United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.A., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

U.S. CUSTOMS & BORDER PROTECTION, 

Pine Valley, CA, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 21-1279

Issued: January 21, 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, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 23, 2021 appellant filed a timely appeal from a July 28, 2021 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.

ISSUE

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

condition causally related to the accepted June 14, 2021 employment incident.

1 The Board notes that, following the July 28, 2021 decision, appellant submitted additional evidence to OWCP. 

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

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On June 17, 2021 appellant, then a 30-year-old border patrol agent, filed a traumatic injury 

claim (Form CA-1) alleging that on June 14, 2021 he sustained bruising and swelling to his right 

eye, scrapes and swelling to his left knee and right elbow, and experienced pain in his right thumb

when an aggressive man punched him while in the performance of duty. On the reverse side of 

the claim form, appellant’s supervisor, S.S., acknowledged that appellant was injured in the 

performance of duty. Appellant did not stop work.

In a development letter dated June 22, 2021, OWCP notified appellant of the deficiencies 

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

questionnaire for his completion. OWCP afforded appellant 30 days to submit the necessary 

evidence.

On June 14, 2021 the employing establishment executed an authorization for examination 

and/or treatment (Form CA-16). J.B., the authorizing official, listed the date of injury as June 14, 

2021 and described appellant’s injury as an impact injury to the face and scrapes to the right elbow 

and left knee.

An emergency department note of even date signed by Jessica Fain, a physician assistant, 

related that appellant was punched in the right eye by an intoxicated individual resisting arrest. 

Appellant reported right eye pain and contusion as well as an abrasion to his left knee. Ms. Fain

noted the existence of a bruise underneath his right eye, but found no tenderness with palpitation 

of the zygomatic and no pain with extraocular movement. She diagnosed a right eye contusion.

In a discharge record of even date, Ms. Fain noted appellant’s right eye pain. Her examination 

revealed no sign of damage to appellant’s eye. 

By decision dated July 28, 2021, OWCP accepted that the June 14, 2021 employment 

incident occurred, as alleged, but denied the claim as appellant had not established a diagnosed 

medical condition causally related to the 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

Id.

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

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

is whether the employment incident caused a personal injury.7

The 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 met his burden of proof to establish a right eye contusion

causally related to the accepted June 14, 2021 employment incident.

The Board notes that, pursuant to the Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Initial Development of Claims, Chapter 2.800.6(a) (June 2011), if a condition reported is a minor 

one, such as a burn, laceration, insect sting, or animal bite, which can be identified on visual 

inspection by a lay person, a case may be accepted without a medical report and no development 

of the case need be undertaken, if the injury was witnessed or reported promptly, and no dispute 

exists as to the occurrence of an injury, and no time was lost from work due to disability. 10

In a June 14, 2021 emergency department report, Ms. Fain diagnosed a right eye contusion. 

As the evidence of record establishes that appellant’s employment incident resulted in a visible 

injury, the Board finds that appellant has met his burden of proof to establish a right eye contusion 

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);

DeloresC. 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 April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

9 T.L., Docket No. 18-0778 (issued January22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020);

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

10 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Initial Development of Claims, Chapter 2.800.6(a) 

(June 2011); Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3(c) 

(January2013). See also A.J., Docket No. 20-0484 (issued September 2, 2020); S.K., Docket No. 18-1411 (issued 

July 22, 2020).
4

causally related to the accepted June 14, 2021 employment incident. Upon return of the case 

record, OWCP shall make payment and/or reimbursement of medical expenses with regard to the 

accepted contusion to the right eye.

CONCLUSION

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

causally related to the accepted June 14, 2021 employment injury.

11

ORDER

IT IS HEREBY ORDERED THAT the July 28, 2021 decision of the Office of Workers’

Compensation Programs is reversed. 

Issued: January 21, 2022

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

11 A completed Form CA-16authorization 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); J.G., Docket No. 17-1062 (issued February 13, 2018); TracyP. Spillane, 54 ECAB 608 (2003).