United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.A., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Lexington, KY, Employer 

__________________________________________ 

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Docket No. 15-1094 

Issued: October 26, 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 H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On April 17, 2015 appellant, through counsel, filed a timely appeal from a February 12, 

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 established that she sustained a specific, medically 

diagnosed injury to her shoulders, arms, and/or neck, causally related to factors of her federal 

employment, as alleged. 

On appeal, appellant’s counsel contends that OWCP’s decision is contrary to fact and 

law. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On February 20, 2013 appellant, then a 50-year-old distributions clerk, filed an 

occupational disease claim (Form CA-2) alleging that due to lifting trays and repetitive motion 

performed during her federal employment she suffered from bilateral shoulder pain. The 

employing establishment controverted the claim. 

In a February 4, 2013 note regarding a visit, Dr. Bassem Adie, an internist,2 noted that 

appellant complained of pain in her arms, shoulders, and neck that started about 10 days ago. He 

noted that she had no recent trauma. Dr. Adie assessed appellant with shoulder pain, arm pain, 

and neck pain, most likely from bursitis in shoulder with the possibility of arthritis in the neck or 

nerve injury in the neck. He suggested that she rest for the next week and avoid heavy lifting of 

more than 10 pounds. In a February 11, 2013 note, Dr. Adie found that appellant should 

continue to rest at home for the next week, and that she was disabled from her job at this time. 

In a March 5, 2013 report, Dr. Gary Bray, a Board-certified orthopedic surgeon, assessed 

appellant with neck pain. He noted that her left arm problem began five weeks ago and now 

occurs continuously. Dr. Bray noted that appellant stated that the injury occurred at work and 

noted that she lifted trays of mail up to 70 pounds. He noted that her symptoms are severe and 

are made worse by moving and job requirements. 

In a May 15, 2013 report, Dr. Adie noted that appellant’s injury began after heavy lifting 

at work and that her neck injury is related to the heavy lifting and is most likely work related. 

He noted that she needed to continue to rest at home and was unable to do any heavy lifting. 

By decision dated May 21, 2013, OWCP denied appellant’s claim, finding that she had 

not established that fact of injury occurred. It noted that she did not submit medical evidence 

that established how the alleged employment activities caused or aggravated a diagnosed medical 

condition. 

On June 14, 2013 appellant requested an oral hearing. 

In a disability claim form completed on April 17, 2013, Dr. Adie diagnosed appellant 

with neck and shoulder pain, and possible herniated disc. He checked a box noting that she was 

currently disabled from her job, and noted that this was due to neck and shoulder pain and 

numbness, and tingling in her arms. 

In a June 18, 2013 report, Dr. Robert C. Pope, an osteopath, noted that he conducted a 

magnetic resonance imaging (MRI) scan and listed his impression as partial tear of the articular 

surface of the footplate of the supraspinatus tendon, tendinosis of the subscapularis and 

infraspinatus, mild degenerative changes of the acromioclavicular joint, and mild subacromial 

bursitis. 

In a June 21, 2013 note, Dr. Adie noted that appellant had a herniated disc in the cervical 

spine, tendinitis, and tendon tear in the left shoulder. He noted that she was unable to work at 

 2

 Dr. Adie is not Board-certified. 
3

that time. In an August 23, 2013 progress report, Dr. Adie noted that appellant’s neck and 

shoulder pain continued with no significant change. He noted that she was still unable to return 

to work due to her injuries. 

At the November 18, 2013 hearing, appellant testified as to the physical duties of her job. 

She noted that her job duties involved loading, sweeping, feeding, channel dispatching, setting 

up, twisting, and bending for eight hours a day every day. Appellant noted that Dr. Adie referred 

her to a neurosurgeon, and this was pending. 

In a January 31, 2014 decision, the hearing representative determined that appellant 

established that she performed heavy lifting during her federal employment and established neck 

and left shoulder diagnoses. However, she found that appellant’s claim remained denied as she 

had not established causal relationship. 

On April 1, 2014 appellant requested reconsideration. Additionally, on January 30, 2015 

appellant, through counsel, requested reconsideration. 

Appellant submitted a functional capacity evaluation and progress notes by her 

occupational therapist, Michael Milicia from December 13, 2013. She also submitted nurses 

notes by Jacelyn R. Golden from July 15, 2004 and notes regarding physical therapy 

appointments in 2003 by Nadia Buskey. 

A March 13, 2003 radiological examination was interpreted by Dr. Bradford Richmond, a 

Board-certified radiologist, as showing sclerotic change of the greater tuberosity of the humeral 

head, likely secondary to tendinitis, or stress-related sequela. 

In a January 6, 2015 note, Dr. Sandra M. Fakult, an internist,3

 diagnosed sprain of 

unspecified site of shoulder and upper arm. She noted appellant’s statement that she was “lifting 

heavy trays twisting turning repetitive motion pulling and pushing heavy APCs moving heavy 

racks.” 

In a January 20, 2015 physician work activity status report, Dr. Richard M. Cole, an 

osteopath, diagnosed appellant with sprain of unspecified site of the shoulder and upper arm and 

neck sprain. 

By decision dated February 12, 2015, OWCP denied modification of the January 31, 

2014 decision. 

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, 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 

 3

 Dr. Fakult is not Board-certified. 
4

the employment injury.4 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.5

 

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

an analysis of whether fact of injury has been established.6

 To establish fact of injury in 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.7 

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 evidence which includes a physician’s 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, 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.8

ANALYSIS 

The Board finds that appellant has not established that she suffered from a medically 

diagnosed condition causally related to the accepted factors of her federal employment. 

Appellant submitted medical reports by her treating internist, Dr. Adie, dated from 

February 4 through August 23, 2013. In his February 4, 2013 note, Dr. Adie noted that she 

complained of pain in her arms, shoulders, and neck that began 10 days prior to his note. He 

treated appellant with rest and work restrictions. Although Dr. Adie’s initial diagnoses were 

speculative, with definitive statements only being made with regard to pain, in his June 21, 2013 

note he diagnosed a herniated disc in the cervical spine, tendinitis, and tendon tear in the left 

shoulder. However, he never opined as to a relationship between the specific diagnoses made in 

his June 21, 2013 note to the accepted factors of appellant’s federal employment. 

Similarly, none of the other treating physicians makes a definitive statement linking 

appellant’s specific diagnoses to her federal employment duties. Dr. Bray noted in his March 5, 

2013 report that appellant’s symptoms of neck pain and problems with her left arm began five 

weeks prior to his evaluation of her and noted that the injury occurred at work, noting that she 

 4 Elaine Pendleton, 40 ECAB 1143 (1989). 

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

6 See S.P., 59 ECAB 184, 188 (2007). 

7 See Roy L. Humphrey ̧ 57 ECAB 238, 241 (2005); see also P.W., Docket No. 10-2402 (issued August 5, 2011). 

8 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, supra note 5. 
5

lifted trays of mail of up to 70 pounds. The Board notes that pain is a symptom and not a 

compensable medical diagnosis.9

 Therefore, Dr. Bray’s report cannot establish a medical 

condition. Dr. Pope and Dr. Richmond conducted diagnostic tests. Dr. Pope interpreted an MRI 

scan and Dr. Richmond conducted a radiological examination. Although both Dr. Pope and 

Dr. Richmond made objective findings, neither physician discussed any connection between a 

diagnosed condition and the factors of appellant’s employment. Dr. Fakult noted appellant’s 

statement with regard to her employment duties and diagnosed sprain of an unspecified site of 

her shoulder and arm, but did not make any independent statement explaining any causal 

relationship between the listed factors of her employment and the diagnosed conditions. 

Dr. Cole made no statement with regard to her employment and any possible causal relationship 

to her medical diagnoses of sprain of the unspecified site of shoulder and upper arm and neck 

sprain. Appellant also submitted notes and evaluations by her occupational and physical 

therapists and nurse’s notes. However, these reports have no probative medical value as physical 

and occupational therapists and nurses are not considered physicians as defined under FECA.10 

Because appellant has not provided a medical opinion establishing a causal relationship between 

a medical diagnosis and the accepted factors of her federal employment, she has not met her 

burden of proof. 

Causal relationship must be based on rationalized medical opinion evidence.11 A 

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.12 As appellant did not submit a rationalized medical opinion supporting that her 

injuries were causally related to the factors of her federal employment, she did not meet her 

burden of proof to establish an employment-related traumatic injury. 

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 established that she sustained a specific, medically 

diagnosed injury to her shoulders, arms, and/or neck, causally related to factors of her federal 

employment, as alleged. 

 9 V.S., Docket No. 14-2028 (issued June 3, 2015). 

10 The term physician includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, 

and osteopathic practitioners within the scope of their practice as defined by State law. 5 U.S.C. § 8102(2); 

A.C., Docket No. 08-1453 (issued November 18, 2008) (records from a physical therapist do not constitute 

competent medical opinion in support of causal relation, as physical therapists are not physicians as defined under 

FECA; L.D., 59 ECAB 648 (2008) (a nurse practitioner is not a physician as defined under FECA); 

Roy L. Humphrey, 57 ECAB 238 (2005). See also J.G., Docket No. 15-251 (issued April 13, 2015). 

11 M.E., Docket No. 14-1064 (issued September 29, 2014). 

12 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 G.G., Docket 

No. 15-234 (issued April 9, 2015). 
6

ORDER 

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

Compensation Programs dated February 12, 2015 is affirmed. 

Issued: October 26, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board