United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

G.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Gulfport, MS, Employer 

__________________________________________ 

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Docket No. 15-1614 

Issued: December 17, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On July 22, 2015 appellant filed a timely appeal from a May 11, 2015 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 has met his burden of proof to establish a left shoulder 

injury on April 2, 2015 in the performance of duty. 

FACTUAL HISTORY 

On April 2, 2015 appellant, then a 32-year-old city carrier associate, filed a traumatic 

injury claim (Form CA-1) alleging that at 11:20 a.m. that day, he dislocated his left shoulder 

when reaching for a package on the floor of his delivery truck. In a supporting statement, 

appellant explained that he attempted to pull a package from under a tray. When this failed, he 

 1

 5 U.S.C. § 8101 et seq. 
2

“went around and twisted shoulder to dislocation.” Appellant stopped work on April 2, 2015. 

His supervisor affirmed that appellant was in the performance of duty at the time of the claimed 

incident. On April 2, 2015 the supervisor completed a Form CA-16 authorizing appellant to seek 

medical treatment. 

In an April 6, 2015 letter, OWCP advised appellant of the additional evidence needed to 

establish his claim, including factual evidence corroborating that the claimed April 2, 2015 

incident occurred at the time, place, and in the manner alleged, and narrative report from his 

attending physician explaining how and why that incident would cause a left shoulder 

dislocation. It afforded appellant 30 days to submit such evidence. 

In response, appellant provided April 2, 2015 reports from Dr. Ronnie Ali, an attending 

osteopathic physician Board-certified in emergency medicine, diagnosing a left shoulder 

dislocation.2

 He presented at the emergency room at 12:33 pm. Dr. Ali related appellant’s 

account of “a left shoulder dislocation that occurred today when he tried to pick something up. 

[Appellant] has a history of shoulder dislocations.” Dr. Ali reduced the dislocation and 

prescribed analgesic medication. He released appellant to work with no use of the left arm. 

Dr. Ali checked a box marked “yes” indicating his support for causal relationship “as stated by 

[appellant’s] history.” 

Dr. Henry Leis, an attending Board-certified orthopedic surgeon, noted that appellant 

presented on April 8, 2015 “for a new workers’ comp visit.” He related appellant’s account of 

feeling a pop in his left shoulder when he reached for a package six days previously, and his 

emergency treatment for a dislocation. Appellant experienced ongoing pain and paresthesias 

from the left shoulder radiating into the left elbow. On examination of the left shoulder, Dr. Leis 

found tenderness to palpation, full ranges of motion, full strength, and positive Hawkins, Neer, 

and Crosman signs. He obtained x-rays showing acromioclavicular joint arthrosis with 

narrowing of the supraspinatus outlet. Dr. Leis diagnosed a history of left shoulder dislocation 

times two, left shoulder derangement, left shoulder instability, and a possible labral tear. He 

administered a Depo Medrol injection to the left shoulder. Dr. Leis released appellant to limited 

duty with no use of the left arm.3

The employing establishment submitted an April 20, 2015 letter controverting the claim 

as appellant had a history of left shoulder dislocation due to an injury sustained while in military 

service. It asserted that the preexisting shoulder condition negated his compensation claim. 

By decision dated May 11 2015, OWCP denied appellant’s claim, finding that fact of 

injury was not established. It found that he did not establish the April 2, 2015 reaching incident 

as factual because he did respond to the April 6, 2015 request for a statement describing the 

incident. OWCP further found that, had appellant established the April 2, 2015 incident as 

factual, the medical evidence was insufficient to establish causal relationship as Dr. Leis did “not 

state the injury was a result of work factors, but rather references a history of shoulder 

dislocation.” 

 2

 April 2, 2015 x-rays of the left shoulder demonstrated an anterior shoulder dislocation. 

3

 It is not clear from the record if or when appellant returned to work. 
3

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 and/or specific condition for which compensation is claimed are causally related to the 

employment injury.4 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.5

In order to determine whether an employee sustained a traumatic injury in the 

performance of duty, OWCP begins with an analysis of whether “fact of injury” has been 

established. Generally, fact of injury consists of two components that must be considered 

conjunctively. First, the employee must submit sufficient evidence to establish that he or she 

actually experienced the employment incident that is alleged to have occurred.6 An employee 

has not met his or her burden of proof in establishing the occurrence of an injury when there are 

such inconsistencies in the evidence as to cast serious doubt upon the validity of the claim.7

 

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

evidence, to establish that the employment incident caused a personal injury.8 

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is a causal relationship 

between the claimant’s diagnosed condition and the implicated 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 medial 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.9

ANALYSIS 

Appellant claimed that he dislocated his left shoulder while in the performance of duty at 

11:20 a.m. on April 2, 2015, when he tried to lift a package from the floor of his delivery truck. 

He provided a detailed description on his claim form and in his supporting statement of how he 

dislocated his shoulder. OWCP denied the claim, finding that appellant had not established the 

April 2, 2015 lifting incident as factual. However, the Board finds that the record supports fact 

of incident. 

 4 Joe D. Cameron, 41 ECAB 153 (1989). 

5 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999). 

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

7 S.N., Docket No. 12-1222 (issued August 23, 2013); Tia L. Love, 40 ECAB 586, 590 (1989). 

8 Deborah L. Beatty, 54 ECAB 340 (2003).

9 Solomon Polen, 51 ECAB 341 (2000). 
4

Appellant promptly reported the incident to his supervisor on April 2, 2015. The 

supervisor confirmed that appellant was in the performance of duty at the time. She also 

completed a Form CA-16 authorizing medical treatment. Appellant reported to an emergency 

room at 12:33 pm on April 2, 2015, approximately 1 hour and 10 minutes after the alleged lifting 

incident. Further, there is no evidence of record indicating that the April 2, 2015 lifting incident 

did not occur at the time, place, and in the manner alleged. The Board notes that while the 

employing establishment controverted the claim, it did not argue that the claimed April 2, 2015 

incident did not occur as appellant alleged. Appellant’s account of events is thus entitled to 

substantial weight.10 Under these circumstances, he has established fact of incident. Therefore, 

the medical evidence must be analyzed to determine whether appellant has established causal 

relationship. 

In support of his claim, appellant submitted April 2, 2015 reports from Dr. Ali, an 

attending osteopathic physician Board-certified in emergency medicine. Dr. Ali noted 

appellant’s account of injuring his shoulder earlier that day while trying to lift something, but did 

not specifically mention a work incident. He acknowledged appellant’s history of shoulder 

dislocations. Dr. Ali checked a box marked “yes” on a form report indicating that the left 

shoulder dislocation was due to the history appellant described. However, the Board has held 

that, in the absence of rationale, checking a box on a form report is of diminished probative value 

in establishing causal relationship.11 Dr. Ali’s opinion is therefore insufficient to meet 

appellant’s burden of proof. 

Dr. Leis, an attending Board-certified orthopedic surgeon, noted the April 2, 2015 

occupational incident, and diagnosed a history of left shoulder dislocation with derangement. 

However, he did not explain how and why appellant’s attempt to lift a package from under a tray 

in his truck, or twisting his shoulder on his second attempt, would cause the claimed left shoulder 

dislocation. The lack of medical rationale significantly diminishes the probative value of 

Dr. Leis’ opinion.12

OWCP advised appellant by April 6, 2015 letter of the necessity of providing a narrative 

report from his attending physician with medical rationale supporting causal relationship. As 

appellant did not provide such evidence, OWCP’s May 11, 2015 decision denying the claim was 

proper, but the claim shall be modified to reflect that appellant established that the claimed 

incident occurred but that he did not meet his burden of proof in establishing that the incident 

caused an injury. 

The Board notes that the employing establishment issued a Form CA-16 authorization for 

medical treatment on April 2, 2015. Where an employing establishment properly executes a 

Form CA-16, which authorizes medical treatment as a result an employee’s claim for an 

employment-related injury, the Form CA-16 creates a contractual obligation, which does not 

involve the employee directly, to pay for the cost of the examination or treatment regardless of 

the action taken on the claim.13 The period for which treatment is authorized by a Form CA-16 

 10 John J. Carlone, 41 ECAB 354 (1989). 

11 D.D., 57 ECAB 734, 738 (2006) 

12 Deborah L. Beatty, supra note 8. 

13 Tracey P. Spillane, 54 ECAB 608 (2003); A.B., Docket No. 15-1002 (issued August 14, 2015). 
5

is limited to 60 days from the date of issuance, unless terminated earlier by OWCP.14 In this 

case, it is unclear whether OWCP paid for the cost of appellant’s examinations. On return of the 

case record, OWCP should further address the issue.15

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 has not met his burden of proof to establish a left shoulder 

injury in the performance of duty on April 2, 2015. 

ORDER 

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

Compensation Programs dated May 11, 2015 is affirmed as modified. 

Issued: December 17, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 14 20 C.F.R. § 10.300(c). 

15 Tracey P. Spillane, supra note 13.