United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.S., Appellant 

and 

DEPARTMENT OF DEFENSE, NATIONAL 

SECURITY AGENCY, Fort Meade, MD, 

Employer 

__________________________________________ 

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Docket No. 14-1470 

Issued: October 21, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 16, 2014 appellant filed a timely appeal from a January 16, 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 traumatic injury in 

the performance of duty on June 13, 2013. 

 1

 5 U.S.C. §§ 8101-8193. 
2

FACTUAL HISTORY 

On July 16, 2013 appellant, then a 47-year-old part-time office assistant, filed a traumatic 

injury claim alleging that on June 13, 2013 she injured her right shoulder causing an 

acromioclavicular joint separation. She stated that she felt a pop in her right shoulder while 

opening mail with a letter opener. Appellant’s supervisor, Michael J. Ciabby, indicated that 

appellant first reported the injury on July 17, 2013. In an occupational health mishap report 

dated July 8, 2013, appellant repeated that on June 13, 2013 she heard a pop while opening mail. 

She stated that on June 24, 2013 when she felt a burning going down her arm, she went to 

occupational health where she was told to see her doctor. Appellant related that she saw her 

doctor on June 25, 2013, and he sent her for an x-ray which showed inflammation in the 

shoulder. Her doctor recommended a computerized tomography scan. 

In reports dated July 19, 2013, Dr. Brent Hines, a Board-certified osteopath specializing 

in orthopedic surgery, noted that appellant was seen for evaluation of right shoulder pain that 

began on June 13, 2013 as a result of repetitive use. He noted her report that she felt a popping 

sensation in her shoulder when she was rushing to open mail at work and currently had right 

shoulder pain that radiated down the arm and was aggravated by lateral reaching, overhead 

activities and repetitive use and movement of the arm. Dr. Hines indicated that appellant had 

stopped work. On right upper extremity examination, he noted weak supraspinatus and external 

rotation but normal range of motion and tenderness to palpation over the impingement area. 

X-rays demonstrated degenerative changes and no evidence of fracture or dislocation. Dr. Hines 

diagnosed impingement syndrome, right shoulder; right rotator cuff syndrome; and right 

shoulder pain and advised that appellant could return to modified duty with no use of the right 

upper extremity. 

On August 23, 2013 Dr. Hines noted that appellant had good relief from a steroid 

injection and advised that she could return to regular duties with no restrictions. In a 

September 11, 2013 report, Darcy Kresge, a physician’s assistant, reported that appellant had an 

increase in right shoulder pain since returning to work without restriction. She again restricted 

appellant to no use of the right arm. On September 13, 2013 Dr. Hines noted appellant’s 

complaint of right shoulder pain exacerbated by regular activities which had increased over the 

past several days. He provided physical examination findings, reiterated his diagnoses and 

recommended a magnetic resonance imaging scan study. An October 21, 2013 right shoulder 

ultrasound demonstrated a small, full thickness or high grade partial thickness tear of the anterior 

portion of the supraspinatus, increased fluid around the biceps tendon consistent with tendinitis, 

and findings consistent with shoulder impingement syndrome. In an October 25, 2013 report, 

Dr. Hines noted the ultrasound findings. He opined that the rotator cuff tear was likely a 

preexisting condition but that appellant had exacerbated the condition and she would likely 

continue to aggravate it with repetitive-type activities. Dr. Hines indicated that appellant could 

return to modified duties that day. 

By letter dated November 25, 2013, OWCP informed appellant that the evidence received 

was insufficient to support her claim because it did not include a physician’s opinion as to how 

the claimed injury resulted in the diagnosed condition. Appellant was asked to provide a 

narrative medical report that included an opinion, supported by a medical explanation, as to how 

the reported work incident on June 13, 2013 caused or aggravated a medical condition. She was 
3

also asked to provide a statement regarding the circumstances of the claimed injury, her medical 

treatment, and any similar condition that preceded the claimed injury. Appellant was also 

instructed to explain why she did not report the injury until July 17, 2013. 

In a November 9, 2013 report, Dr. Hines noted that right shoulder surgery was planned 

for November 20, 2013. On November 20, 2013 he performed a right arthroscopic rotator cuff 

repair with subacromial decompression, biceps tenodesis, lysis of adhesions and bursectomy. 

By decision dated January 16, 2014, OWCP denied the claim on the grounds that the 

evidence did not support that the injury occurred as appellant described, noting that the only 

history of injury was the brief statement on the claim form and that she did not respond to the 

November 25, 2013 development letter. It further found that the medical evidence did not 

establish a diagnosed condition caused by the claimed June 13, 2013 work incident. 

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 timely filed within the applicable time 

limitation period of FECA, that an injury was sustained in the performance of duty as alleged 

and that any disability and/or specific condition for which compensation is claimed are causally 

related to the employment injury. Regardless of whether the asserted claim involves traumatic 

injury or occupational disease, an employee must satisfy this burden of proof.2

 OWCP regulations at 20 C.F.R. § 10.5(ee) define a traumatic injury as a condition of the 

body caused by a specific event or incident or series of events or incidents within a single 

workday or shift.3 To determine whether an employee sustained a traumatic injury in the 

performance of duty, OWCP must determine whether “fact of injury” is established. First, an 

employee has the burden of proof to demonstrate the occurrence of an injury at the time, place 

and in the manner alleged, by a preponderance of the reliable, probative and substantial 

evidence. Second, the employee must submit sufficient evidence, generally only in the form of 

medical evidence, to establish a causal relationship between the employment incident and the 

alleged disability and/or condition for which compensation is claimed. An employee may 

establish that the employment incident occurred as alleged, but fail to show that his or her 

disability and/or condition relates to the employment incident.4

 Causal relationship is a medical issue, and the medical evidence required to establish a 

causal relationship is rationalized medical evidence.5

 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 

 2 Gary J. Watling, 52 ECAB 278 (2001). 

3

 20 C.F.R. § 10.5(ee) (1999, 2011); Ellen L. Noble, 55 ECAB 530 (2004). 

4 Gary J. Watling, supra note 2. 

5 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 
4

relationship between the diagnosed condition and the specific employment factors identified by 

the employee.6 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 causal relationship.7

ANALYSIS 

The Board finds that appellant opened mail at work on June 13, 2013. There is no 

contrary evidence. The Board, however, finds that the medical evidence submitted by appellant 

is insufficient to establish that her opening mail caused a medical condition as none of the 

medical evidence related a diagnosed condition specifically to such duties. 

Dr. Hines submitted reports from July 19 to November 20, 2013 when he performed a 

right arthroscopic rotator cuff repair. While he noted appellant’s report that her right shoulder 

pain began on June 13, 2013 when she felt a popping sensation and initially diagnosed right 

impingement syndrome, Dr. Hines did not provide sufficient medical rationale to fulfill 

appellant’s burden that she sustained a work injury on that date. Following the October 21, 2013 

ultrasound, he diagnosed a preexisting right shoulder rotator cuff tear that had been exacerbated. 

Dr. Hines opined that repetitive activities would continue to exacerbate the condition. However, 

he did not specifically relate any of the diagnosed conditions to the June 13, 2013 incident when 

appellant was opening mail or offer any explanation of how the mechanics of the June 13, 2013 

incident could have resulted in an injury. Without a detailed medical report describing the 

employment incident in detail and noting how and why appellant sustained a right shoulder 

condition as a result of the June 13, 2013 incident, Dr. Hines’ opinion is insufficient to meet 

appellant’s burden of proof.8

Medical evidence submitted to support a claim for compensation should reflect a correct 

history, and the physician should offer a medically sound explanation of how the claimed work 

event caused or aggravated the claimed condition. Dr. Hines did not do so.9 The Board notes 

that appellant did not respond to OWCP’s November 25, 2013 request for further information. 

The Board also notes that the September 11, 2013 report from Ms. Kresge does not 

constitute medical evidence as nurse practitioners and physician’s assistants are not considered 

physicians under FECA. Also, the October 21, 2013 right shoulder ultrasound study did not 

address the cause of any diagnosed condition. Medical evidence that does not offer any opinion 

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

causal relationship. Appellant, therefore, did not meet her burden of proof to establish that she 

sustained a traumatic injury on June 13, 2013. 

 6 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 

7 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

8 Leslie C. Moore, supra note 6. 

9 Id. 
5

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 establish an employment-related injury on 

June 13, 2013. 

ORDER 

IT IS HEREBY ORDERED THAT the January 16, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: October 21, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board