pregnant. He diagnosed S1 joint inflammation and lumbar disc displacement 

and indicated by checkmark that the diagnosed conditions were causally related to the employment 

incident. However, the Board has held that an opinion on causal relationship with an affirmative

check mark, without more by way of medical rationale, is insufficient to establish the claim.18 In 

these reports and corresponding progress notes of the same date, Dr. VonGvorachoti failed to offer

a further opinion regarding the cause of the diagnosed conditions. 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 Thus, these reports are insufficient to 

establish appellant’s claim.

In November 8, 2017 and January 24, 2018 reports, Dr. VonGvorachoti opined that the 

August 21, 2017 employment incident injured appellant’s lumbar spine. He diagnosed 

displacement of lumbar intervertebral disc and inflammation of sacroiliac joint. 

Dr. VonGvorachoti also noted that appellant’s prior work injury in June 2016 predisposed her to 

future back injuries and that she was pregnant, which placed extra strain on her back. While he

opined that the August 21, 2017 work incident aggravated conditions caused by the claimed 

June 30, 2016 injury, Dr. VonGvorachoti did not explain how physiologically a heavy patient 

falling on appellant caused or aggravated her displacement of lumbar intervertebral disc and 

inflammation of sacroiliac joint conditions.20 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.21 Additionally, Dr. VonGvorachoti’s opinion that a heavy patient falling on 

 

17 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).

18 J.S., Docket No. 20-0534 (issued December 31, 2020); C.S., Docket No. 18-1633 (issued December 30, 2019); 

D.S., Docket No. 17-1566 (issued December 31, 2018).

19 See V.S., Docket No. 19-1370 (issued November 30, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); 

D.K., Docket No. 17-1549 (issued July 6, 2018).

20 See C.H., Docket No. 20-0228 (issued October 7, 2020); D.J., Docket No. 16-0663 (issued October 20, 2016).

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

K.G., Docket No. 18-1598 (issued January 7, 2020); M.S., Docket No. 19-0913 (issued November 25, 2019).
6

appellant was a “potential mechanism for back injuries” was speculative and equivocal in nature. 

The Board has held that speculative and equivocal medical opinions regarding causal relationship 

have no probative value.22 Dr. VonGvorachoti’s reports, therefore, lack medical rationale and are 

insufficient to establish causal relationship.

The record also contains an August 25, 2017 report by Dr. Ramzan, who diagnosed a leg 

strain, and an August 28, 2017 report by Dr. Tafoya, who diagnosed right calf strain and right 

gluteal strain. However, neither Dr. Ramazan nor Dr. Tafoya offered an opinion regarding causal 

relationship. 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.23 These reports, therefore, 

are insufficient to establish appellant’s claim.

The record also contains September 1 and October 17, 2016 lumbar MRI scans, which 

predate the August 21, 2017 employment incident. The Board has long held that diagnostic 

studies, standing alone, lack probative value on the issue of causal relationship as they do not 

address whether the employment injury caused any of the diagnosed conditions.24 These reports 

are, therefore, insufficient to establish appellant’s claim.

The Board, thus, finds that appellant has not met her burden of proof to establish that her 

diagnosed medical conditions of displacement of lumbar intervertebral disc, inflammation of 

sacroiliac joint, leg sprain, right calf strain, and right gluteal strain were not caused or aggravated 

by the accepted August 21, 2017 employment incident.

On appeal appellant argues that the narrative report of November 8, 2017 from

Dr. VonGvorachoti, supports that her back conditions were causally related to the accepted 

August 21, 2017 employment incident. For the reasons explained above, however,

Dr. VonGvorachoti’s medical reports are insufficient to establish her claim.

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 back or right 

leg condition causally related to the accepted August 21, 2017 employment incident.

 

22 B.S., Docket No. 20-0927 (issued January 29, 2021); R.C., Docket No. 18-1695 (issued March 12, 2019); Ricky S. 

Storms, 52 ECAB 349 (2001).

23 See supra note 20. 

24 J.P., Docket No. 19-0216 (issued December 13, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
7

ORDER

IT IS HEREBY ORDERED THAT the May 20, 2020 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: April 26, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board