United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

O.M., Appellant 

and 

DEFENSE AGENCIES, DLA-DISTRIBUTION 

REGION EAST INJURY COMPENSATION 

CENTER, Fort Belvoir, VA, Employer 

__________________________________________ 

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Docket No. 15-1723 

Issued: November 5, 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 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On August 17, 2015 appellant filed a timely appeal from a March 9, 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 met her burden of proof to establish that she developed 

bilateral hand and shoulder conditions causally related to factors of her federal employment. 

FACTUAL HISTORY 

On December 16, 2014 appellant, then a 60-year-old materials examiner and identifier 

(forklift operator), filed an occupational disease claim (Form CA-2) alleging that she developed 

                                                             1

 5 U.S.C. § 8101 et seq.
2

tendinitis in both hands and bilateral rotator cuff shoulder pain as a result of her federal 

employment duties.2

 She explained that her duties entailed manual labor and constant 

mobilization which caused her muscle tendons to be severely aggravated. Appellant first became 

aware of her condition and of its relationship to her employment on May 28, 2014. On the 

reverse side of the form, her supervisor, Rebecca Green, contended that she was first notified on 

December 10, 2014 and that appellant had not stopped work. 

By letter dated January 26, 2015, OWCP informed appellant that the evidence of record 

was insufficient to support her claim. Appellant was advised of the medical and factual evidence 

necessary to establish her claim. She was provided 30 days to respond to the request. OWCP 

requested that appellant describe in detail the employment-related activities which she believed 

contributed to her condition, how often she performed the activities described, the length and 

period of the described activities, activities she engaged in outside of her federal employment, 

the reason for her delay in notifying her supervisor, and whether she sustained any other injuries 

since the time she realized her condition was employment related. Appellant did not respond to 

the request for further factual information. 

OWCP subsequently received a January 26, 2015 report from Dr. John Grandrimo, an 

osteopathic physician. Dr. Grandrimo reported that appellant sought treatment for a new 

problem due to complaints of bilateral shoulder pain. Appellant informed him that she injured 

both shoulders at work when using a gate which was heavy to lift. Dr. Grandrimo stated that her 

job entailed a lot of overhead work. Activities which increased appellant’s symptoms involved 

lifting the heavy gate at work, pushing, pulling, carrying, and lifting anything in front of her that 

is heavy. Upon physical examination and review of diagnostic testing, Dr. Grandrimo diagnosed 

left rotator cuff tear secondary to workers’ compensation injury and right shoulder impingement 

with exacerbation secondary to workers’ compensation injury. He opined that, based upon 

examination and clinical description, appellant’s right and left shoulder conditions were related 

to work. 

By decision dated March 9, 2015, OWCP denied appellant’s claim finding that the 

evidence of record failed to establish that the occupational exposure occurred as alleged. It noted 

that she failed to establish fact of injury because she did not respond to the questions provided in 

its January 26, 2015 development letter. 

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 are causally related to the 

                                                             2

 The Board notes that appellant has seven other traumatic and occupational disease claims from June 10, 2003 

through August 29, 2014. The record before the Board contains no other information pertaining to these claims. 
3

employment injury.3

 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.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.5 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, 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.6

ANALYSIS 

The Board finds that appellant failed to establish that she developed bilateral hand and 

shoulder conditions in the performance of duty as a forklift operator. 

Appellant alleged that she developed bilateral hand tendinitis and a bilateral rotator cuff 

injury as a result of her federal employment duties. By letter dated January 26, 2015, OWCP 

advised her that additional factual and medical evidence was required to establish her claim. It 

requested appellant describe in detail the employment-related activities which she believed 

contributed to her condition, how often she performed the activities described, the length and 

period of the described activities. Appellant did not respond to this request. 

To establish a claim for compensation, the Board has held that an employee must submit 

a statement which identifies the factors of employment believed to have caused her condition and 

submit medical evidence to establish causal relation.7

Appellant has provided insufficient detail to establish that an occupational exposure 

occurred as alleged.8

 On her Form CA-2, she explained that her injuries were caused by her 

employment duties which entailed manual labor and constant mobilization, resulting in severely 

                                                             3 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

4 Michael E. Smith, 50 ECAB 313 (1999). 

5 Elaine Pendleton, supra note 3. 

6 See Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994). 

7 See Donald W. Wenzel, 56 ECAB 390 (2005). 

8 A.S., Docket No. 14-1983 (issued January 14, 2015). 
4

aggravated muscle tendons. The Board notes that appellant’s description of the occupational 

exposure is vague and fails to provide any detail regarding the actual employment duties to 

which she is attributing her injury. The only explanation provided pertaining to her employment 

duties was the generalized and vague statement noted on her Form CA-2. By failing to describe 

her employment duties and circumstances surrounding her alleged injury, appellant has not 

established that the occupational exposure occurred as alleged.9

Subsequent to the Form CA-2, the only evidence received was Dr. Grandrimo’s 

January 26, 2015 medical report. The Board notes that in his report Dr. Grandrimo described 

some of appellant’s employment duties. However, Dr. Grandrimo’s report lacks sufficient 

explanation to determine which specific employment duties appellant is attributing her injury to, 

how often she performed these tasks, the frequency and duration of each task, whether she had 

prior injuries, and any nonwork-related activities. Furthermore, it is unclear whether 

Dr. Grandrimo was attributing appellant’s bilateral shoulder injury to an incident having 

occurred in a single workday, as a result of lifting a heavy gate, or a result of an occupational 

injury produced by her work environment over a period longer than a single workday or shift.10

The Board finds that the evidence of record is insufficient to establish a claim as 

appellant failed to describe the specific employment factors alleged to have caused or 

contributed to her alleged hand and shoulder conditions. 

As appellant has not established the employment factors alleged to have caused her 

claimed conditions, it is not necessary to consider the medical evidence with respect to causal 

relationship.11 

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.605 and 10.607. 

CONCLUSION 

The Board finds that appellant did not establish that she developed bilateral hand and 

shoulder conditions causally related to factors of her federal employment. 

                                                             9 P.T., Docket No. 14-598 (issued August 5, 2014). 

10 A traumatic injury means 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). An occupational disease is defined 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). 

11 Supra note 8. 
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ORDER 

IT IS HEREBY ORDERED THAT the March 9, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: November 5, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board