United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.C., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Camden, NJ, Employer
__________________________________________

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Appearances:
Thomas R. Uliase, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 08-809
Issued: August 8, 2008

Case Submitted on the Record

DECISION AND ORDER
Before:
DAVID S. GERSON, Judge
COLLEEN DUFFY KIKO, Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On January 23, 2008 appellant filed a timely appeal from the Office of Workers’
Compensation Programs’ merit decision dated August 20, 2007, denying her claim for
compensation. Pursuant to 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 established a neck or low back injury causally related
to her federal employment.
FACTUAL HISTORY
On December 7, 2006 appellant, then a 56-year-old sales and service associate, filed an
occupational disease claim (Form CA-2) alleging that she sustained neck and low back injuries
as a result of her federal employment. She described the nature of the injury as junctional
degeneration. The reverse of the claim form indicated that appellant was off work from April 20
to July 10, 2006.

In a narrative statement, appellant reported that she had worked over 19 years at the
employing establishment, and her job required her to stand for seven and a half hours per day.
She also stated that her job involved retrieving parcels, pushing and pulling hampers and lifting
up to 70 pounds on occasion. According to appellant, she had two back surgeries in 2000 and
another back surgery in 2006, knee surgery in 1983 and carpal tunnel surgery in 1985. She
indicated that she had neck pain commencing in January 2006, stated that her shoulders were
also affected by her job and she needed another surgery on her left hand.
By decision dated February 21, 2007, the Office denied appellant’s claim for
compensation. It found that the medical evidence was insufficient to establish the claim. On
February 27, 2007 appellant requested an oral hearing before an Office hearing representative.
She submitted additional medical evidence.
In a report dated March 13, 2007, Dr. Alexander Vaccaro, an orthopedic surgeon,
indicated that appellant was initially treated in December 1999 for low back pain. He noted a
November 29, 1999 magnetic resonance imaging (MRI) scan revealed advanced degenerative
changes at L4-5 with moderate stenosis. Dr. Vaccaro indicated that appellant’s back pain
worsened after a July 4, 2000 incident when she pulled someone out of water. He indicated that
appellant underwent L4-5 surgery on October 12, 2000, then she underwent T1-2 fusion surgery
on December 5, 2000. In February 2006 appellant complained of worsening neck pain and she
underwent surgery on April 20, 2006 to remove her anterior instrumentation. Dr. Vaccaro noted
appellant’s general job duties and further stated, “the need for these surgeries appear, within a
reasonable degree of medical certainty, to be a result of cumulative trauma to her spinal axis due
to her responsibilities as a postal clerk.” He noted that he had recommended appellant consider
stopping work at her current job, as her job duties such as standing and lifting up to 70 pounds
had significantly exacerbated her neck and back pain. Dr. Vaccaro opined that “[appellant’s]
condition is a direct result of the work that she has performed at [the employing establishment]
over the last several years.”
Appellant also submitted medical evidence regarding the October 12 and December 5,
2000 and April 20, 2006 surgeries. Dr. Vaccaro noted in a February 14, 2006 report that
appellant had neck pain for the last year and he was worried that the edges of the metallic
implant inserted in the December 5, 2000 surgery had broken. The record also contains medical
evidence regarding treatment in 2000. In a report dated March 16, 2000, Dr. Mitchell Freedman,
an osteopath, diagnosed lumbar disc degeneration and spinal stenosis. He noted in the 1980’s
that appellant lifted a crate at work and had intermittent back pain. Dr. Freedman indicated that
appellant was working full time and avoided much of the lifting.
A hearing before an Office hearing representative was held on June 5, 2007. Appellant’s
representative stated that there was a prior claim accepted for a disc herniation at L4-5 and the
Office approved back surgery for October 2000. The representative stated that appellant was
claiming an aggravation of her back condition and a new neck condition.
In a June 20, 2007 statement, an employing establishment supervisor stated that appellant
would rarely have to lift up to 70 pounds, perhaps only once a month. He indicated trays would
commonly weight 10 to 15 pounds.

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By decision dated August 20, 2007, the hearing representative affirmed the February 21,
2007 Office decision. He found the medical evidence was insufficient to establish the claim.
LEGAL PRECEDENT
A claimant seeking benefits under the Federal Employees’ Compensation Act1 has the
burden of establishing the essential elements of his claim by the weight of the reliable, probative
and substantial evidence, including that an injury was sustained in the performance of duty as
alleged and that any specific condition or disability claimed is causally related to the
employment injury.2
To establish that an injury was sustained in the performance of duty, a claimant must
submit: (1) medical evidence establishing the presence or existence of the disease or condition
for which compensation is claimed; (2) a factual statement identifying employment factors
alleged to have caused or contributed to the presence or occurrence of the disease or condition;
and (3) medical evidence establishing that the diagnosed condition is causally related to the
employment factors identified by the claimant.3
Causal relationship is a medical question that can generally be resolved only by rationalized
medical opinion evidence.4 A physician’s opinion on the issue of whether there is a causal
relationship between the claimant’s diagnosed condition and the implicated employment factors
must be based on a complete factual and medical background of the claimant.5 Additionally, in
order to be considered rationalized, the 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.6
ANALYSIS
Appellant filed an occupational disease claim on December 7, 2006 and referred to her
neck and lower back. Her representative acknowledged that there was a prior claim for a back
injury on June 2, 1995, which was apparently accepted for an L4-5 disc herniation and
October 12, 2000 surgery. It is not entirely clear what appellant is claiming with respect to the
low back in this claim. To the extent she is claiming that employment factors have aggravated a
back condition, she must provide a rationalized medical opinion on causal relationship between a
diagnosed low back condition and the identified employment factors. Dr. Vaccaro refers to the
“surgeries” in his March 13, 2007 report but the Office apparently has already accepted that the
October 12, 2000 L4-5 surgery was employment related. He does not provide a diagnosis of a
1

5 U.S.C. §§ 8101-8193.

2

20 C.F.R. § 10.115(e), (f) (2005); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

3

Ruby I. Fish, 46 ECAB 276, 279 (1994).

4

See Robert G. Morris, 48 ECAB 238 (1996).

5

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

6

Id.

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new low back condition or a rationalized medical opinion on causal relationship with the
identified employment factors. Appellant did not meet her burden of proof with respect to a low
back injury in this claim.
With respect to a cervical or thoracic spine injury, Dr. Vaccaro indicated that appellant
underwent surgery on April 20, 2006. The evidence indicated, however, this surgery was to
remove the instrumentation inserted in the December 5, 2000 T1-2 fusion surgery. As to the
December 5, 2000 surgery, again Dr. Vaccaro referred to the “surgeries” being related to
cumulative trauma at work, without specifically discussing the T1-2 surgery. He does not
provide a clear diagnosis of a cervical or thoracic spine condition or a rationalized medical
opinion on causal relationship with employment. Dr. Vaccaro referred to an exacerbation of
symptoms by work, and then stated appellant’s “condition” was the “direct result” of her work.
It is not clear what condition he is referring to, or whether he felt a neck condition was caused or
aggravated by employment, with a clear explanation of the medical basis for his opinion.
Dr. Vaccaro does not explain how standing, occasional lifting, or any specific job duty
contributed to a diagnosed cervical, thoracic or other condition.
The Board accordingly finds the evidence is not sufficient to meet appellant’s burden of
proof in this claim. The medical evidence does not contain a rationalized medical opinion, based
on a complete and accurate background, on causal relationship between a diagnosed condition
and factors of appellant’s federal employment.
CONCLUSION
Appellant did not submit sufficient medical evidence to establish a neck condition or
aggravation of a low back condition causally related to her federal employment.

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ORDER
IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’
Compensation Programs dated August 20 and February 21, 2007 are affirmed.
Issued: August 8, 2008
Washington, DC

David S. Gerson, Judge
Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

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United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
I.H., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
St. Charles, MO, Employer
__________________________________________

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Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 17-0505
Issued: May 1, 2018

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On January 5, 2017 appellant filed a timely appeal from a November 1, 2016 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.2
ISSUE
The issue is whether appellant met his burden of proof to establish an injury in the
performance of duty, as alleged.

1
2

5 U.S.C. § 8101 et seq.

Appellant timely requested oral argument before the Board. By decision dated May 9, 2017, the Board, after
exercising its discretion, denied oral argument, finding that his arguments on appeal could adequately be addressed in
a decision based on a review of the case record. Order Denying Request for Oral Argument, Docket No. 17-0505
(issued May 9, 2017).

FACTUAL HISTORY
On April 13, 2016 appellant, then a 59-year-old letter carrier, filed an occupational disease
claim (Form CA-2) alleging that he developed “heart disease,” which allegedly arose on or about
October 18, 2015 while in the performance of duty. He indicated that he suffered a heart attack
due to stress. Appellant further stated that the employing establishment was trying to fire him for
no apparent reason.
In an attached narrative statement, appellant reported having experienced shortness of
breath and problems delivering his route ever since August 2015 when, for “no apparent reason,”
the employing establishment informed him that he was being removed from service. He further
indicated that he could not function or concentrate as a direct result of the stress and pressure of
losing his livelihood. Appellant related that the stressful conditions persisted from the day he was
informed of his removal from employment for actions perceived to have occurred more than 30
years prior. He asserted that, with each new development regarding his removal, his condition
worsened and his breathing and chest pain increased at an abnormal rate. Appellant explained that
the Saturday before his heart attack, he could barely finish his route because his shop steward had
told him that the situation had worsened. He noted that he had no prior issues with his heart.
In a May 6, 2016 letter, P.J., an employing establishment representative, controverted
appellant’s claim. She noted that, in August 2015, he received a letter of proposed removal for
falsification of employment application documents. Following arbitration, the proposed removal
was reduced to a 14-day suspension, which appellant accepted. However, he never returned to
work. P.J. further noted that he was diagnosed with coronary artery disease, a condition which
was more attributable to diet than stress.
In a February 10, 2016 letter, Dr. Phillip Apprill, a Board-certified internist specializing in
cardiovascular disease, related that appellant was under his cardiac care and had undergone
multiple cardiac procedures, including coronary artery bypass surgery on October 22, 2015. He
advised that appellant could return to work with restrictions, effective April 7, 2016.
Dr. Apprill continued to treat appellant. In an April 1, 2016 after-visit summary report, he
noted diagnoses of coronary artery disease, essential hypertension - benign, mixed hyperlipidemia,
status post coronary artery bypass graft, and non-ST elevated myocardial infarction.
By development letter dated August 29, 2016, OWCP advised appellant that the evidence
submitted was insufficient to establish his claim. It requested that he respond to an attached factual
questionnaire and submit additional medical evidence to establish a diagnosed condition causally
related to factors of his federal employment. OWCP afforded appellant 30 days to submit the
requested information. It issued a similar letter dated August 29, 2016 to the employing
establishment inquiring about any stress-related accommodations providing him. OWCP also
requested additional information regarding the proposed removal action and the results of any
investigations conducted by the employing establishment.
The employing establishment submitted a print-out of an e-mail dated September 2, 2016
by L.H., of the employing establishment. L.H. explained that appellant falsified his employment
application by answering “NO” to the questions of whether he had ever been fired and/or whether

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he quit knowing that he would be fired. She also noted that he submitted a 1767 (PS Form 1767 –
Report of Hazard, Unsafe Condition or Practice) and in the narrative stated that he was fired, and
consequently the Office of Inspector General (OIG) was notified. L.H. also alluded to the
existence of an OIG report, inquiring whether the OIG’s investigation was needed.
OWCP also received an e-mail dated September 10, 2016 from J.J., a customer service
supervisor. J.J. indicated that she was attaching physician notes listing appellant’s work
limitations. She related that he had not requested limited duty or attempted to return to work. J.J.
reported that appellant was absent without leave as of September 8, 2016.
OWCP received several disability and work status notes from Dr. Ziad A. Dalu, a Boardcertified family practitioner, dated April 29 to August 4, 2016. Dr. Dalu indicated that appellant
was examined in his office and could return to modified duty with restrictions.3 In an August 4,
2016 note, he reported that appellant could return to full duty on September 7, 2016.
In a September 26, 2016 letter, Dr. Dalu indicated that he had reviewed OWCP’s
August 29, 2016 development letter and hoped that this letter would answer all questions regarding
appellant’s current disabilities and overall health. He reviewed appellant’s medical history, which
included a service-connected disability incurred during appellant’s military service, hospitalization
for acute respiratory disease, a chronic back disorder sustained in 1984, incessant knee pain,
arthritis, and high cholesterol for which he was taking medication. Dr. Dalu reported that it was
his determination, along with Dr. Apprill, appellant’s cardiologist, that appellant was physically
unable to continue his current occupation as a letter carrier with the employing establishment. He
related that appellant could return to work, but in a different capacity that was in consideration of
the capabilities and restrictions allowed by appellant’s health issues. Dr. Dalu opined: “the stress
and pressures associated with the fast-paced, high-energy, physically, and mentally challenging
profession of a mail carrier would seriously impact the heart condition and total well-being of
[appellant], and could result in debilitating, life-altering, or fatal cardio episode.” He
recommended that appellant be placed in a position for which he was capable, with consideration
that prolonged exposure to extreme heat or cold, while combined with physical exertion, will cause
appellant’s heart rate and blood pressure to increase to dangerous levels and may induce a heart
problem. Dr. Dalu further noted that appellant could neither stand nor walk for more than an hour
without a 15-minute break, could not lift more than 40 pounds, carry any weight over 10 pounds
for a distance of more than 10 feet, carry more than 10 pounds up any elevation of stairs, and could
not sit for more than two hours without a 15-minute break.
On October 3, 2016 OWCP received appellant’s response to its development
questionnaire. In a September 26, 2016 statement, appellant noted that he had submitted all the
information that he had regarding his claim. He alleged that it was impossible for anyone to
determine the effect that the toll of the past two years has had on his overall mental, physical, and
spiritual health. Appellant asserted that no certified professional of any caliber could truly
understand the thoughts of homicide and suicide that he felt as a result of the probe and
investigation of incidents of his life that occurred over 30 years ago. He indicated that, although
his cardiac condition was the result of a medical condition, there was no way to tell how it was
3
Dr. Dalu examined appellant in his office on April 29, June 20, July8 and 18, and August 4, 2016. He continued
to postpone the date at which appellant could return to full duty.

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aggravated and intensified by stress factors, threats, and harassment generated by his employment.
Appellant related that the threat and possible loss of his employment, which meant the inability to
provide for his family, was more than he could bear. He explained that, since January 2016, the
threat of removal from employment was gone, but he had been in leave without pay status since
his surgery.
Appellant also provided a September 14, 2015 letter that he sent to the employing
establishment in response to the August 24, 2015 proposed removal letter. He alleged that he did
not falsify his employment documents because a simple record check would disclose his
conviction and subsequent incarceration. Appellant expressed his confusion that the employing
establishment was investigating matters that occurred 30 years ago, and his disappointment that
the employing establishment was actively pursuing a way to terminate him from employment. He
also gave examples of how he was a model citizen and requested that the employing establishment
consider his employment record for the past 10 years.
By decision dated November 1, 2016, OWCP denied appellant’s occupational disease
claim. It found that the evidence of record did not support that the injury and/or events occurred
in the performance of duty. OWCP explained that an administrative action, such as a proposal to
terminate, was not considered in the performance of duty, absent evidence of error or abuse on the
part of the employing establishment. It found that appellant had not submitted any evidence of
error or abuse. OWCP further found that he had not submitted medical evidence establishing a
diagnosed condition causally related to a compensable employment factor.
LEGAL PRECEDENT
An employee seeking benefits under FECA4 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 filed within the applicable time
limitation period of FECA, that the injury was sustained while in the performance of duty as
alleged, and that any specific condition or disability for work for which he or she claims
compensation is causally related to that employment injury.5 In an occupational disease claim,
appellant’s burden requires submission of 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.6
Workers’ compensation law does not apply to each and every injury or illness that is
somehow related to an employee’s employment.7 There are situations where an injury or illness
4

Supra note 1.

5

M.M., Docket No. 08-1510 (issued November 25, 2010); G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB
1143, 1145 (1989).
6

R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000).

7

L.D., 58 ECAB 344 (2007); Robert Breeden, 57 ECAB 622 (2006).

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has some connection with the employment, but nevertheless does not come within the concept or
coverage of workers’ compensation.8 Where the injury or illness results from an employee’s
reaction to his or her regular or specially assigned duties or to a requirement imposed by the
employing establishment or by the nature of the work, the injury or illness comes within the
coverage of FECA.9 On the other hand, when an injury or illness results from an employee’s
feelings of job insecurity per se, fear of a reduction-in-force, or his or her frustration from not
being permitted to work in a particular environment or hold a particular position, unhappiness with
doing work, or frustration in not being given the work desired, such injury or illness falls outside
FECA’s coverage because they are found not to have arisen out of employment.10
An employee’s emotional reaction to administrative or personnel matters generally falls
outside FECA’s scope.11 Although related to the employment, administrative and personnel
matters are functions of the employing establishment rather than the regularly or specially assigned
work duties of the employee.12 However, the Board has held that, where the evidence establishes
error or abuse on the part of the employing establishment in what would otherwise be an
administrative matter, coverage will be afforded.13
Perceptions and feelings alone are not compensable. To establish entitlement to benefits,
a claimant must establish a basis in fact for the claim by supporting his or her allegations with
probative and reliable evidence.14 When the matter asserted is a compensable factor of
employment and the evidence of record establishes the truth of the matter, OWCP must base its
decision on an analysis of the medical evidence.15
ANALYSIS
Appellant alleged that work-related stress either caused or contributed to his diagnosed
heart disease. He specifically implicated the employing establishment’s efforts to remove him
from service, which began in August 2015. The employing establishment acknowledged that it
proposed to remove appellant based on alleged falsification of employment application documents.
It also noted that the proposed disciplinary action was later reduced to a 14-day suspension, which
he reportedly accepted. The Board must initially review whether the reported disciplinary action

8

A.K., 58 ECAB 119 (2006); David Apgar, 57 ECAB 137 (2005).

9

Lillian Cutler, 28 ECAB 125 (1976); see also Trudy A. Scott, 52 ECAB 309 (2001).

10

William E. Seare, 47 ECAB 663 (1996).

11

Matilda R. Wyatt, 52 ECAB 421 (2001); Thomas D. McEuen, 41 ECAB 387 (1990), reaff’d on recon., 42 ECAB
556 (1991).
12

David C. Lindsey, Jr., 56 ECAB 263, 268 (2005).

13

William H. Fortner, 49 ECAB 324 (1998).

14

See Kathleen D. Walker, 42 ECAB 603 (1991).

15

See Norma L. Blank, 43 ECAB 384 (1992).

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is a covered employment factor under FECA.16 The Board notes that appellant’s allegations do
not pertain to his regular or specifically assigned duties under Cutler.17 Rather, appellant has
alleged stress from administrative/personnel matters on the part of the employing establishment.
As noted, appellant alleged that the employing establishment tried to fire him for “no
apparent reason.” Administrative and personnel matters, although related to the employee’s
employment, are functions of the employing establishment rather than the regularly or specially
assigned duties of the employee and, as such, are generally not covered under FECA.18 However,
the Board has held that, where the evidence establishes error or abuse on the part of the employing
establishment in what would otherwise be an administrative/personnel matter, coverage will be
afforded.19 In determining whether the employing establishment has erred or acted abusively, the
Board will examine the factual evidence of record to determine whether the employing
establishment acted reasonably.20
The Board finds that appellant has not provided any evidence that the employing
establishment committed any error or abuse in the administrative function of proposing to remove
him from employment. Appellant alleged that the employing establishment tried to fire him for
“no apparent reason.” In a May 6, 2016 letter, however, a human resource specialist for the
employing establishment, explained that his removal from employment was due to the fact that he
falsified answers on his application for employment. She submitted a print-out of a September 2,
2016 e-mail which indicated that appellant provided false answers to his employment application
by answering “No” that he was never fired and “No” that he had never quit knowing he would be
fired. The human resource specialist noted that an OIG report was available. These documents
demonstrate that the employing establishment’s actions were in response to a legitimate concern
over appellant’s employment application and do not show any wrongdoing by the employing
establishment. Although appellant contended that he did not falsify his employment documents,
he did not submit any corroborating evidence to show that the employing establishment acted
wrongly. The Board finds, therefore, that he has not shown error or abuse with respect to the
administrative action to propose to terminate him from employment.21
For this reason, appellant has not established a compensable employment factor under
FECA and, therefore, has not met his burden of proof to establish that he sustained an injury in the
performance of duty.22

16

Paul Trotman-Hall, 45 ECAB 229 (1993) (Michael E. Groom, Alternate Member, concurring).

17

See Lillian Cutler, supra note 9.

18

See supra notes 14 and 15.

19

Supra note 13.

20

Ruth S. Johnson, 46 ECAB 237 (1994).

21

See N.D., Docket No. 16-0823 (issued August 18, 2017).

22
As appellant has not established any compensable employment factors, the Board need not consider the medical
evidence of record. See Margaret S. Krzycki, 43 ECAB 496, 502-03 (1992).

6

On appeal appellant alleges that every aspect of his life, including his children, friends,
neighbors, credit history, and leisure activities, from 1984 to the present was “placed under a
microscope” because of a complaint that he filed against a disgruntled customer (PS Form 1767).
He further asserts that it was “almost impossible” to prove that his medical condition was causally
related to a compensable employment factor. As noted above, a claimant seeking benefits under
FECA has the burden of proof to establish the essential elements of his or her claim, including that
the injury was sustained while in the performance of duty.23 Appellant did not submit sufficient
evidence to establish that his alleged injury occurred in the performance of duty.
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 did not meet his burden of proof to establish an injury in the
performance of duty, as alleged.
ORDER
IT IS HEREBY ORDERED THAT the November 1, 2016 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: May 1, 2018
Washington, DC

Christopher J. Godfrey, 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
23

Supra note 5.

7


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
L.M., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Paterson, NJ, Employer
__________________________________________

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Appearances:
James D. Muirhead, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 16-0481
Issued: June 17, 2016

Case Submitted on the Record

DECISION AND ORDER
Before:
COLLEEN DUFFY KIKO, Judge
ALEC J. KOROMILAS, Alternate Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On January 19, 2016 appellant, through counsel, filed a timely appeal of an August 31,
2015 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 to consider the merits of this case.
ISSUE
The issue is whether appellant met her burden of proof to establish an injury on
November 8, 2011 causally related to the accepted employment incident.
On appeal appellant, through counsel, contends that the medical reports of appellant’s
treating physician established her claim.

1

5 U.S.C. § 8101 et seq.

FACTUAL HISTORY
On November 8, 2011 appellant, then a 38-year-old letter carrier, filed a recurrence of
disability claim (Form CA-2a). She related that her original injury to her back and neck occurred
on October 30, 2010, but on November 8, 2011 she felt pain in her back and neck, and shortness
of breath while loading a package into her truck. Appellant stopped work on November 8, 2011.
The employing establishment controverted the claim. It related that she was found fit for duty
after her prior injury and that she had returned to work on October 21, 2011. The employing
establishment alleged that appellant had complained of back pain prior to loading the vehicle.
By letter dated February 1, 2012, OWCP advised appellant that it was treating her
recurrence claim as a traumatic injury claim.2 It allotted her 30 days to submit additional factual
and medical evidence. Appellant did not submit medical evidence or any other documentation
with her claim.
By decision dated March 2, 2012, OWCP denied appellant’s claim as she had not
established fact of injury. It explained that she did not establish that the November 8, 2011
incident occurred as alleged.
On March 12, 2012 appellant requested reconsideration. In support of her request for
reconsideration, appellant submitted multiple medical reports from her treating Board-certified
orthopedic surgeon, Dr. David B. Basch. In a March 6, 2012 report, Dr. Basch noted that
appellant had recently sustained a work injury which occurred on October 30, 2010. He noted
that appellant attempted to return to work in October 2011, but that in the process of loading a
truck she became symptomatic. Dr. Basch diagnosed chronic cervical strain with disc bulging at
C4-C5, C5-C6, and C6-C7 with indentation on the spinal cord, rule out right-sided
radiculopathy. He also found chronic lumbar strain with internal disc disruption at L4-L5 with
facet joint arthropathy. Dr. Basch noted that appellant remained disabled. Appellant also
submitted reports by Dr. Basch dated April 3 through May 7, 2012. In these reports, Dr. Basch
reiterated appellant’s diagnoses, and stated that appellant needed a magnetic resonance imaging
(MRI) scan.
In a June 13, 2012 decision, OWCP found that the evidence was insufficient to establish
that an employment incident occurred on November 18, 2011. Accordingly, it denied
modification of the prior decision.
In a May 29, 2012 report, Dr. Basch reiterated appellant’s diagnoses and restrictions. He
stated that it remained his medical opinion that appellant’s symptoms and injuries were directly
and causally related to her work injury of October 30, 2010. Dr. Basch noted that appellant was
under a pain management program with a home exercise program and medication, and that she
should continue with her work restrictions, which limited her to sedentary work. In a June 26,
2012 report, he noted that he saw appellant on that date and that she was in moderate distress.

2

20 C.F.R. § 10.5(15), (16) defines a traumatic injury as a wound or other injury caused by a specific event or
incident within a single workday or shift, where as an occupational injury is defined a s a condition produced in the
work environment over a period longer than a single workday or shift.

2

Dr. Basch reiterated appellant’s diagnoses and restrictions, and indicated that she had failed
conservative treatment.
In a July 18, 2013 decision, OWCP determined that the factual component of fact of
injury had been established, but found that the medical evidence was deficient.
Appellant continued to submit reports from Dr. Basch. In reports dated August 27, 2013
and January 14, 2014, Dr. Basch opined that appellant’s diagnoses were causally related to the
work injury of November 8, 2011. He also noted that appellant’s prognosis remained guarded
and that she continued to experience significant residual sequelae following the work injury of
November 8, 2011.
On February 14, 2014 appellant, through counsel, requested reconsideration.
In support of her reconsideration request, appellant submitted additional reports from
Dr. Basch. In a February 11, 2014 report, Dr. Basch noted that appellant was seen on
November 15, 2011 for a November 8, 2011 injury. He indicated that appellant reported at that
time that she was attempting to move a package while loading her mail delivery truck and felt a
sharp severe pain in her low back. Dr. Basch noted that appellant would continue with her home
exercise program and return to sedentary work. In a March 11, 2014 report, he noted that it
remained his opinion that appellant’s conditions were directly caused by the employment
incident of November 8, 2011. Dr. Basch noted that appellant had a long history of conservative
care but remained symptomatic. He stated that appellant remained completely disabled and was
unable to return to work in any capacity.
In a May 1, 2014 decision, OWCP denied modification of its prior decisions. It noted
that, although the evidence of the file was sufficient to establish a diagnosed condition, causal
relationship had not been established.
Appellant continued to submit progress reports from Dr. Basch. In a May 27, 2014
report, Dr. Basch repeated appellant’s diagnoses and also reiterated that appellant’s symptoms
and injuries were directly and causally related to the work injury which occurred on
November 8, 2011. He noted that appellant had failed a long course of conservative care as well
as interventional pain management and injections, and he noted that appellant had been made
aware of further treatment options including surgical intervention.
In his June 24, 2014 report, Dr. Basch again concluded that appellant’s symptoms and
conditions were directly caused by the work injury of November 8, 2011. He added that
appellant remained disabled and was unable to work in any capacity.
On August 18, 2014 Dr. Basch related that he reviewed his medical records regarding
appellant’s November 8, 2011 injury. He noted that appellant was working at the employing
establishment loading parcels into her vehicle. Dr. Basch noted that appellant stated that, to
perform this activity, he had to bend her back repeatedly in an awkward position, reach over and
bend down into a hamper, lift parcels, and twist around to put the packages in the vehicle. He
further noted that appellant had previous injuries to her back and neck related to a work injury of
October 30, 2010. Dr. Basch opined that this mechanism of injury of using improper back
mechanics on November 8, 2011 caused significant exacerbation/aggravation of her cervical and
3

lumbar conditions. He noted that the diagnoses he noted in his office notes remained unchanged.
Dr. Basch concluded that appellant’s current diagnoses were causally related to the injury of
November 8, 2011. He noted that, although MRI scan evaluation of the lumbar spine was
ordered in 2013, it had not been performed.
By letter dated October 6, 2014, appellant, through counsel, requested reconsideration.
She continued to submit reports by Dr. Basch indicating that appellant remained disabled due to
the previously diagnosed conditions.
By decision dated February 20, 2015, OWCP denied modification of the May 1, 2014
decision. It found that the medical evidence of record was not sufficiently rationalized to
establish causal relationship.
By letter dated July 1, 2015, appellant, through counsel, requested reconsideration. In
support thereof, he submitted a March 17, 2015 report wherein Dr. Basch stated that he had
requested an MRI scan evaluation of appellant’s lumbar spine following her work injury of
November 8, 2011 on multiple occasions, including on May 7 and July 30, 2013, but that these
requests had been ignored. Counsel reiterated that appellant’s diagnoses were: (1) chronic
cervical strain with disc bulging at C4-C5, C5-C6, and C6-C7 with compression upon the spinal
cord with bilateral radiculitis and neurological involvement; and (2) chronic lumbar strain with
internal disc disruption at L4-L5 with facet arthopathy, rule out adjacent level disease with
recurrent disc herniation. He concluded that appellant’s conditions were causally related to her
November 8, 2011 employment incident as she was able to complete her essential job duties and
deal with chronic lumbar strain until the injury of November 8, 2011. Counsel noted that this
incident caused an exacerbation of her conditions due to improper back mechanics when she was
forced to load her work truck in an awkward position, which caused her severe pain including
radiculitis. He opined that appellant still required an updated MRI scan evaluation of her lumbar
spine, and has been instructed to proceed with left laminectomy and discectomy at L4-L5.
Counsel stated that appellant was disabled and unable to return to work in any capacity.
By decision dated August 31, 2015, OWCP denied modification of its prior decision. It
found that the evidence of record did not substantiate causal relationship.
LEGAL PRECEDENT
An employee seeking benefits under FECA has the burden of establishing 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, that an injury was sustained in the performance of duty as alleged,
and that any disability and/or specific condition for which compensation is claimed are causally
related to the employment injury. 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.3

3

Jussara L. Arcanjo, 55 ECAB 281, 283 (2004).

4

In order to determine whether an employee actually sustained an injury in the
performance of duty, OWCP begins with an analysis of whether fact of injury has been
established. Generally, fact of injury consists of two components, which must be considered in
conjunction with one another. The first component to be established is that the employee
actually experienced the employment incident or exposure, which is alleged to have occurred.4
In order to meet his or her burden of proof to establish the fact that he or she sustained an injury
in the performance of duty, an employee must submit sufficient evidence to establish that he or
she actually experienced the employment injury or exposure at the time, place, and in the manner
alleged.5
The second component is whether the employment incident caused a personal injury and
generally can be established only by medical evidence.6 The medical evidence required to
establish causal relationship is usually rationalized medical evidence. Rationalized medical
opinion evidence is medical evidence which includes a physician’s rationalized opinion on the
issue of whether there is a causal relationship between the claimant’s diagnosed condition and
the implicated employment factors. The opinion of the physician must be based on a complete
factual and medical background of the claimant, 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 the specific employment factors identified by the claimant.7
ANALYSIS
Appellant alleged that she sustained an employment-related injury on November 8, 2011
while loading a package onto her vehicle. OWCP determined that the employment incident
occurred as alleged. Based on the medical reports of Dr. Basch, appellant’s treating orthopedic
surgeon, appellant established medical diagnoses of chronic cervical strain with disc bulging at
C4-C5, C5-C6, and C6-C7 with indentation on the spinal cord and chronic lumbar strain with
internal disc disruption at L4-L5 with facet joint arthropathy. However, OWCP denied
appellant’s claim as it found that she had failed to establish causal relationship between the
accepted employment incident and the medical diagnoses.
In support, appellant and her counsel submitted medical reports from Dr. Basch. In
multiple medical reports, Dr. Basch opined that appellant’s diagnoses were causally related to
her employment injury of November 8, 2011. He noted appellant’s assertion that she hurt herself
while loading her mail delivery truck and felt a sharp severe pain in her lower back. In a
June 24, 2014 report, appellant recounted to Dr. Basch that she had to bend her back repeatedly
in an awkward position, and had to reach over and bend down into the hamper and lift parcels
and twist to put them in her vehicle. Dr. Basch noted that she had prior injuries to her back and
neck related to an employment injury of October 30, 2010. He opined that the mechanism of
4

See Elaine Pendleton, 40 ECAB 1143 (1989); Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of
Injury, Chapter 2.803(2)(a) (August 2012).
5

Linda S. Jackson, 49 ECAB 486 (1998).

6

John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978).

7

Judith A. Peot, 46 ECAB 1036 (1995); Ruby I. Fish, 46 ECAB 276 (1994).

5

injury of using improper back mechanics on November 8, 2011 caused significant
exacerbation/aggravation of her cervical and lumbar spine conditions. In a March 17, 2015
report, Dr. Basch reiterated that improper back mechanics caused her severe pain including
radiculitis. In this report, he noted that appellant had been able to complete her duties until the
injury of November 8, 2011, which marked a significant exacerbation of her conditions.
The Board finds that Dr. Basch’s reports are insufficient to meet appellant’s burden of
proof with regard to causal relationship. Dr. Basch appears to base his conclusion that
appellant’s medical diagnoses were related to her November 8, 2011 employment incident on the
fact that appellant was able to work prior to the November 8, 2011 incident and unable to work
thereafter. However, neither the fact that a disease or condition manifests itself during the period
of employment nor the belief that the disease or condition was caused or aggravated by
employment factors or incidents is sufficient to establish causal relationship.8 Causal
relationship must be based on rationalized medical opinion evidence which accurately describes
appellant’s work duties and provides a medical explanation with regard to the pathophysiological
process by which these duties would have caused or aggravated the condition.9
An award of compensation may not be based on surmise, conjecture, or speculation.10 As
appellant did not establish that her medical condition was causally related to the accepted factor
of her employment, OWCP properly denied 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.
CONCLUSION
The Board finds that appellant did not meet her burden of proof to establish that she
sustained an employment-related injury on November 8, 2011, as alleged.

8

Dennis M. Mascarenas, 49 ECAB 215 (1997).

9

D.P., Docket No. 15-1325 (issued February 18, 2016).

10

D.I., 59 ECAB 158 (2007); Ruth R. Price, 16 ECAB 688, 691 (1965).

6

ORDER
IT IS HEREBY ORDERED THAT the decision of the Office of Workers’
Compensation Programs dated August 31, 2015 is affirmed.
Issued: June 17, 2016
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge
Employees’ Compensation Appeals Board

7


United States Department of Labor
Employees’ Compensation Appeals Board
___________________________________________
)
)
)
and
)
)
U.S. POSTAL SERVICE, POST OFFICE,
)
St. Louis, MO, Employer
)
___________________________________________ )
P.Y., Appellant

Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 08-937
Issued: April 20, 2009

Case Submitted on the Record

DECISION AND ORDER
Before:
COLLEEN DUFFY KIKO, Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On February 11, 2008 appellant filed a timely appeal of a December 17, 2007 merit
decision of the Office of Workers’ Compensation Programs which denied her claim for a
recurrence of disability. Pursuant to 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 met her burden of proof to establish a recurrence of
disability on July 12, 2007 causally related to her March 5, 1999 employment injury.
FACTUAL HISTORY
On March 5, 1999 appellant, then a 34-year-old mail processor, sustained injury when her
right hand was caught between two mail cars as she tried to stop one from rolling into the other.
She was treated that day and returned to work in a light-duty capacity.
The Office accepted the claim for contusion of the right hand, myalgia and myositis on
the right and right carpal tunnel syndrome for which appellant underwent surgery. Appellant

worked intermittently in a limited-duty capacity for the period March 7 to May 1, 1999. She
stopped work on May 1, 1999 and was released to full duty on June 30, 1999. Appellant had
intermittent periods of disability until she underwent carpal tunnel surgery on
December 17, 1999. She returned to full duty on March 2, 2000.1 On February 9, 2005 the
Office accepted appellant’s claim for a recurrence of myalgia and myositis on
November 27, 2004.
On July 26, 2002 appellant accepted a light-duty job offer as a modified mail processor.
By decision dated October 1, 2002, the Office found that appellant’s actual earnings as a
modified mail processor fairly and reasonably represented her wage-earning capacity. It reduced
her compensation to zero as her actual wages met or exceeded the wages she held when injured.2
On July 17, 2007 appellant claimed a recurrence of disability as of July 12, 2007 causally
related to the March 5, 1999 employment injury. She alleged that she was feeding mail into a
machine when her hand and arm became swollen. The employing establishment indicated that
appellant stopped work on July 12, 2007 and returned on July 20, 2007. It advised that
accommodations were made for her upon returning to work, which included working in the mail
unit. Appellant completed a Form CA-7 requesting compensation for wage loss from July 12 to
20, 2007.
By letter dated July 30, 2007, the Office informed appellant of the evidence needed to
support her claim. It requested that she submit additional medical evidence within 30 days.
The Office received additional CA-7 forms for periods of disability from July 21 to
August 2, August 4 to 17, 18 to 31, and September 3 to 8, 2007.
In a July 12, 2007 report, Dr. Harmeen Chawla, Board-certified in physical medicine and
rehabilitation, noted that appellant reported that “last night she had a sudden increase in pain,
swelling and increase in spasms, and as a result, had to leave work.” She opined that appellant
had a myofascial flare-up of the right upper extremity. Dr. Chawla noted that appellant had a
history of upper extremity reflex sympathy dystrophy (RSD). She placed appellant off work
until July 16, 2007.
The Office received reports dated July 20 to September 12, 2007 from Dr. Chawla, who
diagnosed myofascial pain and placed appellant off work. On July 23, 2007 Dr. Chawla noted
findings on physical examination of continued swelling in the forearm and fingers, continued
neurogenic pain and some spasms. On August 8, 2007 she diagnosed myofascial flare-up of the
right upper extremity with no improvement. Dr. Chawla recommended a stellate ganglion block
and advised appellant to remain off work.
In an August 19, 2007 report, an Office medical adviser reviewed appellant’s history of
injury and treatment, noting that none of the physicians of record had diagnosed RSD. The
1

The record reflects that appellant filed a separate claim for an occupational disease involving her left shoulder
on July 31, 2000. However, this claim was denied by the Office under File No. xxxxxx020.
2

This decision was affirmed by the Office hearing representative on September 22, 2003.

2

Office medical adviser indicated that there were no diagnostic findings to support that
appellant’s current complaints of pain in the right arm were work related and described her pain
as “subjective.” The Office medical adviser also indicated that her ganglion block treatments
were not appropriate.3
In a report received by the Office on August 20, 2007, Dr. Chawla opined that appellant’s
myofascial syndrome involved soft tissue injury to the right shoulder girdle and arm, which was
a “combination of the entire right upper extremity.” In attending physician’s reports dated
August 22 and 29, 2007, she found that appellant was totally disabled and unable to work. On
September 5, 2007 Dr. Chawla noted that appellant was improving and could return to work as
of September 10, 2007. In a September 12, 2007 report, she opined that appellant had a “regular
permanent restriction with frequent rest breaks for stretching.”
In several statements, appellant alleged that she had myofascial pain syndrome, which
was a chronic pain disorder. She denied having any other injuries to her arm since the March 5,
1999 injury. Appellant contended that she had never made a complete recovery and that her arm
never returned to normal. On August 10, 2007 she stated that she performed repetitive lifting at
work which caused her arm to become swollen. Appellant went to a nurse, who indicated that it
was from the original injury. On September 14, 2007 she requested that the Office address her
claim. Appellant alleged that the only difference in this recurrence was that her physician
requested authorization for ganglion blocks and acupuncture.
On September 24, 2007 the Office referred appellant for a second opinion to Dr. John A.
Gragnani, Board-certified in physical medicine and rehabilitation. In an October 8, 2007 report,
Dr. Gragnani noted appellant’s history of injury and treatment. He conducted a physical
examination and found no evidence of swelling, redness, deformity, contracture or any other
signs of vascular or neurologic malfunction of either upper extremity. Dr. Gragnani advised that
appellant had subjective complaints of right upper extremity pain by history, a normal
examination of the right upper extremity and no evidence of myofascial pain or complex regional
pain syndrome. He stated that appellant had “subjective complaints only” and there was no
objective evidence of injury or disease for which causation could be established. Dr. Gragnani
advised that no further medical treatment was required.
The Office found a conflict in medical opinion between Drs. Chawla and Gragnani as to
whether appellant had disability or residuals of her accepted condition.
On October 29, 2007 the Office referred appellant, together with a statement of accepted
facts and the medical record to Dr. Stephen Benz, a Board-certified orthopedic surgeon, for an
impartial medical evaluation.
In a November 14, 2007 report, Dr. Benz reviewed appellant’s history of injury and
treatment. On physical examination of the upper extremities, he found full range of motion of
the right shoulder, elbow, wrist and hands. Dr. Benz found no evidence of erythema, induration
3

In a decision dated August 20, 2007, the Office denied appellant’s request for authorization to perform stellate
ganglion blocks and informed her that a second opinion examination was currently being arranged. Appellant did
not seek review of this decision.

3

or swelling. He advised that she had “nice palpable radial pulses” and strength of 5/5 with intact
sensation. Dr. Benz explained that appellant’s symptoms were strictly subjective and that he
could not make any objective findings. He noted that she did not differentiate any one particular
area when she experienced pain. Dr. Benz determined that appellant’s examination was totally
normal. He found no evidence of any RSD. Dr. Benz noted that appellant had recurrences every
year, and that he did “not believe that there is anything that can be done to reduce this.” He
added that this was a “strictly subjective finding. I do not think that there is anything objective
going on here.” Dr. Benz advised that it would be counterproductive to take appellant away
from her current work restrictions, which would in all likelihood increase her subjective
symptoms.
By decision dated December 17, 2007, the Office denied appellant’s claim for a
recurrence of disability beginning July 12, 2007. It found that the factual evidence did not
establish that the claimed recurrence resulted from the accepted work injury.
LEGAL PRECEDENT
Section 10.5(x) of the Office regulations provides that a recurrence of disability means an
inability to work after an employee has returned to work, caused by a spontaneous change in a
medical condition which had resulted from a previous injury or illness without an intervening
injury or new exposure to the work environment that caused the illness. This term also means an
inability to work that takes place when a light-duty assignment made specifically to
accommodate an employee’s physical limitations due to his or her work-related injury or illness
is withdrawn or when the physical requirements of such an assignment are altered so that they
exceed his or her established physical limitations.”4
When an employee, who is disabled from the job he or she held when injured on account
of employment-related residuals, returns to a light-duty position or the medical evidence
establishes that the employee can perform the light-duty position, the employee has the burden to
establish by the weight of the reliable, probative and substantial evidence, a recurrence of total
disability and to show that he or she cannot perform such light duty. As part of this burden, the
employee must show a change in the nature and extent of the injury-related condition or a change
in the nature and extent of the light-duty job requirements.5
Causal relationship is a medical issue,6 and the medical evidence required to establish a
causal relationship, generally, is rationalized medical evidence. This consists of a physician’s
rationalized medical opinion on the issue of whether there is a causal relationship between the
claimant’s diagnosed condition and the implicated employment factors.7 The physician’s
opinion must be based on a complete factual and medical background of the claimant, must be
4

J.F., 58 ECAB ___ (Docket No. 06-186, issued October 17, 2006); Elaine Sneed, 56 ECAB 373, 379 (2005);
20 C.F.R. § 10.5(x).
5

Richard E. Konnen, 47 ECAB 388 (1996); Terry R. Hedman, 38 ECAB 222, 227 (1986).

6

Elizabeth Stanislav, 49 ECAB 540, 541 (1998).

7

Duane B. Harris, 49 ECAB 170, 173 (1997).

4

one of reasonable medical certainty and must be supported by medical rationale explaining the
nature of the relationship between the diagnosed condition and the specific employment factors
identified by the claimant.8
ANALYSIS
The Office accepted that appellant sustained a contusion of the right hand, myalgia and
myositis on the right, right carpal tunnel syndrome and surgical release. Appellant returned to
work in a light-duty capacity as a modified mail processor on July 26, 2002. On February 9,
2005 the Office accepted appellant’s claim for a recurrence of myalgia and myositis on
November 27, 2004. Appellant subsequently filed a claim for a recurrence of disability
commencing July 12 to September 5, 2007.
The Office determined that a conflict in medical opinion arose between Dr. Chawla,
appellant’s physician, and Dr. Gragnani, regarding the extent of any residuals and disability. It
referred appellant to Dr. Benz, a Board-certified orthopedic surgeon and impartial medical
examiner, to resolve the conflict.
Section 8123 of the Federal Employees’ Compensation Act provides that, if there is
disagreement between the physician making the examination for the United States and the
physician of the employee, the Secretary shall appoint a third physician, who shall make an
examination.9 In situations where there exist opposing medical reports of virtually equal weight
and rationale and the case is referred to an impartial medical specialist for the purpose of
resolving the conflict, the opinion of such specialist, if sufficiently well rationalized and based
upon a proper factual background, must be given special weight.10
The Office properly referred appellant to Dr. Benz, who reviewed appellant’s history of
injury and treatment. Dr. Benz conducted a physical examination and found that appellant had
full range of motion of the right shoulder, elbow, wrist and hands, with no evidence of erythema
or swelling. He determined that appellant’s symptoms were subjective and that he could not
make any objective findings regarding her right upper extremity. Dr. Benz determined that
appellant’s examination was totally normal and noted that further medical treatment was not
warranted. He did not find any disability attributable to her March 5, 1999 work injury.
The Board finds that Dr. Benz provided a detailed and well-rationalized report based on a
proper factual background and thus his opinion is entitled to the special weight accorded an
impartial medical examiner. Dr. Benz’s report is sufficient to resolve the conflict of medical
opinion between Dr. Chawla, and Dr. Gragnani, regarding nature and extent of disability and
residuals of her accepted conditions. Appellant did not provide any additional medical evidence
to overcome the report of Dr. Benz. The evidence does not support that there was a change in

8

Gary L. Fowler, 45 ECAB 365, 371 (1994).

9

5 U.S.C. § 8123; see Charles S. Hamilton, 52 ECAB 110 (2000).

10

Jacqueline Brasch (Ronald Brasch), 52 ECAB 252 (2001).

5

the nature and extent of appellant’s light-duty job requirements during the period in which
recurrent disability is claimed.
For these reasons, the Board finds that appellant has not met her burden of proof to
establish a recurrence of disability commencing July 12, 2007 causally related to her March 5,
1999 employment injury.
CONCLUSION
The Board finds that appellant did not meet her burden of proof to establish a recurrence
of disability beginning July 12, 2007 causally related to the March 5, 1999 employment injury.
ORDER
IT IS HEREBY ORDERED THAT the December 17, 2007 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: April 20, 2009
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

6


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.R., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Chicago, IL, Employer
__________________________________________

)
)
)
)
)
)
)
)

Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 17-1584
Issued: February 8, 2018

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
ALEC J. KOROMILAS, Alternate Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On July 14, 2017 appellant filed a timely appeal from a February 6, 2017 merit decision
and an April 27, 2017 nonmerit 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.
ISSUES
The issues are: (1) whether appellant met her burden of proof to establish an injury
causally related to the accepted September 17, 2015 employment incident; and (2) whether
OWCP properly denied appellant’s request for reconsideration of the merits of her claim
pursuant to 5 U.S.C. § 8128(a).

1

5 U.S.C. § 8101 et seq.

FACTUAL HISTORY
On July 1, 2016 appellant, then a 42-year-old mail carrier, filed a traumatic injury claim
(Form CA-1) alleging that on September 17, 2015 she sustained a torn disc in her neck and a
herniated disc in her back as a result of picking up a tub of mail. She elaborated on the
circumstances of her claimed injury in an attached letter, stating that on September 16, 2015 she
felt pain in her lower back after delivering a route with parcels. The next day her back was
somewhat sore, but appellant proceeded to work and while casing a route, she lifted a mail tub
containing flat mail and heard a pop in her back. She immediately began to experience extreme
pain and difficulty standing. Appellant stated that, after alerting a supervisor, she was taken to
the emergency room of a nearby hospital by her daughter.
She stopped work on
September 17, 2015.
In an attached statement, the employing establishment controverted appellant’s claim. A
supervisor stated that she believed appellant was attempting to claim compensation for an injury
that occurred outside of work. She noted that appellant had admitted verbally that the back
injury did not occur at work, nor had she reported the injury within 30 days. Appellant had
applied for a temporary light-duty assignment on November 16, 2015 and applied for a position
other than letter carrier on February 11, 2016. The supervisor observed that appellant had
applied for these reassignments, yet not filled out a Form CA-1 claiming an injury at work, by
February 11, 2016. She further noted that on March 25, 2016 appellant filled out a Form CA-1,
but did not bring it into the station to ask her supervisors to fill out their portion of the form.
Instead, appellant sent the Form CA-1 to management through a union steward. The supervisor
argued that her submission of a light-duty request proved that appellant was injured outside of
work, and that appellant’s claim was fraudulent.
By letter dated July 7, 2016, OWCP informed appellant of the evidence necessary to
establish her claim. It noted that she had not submitted sufficient evidence to establish either the
factual or medical portions of her claim, and afforded her 30 days to submit additional evidence.
OWCP also requested that appellant respond to a development questionnaire.
By letter dated July 7, 2016, the employing establishment reiterated its controversion of
appellant’s claim. It noted that appellant failed to submit any medical evidence for the first 30
days of her claimed injury, that she failed to file the claim within 30 days, that she informed
supervisors that the injury did not occur on-premises, and that she would seek attention from her
private physician. The employing establishment noted that appellant had been off work since
September 21, 2015, without contacting the employing establishment.
In a report dated July 22, 2016, Dr. Leilanie Narcelles-Mon, a Board-certified internist,
diagnosed radiculopathy of the lower extremities, lumbar musculoskeletal spasm, an L4-L5
annular tear, an L4-L5 disc herniation, degenerative changes to the lower lumbar spine, L4-L5
central canal stenosis, and L5-S1 bilateral facet joint hypertrophy. On examination, she noted
tenderness on palpation of the lower lumbar spine and severe spasm of the lumbar muscles,
weakness of the lower extremities, and radiculopathy of the lower extremities. Dr. NarcellesMon opined that appellant sustained a back injury at work. She explained that appellant had
related that she had bent down from her waist and picked up a bin-basket full of mail, when she

2

stood up she felt a pop on her back and had unbearable back pain and severe stiffness of the
lower back.
Appellant responded to OWCP’s development questionnaire on July 18, 2016. She stated
that she did not sustain any other injury between the date of injury and the date she reported it to
her supervisor on March 25, 2016. Appellant noted that she did not have any similar symptoms
or disability before the date of injury, and clarified that she was claiming a traumatic injury.
In a diagnostic report dated September 25, 2015, Dr. Robert Kidd, a Board-certified
diagnostic radiologist, examined the results of a magnetic resonance imaging (MRI) scan of
appellant’s lumbar spine. He noted impressions of early degenerative change in the lumbar spine
without obvious spondylolysis or listhesis; a focal posterior annular disc tear, posterior
protrusion, and inferior herniation of the disc at L4-L5 causing central canal stenosis; and no
obvious pathological spinal, epidural, or paraspinal soft-tissue enhancement.
In a diagnostic report dated October 27, 2015, Dr. Kidd examined the results of a cervical
spine MRI scan. He noted impressions of early degenerative changes in the cervical spine with
paraspinal muscle spasm and no evidence of obvious spondylosis or listhesis; broad-based
posterior disc protrusions without central canal or neural foraminal stenosis at C2-C3, C3-C4,
and C6-C7; a diffuse posterior disc bulge causing mild central canal and mild bilateral neural
foraminal stenosis without neurological compromise at C4-C5; and a focal right paracentral
annular disc tear along with focal right paracentral protrusion of the disc at C5-C6 causing mild
central canal stenosis.
By decision dated August 15, 2016, OWCP denied appellant’s claim. It accepted that she
had established that she was a federal civilian employee who filed a timely claim, that the
incident occurred, that a medical condition had been diagnosed, and that she was within the
performance of duty. OWCP found, however, that she had not submitted sufficient medical
evidence to establish a causal relationship between the accepted incident of September 17, 2015
and her diagnosed conditions. It noted that Dr. Narcelles-Mon, while rendering an opinion on
causation, did not provide rationale to explain the mechanism of how her conditions were caused
by lifting a tub of mail.
In a note dated September 6, 2016, Dr. Narcelles-Mon noted that she had examined
appellant on September 21, 2015 after an injury on September 17, 2015. She noted that
appellant lifted a tub of mail at work and felt a pop in her back. Dr. Narcelles-Mon wrote,
“[Appellant] developed tear and herniation of the L4-L5 disc from the work accident of
September 17, 2015.”
Appellant submitted a letter dated August 17, 2016 signed by three coworkers,
acknowledging that they witnessed that she sustained an injury on September 17, 2015 due to
casing mail.
On September 7, 2016 appellant requested a review of the written record by an OWCP
hearing representative.
By decision dated February 6, 2017, the hearing representative affirmed the decision of
OWCP dated August 15, 2016. He found that Dr. Narcelles-Mon had presented only a
3

conclusory opinion that appellant felt pain after bending down to lift a mail container, but did not
describe in detail how such an activity caused or contributed to appellant’s diagnosed conditions.
The hearing representative further found that Dr. Narcelles-Mon had not differentiated between
any preexisting spinal degenerative disc disease disclosed by MRI scan and any effects of the
incident of September 17, 2015.
On April 13, 2017 appellant requested reconsideration. She argued that she had informed
supervisors of the claimed injury when it occurred on September 17, 2015, and that she had filed
a union grievance regarding her supervisors’ delay in filing her claim.
Appellant submitted several medical notes dated between September 21, 2015 and
February 26, 2016. The note dated September 21, 2015 from Dr. Narcelles-Mon indicated that
appellant should be off work until at least September 30, 2015. In a partially illegible note dated
September 30, 2015, Dr. Narcelles-Mon indicated that appellant should continue to be off work
until October 12, 2015. In a note dated October 13, 2015, Dr. Richard Mon, a Board-certified
internist, noted that appellant could not work until October 19, 2015. In a partially illegible note
dated October 19, 2015, Dr. Narcelles-Mon recommended work restrictions of no lifting,
pushing, or pulling, or bending from the waist, and recommended that appellant stay off work
until at least October 24, 2014. A partially legible note dated October 28, 2015, from
Dr. Narcelles-Mon referenced work restrictions of no casing mail, no pulling, and no pushing.
An undated note reiterated these work restrictions and recommended physical therapy. In a note
dated November 16, 2015, Dr. Narcelles-Mon noted that appellant would be off work until
December 7, 2015, and with work restrictions of no lifting over 10 pounds, no carrying of over
10 pounds, and no climbing. In a note dated February 26, 2016, she indicated that appellant
could return to work on March 7, 2016 with restrictions of no carrying mail, no lifting, pushing,
pulling, bending, squatting, kneeling, reaching overhead, prolonged walking, or prolonged
standing.
Appellant also submitted a Step B grievance decision dated August 22, 2016. The
decision found that management had violated provisions of the National Agreement when they
did not submit appellant’s Form CA-1 within the specified time frame.
By decision dated April 27, 2017, OWCP denied appellant’s request for reconsideration.
It found that because she had not raised substantial legal questions nor submitted any new and
relevant evidence on reconsideration, she had not met the standard to require merit review of
OWCP’s prior decision.
LEGAL PRECEDENT -- ISSUE 1
An employee seeking benefits under FECA2 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

2

Supra note 1.

4

time limitation period of FECA, that an injury3 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.4
To determine whether a federal employee has sustained a traumatic injury in the
performance of duty, it must first be determined whether fact of injury has been established. A
fact of injury determination is based on two elements. First, the employee must submit sufficient
evidence to establish that he or she actually experienced the employment incident at the time,
place, and in the manner alleged. Second, the employee must submit sufficient evidence,
generally only in the form of medical evidence, to establish that the employment incident caused
a personal injury. An employee may establish that the employment incident occurred as alleged,
but fail to show that his or her condition relates to the employment incident.5
The claimant has the burden of proof to establish by the weight of reliable, probative, and
substantial evidence that the condition for which compensation is sought is causally related to a
specific employment incident or to specific conditions of employment.6 An award of
compensation may not be based on appellant’s belief of causal relationship. Neither the mere
fact that a disease or condition manifests itself during a period of employment nor the belief that
the disease or condition was caused or aggravated by employment factors or incidents is
sufficient to establish causal relationship.7
Causal relationship is a medical issue and the medical evidence generally required to
establish causal relationship is rationalized medical opinion evidence.8 Rationalized medical
opinion evidence is medical evidence which includes a physician’s rationalized opinion on
whether there is causal relationship between the employee’s diagnosed condition and
compensable employment factors.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 the specific employment factors identified by the employee.10
3
OWCP’s regulations define a traumatic injury as a condition of the body caused by a specific event or incident,
or series of events of incidents, within a single workday or shift. Such condition must be caused by external force,
including stress or strain, which is identifiable as to time and place of occurrence and member or function of the
body affected. 20 C.F.R. § 10.5(ee).
4
T.H., 59 ECAB 388, 393 (2008); see Steven S. Saleh, 55 ECAB 169, 171-72 (2003); Elaine Pendleton, 40
ECAB 1143, 1145 (1989).
5

See Shirley A. Temple, 48 ECAB 404, 407 (1997); John J. Carlone 41 ECAB 354, 356-57 (1989).

6

Roma A. Mortenson-Kindschi, 57 ECAB 418, 428 n.37 (2006); Katherine J. Friday, 47 ECAB 591, 594 (1996).

7

P.K., Docket No. 08-2551 (issued June 2, 2009); Dennis M. Mascarenas, 49 ECAB 215, 218 (1997).

8

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).
9

J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379, 384 (2006).

10

I.J., 59 ECAB 408, 415 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

5

ANALYSIS -- ISSUE 1
Appellant alleged that on September 17, 2015 she sustained a torn disc in her neck and a
herniated disc in her back as a result of picking up a tub of mail. OWCP accepted that the
incident occurred as alleged, but denied the claim as the medical evidence of record was
insufficient to establish causal relationship. The Board finds that appellant failed to submit
sufficient evidence to establish a causal relationship between the accepted employment incident
of September 17, 2015 and her diagnosed conditions.
In a report dated July 22, 2016, Dr. Narcelles-Mon, a Board-certified internist, diagnosed
a back injury at work, radiculopathy of the lower extremities, lumbar musculoskeletal spasm, an
L4-L5 annular tear, an L4-L5 disc herniation, degenerative changes to the lower lumbar spine,
L4-L5 central canal stenosis, and L5-S1 bilateral facet joint hypertrophy. On examination, she
noted tenderness on palpation of the lower lumbar spine and severe spasm of the lumbar
muscles, weakness of the lower extremities, and radiculopathy of the lower extremities.
Dr. Narcelles-Mon also related that appellant had stated that she bent down from her waist and
picked up a bin-basket full of mail, when she stood up she felt a pop on her back and had
unbearable back pain and severe stiffness of the lower back. While she provided diagnoses of
appellant’s lumbar conditions, she only restated appellant’s own opinion as to causation of her
diagnosed conditions.11 Dr. Narcelles-Mon made no attempt to explain how pathologically the
employment incident could have caused the diagnosed conditions. Medical evidence submitted
to support a claim for compensation should reflect a correct history, and the physician should
offer a medically sound explanation of how the claimed work event caused or aggravated the
claimed condition.12
In a note dated September 6, 2016, Dr. Narcelles-Mon noted that she had examined
appellant on September 21, 2015 after an injury on September 17, 2015. She reported that
appellant lifted a tub of mail at work and felt a pop in her back. Dr. Narcelles-Mon wrote,
“[Appellant] developed tear and herniation of the L4-L5 disc from the work accident of
September 17, 2015.” The Board has also found that a mere conclusion without the necessary
rationale is insufficient to meet a claimant’s burden of proof.13 A mere conclusory opinion
provided by a physician without the necessary rationale explaining how and why the incident or
work factors were sufficient to result in the diagnosed medical condition is insufficient to meet a
claimant’s burden of proof to establish a claim.14
While Dr. Narcelles-Mon rendered an opinion that appellant’s diagnosed conditions were
related to her work, she did not rationalize her opinion with a medically sound explanation of
how the event of September 17, 2015 caused or aggravated her conditions. This is especially
11

See M.P., Docket No. 06-1388 (issued September 20, 2006).

12

D.D., Docket No. 13-1517 (issued April 14, 2014).

13

T.M., Docket No. 08-0975 (issued February 6, 2009); Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006);
William C. Thomas, 45 ECAB 591 (1994) (a medical report is of limited probative value on the issue of causal
relationship if it contains a conclusion regarding causal relationship which is unsupported by medical rationale).
14

J.D., Docket No. 14-2061 (issued February 27, 2015).

6

important because appellant had evidence of a preexisting condition.15 Dr. Narcelles-Mon did
not render an explanation of whether the degenerative changes found in the diagnostic studies of
Dr. Kidd predated the date of injury, or if the claimed injury could have aggravated the
degenerative changes. As noted above, neither the fact that a disease or condition manifests
itself during a period of employment, nor the belief that the disease or condition was caused or
aggravated by employment factors or incidents, is sufficient to establish causal relationship.16
Without a rationalized biomechanical explanation of how the event of September 17, 2015
caused or aggravated her conditions, Dr. Narcelles-Mon’s opinion on causal relationship is
insufficiently rationalized to establish appellant’s claim.17
OWCP also received diagnostic reports from Dr. Kidd, in which he reviewed appellant’s
MRI lumbar spine scans. However, diagnostic reports which offer no opinion regarding causal
relationship are of limited probative value.18
There were no other medical reports or notes of record containing an opinion on causal
relationship. As appellant has not submitted any sufficiently rationalized medical evidence to
support her claim that she sustained an injury causally related to lifting a tub of mail on
September 17, 2015, she has not met her burden of proof to establish 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.
LEGAL PRECEDENT -- ISSUE 2
To require OWCP to reopen a case for merit review under section 8128(a), OWCP’s
regulations provide that the evidence or argument submitted by a claimant must: (1) show that
OWCP erroneously applied or interpreted a specific point of law; (2) advance a relevant legal
argument not previously considered by OWCP; or (3) constitute relevant and pertinent new
evidence not previously considered by OWCP.19 Section 10.608(b) of OWCP’s regulations
provide that when an application for reconsideration does not meet at least one of the three
requirements enumerated under section 10.606(b)(3), OWCP will deny the application for
reconsideration without reopening the case for a review on the merits.20

15

See S.D., Docket No. 16-0999 (issued October 16, 2017).

16

Supra note 9.

17

See T.G., Docket No. 17-0632 (issued July 26, 2017).

18

See G.H., Docket No. 17-1387 (issued October 24, 2017).

19

20 C.F.R. § 10.606(b)(3); D.K., 59 ECAB 141, 146 (2007).

20

Id. at § 10.608(b); see K.H., 59 ECAB 495, 499 (2008).

7

ANALYSIS -- ISSUE 2
The Board finds that OWCP properly denied appellant’s request for reconsideration of
the merits of her claim.
In her March 29, 2017 request for reconsideration, appellant did not show that OWCP
erroneously applied or interpreted a specific point of law, or advance a new and relevant legal
argument not previously considered. With her request for reconsideration, appellant argued that
her supervisors had been made aware of the injury on the date of injury and that she had filed a
union grievance against her supervisors for delaying submission of her claim. OWCP had
already accepted that the incident occurred as alleged and been submitted in a timely manner,
and as such evidence regarding timeliness of submission of her claim and the specifics of the
incident were irrelevant to the underlying, remaining issue in her claim. The underlying issue is
whether appellant submitted sufficient medical evidence to establish a diagnosed injury related to
the accepted employment incident of September 17, 2015. That is a medical issue which must be
addressed by relevant and pertinent new medical evidence.21
Appellant submitted various notes dated between September 21, 2015 and February 26,
2016, stating that she should be off work and recommending work restrictions. This evidence is
irrelevant to the issue of causal relationship as none of the notes contained an opinion on causal
relationship. Thus, these notes do not comprise a basis for reopening the case.22 A claimant may
be entitled to a merit review by submitting pertinent new and relevant evidence, but appellant did
not submit any such evidence in support of her request for reconsideration.
The Board accordingly finds that appellant did not meet any of the requirements of 20
C.F.R. § 10.606(b)(3). Appellant did not show that OWCP erroneously applied or interpreted a
specific point of law, advance a relevant legal argument not previously considered by OWCP, or
submit relevant and pertinent new evidence not previously considered. Pursuant to 20 C.F.R.
§ 10.608, OWCP properly denied merit review.
CONCLUSION
The Board finds that appellant did not met her burden of proof to establish an injury
causally related to the accepted September 17, 2015 employment incident. The Board further
finds that OWCP properly denied appellant’s request for reconsideration of the merits of her
claim pursuant to 5 U.S.C. § 8128(a).

21

See C.K., Docket No. 17-0341 (issued October 3, 2017).

22

See L.C., Docket No. 17-0518 (issued July 21, 2017).

8

ORDER
IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’
Compensation Programs dated April 27 and February 6, 2017 are affirmed.
Issued: February 8, 2018
Washington, DC

Christopher J. Godfrey, Chief Judge
Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge
Employees’ Compensation Appeals Board

9


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
C.B., Appellant
and
DEPARTMENT OF TRANSPORTATION,
FEDERAL AVIATION ADMINISTRATION,
Amarillo, TX, Employer
__________________________________________

)
)
)
)
)
)
)
)
)

Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 12-1604
Issued: January 10, 2013

Case Submitted on the Record

DECISION AND ORDER
Before:
RICHARD J. DASCHBACH, Chief Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On July 23, 2012 appellant filed timely appeals of April 19 and June 15, 2012 merit
decisions 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 the case.
ISSUE
The issue is whether appellant met his burden of proof to establish that he sustained a
traumatic injury while in the performance of duty on February 17, 2012.
FACTUAL HISTORY
On February 24, 2012 appellant, then a 44-year-old air traffic control specialist, filed a
traumatic injury claim alleging that he strained his lower back while moving a filing cabinet on
1

5 U.S.C. § 8101 et seq.

February 17, 2012. The employing establishment controverted the claim on the grounds that he
moved furniture in and out of the union’s office and engaged in personal activity not within the
course of employment.
In a March 13, 2012 letter, OWCP advised appellant that additional information was
needed to establish his claim. It gave him 30 days to submit a statement detailing how moving
furniture on February 17, 2012 arose within the scope of his employment and a report from a
qualified physician explaining how this activity caused or contributed to a diagnosed condition.
Appellant specified in a March 24, 2012 statement that he was transporting surplus
furniture from an air traffic control tower to a storage building on February 17, 2012 under the
direction of his supervisor. He added that he previously sustained a cervical disc rupture in 2004
and a lower back injury in 2008.
A November 3, 2008 magnetic resonance imaging (MRI) scan obtained by Dr. Rakesh
Shah, a Board-certified diagnostic radiologist, exhibited L4-L5 and L5-S1 disc protrusions. A
March 19, 2012 MRI scan report from Dr. Gail Bentley, a Board-certified anatomic and clinical
pathologist, showed L3-L4 central disc protrusion and bilateral facet hypertrophy, L4-L5 left
paramedian disc protrusion, lateral recess narrowing, and neural foraminal stenosis and L5-S1
central disc extrusion.
In an April 5, 2012 note, Dr. Vinod S. Patel, an internist, diagnosed appellant with acute
lumbar strain and chronic back pain. He remarked that appellant also complained of left lower
extremity radicular pain.
By decision dated April 19, 2012, OWCP denied appellant’s claim, finding the medical
evidence insufficient to establish that a lumbar condition resulted from the accepted February 17,
2012 employment incident.
Appellant requested reconsideration on May 29, 2012 and submitted a copy of
Dr. Bentley’s March 19, 2012 MRI scan report.
On June 15, 2012 OWCP denied modification of the April 19, 2012 decision.
LEGAL PRECEDENT
An employee seeking compensation under FECA has the burden of establishing the
essential elements of his or her claim by the weight of reliable, probative and substantial
evidence,2 including that he of she is an “employee” within the meaning of FECA and that he or
she filed his or her claim within the applicable time limitation.3 The employee must also
establish that he or she sustained an injury in the performance of duty as alleged and that his or
her disability for work, if any, was causally related to the employment injury.4
2

J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 57 (1968).

3

R.C., 59 ECAB 427 (2008).

4

Id.; Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

2

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. First, the employee must
submit sufficient evidence to establish that he or she actually experienced the employment
incident at the time, place and in the manner alleged. Second, the employee must submit
medical evidence to establish that the employment incident caused a personal injury.5
Rationalized medical opinion evidence is generally required to establish causal
relationship. The opinion of the physician must be based on a complete factual and medical
background, 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 the
specific employment factors identified by the claimant.6
ANALYSIS
The case record supports that appellant moved a filing cabinet while in the performance
of duty on February 17, 2012. The Board finds, however, that he did not establish his traumatic
injury claim because the medical evidence did not establish that the accepted employment
incident caused or contributed to a lumbar condition.
In an April 5, 2012 note, Dr. Patel diagnosed appellant with acute lumbar strain and
chronic back pain. He also pointed out that appellant had left lower extremity symptoms. A
prior March 19, 2012 MRI scan report from Dr. Bentley confirmed L3-L4 central disc protrusion
and bilateral facet hypertrophy, L4-L5 left paramedian disc protrusion, lateral recess narrowing,
and neural foraminal stenosis and L5-S1 central disc extrusion. However, neither Dr. Patel nor
Dr. Bentley discussed whether the lumbar condition was due to appellant’s federal employment
activity. Therefore, their opinions were of diminished probative value on the issue of causal
relationship.7 Moreover, Dr. Shah’s November 3, 2008 MRI scan report was immaterial because
it predated the February 17, 2012 work event.8 In the absence of rationalized medical opinion
evidence, appellant failed to meet his burden of proof.
Appellant may submit new evidence or argument as part of a formal 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.

5

T.H., 59 ECAB 388 (2008).

6

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).

7

J.F., Docket No. 09-1061 (issued November 17, 2009); S.E., Docket No. 08-2214 (issued May 6, 2009). See
also John W. Montoya, 54 ECAB 306, 309 (2003) (a physician’s opinion must discuss whether the employment
incident described by the claimant caused or contributed to a diagnosed medical condition).
8

See F.W., Docket No. 10-1975 (issued May 13, 2011).

3

CONCLUSION
The Board finds that appellant did not establish that he sustained a traumatic injury while
in the performance of duty on February 17, 2012.
ORDER
IT IS HEREBY ORDERED THAT the June 15 and April 19, 2012 merit decisions of
the Office of Workers’ Compensation Programs be affirmed.
Issued: January 10, 2013
Washington, DC

Richard J. Daschbach, Chief Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

4