J.G. and U.S. Postal Service, Mishawaka Post Office (Board decision, May 20, 2024)

ECAB final decision. The Board affirmed OWCP’s denial because the medical evidence did not establish a diagnosed condition connected to the accepted October 25, 2023 motor vehicle accident. 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).

Plain-English summary

A rural carrier reported a left rib injury after a motor vehicle accident while working. The only medical evidence before OWCP was a return-to-work note that imposed a lifting restriction but gave no diagnosis or opinion connecting a condition to the accident. The Board found that the note could not establish a diagnosed medical condition or causal relationship and affirmed OWCP’s denial.

Decision snapshot

• Cited authorities: 5 U.S.C. § 8101; 20 C.F.R. § 501.2(c); 20 C.F.R. § 501.3.
• Outcome: Traumatic injury claim denial affirmed.
• Key point: A work restriction without a diagnosis and reasoned causal opinion does not establish a compensable injury.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
J.G., Appellant
)
)
and ) Docket No. 24-0403
)
Issued: May 20, 2024
U.S. POSTAL SERVICE, MISHAWAKA POST )
OFFICE, Mishawaka, IN, Employer
)
__________ )

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

DECISION AND ORDER

Before:
JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 7, 2024 appellant filed a timely appeal from a February 2, 2024 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 has met his burden of proof to establish a diagnosed medical condition in connection with the accepted October 25, 2023 employment incident.

1
5 U.S.C. § 8101 et seq.
2
The Board notes that, following the February 2, 2024 decision, appellant submitted additional evidence to OWCP.
However, the Board’s Rules of Procedures 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.

FACTUAL HISTORY

On November 21, 2023 appellant, then a 53-year-old rural carrier, filed a traumatic injury claim (Form CA-1) alleging that on October 25, 2023 he sustained a left rib injury when he was involved in a motor vehicle accident (MVA) while in the performance of duty. He stopped work on November 2, 2023 and worked intermittently thereafter.

In an November 27, 2023 development letter, OWCP informed appellant of the deficiencies in his claim. It advised him of the type of factual and medical evidence needed and provided a questionnaire for his completion. OWCP afforded appellant 60 days to submit the necessary evidence.

OWCP received additional evidence. In an October 30, 2023 return-to-work note, Dr. Arthur Wang, a Board-certified family practitioner, returned appellant to work on November 6, 2023 subject to a lifting restriction of 10 pounds.

In a follow-up letter dated December 28, 2023, OWCP advised appellant that it had conducted an interim review of his case and found that the evidence remain ed insufficient to establish his claim. It further advised him of the type of factual and medical evidence needed. OWCP noted that appellant had 60 days from the November 27, 2023 letter to submit the requested supporting evidence. It further advised that if the evidence was not received during this time, it would issue a decision based on the evidence contained in the record . No response was received.

By decision dated February 2, 2024, OWCP denied appellant’s traumatic injury claim, finding that the evidence was insufficient to establish a medical diagnosis in connection with the accepted October 25, 2023 employment incident. It concluded, therefore, that the requirements had not been met to establish an injury as defined under FECA.

LEGAL PRECEDENT

An employee seeking benefits under FECA 3 has the burden of proof to establish the essential elements of his or her claim, including that the individual is an employee of the United States within the meaning of FECA, that the claim was timely filed within the applicable time limitation of FECA, 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 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

3
Id.
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). 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).

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. First, the employee must submit sufficient evidence to establish that he or she actually experienced the employment incident at the time and place, and in the manner alleged. Second, the employee must submit sufficient evidence to establish that the employment incident caused a n injury.7

The medical evidence required to establish a causal relationship 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 incident identified by the employee. 9

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a diagnosed medical condition in connection with the accepted October 25, 2023 employment incident.

In support of his claim, appellant submitted an October 30, 2023 note from Dr. Wang who returned appellant to work on November 6, 2023 subject to a lifting restriction of 10 pounds. However, this note contains neither a diagnosis nor an opinion on causal relationship. The Board has held that a medical report that does not offer an opinion regarding the cause of an employee’s condition is of no probative value on the issue of causal relationship.10 As such, Dr. Wang’s note is insufficient to meet appellant’s burden of proof.

As the medical evidence of record is insufficient to establish a diagnosed medical condition in connection with the accepted October 25, 2023 employment incident, the Board finds that appellant has not met his burden of proof.

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

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish a diagnosed medical condition in connection with the accepted October 25, 2023 employment incident.

7
T.J., Docket No. 19-0461 (issued August 11, 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
See C.H., Docket No. 22-1186 (issued December 22, 2022); D.Y., Docket No. 20-0112 (issued June 25, 2020);
L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

3

ORDER

IT IS HEREBY ORDERED THAT the February 2, 2024 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: May 20, 2024
Washington, DC

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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

James D. McGinley, Alternate Judge
Employees’ Compensation Appeals Board

4