E.S. and U.S. Postal Service, Toledo Post Office (Board decision, August 17, 2026)

ECAB final decision. The Board affirmed OWCP's denial of the occupational disease claim. 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). Under 5 U.S.C. § 8128(b), FECA compensation decisions are generally not subject to court review.

Plain-English summary

A city postal carrier claimed that carrying a heavy mailbag and navigating stairs while delivering mail caused several lower back conditions. OWCP denied his occupational disease claim. The Board found that the medical submissions did not adequately explain how the identified duties caused or aggravated his diagnosed conditions. It also found that diagnostic images alone could not establish the needed work connection. The Board affirmed the denial.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.; 20 C.F.R. §§ 501.2(c), 501.3.
• Outcome: Occupational disease claim denial affirmed.
• Key point: Medical evidence needed a reasoned explanation connecting the back conditions to specific work factors.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
E.S., Appellant
)
) Docket No. 26-0434
and ) Issued: August 17, 2026
)
U.S. POSTAL SERVICE, TOLEDO POST
)
OFFICE, Toledo, OH, Employer
)
__________ )

Appearances: Case Submitted on the Record
Brett E. Blumstein, Esq., for the appellant1
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
ALEC J. KOROMILAS, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 9, 2026 appellant, through counsel, filed a timely appeal from a February 18, 2026 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act2 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.

1
In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 2 5 U.S.C. § 8101 et seq.
ISSUE

The issue is whether appellant has met his burden of proof to establish a medical condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On August 19, 2024 appellant, then a 59-year-old city carrier, filed an occupational disease claim (Form CA-2) alleging that he developed lumbar anterolisthesis, L4-5 facet hypertrophy, L5- S1 disc protrusion, radiculopathy, and sacroiliitis due to factors of his federal employment, including carrying a 65-pound mailbag while delivering mail to historical homes that required him to descend staircases without handrails. He noted that he first became aware of his condition and realized its relation to his federal employment on August 30, 2021.3 On the reverse side of the claim form, appellant’s supervisor asserted that he has another open claim for the same injury from September 7, 2023 under OWCP File No. xxxxxx217 for which he was currently working two hours per day.4

In support of his claim, appellant submitted an accompanying narrative statement describing his employment duties which he attributed to his medical conditions, as well as a September 23, 2023 x-ray of the lumbar spine revealing an impression of lower lumbar degenerative disc disease without acute osseous abnormality.

In an August 30, 2024 development letter, OWCP informed appellant of the deficiencies of his claim. It advised him of the type of factual and medical evidence needed to establish his claim and provided a questionnaire for his completion. OWCP afforded appellant 60 days to submit the necessary evidence. In a separate development letter of even date, it requested that the employing establishment provide additional information regarding appellant’s occupational disease claim, including comments from a knowledgeable supervisor. OWCP afforded the employing establishment 30 days to respond. No additional evidence was received.

In a follow-up letter dated October 23, 2024, OWCP advised appellant that it had conducted an interim review, and the evidence remained insufficient to establish his claim. It noted that he had 60 days from the August 30, 2024 letter to submit the necessary evidence. OWCP 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.

3
OWCP assigned the present claim OWCP File No. xxxxxx408. Appellant has a prior traumatic injury claim (Form CA-1) under OWCP File No. xxxxxx993, which was accepted for a September 19, 2020 strain of muscle, fascia and tendon of lower back; and strain of muscle, fascia and tendon of left hip, initial encounter. On January 21, 2025, OWCP administratively combined OWCP File Nos. xxxxxx408 and xxxxxx993, with the latter serving as the master file. 4 The record reflects that, under OWCP File No. xxxxxx217, appellant has a prior occupational disease claim (Form CA-2) which OWCP accepted for an aggravation of bilateral ankle, bilateral foot, and bilateral hip primary osteoarthritis. He also has a previously accepted occupational disease claim under OWCP File No. xxxxxx625 which was accepted on July 23, 2003 by OWCP for lumbar strain. Appellant’s claims for OWCP File Nos. xxxxxx217 and xxxxxx625 have not been administratively combined with master file No. xxxxxx993.

2
By decision dated October 28, 2024, OWCP denied appellant’s claim, finding that the medical evidence of record was insufficient to establish a medical diagnosis in connection with the accepted factors of his federal employment. It concluded, therefore, that the requirements had not been met to establish an injury as defined by FECA.

On January 6, 2025 appellant, through counsel, requested reconsideration. In support thereof, appellant submitted medical reports dated September 9 and November 12, 2024 from Dr. Hossein Elgafy, a Board-certified orthopedic surgeon. He also resubmitted the September 23, 2023 x-ray of the lumbar spine previously of record.

In his September 9, 2024 narrative report, Dr. Elgafy indicated that appellant was evaluated for low back pain radiating to the left lower extremity, which had been present for multiple years. He noted that appellant worked as a mail carrier and first injured his back on September 19, 2020. Dr. Elgafy reviewed September 23, 2023 radiographs of the lumbar spine, which demonstrated L4-5 spondylolisthesis and L4-5 facet joint arthritis. He opined that appellant’s condition was degenerative in nature and that his work as a mail carrier could substantially aggravate this condition.

On November 12, 2024, Dr. Elgafy evaluated appellant for low back pain radiating to the left lower extremity. He noted that appellant worked as a mail carrier who first injured his back on September 19, 2020 when carrying heavy packages, navigating stairs and repetitive bending. Dr. Elgafy diagnosed L4-5 spondylolisthesis and lumbar radiculopathy as revealed in the radiographs of the lumbar spine taken on September 23, 2023 which were degenerative age-related conditions. However, he opined that the diagnoses of L4-5 spondylolisthesis and lumbar radiculopathy were substantially aggravated by the nature of appellant’s job as mail carrier that involved constant carrying of heavy packages for several years.

By decision dated January 20, 2025, OWCP modified the October 28, 2024 decision finding a medical diagnosis in connection with the accepted employment factors. However, the claim remained denied as the medical evidence of record was insufficient to establish causal relationship between a medical condition and the accepted factors of appellant’s federal employment.

On January 20, 2026 appellant, through counsel, requested reconsideration. He argued that Dr. Elgafy’s January 6, 2026 report was supportive of appellant’s claim.

In a January 6, 2026 report, Dr. Elgafy discussed appellant’s low back pain radiating to the left lower extremity that had been present for multiple years, noting that appellant was a mail carrier who initially injured his back on September 19, 2020. He diagnosed C9 and L4-5 spondylolisthesis, spinal stenosis, and radiculopathy.

By decision dated February 18, 2026, OWCP denied modification of its January 20, 2025 decision.

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LEGAL PRECEDENT

An employee seeking benefits under FECA5 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,6 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.7 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.8

To establish that an injury was sustained in the performance of duty in an occupational disease claim, an employee must submit 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.9

Causal relationship is a medical question that requires rationalized medical opinion evidence to resolve the issue.10 A physician’s opinion on whether there is causal relationship between the diagnosed condition and the implicated employment factor(s) must be based on a complete factual and medical background.11 Additionally, the physician’s 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 factor(s).12

5
Supra note 1.
6
E.K., Docket No. 22-1130 (issued December 30, 2022); 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). 7 S.H., Docket No. 22-0391 (issued June 29, 2022); 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). 8 E.H., Docket No. 22-0401 (issued June 29, 2022); 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). 9 R.G., Docket No. 19-0233 (issued July 16, 2019); see also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I.
Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989). 10 S.M., Docket No. 22-0075 (issued May 6, 2022); 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). 11 M.V., Docket No. 18-0884 (issued December 28, 2018).
12
J.D., Docket No. 22-0935 (issued December 16, 2022); T.L., Docket No. 18-0778 (issued January 22, 2020);
Y.S., Docket No. 18-0366 (issued January 22, 2020); Victor J. Woodhams, supra note 9.

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ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a medical condition causally related to the accepted factors of his federal employment.

In reports dated September 9, 2024 through January 6, 2026, Dr. Elgafy evaluated appellant for low back pain radiating to the left lower extremity which had been present for multiple years, noting that appellant first injured his back on September 19, 2020. He diagnosed L4-5 spondylolisthesis and lumbar radiculopathy as revealed in the radiographs of the lumbar spine taken on September 23, 2023, and opined that while the conditions were degenerative, they were substantially aggravated by the nature of appellant’s job as a mail carrier who performed constant carrying of heavy packages for several years. However, Dr. Elgafy did not explain with sufficient rationale how the accepted employment factors caused an injury to appellant’s lumbar spine.13 A medical report is of limited probative value on the issue of causal relationship if it contains an opinion regarding causal relationship which is unsupported by medical rationale.14 Medical rationale is particularly necessary where, as here, there are preexisting conditions involving the same body parts.15 Therefore, Dr. Elgafy’s reports are insufficient to establish the claim.

The remaining medical evidence consists of diagnostic test results. The Board has held that diagnostic studies, standing alone, lack probative value as they do not address whether the employment factors caused any of the diagnosed conditions.16 Such reports are therefore insufficient to establish appellant’s claim.

As the medical evidence of record is insufficient to establish a medical condition causally related to the accepted factors of federal employment, the Board finds that appellant has not met his burden of proof.17

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.

13
See C.B., (S.B), Docket No. 19-1629 (issued April 7, 2020); V.T., Docket No. 18-0881 (issued November 19, 2018); S.E., Docket No. 08-2214 (issued May 6, 2009); T.M., Docket No. 08-0975 (issued February 6, 2009). 14 J.W., Docket No. 25-0011 (issued November 19, 2024); B.W., Docket No. 21-0536 (issued March 6, 2023);
M.M., Docket No. 20-1557 (issued November 3, 2021).
15
R.W., Docket No. 19-0844 (issued May 29, 2020); A.M., Docket No. 19-1138 (issued February 18, 2020);
A.J., Docket No. 18-1116 (issued January 23, 2019).
16
See M.P., Docket No. 23-1131 (issued June 18, 2024); V.A., Docket No. 21-1023 (issued March 6, 2023); M.K., Docket No. 21-0520 (issued August 23, 2021); F.D., Docket No. 19-0932 (issued October 3, 2019). 17 I.D., Docket No. 22-0848 (issued September 2, 2022); T.G., Docket No. 14-751 (issued October 20, 2014).

5
CONCLUSION

The Board finds that appellant has not met his burden of proof to establish a medical condition causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the February 18, 2026 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: August 17, 2026
Washington, DC

Alec J. Koromilas, 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

6