United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.A., Appellant 

and 

DEPARTMENT OF THE ARMY, DEFENSE 

LANGUAGE INSTITUTE FOREIGN 

LANGUAGE CENTER, Monterey, CA, 

Employer 

__________________________________________ 

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Docket No. 14-1768 

Issued: February 5, 2015 

Appearances: Case Submitted on the Record

William H. Brawner, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 13, 2014 appellant, through her attorney, filed a timely appeal from a July 2, 

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 that she sustained an 

occupational disease in the performance of duty. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On November 3, 2013 appellant, then a 69-year-old administrative support technician, 

filed an occupational disease claim alleging that she developed bilateral shoulder impingement 

and an aggravation of L4-5 spondylolisthesis due to repetitive lifting of objects weighting 

approximately 5 to 15 pounds, bending, twisting, stooping, and turning while on detail from 

October 4, 2011 through December 19, 2012. She did not stop work, but subsequently retired on 

November 30, 2013. 

In a January 22, 2013 report, Dr. Jeffrey Carter, Board-certified in orthopedic surgery and 

sports medicine, noted that appellant complained of pain in both shoulders, and her back. He 

advised that she previously underwent rotator cuff repair in 2011. He stated that appellant 

attributed her back pain to lifting at work and pushing a heavy object. On physical examination, 

Dr. Carter found that there was no tenderness or range of motion deficits in the upper 

extremities. He recommended that appellant see her primary workers’ compensation doctor to 

determine if her back complaints were employment related. In a May 2, 2013 report, Dr. Carter 

noted that she complained of right shoulder aching, and soreness. He advised that appellant fell 

on December 18, 2012 and went to the emergency room for back pain, and over time developed 

shoulder pain. On physical examination, Dr. Carter found tenderness of the posterior arm. He 

stated that appellant’s pain was due to her cervical spine and that there was obvious limited range 

of motion in the neck and increased kyphosis. Dr. Carter opined that her cervical problems were 

long standing and degenerative, and were not attributable to a work problem although her 

symptoms may have been aggravated by a recent fall. 

By letter dated December 20, 2013, OWCP notified appellant of the deficiencies in her 

claim and advised her of the type of evidence needed to establish her claim. 

By decision dated January 22, 2014, OWCP denied appellant’s claim because evidence 

did not establish that appellant sustained an injury in the manner alleged. 

Appellant subsequently submitted documents describing the duties that she performed. 

She also submitted a coworker’s statement describing some of her duties and documents from 

the employing establishment noting certain of her duties. 

Appellant also submitted medical evidence. In a December 21, 2012 hospital report, 

Dr. Musa Khaliqi, Board-certified in internal medicine, noted that she complained of back, left 

shoulder, and arm pain. He noted that appellant worked as a supply technician where she did 

lots of lifting, pushing, and pulling. Dr. Khaliqi advised that a lumbar spine x-ray revealed mild 

anterolisthesis at L4-5, degenerative disc disease at L4-5, and facet joint arthrosis at L4-5, and 

L5-S1. He stated that a spinal cord magnetic resonance imaging (MRI) scan showed severe 

spinal canal stenosis at L4-5 due to a combination of anterolisthesis, broad budging of the disc 

osteophyte complex lateralized to the right, ligamentum flavum hypertrophy, and hypertrophic 

facet degenerative changes. Dr. Khaliqi offered an assessment that included acute intractable 

back pain. In a December 22, 2012 report, he stated that appellant was “involved in a workers’ 

compensation issue where she had to go home from work because of the severity of the pain.” 

Dr. Khaliqi assessed lumbar radiculopathy and low back pain in the left L5 distribution. In a 
3

December 22, 2012 discharge report, he advised that appellant was improved and could engage 

in activity as tolerated but could not perform heavy lifting. 

In an April 24, 2013 report, Dr. Mark Howard, a Board-certified orthopedic surgeon, 

noted that appellant complained of bilateral recurrent shoulder pain and pain in the hips. He 

advised that initially she sustained a shoulder condition due to an industrial injury but he 

acknowledged that he did not have the specifics of that injury. Dr. Howard further advised that 

appellant related that she developed lumbar pain after her job began to require more labor 

intensive duties. He noted that she was hospitalized in December 2012 for her back condition 

and she believed that it was attributable to the change and overall increase in her work activities. 

On physical examination of the lumbar spine Dr. Howard found that there was no tenderness or 

spasm and full range of motion. Upon shoulder examination, he found no clear rotator cuff 

weakness, mild impingement, and a mild limitation of internal rotation. Dr. Howard diagnosed 

bilateral shoulder impingement and L4-5 disc protrusion. He opined that, although appellant 

inquired about a workers’ compensation claim, he did not have a clear cut basis that would 

support her belief that the injury was work related. In a June 19, 2013 report, Dr. Howard 

advised that she was experiencing lower levels of axial lumbar pain since being allowed to 

perform lighter work duties. He also advised that the examination was without specific 

pathological findings. Dr. Howard diagnosed L4-5 degenerative spondylolisthesis, and bilateral 

shoulder impingement. 

In April 9, 2013 diagnostic reports, Dr. Joan Frisoli, Board-certified in diagnostic 

radiology, noted that shoulder and thoracic spine x-rays revealed a mild loss of the glenohumeral 

joint space, osteophyte present at the acromioclavicular joint, mild degenerative change, a trace 

scoliosis, and no compression fracture. 

In a January 8, 2014 report, Dr. Howard advised that he treated appellant on two 

occasions. He noted that she had significant deformity of the lumbar segments specifically a 

grade 1 L4-5 degenerative spondylolisthesis with a significant associated lumbar spondylotic 

stenosis. Dr. Howard advised that he read a multipage document from counsel which described 

appellant’s work history and job duties. He related that this document indicated that appellant’s 

duties changed when the employing establishment became overstaffed with clerical personnel 

and she was transferred to work as a supply clerk in which she engaged in repetitive bending, 

twisting, reaching and carrying up to 15 pounds. Dr. Howard opined that “it does appear as if 

the work-related activities ... significantly contributed to her low back ‘going out’ and her 

subsequent need for medical care” since December 2012. He advised that appellant’s 

degenerative conditions were “clearly preexisting” although she did not report that she had 

significant prior spinal problems or a need for medical care. Dr. Howard opined that 50 percent 

of appellant’s past and future need for treatment is attributable to nonindustrial preexisting 

factors including appellant’s spondylolisthesis and associated spinal stenosis and the “50 percent 

related to the specific workplace exposure and activities in October of 2011 through 

December 2012.” 

On April 1, 2014 appellant, through her attorney, requested reconsideration. 
4

By decision dated July 2, 2014, OWCP found that appellant established the work duties 

that she believed caused her condition. However, it found that the evidence did not medically 

establish that her diagnosed conditions were causally related to work duties. 

On appeal, appellant argued that she submitted sufficient evidence to establish her claim 

or, in the alterative, that OWCP had a responsibility to develop the claim. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden to establish 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, that an injury was sustained in the performance of duty as alleged and that any 

disabilities and/or specific conditions for which compensation is claimed are causally related to 

the employment injury.2 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.3

Whether an employee actually sustained an injury in the performance of duty begins with 

an analysis of whether fact of injury has been established. To establish an occupational disease 

claim, an employee must submit: (1) a factual statement identifying employment factors alleged 

to have caused or contributed to the presence or occurrence of the disease or condition; 

(2) medical evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the employee.4 

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

causal relationship is rationalized medical opinion evidence. Rationalized medical opinion 

evidence is generally required to establish causal relationship. The opinion of the physician must 

be based on a complete factual and medical background, 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.5

 

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.6

 

 2 Elaine Pendleton, 40 ECAB 1143 (1989). 

3 Victor J. Woodhams, 41 ECAB 345 (1989). 

4 R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000). 

5 I.J., 59 ECAB 408 (2008); supra note 3. 

6

 James Mack, 43 ECAB 321 (1991). 
5

ANALYSIS 

Appellant claimed that she sustained a shoulder and back injury due to factors of her 

employment. There is no dispute that her job included lifting of objects weighting 

approximately 5 to 15 pounds. In addition, appellant’s ** included bending, twisting, stooping, 

and turning while on ** detail. However, the medical evidence is insufficient to establish that 

appellant’s claimed back and shoulder injury is causally related to such employment factors. 

In his January 8, 2014 report, Dr. Howard advised that appellant had significant L4-5 

degenerative spondylolisthesis with associated spondylotic stenosis. He noted reviewing her 

work duties and opined that her work-related activities significantly contributed to her low back 

“going out” and her subsequent need for medical care. Dr. Howard stated that 50 percent of 

appellant’s past and future need for treatment is attributable to nonindustrial preexisting factors 

including her spondylolisthesis, and associated spinal stenosis, and the other 50 percent is 

attributable to industrial factors including the specific workplace exposure and activities in 

October 2011 through December 2012. Although Dr. Howard offers an opinion on causal 

relationship, he fails to provide any medical rationale to explain his opinion. As noted, 

rationalized medical opinion evidence is generally required to establish causal relationship. The 

need for rationale by a physician is particularly important here since the record indicates that 

appellant has preexisting degenerative conditions. Additionally, rationale is needed in view of 

Dr. Howard’s April 24, 2013 report where he advised that he did not have a clear cut basis that 

would support appellant’s belief that the injury was work related. Dr. Howard’s January 8, 2014 

report did not explain why he changed his opinion. 

In his January 22, 2013 report, Dr. Carter noted that appellant complained of pain in both 

shoulders and back. He stated that she attributed her back pain to lifting at work and pushing a 

heavy object which he described as a work-related injury. However, Dr. Carter merely states the 

history as related to him by appellant. The Board has held that a physician’s opinion regarding 

causal relationship that appears to be primarily based on appellant’s own representations rather 

than on objective medical findings is of limited probative value.7

 In his May 2, 2013 report, 

Dr. Carter noted that appellant complained of right shoulder aching and soreness. He stated that 

her pain was due to her cervical spine and that there was obvious limited range of motion in the 

neck and increased kyphosis. Dr. Carter opined that appellant’s cervical problems were long 

standing and degenerative, and were not attributable to a work problem although her symptoms 

may have been aggravated by work-related factors. Although he stated that work factors may 

have aggravated her conditions, the Board had held that medical opinions which are speculative 

or equivocal are of diminished probative value.8

 Dr. Carter did not provide any unequivocal and 

reasoned support to explain how any particular work duties aggravated any diagnosed condition. 

 7 See C.G. Docket No. 14-1430 (issued November 7, 2014). 

8 See S.E., Docket No. 08-2214 (issued May 6, 2009) (finding that opinions such as the condition is probably 

related, most likely related or could be related are speculative and diminish the probative value of the medical 

opinion); Cecilia M. Corley, 56 ECAB 662, 669 (2005) (finding that medical opinions which are speculative or 

equivocal are of diminished probative value). 
6

In his December 21, 2012 report, Dr. Khaliqi diagnosed lumbar radiculopathy and low 

back pain in the left L5 distribution. He stated that appellant was “involved in a workers’ 

compensation issue where she had to go home from work because of the severity of the pain.” 

Although he states that appellant was involved in a worker’s compensation issue, Dr. Khaliqi’s 

statement is insufficient to discharge appellant’s burden of proof as he does not explain how any 

particular work factors caused or contributed to the diagnosed conditions. 

Other medical reports of record are insufficient to discharge appellant’s burden of proof 

because they do not offer a physician’s opinion on causal relationship.9

 

Counsel argued on appeal that appellant had established her claim or, in the alterative, 

that OWCP failed to adequately develop the medical evidence in the record. Counsel 

resubmitted a lb page brief in which he discussed the facts and law relevant to the claim. 

However, for the reasons listed above, the Board finds that the medical evidence did not include 

the necessary medical reasoning explaining the reasons why particular work duties caused or 

contributed to her diagnosed medical conditions. 

Consequently, appellant has submitted insufficient medical evidence to establish her 

claim. As noted, causal relationship is a medical question that must be established by probative 

medical opinion from a physician. The physician must accurately describe appellant’s work 

duties and medically explain the pathophysiological process by which these duties would have 

caused or aggravated her condition.10 Because appellant has not provided such medical opinion 

evidence in this case, she has failed to meet her burden of proof. 

Appellant may submit new evidence or argument as part of a formal 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 that she sustained an occupational disease 

caused by work-related events. 

 9 See Jaja K. Asaramo, 55 ECAB 200 (2004) (medical evidence that does not offer an opinion regarding the cause 

of an employee’s condition is of limited probative value on the issue of causal relationship). 

10 Solomon Polen, 51 ECAB 341 (2000) (rationalized medical evidence must relate specific employment factors 

identified by the claimant to the claimant’s condition, with stated reasons by a physician). See also S.T., Docket No. 

11-237 (issued September 9, 2011). 
7

ORDER 

IT IS HEREBY ORDERED THAT the July 2, 2014 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: February 5, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board