In this OWCP claim the federal employee was injured more than 3 years ago while working as a screener for the Transportation Security Administration. She promptly sought medical treatment and timely filed her claim for federal workers compensation benefits.
Not until 2009 did the OWCP review her claim and then issued a decision denying her claim for compensation. The OWCP argued that the claimant failed to submit sufficient medical evidence showing that she was injured on the job. The OWCP argued that she failed to show proof of "fact of injury".
The claimant timely appealed and requested and oral hearing. A hearing was held and in 2010 the OWCP again denied her claim due to lack of proof of "fact of injury".
The claimant appealled again.
The OWCP denied again.
The claimant then approached this office and requested assistance on her next appeal to OWCP.
Reviewing the case from the start I found that the OWCP had mischaracterized the definition of "fact of injury" in the claim. I argued that the OWCP was not clear whether it had denied the claim due to discrepancies in the medical evidence (of which none existed) so as to cast doubt whether the injury actually occurred or had the OWCP denied the claim due to a lack of submission of medical evidence.Establishing whether an injury, traumatic or occupational was sustained in the performance of duty as alleged, i.e., 'fact of injury," and establishing whether there is a causal relationship between the injury and any disability and/or specific condition for which compensation is claimed, i.e., "causal relationship," are distinct elements of a compensation claim. While the issue of "causal relationship" cannot be established until "fact of injury" is established, acceptance of fact of injury is not contingent upon an employee proving a causal relationship between the injury and any disability and/or specific condition for which compensations is claimed.
I argued that the OWCP wrongfully intermingled the the separate and distinct issues of "fact of injury" and "causal relationship" such that there is not a competent or clear reason made by the Office that adequately supports the denial of the claim.
I then obtained and submitted new additional medical evidence supporting the claimant's claim of injury and ongoing medical treatment.
Upon review of these arguments, the OWCP fully agreed that it had erred in denying this claim of injury.The OWCP found that the medical evidence of file does implicate that the claimed condition is causally related to federal employment the opinion on causal relationship has been supported with affirmative evidence,
the physicians explained by medical rationale and provided an accurate medical and factual
background. Although compensation awards must be based on reliable, probative and substantial evidence, the evidence required is only that necessary to convince the adjudicator that the conclusion drawn is rational and sound; it is not necessary that the evidence be so conclusive as to establish causal connection beyond all possible doubt. Where the relative circumstances strongly suggest a causal relationship and where the medical evidence also supports a causal relationship, appellant has met his burden of proof.
The decision denying injury was reversed and the claim accepted with compensation benefits awarded.