United States Department of Labor

Employees’ Compensation Appeals Board

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M.O., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

INSTALLATION MANAGEMENT 

COMMAND, DIRECTORATE OF 

EMERGENCY SERVICES, Fort Meade, MD, 

Employer

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Docket No. 21-0940

Issued: January 25, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 8, 2021 appellant filed a timely appeal from a January 14, 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 his burden of proof to establish a medical condition 

causally related to the accepted February 3, 2020 employment incident.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On February 3, 2020 appellant, then a 40-year-old firefighter, filed a traumatic injury claim 

(Form CA-1) alleging that on that date he sustained a back and left lower extremity injury while 

in the performance of duty.2 He stated that, while conducting hose advancement drills, he backed 

up, lost his footing, and tripped backward, landing awkwardly on his back. Appellant felt a 

popping sensation in his left leg and experienced pain radiating up his back. He stopped work on 

February 4, 2020.

In a February 4, 2020 hospital emergency department report, Dr. Islam Al-Junaidi, a 

Board-certified internist, ordered left knee and lumbar x-rays. Dr. Joseph G. Livingston, a Boardcertified radiologist, reviewed left knee x-rays obtained that day and compared them to a June 19, 

2015 magnetic resonance imaging (MRI) scan of the left knee. He opined that the left knee x-rays 

were negative for fracture or dislocation. Dr. Ravi S. Kasat, a Board-certified radiologist, opined 

that, lumbar x-rays obtained that day showed no fracture or dislocation.

In a February 4, 2020 medical excuse slip, Dr. Al-Junaidi released appellant from work 

through February 11, 2020. 

In a February 12, 2020 emergency department report, Dr. Al-Junaidi ordered x-rays of the 

left hip, pelvis, sacrum, and coccyx. He diagnosed closed fracture of sacrum and coccyx, initial 

encounter, and left hip pain. Dr. Niloy Dasgupta, a Board-certified radiologist, opined that left 

hip, sacrum, and coccyx x-rays obtained that day were negative for fracture or malalignment.

In a March 2, 2020 development letter, OWCP informed appellant of the deficiencies of 

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

questionnaire for his completion. OWCP afforded appellant 30 days to respond.

In response, appellant submitted a February 25, 2020 report by Dr. Jeremie Axe, a Boardcertified orthopedic surgeon, noting a February 3, 2020 left knee injury and lumbar symptoms. 

Dr. Axe diagnosed a herniated lumbar disc. He ordered imaging studies and prescribed 

medication. 

A February 28, 2020 lumbar MRI scan reviewed by Dr. Alberto Iaia, a Board-certified 

radiologist, noted appellant’s history of back pain and radiculopathy. He opined that the study 

demonstrated disc desiccation, a mild annular bulge at L2-3 without spinal stenosis or foraminal 

narrowing, and minimal facet joint osteoarthritis at L5-S1.

In an attending physician’s report (Form CA-20) dated February 11, 2020, Dr. Nadiene 

Haynes, a physician specializing in family medicine, noted that appellant was injured when pulling 

a fire hose, slipped, and landed on his back. She diagnosed lumbar sprain and knee pain. 

Dr. Haynes checked a box marked “Yes” to indicate her opinion that appellant’s condition was 

caused or aggravated by his employment. 

2 Appellant has a prior claim accepted for an April 16, 2015 sprain of the medial collateral ligament of the left knee 

under OWCP File No. xxxxxx635. Appellant’s claims have not been administratively combined by OWCP. 
3

In a February 11, 2020 duty status report (Form CA-17), Dr. Axe diagnosed a lumbar 

sprain related to the February 3, 2020 incident and held appellant off from work. 

Dr. Axe, in March 12, 2020 reports, noted that appellant had no relevant past medical or 

surgical history prior to the claimed February 3, 2020 employment incident. He related that on 

February 3, 2020 appellant slipped and fell directly onto his back when he pulled a hose away 

from a building while at work. Appellant experienced immediate lumbar pain radiating into the 

left lower extremity. A lumbar MRI scan demonstrated a small, herniated disc. Dr. Axe prescribed 

medication, which relieved appellant’s symptoms. He diagnosed a herniated lumbar disc and left 

leg pain. Dr. Axe opined that this diagnosis was “directly related to [appellant’s] fall as he had no 

preexisting pain in his back or pain down his leg.” He returned appellant to full-duty work 

effective March 16, 2020. 

By decision dated April 2, 2020, OWCP accepted that the February 3, 2020 employment 

incident occurred as alleged, but denied the claim, finding that the medical evidence of record was 

insufficient to establish causal relationship between appellant’s diagnosed conditions and the 

accepted February 3, 2020 employment incident. 

OWCP received an undated statement by the employing establishment asserting that 

appellant had been injured while in the performance of duty when advancing hand lines during a 

training exercise. It specified that at “the time of injury [appellant] was operating in the capacity 

of a firefighter in his duties.”

On April 10, 2020 appellant requested reconsideration.

In an April 20, 2020 Form CA-20, Dr. Axe noted that on February 3, 2020 appellant was 

“at fire academy pulling a hose, slipped [and] fell onto his back.” He diagnosed a herniated nucleus 

pulposus of lumbar spine. Dr. Axe opined that the diagnosis was “related to direct fall onto back”

while at work and checked a box marked “Yes” to indicate his opinion that appellant’s condition 

was caused or aggravated by his employment. He explained that the condition was “caused by fall 

at work” and found appellant totally disabled from work from February 25 through 

March 12, 2020. Dr. Axe returned appellant to full duty effective March 16, 2020.

By decision dated July 8, 2020, OWCP denied modification of its prior decision. 

In an August 4, 2020 report, Dr. Axe noted that he first treated appellant on February 25, 

2020 for lumbar and left knee pain related to the February 3, 2020 employment incident. He

opined that the herniated lumbar disc demonstrated by the February 28, 2020 MRI scan study was 

“directly caused by [appellant’s] fall on February 3, 2020.”

On October 16, 2020 appellant requested reconsideration. He submitted a witness 

statement by coworker A.B., who recalled that on February 3, 2020 appellant pulled a hose from 

a building during training, tripped, and fell directly onto his back. 

By decision dated January 14, 2021, OWCP denied modification of its prior decision.
4

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 of FECA, that the claim was timely filed within the applicable time 

limitation 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 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 first must be determined whether fact of injury has been established. There 

are two components involved in establishing fact of injury. The first component 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 medical 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

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.10

3

Supra note 1.

4

J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. Cameron, 41 ECAB 153(1989).

5 L.C., Docket No. 19-1301 (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 D.K., Docket No. 21-0214 (issued September 29, 2021); 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).

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

G.T., Docket No. 21-0170 (issued September 29, 2021); D.W., Docket No. 20-0674 (issued September 29, 2020).
5

ANALYSIS

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

condition causally related to the accepted February 3, 2020 employment incident.

Dr. Al-Junaidi, in reports dated February 4 and 12, 2020, diagnosed a closed fracture of 

the sacrum and coccyx, and left hip pain. He held appellant off from work through 

February 11, 2020. However, Dr. Al-Junaidi offered no opinion on causal relationship in these 

reports. Medical evidence that fails to address causation is of no probative value on that issue. 11 

As such, these reports are insufficient to meet appellant’s burden of proof. 

In a February 11, 2020 Form CA-20, Dr. Haynes noted that appellant had been injured 

when pulling a fire hose, slipped, and landed on his back. She indicated support for causal 

relationship by checking a box marked “Yes.” The Board has held, however, that an opinion on 

causal relationship with an affirmative check mark, without more by the way of medical rationale, 

is insufficient to establish the claim.12 Therefore, this evidence is insufficient to meet appellant’s 

burden of proof. 

In reports dated February 25 through August 4, 2020, Dr. Axe noted the accepted 

February 3, 2020 employment incident and diagnosed a herniated lumbar disc. He opined on 

March 12, April 20, and August 4, 2020 that the herniated lumbar disc was directly related to the 

February 3, 2020 slip and fall, based upon the mechanism described by appellant, and findings 

documented within his medical record. While he discussed the February 3, 2020 employment 

incident and other aspects of appellant’s medical history, Dr. Axe did not offer a rationalized 

medical opinion explaining how that incident caused appellant’s diagnosed conditions.13 The 

Board has held that a medical opinion should reflect a correct history and offer a medically-sound 

and rationalized explanation by the physician of how the specific employment incident

physiologically caused or aggravated the diagnosed conditions.14 Dr. Axe’s reports are, therefore, 

of limited probative value and insufficient to establish causal relationship. 

Finally, the record also contains the February 4, 2020 left knee x-rays, February 12, 2020 

x-rays of the left hip, pelvis, sacrum, and coccyx, and a February 28, 2020 lumbar MRI scan. The 

Board has long held, however, that diagnostic studies, standing alone, lack probative value as they 

11 C.G., Docket No. 20-0957 (issued January27, 2021); L.G., Docket No. 20-0433 (issued August 6, 2020); S.D., 

Docket No. 20-0413 (issued July 28, 2020); S.K., Docket No. 20-0102 (issued June 12, 2020); L.B., Docket No. 

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

12 C.S., Docket No. 21-0051 (issued September 2, 2021); see D.S., Docket No. 21-0037 (issued May 27, 2021);

RichardG. Chasse,Docket No. 99-1574 (issued June 27, 2000).

13 J.N., Docket No. 21-0606 (issued November 23, 2021); T.W., Docket No. 20-0767 (issued January 13, 2021);

see H.A., Docket No. 18-1466 (issued August 23, 2019); L.R., Docket No. 16-0736 (issued September 2, 2016).

14 T.G., Docket No. 21-0175 (issued June 23, 2021); J.D.,Docket No. 19-1953 (issued January 11, 2021); see K.W.,

Docket No. 19-1906 (issued April1, 2020).
6

do not provide an opinion regarding the cause of the diagnosed conditions. 15 These diagnostic

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

As the evidence of record is insufficient to establish a medical condition causally related 

to the accepted employment incident, the Board finds that appellant 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 February 3, 2020 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the January 14, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 25, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

15 L.T., Docket No. 20-0582 (issued November 15, 2021); L.B., Docket No. 19-1907 (issued August 14, 2020); J.K., 

Docket No. 20-0591 (issued August12, 2020).