United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.B., Appellant 

and 

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION FACILITY, 

San Bernardino, CA, Employer 

__________________________________________ 

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Docket No. 14-1089 

Issued: September 5, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On April 10, 2014 appellant filed a timely appeal from a January 23, 2014 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. 

ISSUE 

The issue is whether appellant met her burden of proof to establish a left hip condition 

causally related to factors of her federal employment. 

FACTUAL HISTORY 

On November 27, 2013 appellant, then a 43-year-old mail clerk, filed an occupational 

disease claim (Form CA-2) alleging that she developed a mass on her left hip as a result of 

 1

 5 U.S.C. § 8101 et seq. 
2

moving bundles and pallets, lifting trays of letters and parcels and pushing and pulling 

equipment. She became aware of her condition and of its relationship to her employment on 

November 18, 2013. The employing establishment did not note a date of work stoppage and 

checked a box indicating “no” to the question of whether medical reports showed that appellant 

was disabled for work. 

On July 27, 2012 Dr. Michael B. Roach, a Board-certified orthopedic surgeon, diagnosed 

lumbago. He noted pain of the joint of the pelvic region and thigh. Dr. Roach stated that 

appellant was treated for lower back pain. He noted that this was a recurrent problem, with 

aching pain in the lower back radiating to the left thigh. Dr. Roach stated that appellant worked 

as a postal employee. He noted that x-rays of the left hip showed no arthritis, while x-rays of the 

lumbar spine were also normal. Dr. Roach assessed appellant with intermittent low back pain, 

probably related to early lumbar spondylosis. 

In a report dated October 30, 2012, Dr. Roach assessed appellant with intermittent lower 

back pain. He noted that she worked for the employing establishment and that vigorous work 

there occasionally aggravated her back. Dr. Roach recommended that appellant perform 

flexibility exercises and work on an elliptical trainer. 

In a report dated July 10, 2013, Dr. Michael T. Mai, a Board-certified orthopedic 

surgeon, diagnosed appellant with lumbar radiculopathy and degenerative joint disease of the left 

hip. He noted that she had no prior history of injury of the left hip or history of preventative 

surgery. Dr. Mai stated that the pain was worse with activities and better at rest. On 

examination, he noted pain with hip flexion. Dr. Mai assessed appellant as having possible 

avascular necrosis of the left hip joint or a possible labral tear. He recommended a magnetic 

resonance imaging (MRI) scan. 

In a report dated July 30, 2013, Dr. Dina Ragheb, a Board-certified radiologist, reviewed 

the results of an MRI scan obtained that date. She noted a two centimeter (cm) oval-shaped 

lesion lateral to the quadriceps tendons between the gluteus musculature and the quadratus 

femoris in the left hip. Dr. Ragheb stated that it represented either a complex fluid collection or 

solid mass including a nerve sheath tumor. On examination of the pelvis, she found probable 

subserosal fibroid and a complex lesion in the left adnexa, likely a complex cyst. Dr. Ragheb 

recommended another MRI scan of the left hip with intravenous gadolinium and a pelvic 

ultrasound for further evaluation. 

On August 23, 2013 Dr. Mai stated that appellant could return to light-duty immediately, 

with restrictions of no heavy lifting and no constant standing or walking. 

In a report dated September 9, 2013, Dr. Ragheb examined the results of an MRI scan 

with contrast obtained that date. She found an 18 millimeter oval-shaped solid lesion lateral to 

the left quadriceps tendons between the gluteal musculature and quadratus femoris muscle, 

which she stated could represent a nerve sheath tumor. Dr. Ragheb also found a fibroid uterus, 

with a one cm lesion in the left adnexa. 

In notes dated November 18, 2013, Dr. Mohammed K. Shahin, a Board-certified 

internist, reviewed the MRI scans from July 26 and September 5, 2013. He assessed appellant 
3

with left hip pain and a mass of the left hip region, possibly on the nerve sheet. Dr. Shahin noted 

that her pain was aggravated by lifting, pushing or carrying heavy objects. 

On December 10, 2013 OWCP advised appellant of the evidence needed to establish her 

claim. It requested that she respond to its inquiries and submit a comprehensive medical report 

from an attending physician with a description of symptoms, results of examinations and tests, 

diagnoses, the clinical course of treatment provided, a description of her medical history along 

with the history of her employment exposure and nonemployment activities that contribute to the 

condition. OWCP requested a physician’s opinion supported by a medical explanation as to 

whether her work-related exposure resulted in the diagnosed condition. Appellant resubmitted 

the November 18, 2013 notes of Dr. Shahin and copies of her MRI scans. 

In a January 7, 2014 report, Dr. Shahin reviewed appellant’s medical history. He 

diagnosed a nerve sheath tumor of the left hip, left hip pain, degenerative joint disease, 

gastroesophageal reflux disease, anxiety associated with depression and stable major depressive 

disorder. Dr. Shahin noted that persistent pain and numbness in the left hip area was aggravated 

by heavy lifting or squatting. 

Appellant responded to OWCP’s inquiries on January 8, 2014. She stated that, in 2010, 

she noticed a throbbing and stabbing pain on her left hip, which became worse over time. 

Appellant also experienced weakness of the left leg and numbness down to the tip of the left foot 

and stated that constant lifting and/or heavy lifting made it worse. 

By decision dated January 23, 2014, OWCP denied appellant’s claim. It found that the 

medical evidence did not establish that she had been diagnosed with a condition in connection 

with factors of her federal employment. 

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 filed within the applicable time 

limitation; that an injury was sustained while in the performance of duty as alleged and that any 

disability or specific condition for which compensation is claimed is causally related to the 

employment injury.2

 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated on a traumatic injury or occupational disease.3 

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (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 

employment factors identified by the claimant were the proximate cause of the condition for 

 2 Gary J. Watling, 52 ECAB 278, 279 (2001); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

3 Michael E. Smith, 50 ECAB 313, 315 (1999). 
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which compensation is claimed or, stated differently, medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the claimant. 

The claimant has the burden of establishing 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.4 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 a causal relationship.5

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.6

 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s reasoned opinion on whether 

there is a causal relationship between the claimant’s diagnosed condition and the compensable 

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

 The weight of 

medical evidence is determined by its reliability, its probative value, its convincing quality, the 

care of analysis manifested and the medical rationale expressed in support of the physician’s 

opinion.8

ANALYSIS 

OWCP accepted that appellant established the employment exposures of repetitive lifting 

and walking as a mail clerk. The Board finds that she has not submitted sufficient medical 

evidence to establish that her left hip condition was caused or aggravated by factors of her 

federal employment. 

In a January 7, 2014 report, Dr. Shahin reviewed appellant’s medical history and 

diagnosed a nerve sheath tumor of the left hip. This diagnosis was supported by several 

diagnostic MRI scan studies obtained by Dr. Ragheb, who found a solid lesion lateral to the left 

quadriceps tendons between the gluteal musculature and quadratus femoris muscle. 

Appellant has not submitted sufficient evidence to establish that her left hip condition 

was caused or aggravated by factors of her federal employment. While Dr. Roach mentioned 

that she worked at the employing establishment as a postal employee and that, vigorous work 

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

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

6 Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117, 123 (2005). 

7 Leslie C. Moore, 52 ECAB 132, 134 (2000). 

8 Jennifer Atkerson, 55 ECAB 317, 319 (2004); Naomi A. Lilly, 10 ECAB 560, 573 (1959). 
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occasionally aggravated her back, he did not offer a clear opinion regarding the causal 

relationship of her left hip condition. There are no other reports of record that provided a 

physician’s opinion on the issue of a causal relationship between appellant’s left hip condition 

and work-related factors. Medical evidence which does not offer any opinion regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal 

relationship.9 The reports are not sufficient to meet appellant’s burden to establish a causal 

relationship between work-related factors and her claimed injury. 

The Board finds that the medical evidence does not establish that appellant sustained a 

left hip injury causally related to her employment. An award of compensation may not be based 

on surmise, conjecture or speculation. Neither the fact that appellant’s condition became 

apparent during a period of employment nor the belief that her condition was caused, 

precipitated or aggravated by her employment, is sufficient to establish causal relationship.10 

Causal relationships must be established by rationalized medical opinion evidence. 

Consequently, OWCP properly found that appellant did not meet her burden of proof in 

establishing 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 her 

claimed left hip condition was causally related to her federal employment. 

 9 Michael E. Smith, 50 ECAB 313, 316 n.8 (1999). 

10 See Dennis M. Mascarenas, supra note 5. 
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ORDER 

IT IS HEREBY ORDERED THAT the January 23, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 5, 2014 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board