United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

W.G., Appellant 

and 

U.S. POSTAL SERVICE, BULK MAIL 

CENTER, Jersey City, NJ, Employer 

__________________________________________ 

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Docket No. 14-1420 

Issued: November 12, 2014 

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 9, 2014 appellant, through his attorney, filed a timely appeal from a March 25, 

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 has established that he sustained a right shoulder injury in 

the performance of duty on June 9, 2012. 

FACTUAL HISTORY 

On July 3, 2012 appellant, then a 60-year-old mail handler, filed a traumatic injury claim 

(Form CA-1) alleging that on June 9, 2012 he sustained a right shoulder injury when he tripped 

over an empty pallet and fell back on his shoulder. The record contains a Form CA-16 

 1

 5 U.S.C. § 8101 et seq. 
2

(authorization for examination and treatment) dated July 2, 2012 indicating that Meadowlands 

Hospital was authorized to provide necessary treatment. 

Appellant received treatment at the hospital on July 2, 2012 from Dr. Fabian Morales, 

Board-certified in emergency medicine, who provided a history that appellant was status post 

right rotator cuff tear and injury sustained at work one year earlier and repaired. Dr. Morales 

indicated that appellant had fallen at work three weeks earlier. He provided results on 

examination and diagnosed rotator cuff impingement syndrome. In a July 3, 2012 Form CA-20 

report, Dr. Morales indicated that appellant had undergone rotator cuff surgery in 2011. He 

diagnosed rotator cuff impairment syndrome and shoulder pain, checking a box “yes” that the 

conditions were employment related. 

In a report dated July 16, 2012, Dr. Edward Decter, a Board-certified orthopedic surgeon, 

stated that appellant had prior right shoulder surgery from a Dr. Zafer A. Termanini in 2011 and 

“June 2012.” Dr. Decter stated that appellant had tripped over a pallet and reinjured his shoulder 

and an magnetic resonance imaging (MRI) scan was necessary to determine if he had a retear of 

his rotator cuff. Appellant underwent an MRI scan on October 3, 2012 and in a report of that 

date, Dr. Anuj Tolia, a radiologist, stated that the MRI scan did not show a rotator cuff retear or 

labral tear, but did indicate stable, moderate acromioclavicular (AC) joint osteoarthritis. In a 

brief report dated October 5, 2012, Dr. Decter noted the MRI scan results and stated that 

arthroscopic surgery was planned to treat the arthritis. 

In a decision dated November 27, 2012, OWCP denied the claim for compensation. It 

found that the medical evidence was insufficient to establish the claim. 

Appellant requested a hearing, which was held on March 25, 2013. In a report dated 

March 4, 2013, Dr. Decter noted that appellant “is still having persistence of pain of his right AC 

joint, which [appellant] injured over of the years of doing repetitive motions.” He indicated that 

appellant was still interested in surgery. By report dated May 16, 2013, Dr. Decter stated that 

appellant injured his right shoulder on June 2012 when he tripped and fell backwards on his 

shoulder. He diagnosed AC joint osteoarthritis, stating that appellant continued to have right 

shoulder pain and arthroscopic surgery should be authorized. 

By decision dated June 12, 2013, the hearing representative affirmed the November 27, 

2012 OWCP decision. The hearing representative found that the medical evidence was not 

sufficient to establish causal relationship between a diagnosed condition and the employment 

incident. 

On February 3, 2014 appellant, through his representative, requested reconsideration. He 

submitted a January 23, 2014 report from Dr. Decter, stating that in June 2012 appellant had 

fallen and injured his shoulder. Dr. Decter indicated that appellant had surgery by a 

Dr. Termanini and appellant was sent back to work and then he hurt his shoulder. He again 

stated that appellant had osteoarthritis of the AC joint and surgery was recommended. 

Dr. Decter further stated, “I believe that this accident is the precipitating cause of [appellant’s] 

shoulder pain and he has had an unsuccessful procedure by Dr. Termanini.” 
3

In a decision dated March 25, 2014, OWCP reviewed the case on its merits and denied 

modification. It found that the medical evidence was insufficient to establish the claim. 

LEGAL PRECEDENT 

FECA provides for the payment of compensation for “the disability or death of an 

employee resulting from personal injury sustained while in the performance of duty.”2

 The 

phrase “sustained while in the performance of duty” in FECA is regarded as the equivalent of the 

commonly found requisite in workers’ compensation law of “arising out of an in the course of 

employment.”3

 An employee seeking benefits under FECA has the burden of establishing that 

he or she sustained an injury while in the performance of duty.4

 In order to determine whether 

an employee actually sustained an 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 which must be considered in conjunction with one another. The first 

component to be established is that the employee actually experienced the employment incident 

which is alleged to have occurred. The second component is whether the employment incident 

caused a personal injury and generally this can be established only by medical evidence.5

 

OWCP’s procedures recognize that a claim may be accepted without a medical report 

when the condition is a minor one which can be identified on visual inspection.6 In clear-cut 

traumatic injury claims, such as a fall resulting in a broken arm, a physician’s affirmative 

statement is sufficient and no rationalized opinion on causal relationship is needed. In all other 

traumatic injury claims, a rationalized medical opinion supporting causal relationship is 

required.7

 

Rationalized medical opinion evidence is medical evidence that is based on a complete 

factual and medical background, of reasonable medical certainty and supported by medical 

rationale explaining the nature of the relationship between the diagnosed condition and the 

specific employment factors identified by the claimant. The weight of medical evidence is 

determined by its reliability, its probative value, its convincing quality, the care of the analysis 

manifested and the medical rationale expressed in support of the physician’s opinion.8

 2

 5 U.S.C. § 8102(a). 

3 Valerie C. Boward, 50 ECAB 126 (1998). 

4 Melinda C. Epperly, 45 ECAB 196, 198 (1993); see also 20 C.F.R. § 10.115. 

5 See John J. Carlone, 41 ECAB 354, 357 (1989). 

6

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3(d) (June 1995). 

7 Id. 

8 Jennifer Atkerson, 55 ECAB 317, 319 (2004). 
4

ANALYSIS 

In the present case, appellant alleged that he fell backward on his right shoulder while in 

the performance of duty on June 9, 2012. OWCP accepted that the incident occurred as alleged. 

The issue is whether there is sufficient medical evidence to establish causal relationship between 

a diagnosed condition and the employment incident. 

Appellant initially received treatment from Dr. Morales on July 2, 2012. He diagnosed a 

rotator cuff impingement syndrome and shoulder pain, without providing a rationalized medical 

opinion on causal relationship with the June 9, 2012 employment incident. The checking of a 

box “yes” in the July 3, 2012 CA-20 form report is of little probative value without further 

explanation.9

With respect to the reports from Dr. Decter, the Board finds that appellant has not 

submitted a report with a rationalized medical opinion based on a complete and accurate 

background. In his initial July 16, 2012 report, Dr. Decter indicated that appellant had two prior 

right shoulder surgeries. He stated that the first was in 2011 and a second in June 2012. 

Dr. Morales referred to only a prior surgery in 2011 and in his January 23, 2014 report Dr. Decter 

appears to discuss only one prior surgery, without providing the date. The relevant medical history 

regarding the right shoulder is not clearly set forth for proper foundation in the reports of record. 

In his brief March 4, 2013 report, Dr. Decter states that the diagnosed arthritis condition 

was the result of years of repetitive motion. However, appellant has not alleged an occupation 

disease claim.10 As to the June 9, 2012 incident, Dr. Decter states in his January 23, 2014 report 

that this was the “precipitating cause” of appellant’s arthritis condition. Stating that an incident is 

the precipitating cause of a condition is not sufficient to show causal relationship without 

additional explanation.11 That is particularly true in this case, as Dr. Decter had previously referred 

to years of repetitive motion as the cause of appellant’s shoulder condition. He did not clearly 

explain the relationship between the employment incident and the diagnosed osteoarthritis 

condition. 

The Board finds that the record does not contain a rationalized medical opinion, based on a 

complete and accurate background, as to the causal relationship between a diagnosed AC joint 

arthritis and the June 9, 2012 employment incident. It is appellant’s burden of proof and for the 

reasons set forth herein, he did not meet his burden in this case. 

On appeal, appellant argues that Dr. Decter’s January 23, 2014 report is sufficient to 

establish causal relationship, as he opined that the employing establishment incident was the 

precipitating cause of appellant’s condition. For the reasons noted above, the Board finds that 

the medical evidence is not sufficient to establish a right shoulder arthritis condition as causally 

related to the June 9, 2012 employment incident. 

 9 See Barbara J. Williams, 40 ECAB 649, 656 (1989). 

10 An occupational disease or illness is a condition produced by the work environment over a period longer than a 

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

11 See. e.g., Roberta Kirwin, Docket No. 97-1772 (issued February 25, 1999). 
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. 

The Board also notes that the employing establishment issued appellant a CA-16 form on 

July 2, 2012 authorizing medical treatment.12 The Board has held that where an employing 

establishment properly executes a CA-16 form, which authorizes medical treatment as a result of 

an employee’s claim for an employment-related injury, it creates a contractual obligation, which 

does not involve the employee directly, to pay the cost of the examination or treatment regardless 

of the action taken on the claim.13 Although OWCP denied appellant’s claim for an injury, it did 

not address whether he is entitled to reimbursement of medical expenses pursuant to the CA-16 

form. Upon return of the case record, OWCP should further address this issue.14

CONCLUSION 

The Board finds that appellant has not established that he sustained a right shoulder 

injury in the performance of duty on June 9, 2012. Upon return of the case record, OWCP 

should address the issue of whether appellant is entitled to reimbursement of medical expenses 

pursuant to the CA-16 form. 

 12 20 C.F.R. § 10.300 provides that, when an employee sustains a work-related traumatic injury requiring medical 

treatment, the employing establishment should issue a CA-16 form. 

13 See D.M., Docket No. 13-535 (issued June 6, 2013). 

14 See P.B., Docket No. 14-837 (issued August 12, 2014). 
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ORDER 

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

Compensation Programs dated March 25, 2014 is affirmed as modified. 

Issued: November 12, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board