United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Jacksonville, FL, Employer

__________________________________________

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Docket No. 22-0586

Issued: July 12, 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

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 3, 2022 appellant filed a timely appeal from a February 16, 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.

ISSUE

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

causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On December 17, 2021 appellant, then a 62-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he developed bilateral knee osteoarthritis and lumbar 

spine pain due to the factors of his federal employment. He noted that he first became aware of 

1

5 U.S.C. § 8101 et seq.
2

his condition on October 20, 2020 and realized its relation to his federal employment on 

January 13, 2021. Appellant did not stop work.

In a medical report dated January 13, 2021, Justin Juelich, a physician assistant, related 

that appellant was experiencing sharp, burning, and shooting pain in the lower back, which radiated 

down his bilateral lower extremities to the ankles. He performed a physical examination of the 

lumbar spine and diagnosed a lumbar degenerative disc with radiculopathy and low back pain.

A diagnostic report dated April 21, 2021 from Dr. Jerome Puryear, Jr., a Board-certified 

radiologist, indicated that a magnetic resonance imaging (MRI) scan of appellant’s lumbar spine, 

revealed a multilevel dehydrated disc and degenerative changes throughout the lumbar spine.

In a medical report dated June 3, 2021, Dr. Richard Picerno, a Board-certified orthopedist, 

related that appellant had been experiencing bilateral knee pain for over six months and that he 

was experiencing a loss of strength in the knee in addition to persistent popping, bruising, stiffness, 

and swelling. He reviewed x-rays and diagnosed bilateral knee osteoarthritis.

On December 23, 2021 the employing establishment controverted appellant’s claim, 

contending that he had not providedevidence to establish that his medical conditions were causally 

related to his work-related factors.

In an undated statement, appellant noted that his official duties as a mail handler included 

continuously holding bundles of magazines, parcels, and papers that weighed up to 10 pounds. He 

further related that his duties required him to repetitively reach, twist, and stretch for two hours. 

Appellant would also load and unload bulk mail throughout buildings, push and pull heavy 

containers, trays, and sacks of mail. He also sorted packages weighing up to 70 pounds, and would 

stand on his feet during his entire shift. Appellant noted that he retired from federal service on 

March 31, 2021.

In a development letter dated December 29, 2021, OWCP informed appellant of the 

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

establish his claim and provided a questionnaire for his completion. In a separate development 

letter of even date, OWCP requested that the employing establishment provide comments from a 

knowledgeable supervisor regarding the accuracy of appellant’s allegations. It afforded both 

parties 30 days to respond.

OWCP received additional evidence. In a duty status report (Form CA-17) dated 

January 12, 2022, an unidentifiable healthcare provider noted that appellant was a mail handler 

and indicated that he injured himself when he lifted heavy sacs of mail onto a conveyor belt. 

Appellant was diagnosed with bilateral knee osteoarthritis and lumbar degenerative disc with 

radiculopathy.

In an attending physician’s report (Form CA-20) dated January 12, 2022, Dr. Fady ElBahri, a Board-certified orthopedist, noted a history of injury that appellant developed lower back 

pain, which radiated down his leg. He diagnosed degenerative disc disease and bulging lumbar 

discs. Dr. El-Bahri affirmatively indicated, by checking a box marked “Yes,” that appellant’s 

conditions were caused or aggravated by the claimed factors of his federal employment, including 

heavy lifting, bending, squatting, standing for long periods of time, and repetitive movements. In 
3

a separate Form CA-20 of even date, he diagnosed bilateral knee osteoarthritis and also checked a 

box marked “Yes,” indicating that appellant’s bilateral knee condition was caused or aggravated 

by his work-related duties.

By decision dated February 16, 2022, OWCP accepted that appellant established a 

diagnosed medical condition causally related to the accepted employment factors. However, it 

denied his claim, finding that the medical evidence of record was insufficient to establish causal 

relationship between the diagnosed conditions and the accepted factors of hisfederal employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence, 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 period of 

FECA, that an injury was sustained in the performance of duty as alleged, and that any disability 

or specific condition for which compensation is claimed is causally related to the employment 

injury.3 These are the essential elements of every compensation claim regardless of whether the 

claim is predicated on a traumatic injury or an occupational disease.

4

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, an employee must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence o f the 

disease or condition; (2) medical evidence establishing the presence or existence of the disease or 

condition for which compensation is claimed; and (3) medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the employee. 5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 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.7 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

2

Supra note 1.

3 K.V., Docket No. 18-0947 (issued March 4, 2019); M.E.,Docket No. 18-1135 (issued January 4, 2019);Kathryn 

Haggerty, 45 ECAB 383, 388 (1994).

4 K.V. and M.E., id.; Elaine Pendleton, 40 ECAB 1143 (1989).

5 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005);Ruby I. 

Fish, 46 ECAB 276, 279 (1994);Victor J. Woodhams, 41 ECAB 345 (1989).

6 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

7 M.V., Docket No. 18-0884 (issued December 28, 2018).
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rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).8

ANALYSIS

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

condition causally related to the accepted factors of his federal employment.

In support of his claim, appellant submitted CA-20 forms dated January 12, 2022 from

Dr. El-Bahri, who diagnosed a lumbar degenerative disc with radiculopathy, bulging lumbar discs, 

and bilateral knee osteoarthritis. In both forms, Dr. El-Bahri checked a box marked “Yes”

indicating that his conditions were caused or aggravated by the accepted employment factors. 

While these reports generally support causal relationship, he did not offer medical rationale 

sufficient to explain how and why he believed that the accepted employment factors resulted in or 

contributed to the diagnosed conditions. When a physician’s opinion on causal relationship 

consists only of checking a box marked “Yes” in response to a form question, without rationale

explaining causal relationship, that opinion has limited probative value and is insufficient to 

establish a claim.9 

Dr. Picerno provided a June 3, 2021 medical report, wherein he examined appellant’s knee 

pain and diagnosed bilateral knee osteoarthritis. He, however, did not address the cause of 

appellant’s bilateral osteoarthritis. 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.10 Thus, the Board finds that Dr. Picerno’s report is of no probative value on 

the issue of causal relationship and is insufficient to establish appellant’s burden of proof.

OWCP also received a Form CA-17 dated January 12, 2022 from an unidentifiable health 

care provider. The Board has held that reports that are unsigned or bear an illegible signature lack 

proper identification and cannot be considered probative medical evidence as the author cannot be 

identified as a physician.11 Therefore, this report is also insufficient to establish appellant’s claim.

Appellant further submitted a January 13, 2021 report from Mr. Juelich, a physician 

assistant, who diagnosed degenerative disc and spondylolisthesis. The Board has long held that 

medical reports signed solely by a physician assistant, registered nurse, or medical assistant are of 

8

Id.; Victor J. Woodhams, supra note 6.

9

J.K., Docket No. 20-0527 (issued May 24, 2022); J.K., Docket No. 20-0590 (issued July 17, 2020); J.A., Docket 

No. 17-1936 (issued August 13, 2018); DonaldW. Long, 41 ECAB 142 (1989); LillianM. Jones, 34 ECAB 379, 

381 (1982).

10 R.I., Docket No. 21-0033 (issued May 18, 2021); E.G., Docket No. 20-1191 (issued April5, 2021); L.B., Docket 

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

11 L.B. Docket No. 21-0353 (issued May 23, 2022); T.D., Docket No. 20-0835 (issued February 2, 2021); R.C., 

Docket No. 19-0376 (issued July 15, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); MertonJ. Sills, 39 

ECAB 572, 575 (1988).
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no probative value as such healthcare providers are not considered physicians as de fined under 

FECA and are, therefore, not competent to provide medical opinions. 12 

The record also contains an MRI scan of appellant’s lumbar spine signed by Dr. Puryear.

However, diagnostic studies, standing alone, lack probative value and are, therefore, insufficient 

to establish the claim.13 

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

appellant’s diagnosed medical conditions and the accepted employment factors, the Board finds 

that he has not met his 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 his burden of proof to establish a medical

condition causally related to the accepted factors of his federal employment.

12 Section 8101(2) of FECA provides that physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law. 5 

U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013); R.L., Docket No. 19-0440 (issued July 8, 2019) (a physician 

assistant is not considered a physician as defined under FECA); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) 

(lay individuals such as physician assistants, nurses, and physical therapists are not competent to render a medical 

opinion under FECA).

13 J.K., Docket No. 20-0591 (issued August 12, 2020); see A.B., Docket No. 17-0301 (issued May 19, 2017).
6

ORDER

IT IS HEREBY ORDERED THAT the February 16, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 12, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board