W.O. and Department of the Treasury, Internal Revenue Service, Ogden, UT (Board decision, February 15, 2023)

ECAB final decision. The Board affirmed OWCP's denial of the claimed September 10, 2021 work injury. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A computer clerk for the Internal Revenue Service reported striking her back when she fell onto a pallet while pushing a roll of paper at work. OWCP accepted that the incident occurred but denied her injury claim. Her physician's note described the fall without diagnosing a condition or explaining a causal relationship. The Board affirmed the denial because the medical evidence did not establish a diagnosed condition connected to the incident.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: December 13, 2021 claim denial affirmed.
• Key point: An accepted workplace incident alone does not establish an injury without a medical diagnosis and reasoned causal opinion.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
W.O., Appellant
)
)
and ) Docket No. 22-0418
) Issued: February 15, 2023
DEPARTMENT OF THE TREASURY,
)
INTERNAL REVENUE SERVICE, Ogden, UT,
)
Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
ALEC J. KOROMILAS, Chief Judge
JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 27, 2022 appellant filed a timely appeal from a December 13, 2021 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.2

1
5 U.S.C. § 8101 et seq.
2
The Board notes that, following the December 13, 2021 decision, OWCP received additional evidence. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id. ISSUE

The issue is whether appellant has met her burden of proof to establish a diagnosed medical condition in connection with the accepted September 10, 2021 employment incident.

FACTUAL HISTORY

On October 29, 2021 appellant, then a 59-year-old computer clerk and assistant, filed a traumatic injury claim (Form CA-1) alleging that on September 10, 2021 she injured her back when she fell onto a pallet as she was pushing a roll of paper while in the performance of duty. On the reverse side of the claim form, appellant’s supervisor acknowledged that appellant was injured in the performance of duty. Appellant did not stop work.

In support of her claim, appellant submitted a prescription note dated September 20, 2021 from Dr. Jeffery L. Degrauw, a Board-certified family practice specialist. Dr. Degrauw advised that she was seen for a fall at work on September 10, 2021 during which time she struck her back and the back of her head.

In a development letter dated November 4, 2021, OWCP advised appellant of the deficiencies of her claim and further advised her that additional factual and medical evidence was necessary to establish her claim. It noted the type of factual and medical evidence needed and provided her with a questionnaire. OWCP afforded appellant 30 days to submit the necessary evidence. Appellant did not respond.

By decision dated December 13, 2021, OWCP accepted that the September 10, 2021 employment incident occurred, as alleged, but denied appellant’s claim finding that she had not submitted medical evidence containing a medical diagnosis in connection with her accepted employment incident. It concluded, therefore, that the requirements had not been met to establish an injury as defined by FECA.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the essential elements of his or her claim, including that the individual is an employee of the United States within the meaning FECA, that the claim was timely filed within the applicable time limitation period of FECA,4 that an injury was sustained in the performance of duty as alleged, and that any disability or medical condition for which compensation is claimed is causally related

3
Supra note 1.
4
F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D.
Cameron, 41 ECAB 153 (1989).

2 to the employment injury.5 These are the essential elements of each and every compensation claim, regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.6

To determine whether a federal employee has sustained a traumatic injury in the performance of duty, it must first be determined whether fact of injury has been established. There are two components involved in establishing fact of injury. The first component to be established is that 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. The second component is whether the employment incident caused a personal injury and can be established only by medical evidence.7

The medical evidence required to establish causal relationship between a claimed specific condition and an employment incident is rationalized medical opinion evidence.8 The opinion of the physician must be based on a complete factual and medical background of the employee, must be one of reasonable medical certainty, and must be supported by medical rationale explaining the nature of the relationship between the diagnosed condition and specific employment factors identified by the employee.9

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a diagnosed medical condition in connection with the accepted September 10, 2021 employment incident.

OWCP received a prescription note dated September 20, 2021 from Dr. Degrauw. While Dr. Degrauw noted that appellant struck her back and head during a fall on September 10, 2021 he neither provided a diagnosis of her medical condition, nor an opinion on causal relationship. The Board has held that a medical report is of no probative value if it does not provide a firm diagnosis of a particular medical condition, and a rationalized medical opinion that the accepted employment incident or events caused or aggravated the diagnosed condition.10

5
L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); James E. Chadden, Sr., 40 ECAB 312 (1988). 6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016);
Delores C. Ellyett, 41 ECAB 992 (1990).
7
T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. Carlone, 41 ECAB 354 (1989). 8 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. Morris, 48 ECAB 238 (1996). 9 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020);
Victor J. Woodhams, 41 ECAB 345, 352 (1989).
10
L.E., Docket No. 19-0470 (issued August 12, 2019); M.J., Docket No. 18-1114 (issued February 5, 2019); see also L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

3
 As there is no medical evidence of record establishing a firm diagnosis of a medical condition, and rationalized medical opinion in connection with the accepted September 10, 2021 employment incident, the Board finds that appellant has not met her burden of proof.

Appellant may submit new evidence or argument with a written request for reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R.
§§ 10.605 through 10.607.

CONCLUSION

The Board finds that appellant has not met her burden of proof to establish a diagnosed medical condition in connection with the accepted September 10, 2021 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the December 13, 2021 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: February 15, 2023
Washington, DC

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

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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

4