United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.A., Appellant

and

U.S. POSTAL SERVICE, FORT POINT POST 

OFFICE, Boston, MA, Employer

__________________________________________

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Docket No. 23-1065

Issued: January 22, 2024

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On August 7, 2023 appellant filed a timely appeal from a June 1, 2023 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 medical condition 

causally related to the accepted January 24, 2020 employment incident.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On February 5, 2020 appellant, then a 48-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on January 24, 2020 she injured her lower back while in the 

performance of duty. She explained that she experienced a sharp pain in her lower back as well as 

numbness in her legs with spasms when lifting a heavy mail bin. Appellant stopped work on the 

alleged date of injury.

In a January 24, 2020 report, Christina C. Cheng, a physician assistant, noted that appellant 

presented with acute back pain after lifting a heavy postal bin full of mail at work. Appellant 

asserted that she had no prior back injury or surgery. Ms. Cheng diagnosed acute bilateral back 

pain. 

In a January 24, 2020 report, Kelley J. Burke, a registered nurse, related that appellant was 

bending over to pick up something when she experienced a tight pull and numbness. 

In a January 24, 2020 emergency room report, Dr. Paul D. Biddinger, Board-certified in 

emergency medicine, noted that appellant presented with back pain after lifting a heavy box of 

mail at work. He observed that she experienced severe low back pain that radiated down into her 

legs, as well as a tingling sensation in her legs. Dr. Biddinger conducted a physical examination 

and diagnosed acute bilateral back pain. An after-visit summary of even date reiterated his 

diagnosis of acute bilateral back pain.

In a February 10, 2020 medical report, Dr. Bonnie A. Southworth, Board-certified in 

internal medicine, reported that appellant experienced persistent lower back pain and muscle 

spasms. She observed that appellant had pain and stiffness when lying down. Dr. Southworth 

conducted a physical examination and diagnosed back pain.

In an undated attending physician’s report (Form CA-20), Dr. Southworth, described 

appellant’s injury as occurring as a result of lifting a large, heavy postal bin full of mail on 

January 24, 2020 when she experienced acute lower back pain and spasms. She diagnosed acute 

lower back pain. Dr. Southworth checked a box “Yes” indicating that appellant’s condition was 

caused or aggravated by the employment incident. In a Form CA-20 dated February 13, 2020,

Dr. Southworth reiterated her findings and diagnosis.

A February 28, 2020 magnetic resonance imaging (MRI) scan of the lumbar spine revealed 

bilateral neural foraminal narrowing as well as narrowing of the bilateral lateral recesses with 

involvement of the transiting L5 nerve roots and mild spinal canal narrowing at the L4-5 level. It 

also demonstrated a progression of mild right neural foraminal narrowing as well as mild left 

neural foraminal narrowing at the L3-4 level.

2 Docket No. 21-1002 (issued April 17, 2023).
3

In an April 22, 2020 note, Dr. Southworth related that appellant had persistent back pain 

and could not sit or stand for any length of time or lift any heavy objects.

By decision dated April 30, 2020, OWCP accepted that the January 24, 2020 employment 

incident occurred as alleged, but denied appellant’s claim, finding that she had not submitted 

medical evidence containing a medical diagnosis in connection with her accepted employment 

incident. It concluded therefore that the requirements had not been met to establish an injury as 

defined under FECA.

In a January 27, 2020 duty status report (Form CA-17), Dr. Southworth diagnosed lower 

back pain. 

In an April 8, 2020 form report, Dr. Southworth diagnosed persistent low back pain.

In a May 11, 2020 medical report, Dr. Zacharia Isaac, Board-certified in physical medicine 

and rehabilitation, noted that appellant’s pain started on January 24, 2020 during a work-related 

incident. He related that she experienced severe flare-up of pain in her low back with associated 

buttock numbness that radiated down to the sacral region. Dr. Isaac indicated that appellant was 

treated in the emergency room and was no longer working. He also indicated that she subsequently 

underwent physical therapy treatments. Dr. Isaac reviewed appellant’s February 28, 2020 MRI 

scan of the lumbar spine and diagnosed spondylosis of lumbar region without myelopathy or 

radiculopathy and exacerbation of low back pain with associated degenerative changes of the disc 

at the L4-5 level and facet arthropathy at the L4-5 and L5-S1 levels. Dr. Isaac opined that her low 

back pain was exacerbated after the accepted January 24, 2020 employment incident. He 

explained that compounding issues included deconditioning of appellant’s core muscles, 

overweight, and physically demanding job. Dr. Isaac recommended that she remain off work.

A July 15, 2020 x-ray of appellant’s lumbar spine revealed mild degenerative changes of 

the cervical spine and transitional lumbar anatomy without evidence of instability on flexion and 

extension views. 

On December 2, 2020 appellant requested reconsideration.

By decision dated March 2, 2021, OWCP denied modification of the April 30, 2020 

decision. 

In an August 26, 2020 progress report, Dr. Isaac reiterated his findings and diagnoses.

In a December 14, 2020 progress report, Dr. Isaac noted that appellant’s symptoms 

worsened with movement or sitting, and at nighttime. He indicated that her symptoms decreased 

with heat or side laying. Dr. Isaac conducted a physical examination and diagnosed sacroiliitis 

and exacerbation of low back pain with associated degenerative changes of the disc at the L4 -5 

level and facet arthropathy at the L4-5 and L5-S1 levels. He again opined that appellant’s low 

back pain was exacerbated after her accepted January 24, 2020 employment incident and explained 

that compounding issues included deconditioning of her core muscles, overweight, and physically 

demanding job. 
4

In a February 24, 2021 progress report, Dr. Isaac reiterated his findings and diagnosed 

exacerbation of low back pain with associated degenerative changes of the disc at the L4 -5 level 

and facet arthropathy at the L4-5 and L5-S1 levels versus S1 joint dysfunction. He again opined 

that appellant’s low back pain was exacerbated after her accepted January 24, 2020 employment 

incident and again explained that compounding issues included her physically demanding job. 

On April 7, 2021 appellant requested reconsideration.

By decision dated June 3, 2021, OWCP denied modification of the March 2, 2021 decision. 

On June 21, 2021 appellant filed a timely appeal to the Board from OWCP’s June 3, 2021 

decision to the Board. By decision dated April 17, 2023, the Board found that appellant had met 

her burden of proof to establish diagnoses of spondylosis of the lumbar region without myelopathy 

or radiculopathy, sacroiliitis, degenerative changes of the disc at the L4-5 level, and facet 

arthropathy at the L4-5 and L5-S1 levels.3 The Board further found that the case was not in posture 

for decision as to whether her diagnosed medical conditions were causally related to the accepted 

January 24, 2020 employment incident. The Board remanded the case for consideration of the 

medical evidence with regard to the issue of causal relationship, to be followed by issuance of a 

de novo decision of OWCP.

By decision dated June 1, 2023, OWCP denied modification of the denial of appellant’s

claim, finding that she had not submitted sufficient medical evidence to establish causal 

relationship between the accepted January 24, 2020 employment incident and her diagnosed 

medical conditions. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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,5that 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.6 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.7

3

Id.

4

Supra note 1.

5 F.H., Docket No.18-0869 (issued January29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989). 

6 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).

7 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990).
5

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 an injury and can be established only by medical 

evidence.8 

The medical evidence required to establish a causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence. 9 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.10

In a 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.11

ANALYSIS

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

condition causally related to the accepted January 24, 2020 employment incident.

In support of her claim, appellant submitted reports from Dr. Isaac. In his May 11, 2020 

medical report, Dr. Isaac noted that her pain started on January 24, 2020 during a work-related 

incident. He related that appellant experienced severe flare-up of pain in her low back with 

associated buttock numbness that radiated down to the sacral region. Dr. Isaac diagnosed 

spondylosis of lumbar region without myelopathy or radiculopathy and exacerbation of low back 

pain with associated degenerative changes of the disc at the L4-5 level and facet arthropathy at the 

L4-5 and L5-S1 levels. He opined that appellant’s low back pain was exacerbated after the 

accepted January 24, 2020 employment incident. Dr. Isaac also explained that a compounding 

issue included her physically demanding job. On August 26, 2020 he reiterated his findings and 

diagnoses. On December 14, 2020 and February 24, 2021 Dr. Isaac opined that appellant’s low 

8 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).

9

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

10 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).

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

also L.S., Docket No. 18-0518 (issued February 19, 2020).
6

back pain was exacerbated after her accepted January 24, 2020 employment incident and again 

noted her physically demanding job as a compounding issues. 

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/disability was 

causally related to the accepted employment incident. The Board has held that a medical opinion 

that does not offer a medically sound and rationalized explanation by the physician of how the 

specific employment incident physiologically caused or aggravated the diagnosed conditions is of 

limited probative value.12 Dr. Isaac did not support his medical opinion with sufficient rationale 

differentiating appellant’s preexisting conditions from the current condition. The Board has 

explained that such rationale is especially important in a case involving a preexisting condition.13 

While Dr. Isaac provided an opinion that appellant’s diagnosed conditions were related to a work 

incident on January 24, 2020 he did not provide sufficient medical rationale explaining how the 

conditions were related to the accepted incident. As such, these reports are insufficient to establish 

her claim.14

On January 24, 2020 Dr. Biddinger diagnosed acute bilateral back pain. In reports dated 

from January 27 through April 22, 2020 Dr. Southworth diagnosed back pain. The Board notes 

that, under FECA, the assessment of pain is not considered a compensable medical diagnosis, as 

pain merely refers to a symptom of an underlying condition.15 For this reason, the above-noted 

reports of Drs. Biddinger and Southworth are insufficient to establish appellant’s claim.

Appellant submitted reports signed by a physician assistant dated January 24, 2020; and 

signed by a registered nurse of the same date. However, the Board has held that medical reports 

signed by a nurse, a physical therapist, or a physician assistant are of no probative value, because 

these medical providers are not considered physicians as defined under FECA. 16 As such, these 

reports are of no probative value.

The diagnostic reports of record, including an MRI scan and an x-ray, also do not constitute 

probative medical evidence. The Board has held that diagnostic tests, standing alone, lack 

12 J.B., Docket No. 21-0011 (issued April 20, 2021); A.M., Docket No. 19-1394 (issued February 23, 2021).

13 Id. 

14 B.S., Docket No. 22-0102 (issued May 19, 2022); Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 

ECAB 149, 155-56 (2006); D’Wayne Avila, 57 ECAB 642, 649 (2006).

15 J.L., Docket No. 20-1662 (issued October 7, 2022); D.B., Docket No. 21-0550 (issued March 7, 2022).

16 Section 8101(2) provides that a 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 alsosupra note 11 at Chapter 2.805.3a(1) (January 2013); A.M., Docket 

No. 20-1575 (issued May 24, 2021) (physical therapists are not physicians as defined by FECA); M.J., Docket No. 

19-1287 (issued January 13, 2020)(physician assistants are not considered physicians as defined under FECA); T.K., 

Docket No. 19-0055 (issued May 2, 2019) (nurses are not considered physicians as defined under FECA); David P.

Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as nurses, physician assistants, and physical therapists 

are not competent to render a medical opinion under FECA).
7

probative value on the issue of causal relationship as they do not provide an opinion on causal 

relationship.17

As appellant has not submitted rationalized medical evidence establishing a medical 

condition causally related to the accepted January 24, 2020 employment incident, the Board finds 

that she has not met her 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 her burden of proof to establish a medical 

condition causally related to the accepted January 24, 2020 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the June 1, 2023 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 22, 2024

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

17 See C.F., Docket No. 18-1156 (issued January 22, 2019); T.M., Docket No. 08-0975 (issued February 6, 2009).