United States Department of Labor

Employees’ Compensation Appeals Board

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L.L., Appellant

and

DEPARTMENT OF LABOR, BUREAU OF 

LABOR STATISTICS, Dallas, TX, Employer

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Docket No. 22-0733

Issued: May 9, 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

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 27, 2022 appellant filed a timely appeal from a November 16, 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.

ISSUE

The issue is whether appellant has met her burden of proof to expand the acceptance of her 

claim to include a lumbar condition causally related to, or consequential to, her accepted April 28, 

2017 employment injury.

FACTUAL HISTORY

On May 16, 2017 appellant, then a 58-year-old administrative clerk, filed a traumatic injury 

claim (Form CA-1) alleging that on April 28, 2017 she fractured her right foot and experienced 

soreness in her hands, elbows, neck, knees, and right ankle when her ankle got tangled in a cable 

causing her to fall as she was walking to the employing establishment while in the performance of 

1

5 U.S.C. § 8101 et seq.
2

duty. She stopped work on May 2, 2017 and returned on May 16, 2017. OWCP accepted 

appellant’s claim for bilateral knee contusions, cervical spine sprain, bilateral hand contusions, 

and right foot strain.

Appellant continued to receive medical treatment. In a letter dated May 3, 2018,

Dr. Marvin Van Hal, a Board-certified orthopedic surgeon, indicated that she had informed him 

that she injured her lumbar spine when she fell forward onto her hands and knees. He noted that 

a lumbar spine magnetic resonance imaging (MRI) scan demonstrated facet changes.2 Dr. Van Hal 

noted that appellant’s back was not accepted as part of her work injury, but his records indicated 

that she had previously complained of lumbar spine discomfort. On physical examination, he 

observed that she had 10 degrees of extension and increased low back pain on range of motion.

Dr. Van Hal explained that, “[g]iven [appellant’s] clinical picture and her current continued pain 

and multiple areas of dysfunction,” OWCP should include a lumbar spine strain as a consequential 

injury or an aggravation of a preexisting condition due to the April 28, 2017 employment injury. 

In an accompanying duty status report (Form CA-17), he indicated that she could work with 

restrictions. 

In a report and Form CA-17 dated August 9, 2018, Dr. Van Hal noted examination findings 

of positive straight leg raise testing bilaterally. He assessed that appellant had multiple 

musculoskeletal and possible other issues contributing to a slow recovery.

On September 18, 2018 OWCP referred appellant, a statement of accepted facts (SOAF),

and a series of questions, to Dr. James E. Butler, III, a Board-certified orthopedic surgeon, for a 

second opinion evaluation to determine whether she had a lumbar condition as a consequence of 

her accepted April 28, 2017 employment injury. In a report dated October 25, 2018, Dr. Butler

reviewed her history of injury and the SOAF. He noted that appellant’s claim was accepted for 

bilateral knee contusions, cervical spine sprain, right foot strain, and bilateral hand contusions. 

Dr. Butler recounted her complaints of pain in the lower back, bilateral wrists, right knee, ankle, 

hip, and neck. On physical examination, he observed no sensory deficits bilaterally of the spinal 

dermatomes or the lower extremities. Examination of appellant’s cervical spine revealed 

tenderness at the C7-T1 levels on palpation. Dr. Butler reported that she was unable to move her 

right ankle and could barely move her right foot and toes. He diagnosed knee contusions, cervical 

spine sprain, right foot/ankle sprain, right ankle tenosynovitis, and hand contusions. In response 

to OWCP’s questions, Dr. Butler opined that appellant’s bilateral hand contusions, cervical spine 

sprain, and left knee contusion had resolved. He reported that she still had residuals of her right 

foot and knee conditions and noted that physical examination revealed significantly-restricted 

range of motion, weakness, and gait abnormality. Dr. Butler also indicated that there was “no 

objective evidence to support the lumbar spine condition as causally related to work-related injury 

of [April 28, 2017].” He explained that there was no evidence that appellant reported any lumbar 

spine pain after the April 28, 2017 fall at work. Dr. Butler indicated that, while Dr. Van Hal 

mentioned a September 8, 2017 lumbar spine MRI scan, the findings were consistent with 

degenerative changes, and unlikely caused by a single trip and fall incident.

In reports and CA-17 forms dated October 4, 2018 through May 9, 2019, Dr. Van Hal 

indicated that appellant had multiple musculoskeletal complaints for her cervical spine, lumbar 

2 A September 8, 2017 lumbar spine MRI scan revealed mild grade 1 anterolisthesis of L4 on L5, upper lumbar 

scoliosis with right convexity, mild multilevel spondylosis with annular-type disc bulges, and multilevel neural 

foraminal narrowing, most nota ble at left L4-5.
3

spine, and right lower extremities and slow progress with recovery. He reported that it was difficult 

to conduct a clinical examination because of her symptoms and lack of effort. Dr. Van Hal opined 

that appellant had chronic pain disorder associated with musculoskeletal dysfunction with 

suggestion of fibromyalgia-type syndrome and cervical pathology associated with spondylosis.

On May 20, 2019 OWCP received a request for authorization of an MRIscan of appellant’s

lumbar spine.

In a letter dated May 23, 2019, OWCP indicated that it had received appellant’s request for 

authorization of a lumbar spine MRI scan. It advised her that the medical evidence of record was 

insufficient to authorize the proposed treatment because she did not have an accepted lumbar spine 

condition. OWCP requested that appellant provide a detailed narrative medical report from her 

treating physician explaining how a diagnosed lumbar condition was caused or aggravated by her 

April 28, 2017 employment injury.

A May 22, 2019 lumbar spine MRI scan demonstrated degenerative changes without 

central spinal stenosis or neural foraminal stenosis, mild dextroscoliosis, and grade 1 

anterolisthesis of L4 on L5.3

In reports and CA-17 forms dated June 20 through October 24, 2019, Dr. Van Hal noted 

that appellant continued to complain of multiple musculoskeletal issues. He provided examination 

findings and diagnosed chronic recurrent pain, multiple musculoskeletal issues, and underlying 

disorder of the lumbar spine.

Appellant also submitted a February 6, 2019 report by Dr. Dorit Sar-Shalom, a 

chiropractor, who noted appellant’s complaints of neck, right knee, and right ankle pain. 

Dr. Sar-Shalom provided examination findings and diagnosed cervical spine sprain, right knee and 

right foot contusions, and right foot strain.

On August 26, 2019 OWCP expanded the acceptance of appellant’s claim to include right 

ankle tenosynovitis. 

In a report and Form CA-17 dated January 16, 2020, Dr. Van Hal indicated that the claims 

examiner had requested an explanation about appellant’s lumbar spine condition. He opined that 

she has a lumbar strain and an underlying anterolisthesis of L4 on L5 and facet changes. 

Dr. Van Hal reported that straight leg raise testing showed increased tightness in both legs and 

pain in the right leg. He diagnosed major psychosocial issues and pain control issues and 

recommended that appellant work from home and with restrictions. 

In reports and Forms CA-17 dated June 1, 2020 through March 25, 2021, Dr. Van Hal 

recounted that appellant still had symptoms into her ankle, knee, hip, and arm. He reported that 

she could work with restrictions and recommended that she work from home. 

By decision dated November 16, 2021, OWCP denied expansion of the acceptance of 

appellant’s claim to include a consequential lumbar injury. It found that the weight of the medical 

3 OWCP subsequently authorized appellant’s request for a lumbar spine MRI scan. 
4

evidence rested with the October 25, 2018 opinion of Dr. Butler, OWCP’s second opinion 

examiner. 

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.4

The claimant bears the burden of proof to establish a claim for a consequential injury.5 As 

part of this burden, he or she must present rationalized medical opinion evidence, based on a 

complete factual and medical background, establishing causal relationship.6 The opinion of the 

physician 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 his or he employment injury.7

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

intervening cause attributable to the claimant’s own intentional misconduct.8 The basic rule is that 

a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is 

compensable if it is the direct and natural result of a compensable primary injury.9 

ANALYSIS

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of her claim to include a lumbar condition causally related to, or consequential to, her accepted 

April 28, 2017 employment injury.

In an October 25, 2018 report, Dr. Butler, an OWCP second opinion examiner, opined that 

there was no objective evidence to support a lumbar spine condition as a consequence of the 

April 28, 2017 employment injury. He noted that appellant did not report lumbar spine pain after 

the April 28, 2017 employment injury and that lumbar spine MRI scan findings were consistent 

with degenerative changes, not a single trip and fall incident. Dr. Butler’s report is well 

4

J.R., Docket No. 20-0292 (issued June 26, 2020); W.L., Docket No. 17-1965 (issued September 12, 2018); V.B., 

Docket No. 12-0599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200, 204 (2004).

5 V.K., Docket No. 19-0422 (issued June10, 2020); A.H., Docket No. 18-1632 (issued June1, 2020); I.S., Docket 

No. 19-1461 (issued April 30, 2020).

6 F.A., Docket No. 20-1652 (issued May 21, 2021); E.M., Docket No. 18-1599 (issued March 7, 2019); Victor J. 

Woodhams, 41 ECAB 345 (1989).

7 M.M., Docket No. 20-1557 (issued November 3, 2021); M.V., Docket No. 18-0884 (issued December 28, 2018).

8

I.S., Docket No. 19-1461 (issued April30, 2020); A.M., Docket No. 18-0685 (issued October 26, 2018); Mary 

Poller, 55 ECAB 483, 487 (2004).

9

J.M., Docket No. 19-1926 (issued March 19, 2021); SusanneW. Underwood (Randall L. Underwood), 53 ECAB 

139, 141 n. 7 (2001).
5

rationalized and is based on examination findings and an accurate history of injury. Therefore, the 

Board finds that his report constitutes the weight of the medical evidence. 10

The evidence submitted in support of the appellant’s expansion claim is insufficient to 

overcome the weight accorded to Dr. Butler as the second opinion physician, or to create a conflict 

in medical opinion.

Appellant submitted a May 3, 2018 from Dr. Van Hal who indicated that appellant had 

informed him of a lumbar spine injury when she fell forward onto her hands and knees. He noted 

lumbar spine MRI scan findings and provided examination findings. Dr. Van Hal explained that, 

“[g]iven [appellant’s] clinical picture and her current continued pain and multiple areas of 

dysfunction,” OWCP should include a lumbar spine strain as a consequential injury or an 

aggravation of a preexisting condition due to the April 28, 2017 employment injury. However, he

did not provide sufficient medical rationale to explain how the lumbar strain was causally related 

to the accepted April 28, 2017 employment injury. The Board has held that a report is of limited 

probative value regarding causal relationship if it does not contain medical rationale explaining 

how a given medical condition has an employment-related cause.11 Therefore, this report is 

insufficient to establish appellant’s expansion claim. 

The additional reports and CA-17 forms by Dr. Van Hal are likewise insufficient to 

establish appellant’s expansion claim as none of them address the issue of whether her lumbar 

spine condition was causally related to the accepted April 28, 2017 employment injury. As the 

Board has held, medical evidence that does not provide an opinion regarding the cause of an 

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

12

 Therefore, this 

evidence is insufficient to establish appellant’s claim.

Appellant also submitted a May 22, 2019 lumbar spine MRI scan. However, diagnostic 

studies, standing alone lack probative value on causal relationship as they do not address whether 

her employment caused the diagnosed condition.13

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

finds that appellant has not met her burden of proof to establish the expansion of 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.

10 A.C., Docket No. 21-1093 (issued July 21, 2022).

11 See L.G., Docket No. 21-0770 (issued October 13, 2022); T.T., Docket No. 18-1054 (issued April8, 2020); Y.D., 

Docket No. 16-1896 (issued February 10, 2017).

12 See S.Y., Docket No. 20-0347 (issued March 31, 2023); T.H., Docket No. 18-0704 (issued September 6, 2018); 

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

13 See M.D., Docket No. 21-1270 (issued March 21, 2022).
6

CONCLUSION

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of her claim to include a lumbar condition causally related to, or consequential to, her accepted 

April 28, 2017 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the November 16, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 9, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board