United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

V.R., Appellant 

and 

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Boise, ID, Employer 

__________________________________________ 

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Docket No. 14-1695 

Issued: January 9, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On August 1, 2014 appellant, through her attorney, filed a timely application for review 

from a March 11, 2014 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 that she sustained a 

condition of the arms and hands causally related to factors of her federal employment. 

FACTUAL HISTORY 

On May 6, 2013 appellant, then a 50-year-old postal clerk, filed an occupational disease 

claim (Form CA-2) alleging that she sustained numbness and tingling to her arm, and hand as a 

result of grasping mail, reaching above her shoulder, and lifting trays on a repetitive basis. She 

 1

 5 U.S.C. § 8101 et seq. 
2

noted that she “came back from Easter and have woke in pain every night.” Appellant first 

became aware of her claimed condition on April 30, 2013 and of its relationship to her 

employment on May 8, 2013. 

Appellant submitted a report signed by a physician’s assistant dated May 8, 2013. She 

also submitted several unsigned and/or illegible medical notes. 

By letter dated May 9, 2013, the employing establishment challenged appellant’s claim. 

It noted that she had not submitted medical documentation to substantiate her claim and that she 

had continued to work without wage loss. The employing establishment further noted that 

appellant alleged her pain began after she returned from Easter, a holiday, and that she may have 

injured herself outside of the scope of her employment. 

In a duty status report dated May 9, 2013, Dr. Dale L. Mock, a family practitioner, 

recommended that appellant follow certain work restrictions in the performance of her duties, 

including working only part time at four hours a day. He stated that his diagnosis due to her 

injury was cervical radiculopathy and carpal tunnel syndrome. In another duty status report 

dated May 14, 2013, Dr. Mock recommended that appellant not return to work. He wrote, “This 

is work related but this person [illegible] at job site provided [appellant] can be placed where it 

will not aggravate symptoms.” 

In a diagnostic report dated May 16, 2013, Dr. Dallas Peck, a Board-certified radiologist, 

diagnosed appellant with a spondylitic change in the upper- to mid-cervical spine, most 

pronounced at C5-6, where there was significant bilateral foraminal narrowing, more pronounced 

on the left. 

By decision dated July 8, 2013, OWCP denied appellant’s claim. It found that she had 

not submitted sufficient medical evidence to establish a causal relationship between duties of her 

employment and her diagnosed conditions. 

On December 12, 2013 appellant, through her attorney, requested reconsideration of 

OWCP’s July 8, 2013 decision. In an attached memorandum, counsel contended that new 

medical evidence, attached to the request for reconsideration, met appellant’s burden to receive a 

merit review of the July 8, 2013 decision. 

In a diagnostic report dated October 8, 2013, Dr. Steven V. Marx, a Board-certified 

radiologist, examined the results of an x-ray of appellant’s cervical spine. He found a 

satisfactory appearance of fusion at C5-6 with no abnormal movement, and movement at C2-3, 

C3-4 and C4-5. 

By letter dated July 18, 2013, Dr. R. Tyler Frizzell, a Board-certified neurological 

surgeon, described how appellant’s need for cervical surgery was related to her work at the 

employing establishment. He noted that on May 8, 2013 appellant was at work running a 

delivery bar code sorter (DBCS) machine and that, after repetitively reaching to the top of the 

machine and grasping the mail, she developed significant pain into the arms consistent with 

cervical radiculopathy. Dr. Frizzell wrote, “In summary, I believe that her work on the DBCS 

machine on May 8, 2013, led to her cervical radiculopathy and the need for cervical spine 

surgery.” 
3

By letter dated September 5, 2013, Dr. Mock stated that, on or about April 29 or 30, 

2013, appellant was at work performing her regular duties and lifted a box of mail from an 

overhead shelf weighing approximately 30 to 40 pounds. At that time, appellant felt immediate 

numbness and tingling in her bilateral shoulders with radiating pain, and numbness down to her 

arms, and fingertips. Dr. Mock stated that she worked with this condition until May 4, 2013, at 

which time she had to stop working due to discomfort in her bilateral shoulders, arms, and hands. 

He wrote, “This situation was most certainly due to a work-related injury that initially developed 

on April 29 or 30, 2013, while [appellant] was at her usual job performing her usual tasks.” 

Appellant submitted a diagnostic report from Dr. Adam S. Maxfield, a Board-certified 

radiologist, containing diagnoses of an anterior cervical discectomy and fusion at C5-6, and mild 

degenerative changes of the cervical spine. 

By decision dated March 11, 2014, OWCP denied appellant’s request for reconsideration. 

It found that the evidence submitted on reconsideration was not relevant and pertinent new 

evidence not previously considered by OWCP and that she had not met the requirements for 

entitlement to a merit review of her claim. 

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 an 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 

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 

 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). 

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

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 

Appellant filed a claim for occupational disease on May 6, 2013, alleging that she 

sustained numbness, and tingling to her arm, and hand as a result of grasping mail, reaching 

above her shoulder and lifting trays on a repetitive basis. OWCP denied her claim on July 8, 

2013, finding that she had not submitted sufficient medical evidence to establish a causal 

relationship between the condition of her arms and hands and factors of her federal employment. 

It accepted that appellant was a federal civilian employee, who filed a timely claim; that the 

factors of employment occurred; that a medical condition had been diagnosed; and that she was 

within the performance of duty. Appellant requested reconsideration and by decision dated 

March 11, 2014, OWCP stated that it had not reviewed the merits of her case and declined her 

request for reconsideration. 

Although OWCP’s March 11, 2014 decision indicated on its face that it was not a review 

of the merits of appellant’s claim, perusal of this decision establishes that it did in fact constitute 

merit review. This decision evaluated the medical evidence submitted on reconsideration to 

determine whether it constituted a rationalized medical opinion, while noting specific 

deficiencies with the medical reports of Drs. Frizzell and Mock. In particular, it noted, “Though 

the September 5, 2013 letter was newly introduced to the record relative to the July 8, 2013 

decision, its content failed to provide a substantive discussion of causal relationship. The 

repeated assertion that the claimant’s condition is related to work does not constitute a 

rationalized, medical opinion. The document is not material to the issue at hand, causal 

relationship.” 

 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). 
5

The standard for determining whether a request for reconsideration should be granted is 

not whether appellant has submitted sufficient evidence to establish his or her claim on the 

merits, but whether evidence or argument submitted by appellant: (1) shows that OWCP 

erroneously applied or interpreted a specific point of law; (2) advances a relevant legal argument 

not previously considered by OWCP; or (3) constitutes relevant and pertinent new evidence not 

previously considered by OWCP.9 A determination of whether evidence submitted by appellant 

suffices to establish an element of his claim, rather than merely whether the standard for 

reconsideration has been met, constitutes a merit review. As the March 11, 2014 decision of 

OWCP in fact reviewed the merits of appellant’s claim, the Board will do so on the present 

appeal.10 

Thus, the issue on appeal is whether appellant has submitted sufficient medical evidence 

to establish a causal relationship between her diagnosed cervical radiculopathy and factors of her 

federal employment. The Board finds that appellant has not submitted sufficient medical 

evidence to establish such a relationship, as the medical reports provide insufficient rationale as 

to how factors of appellant’s employment, over the course of multiple work shifts, caused or 

contributed to her diagnosed condition.11

Appellant’s occupational disease claim was initially denied based upon insufficient 

medical evidence establishing that her diagnosed conditions were causally related to the 

employment factors identified by appellant. Hence, the type of medical evidence that would 

establish her claim is that which attributes her diagnosed conditions to identified factors of 

employment over a period longer than a single workday or shift. 

In a duty status report dated May 9, 2013, Dr. Mock recommended that appellant follow 

certain work restrictions in the performance of her duties, including working only part time at 

four hours per day. He stated that his diagnosis due to her injury was cervical radiculopathy, and 

carpal tunnel syndrome. In another duty status report dated May 14, 2013, Dr. Mock 

recommended that appellant not return to work. He wrote, “This is work related but this person 

[illegible] at job site provided she can be placed where it will not aggravate symptoms.” The 

Board finds that Dr. Mock did not provide adequate medical rationale on causal relationship. 

Dr. Mock did not explain in physiological terms how appellant’s duties of grasping mail, 

reaching above her shoulder and lifting trays on a repetitive basis had caused or contributed to 

her cervical radiculopathy. The Board has long held that medical opinions not containing 

rationale on causal relation are entitled to little probative value and are generally insufficient to 

meet appellant’s burden of proof.12 As such, Dr. Mock’s May 9 and 14, 2013 duty status reports 

are insufficient to meet appellant’s burden of proof. 

 9

 20 C.F.R. § 10.606(b)(2); D.K., 59 ECAB 141, 146 (2007). 

10 See M.M., Docket No. 07-1657 (issued May 15, 2008). 

11 OWCP’s regulations 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. 20 C.F.R. § 10.5(ee). These regulations define an 

occupational disease or illness as a condition produced by the work environment over a period longer than a single 

workday or shift. 20 C.F.R. § 10.5(q). 

12 Carolyn F. Allen, 47 ECAB 240, 246 (1995). 
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The report of Dr. Frizzell dated July 18, 2013, instead of attributing appellant’s diagnosed 

conditions to the identified employment factors of grasping mail, reaching above her shoulder, 

and lifting trays on a repetitive basis over a period longer than a single shift, attributed her 

diagnoses to a particular traumatic incident on May 8, 2013. Dr. Frizzell did not mention work 

factors occurring over a longer period of time as contributing to or causing appellant’s diagnosed 

conditions. As appellant’s claim is for an occupational disease, and as Dr. Frizzell’s opinion on 

causal relationship related her diagnoses to a single traumatic incident, her July 18, 2013 letter is 

of diminished probative value on the issue of a causal relationship between duties of appellant’s 

federal employment and her diagnosed condition of cervical radiculopathy, because it is not 

based on an accurate factual background according to appellant’s history of injury. 

Similarly, Dr. Mock’s September 5, 2013 letter attributed appellant’s diagnoses to a 

single traumatic event on April 29 or 30, 2013. He did not mention work factors occurring over 

the course of several shifts as contributing to appellant’s diagnoses and did not mention an injury 

on May 8, 2013. Dr. Mock’s opinion, like Dr. Frizzell’s, supports only a single date of injury; 

but unlike hers, the date chosen was April 29 or 30, 2013. As such, his letter is of diminished 

probative value on the issue of a causal relationship between factors of appellant’s work and her 

diagnosed condition. 

The diagnostic studies of Drs. Marx, Maxfield, and Peck do not contain an opinion on the 

causal relationship between appellant’s diagnoses and duties of her federal employment. 

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.13 Hence, these reports are 

insufficient to meet appellant’s burden of proof to establish a causal relationship between her 

diagnosed condition of cervical radiculopathy and factors of her federal employment. 

Appellant submitted several illegible reports, in which the signature indicating the 

identity of the person completing the report was also illegible. The Board has held that a medical 

report may not be considered as probative medical evidence if there is no indication that the 

person completing the report qualifies as a physician as defined in 5 U.S.C. § 8101(2). Reports 

lacking proper identification do not constitute probative medical evidence.14

Appellant also submitted a report from a physician’s assistant dated May 8, 2013, which 

was not countersigned by a physician. Physicians’ assistants do not qualify as physicians under 

FECA, and their reports do not constitute probative medical evidence unless countersigned by a 

physician.15 As such, this report does not support appellant’s claim for compensation. 

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 S.E., Docket No. 08-2214 (issued May 6, 2009). 

14 C.B., Docket No. 09-2027 (issued May 12, 2010). 

15 See 5 U.S.C. § 8101(2); Lyle E. Dayberry, 49 ECAB 369, 372 (1998) (regarding physicians’ assistants). 
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CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she 

sustained a condition of the arms and hands causally related to factors of her federal 

employment. 

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated March 11, 2014 is affirmed, as modified.16

Issued: January 9, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 16 Michael E. Groom, Alternate Judge, participated in the original decision but was no longer a member of the 

Board effective December 27, 2014.