United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

H.C., Appellant

and

U.S. POSTAL SERVICE, PLACENTIA POST 

OFFICE, Placentia, CA, Employer

__________________________________________

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Docket No. 21-0546

Issued: January 6, 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 February 8, 2021 appellant filed a timely appeal from a September 4, 2020 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 establish a lumbar condition 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On October 20, 2017 appellant, then a 56-year-old city carrier, filed an occupational 

disease claim (Form CA-2) alleging that she injured her lower back due to factors of her federal 

employment. She explained that her lower back pain began after a July 2017 fall and, although 

1

5 U.S.C. § 8101 et seq.
2

the pain initially came and went with pain medication, it had been persistent since September 2017. 

Appellant noted that she first became aware of her condition on July 17, 2017 and realized its 

relation to her federal employment on September 29, 2017. She did not stop work.

In duty status reports (Form CA-17) dated October 2 and 16, 2017, Dr. Basimah Khulusi, 

Board-certified in physical medicine and rehabilitation, diagnosed a lumbar disc displacement and 

advised that appellant could return to work with restrictions.

In a development letter dated November 9, 2017, OWCP informed appellant of the

deficiencies of her claim. It advised her of the type of factual and medical evidence needed and 

provided a questionnaire for her completion. OWCP afforded her 30 days to respond.

In an October 3, 2017 diagnostic report, Dr.Jennifer Pedley, a Board-certified chiropractic 

radiologist, performed an x-ray scan of appellant’s lumbar spine, finding mild-to-moderate 

degenerative disc disease from L2-L3 and L3 to L5-S1, mild-to-moderate facet arthrosis from L1-

L2 to L5-S1, mild degenerative disc disease of the lower thoracic spine, osseous neural foramina 

stenosis at L2-L3, L4-L5 and L5-S1, a transitional segment at L5, mild bilateral sacroiliac 

arthrosis, hypolordosis of the lumbar spine and a shallow left convexity of the lumbar spine.

In an October 10, 2017 diagnostic report, Dr. Eric Chen, a Board-certified radiologist, 

noted a magnetic resonance imaging (MRI) scan of appellant’s lumbar spine, observing mild spinal 

canal stenosis at L3-L4 and L4-L5 as well as mild bilateral neuroforaminal stenosis at L2-L3. 

Dr. Khulusi, in a November 13, 2017 Form CA-17, diagnosed a lumbar disc displacement 

and advised that appellant could return to work with restrictions.

In a November 17, 2017 response to OWCP’s development questionnaire, appellant related 

her work duties of pushing a cart, loading and unloading parcels from her vehicle and delivering 

parcels weighing approximately 15 pounds to her lower back injury. She asserted that she did not 

have any other activities aside from her federal employment that contributed to her condition.

In a November 21, 2017 narrative medical report, Dr. Khulusi reviewed appellant’s 

employment duties consisting of casing, lifting, and pulling down and sorting mail, as well as 

walking approximately five miles per day in order to deliver the mail. She related that delivering 

the mail involved appellant making multiple trips to her long-life vehicle (LLV) while carrying a 

tub weighing approximately 15 pounds. While delivering mail, appellant was required to 

frequently twist, pivot, bend, reach, pull, and twist. Additionally,Dr. Khulusi related that appellant 

stepped in and out of her vehicle approximately 80 times per day. Appellant also reported that she 

fell at work on July 17, 2017 when she was descending the stairs at the post office. She did not 

report her fall at that time because her back pain was mild. Dr. Khulusi further related that 

appellant continued to experience intermittent back pain since her July 17, 2017 fall until she fell 

again on September 26, 2017 after she missed a step while exiting her LLV. Since then, her low 

back pain had become more severe. On examination and review of diagnostic studies Dr. Khulusi 

diagnosed a lumbar sprain, lumbar disc displacement and spinal stenosis. She opined that 

appellant’s July 17, 2017 fall caused her to sprain her back when her muscles went into a sudden 

contraction to protect her from suffering severe damage as a result of her fall. Following her fall, 

appellant continued to perform repetitive activities on the job. Dr. Khulusi explained that reaching 
3

into a hamper and into the back of an LLV put appellant’s back at a mechanical disadvantage 

because the center of gravity of the mail she was handling was far away from her own center of 

gravity. She indicated that this increased the load on appellant’s lumbar spine area and aggravated 

the spraining and pressure on her lumbar discs. Dr. Khulusi opined that, when she fell again in 

September, the muscles of her lower back contracted suddenly to minimize her injury; however, 

this ended up placing more excessive pressure on the disc spaces in her lumbar spine area, which 

contributed to her disc displacement. She further explained that the displacement of the discs 

ended up crowding the space in the spinal canal and the neural foramina.

By decision dated January 24, 2018, OWCP denied appellant’s occupational disease claim, 

finding that the medical evidence of record was insufficient to establish that her diagnosed medical 

condition was causally related to the accepted factors of her federal employment.

On March 9, 2018 appellant requested reconsideration of OWCP’s January 24, 2018 

decision.

In support thereof, appellant submitted CA-17 forms dated January 9 and February 27, 

2018, wherein Dr. Khulusi diagnosed a lumbar disc displacement and advised that appellant could 

return to work with restrictions.

In a March 1, 2018 medical narrative, Dr. Khulusi recounted the events of appellant’s 

September 26, 2017 fall, reiterating that the muscles of her whole body contracted suddenly to 

minimize her injury and ended up sustaining a lumbar sprain as a result. She also reasoned that 

the excessive pressures that were exerted on her lumbar disc spaces contributed to the disp lacement 

of the discs in her lumbar area. Dr. Khulusi opined that appellant actually suffered a traumatic 

injury on September 26, 2017 when she fell. She indicated that the traumatic fall in July 2017 

aggravated appellant’s pathology somewhat, causing intermittent low back pain only, clarifying 

that her subsequent fall on September 26, 2017 ended up aggravating her pathology to a more 

significant extent, causing her back pain to become permanent. Dr. Khulusi concluded that the 

September 26, 2017 fall caused a more serious low back sprain that ended up causing more disc 

displacement, which in turn caused spinal stenosis and more crowding of her lumbar nerve roots. 

She diagnosed a lumbar sprain, lumbar disc displacement as a result of the sprain and mild spinal 

stenosis as a result of her lumbar disc displacement. Dr. Khulusi also requested that appellant’s 

claim be converted from an occupational disease claim to a traumatic injury claim.

In an April 10, 2018 Form CA-17, Dr. Khulusi diagnosed a lumbar disc displacement and 

advised that appellant could return to work with restrictions.

By decision dated April 16, 2018, OWCP denied modification of its January 24, 2018 

decision.

On July 3, 2018 appellant requested reconsideration of OWCP’s April 16, 2018 decision. 

She attached a June 21, 2018 narrative medical report in which Dr. Khulusi indicated that in a 

separate Form CA-2 dated October 19, 2017, appellant clearly explained that her injury occurred 

when she slipped on the edge of a step and subsequently felt pain in her lower back that did not go 

away. Dr. Khulusi noted that appellant also indicated that the date she first became aware of her 

injury was September 26, 2017. AppellantinformedDr. Khulusi that the employing establishment 
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made her fill out the previous October 20, 2017 Form CA-2 and changed her answers to indicate 

the date she first became aware was July 17, 2017 and that her injury was caused by this fall. She 

opined that appellant was counseled wrongly by her supervisor and ended up changing her claim 

form and her reports about her injury. Dr. Khulusi asserted that this was proof that appellant 

sustained a traumatic injury due to a September 26, 2017 employment incident.

By decision dated July 16, 2018, OWCP denied appellant’s request for reconsideration, 

finding that her newly submitted evidence did not contain a relevant legal argument not previously 

considered by OWCP.

On April 15, 2019 appellant again requested reconsideration of OWCP’s April 16, 2018 

decision and submitted additional evidence.

In a December 8, 2017 diagnostic report, Dr. Maliheh Massih, Board-certified in 

electrodiagnostic medicine, performed a nerve conduction velocity/electromyography 

(NCV/EMG) test of appellant’s lower extremities, returning an abnormal study that was suggestive 

of highly probable mild right-sided L3-4 subacute lumbosacral radiculopathy.

In a February 21, 2019 narrative report, Dr. Khulusi explained that appellant’s July 17, 

2017 fall caused her to experience intermittent low back pain and that the repetitive activities of 

her employment caused her pain to become constant, starting in September 2017. She again 

explained that her initial fall caused her to sprain her lower back when her muscles suddenly 

contracted to protect her from suffering severe damage. Following the July 17, 2017 fall, 

appellant’s repetitive activities kept making her back condition worse, reasoning that she kept 

suffering repetitive spraining and straining of the soft tissue structures of her lower bac k to 

different degrees. Dr. Khulusi specifically referenced the repetitive activities of reaching into a 

hamper and into the back of her LLV, explaining that her back was placed at a mechanical 

disadvantage because the center of gravity of the items she was handling was far away from her 

own center of gravity. This activity increased the loading stress on her lumbar spine area by many 

multiples. The repetitive spraining and straining continued to occur, resulting in a cumulative 

trauma disorder, causing more damage to the structures of appellant’s lower back. Dr. Khulusi 

diagnosed a lumbar sprain, lumbar disc displacement as a result of her sprain and mild spinal 

stenosis as a result of her lumbar disc displacement.

By decision dated June 21, 2019, OWCP denied modification of its April 16, 2018 

decision.

OWCP continued to receive evidence. In a February 17, 2020 progress report, Dr. Khulusi 

again evaluated appellant for her lumbar conditions. She diagnosed a lumbar sprain, lumbar disc 

displacement as a result of her sprain and mild spinal stenosis as a result of her lumbar disc 

displacement and indicated that she could return to work with modified duties.

On June 10, 2020 appellant, through her then-representative, requested reconsideration of 

OWCP’s June 21, 2019 decision. In an attached memorandum of even date, her representative 

again noted that she was advised to submit a Form CA-2 by her supervisor after her July 2017 fall. 

She argued that, despite a fall normally being considered a traumatic injury, OWCP did not ask 

for clarification in its November 9, 2017 development letter.
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By decision dated September 4, 2020, OWCP denied modification of its June 21, 2019 

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA has the burden of proof to establish 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 period of FECA,2that 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.3 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.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 of 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 factors 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 

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factors.8

ANALYSIS

The Board finds that this case is not in posture for decision.

2

S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

3

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

ECAB 312 (1988).

4 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).

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).

8

Id.; Victor J. Woodhams, supra note 5.
6

In her October 20, 2017 Form CA-2 and November 17, 2017 response to OWCP’s 

questionnaire, appellant consistently related that her symptoms began following a July 17, 2017 

fall and continually worsened as she performed her employment duties consisting of pushing a 

cart, loading and unloading parcels from her vehicle and delivering parcels weighing 

approximately 15 pounds.

In support of her claim, appellant submitted multiple narrative medical reports in which

Dr. Khulusi reviewed her employment activities as well as her July 17 and September 26, 2017 

falls at work. On evaluation and review of diagnostic studies she explained that appellant’s first 

fall on July 17, 2017 caused her to sprain her back and experience intermittent low back pain as 

the muscles in her lower back area suddenly contracted to prevent severe harm as she fell. 

Dr. Khulusi opined that the frequent twisting, pivoting, bending, reaching, pulling, and twisting 

involved in her employment duties increased the loading stress on her lumbar spine area by many 

multiples, resulting in a cumulative trauma disorder precipitated by the repetitive spraining and 

straining of the structures of her lower back. Specifically, she referenced the mechanical 

disadvantage appellant’s lower back was placed in when she regularly reached into a hamper or 

the back of her LLV to lift parcels weighing approximately 15 pounds. Dr. Khlulusi further opined 

that her condition worsened following the September 26, 2017 fall, finding that the subsequent fall 

caused a more serious low back sprain. She explained that this sprain ended up causing more disc 

displacement, which in turn caused spinal stenosis and more crowding of appellant’s lumbar nerve 

roots. Dr. Khulusi diagnosed a lumbar sprain, lumbar disc displacement as a result of her sprain 

and mild spinal stenosis as a result of her lumbar disc displacement. 

The Board finds that, although Dr. Khulusi’s medical opinions are not fully rationalized, 

they constitute relevant evidence in support of appellant’s claim, as they provide an explanation 

of the physiological process by which her accepted factors of federal employment caused or 

aggravated her diagnosed lumbar conditions. As Dr. Khulusi’s narrative medical reports raise an 

uncontroverted inference of causal relationship between her claimed lumbar conditions and the 

accepted factors of her federal employment, further development of appellant’s claim is therefore 

required.9

On remand OWCP shall prepare a statement of accepted facts setting forth the employment 

factors which have been established and refer appellant to a second opinion physician in the 

appropriate field of medicine for an examination and a rationalized medical opinion as to whether 

her accepted employment factors either caused or aggravated her lumbar conditions.10 If the 

second opinion disagrees with the explanations provided by Dr. Khulusi, he or she must provide a 

fully-rationalized explanation explaining why their opinions are unsupported. Following this and 

other such further development as deemed necessary, OWCP shall issue a de novo decision.

9

See A.T., Docket No. 19-1972 (issued June 25, 2020); K.T., Docket No 19-1436 (issued February 21, 2020); 

John J. Carlone, 41 ECAB 354, 356-57(1989).

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

C.C., Docket No. 19-1631 (issued February 12, 2020).
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CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the September 4, 2020 decision of the Office of 

Workers’ Compensation Programs is set aside, and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: January 6, 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