United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.C., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Folsom, LA, Employer 

__________________________________________ 

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Docket No. 15-1012 

Issued: September 1, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On March 31, 2015 appellant, through counsel, filed a timely appeal from a February 18, 

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 sustained an 

occupational disease in the performance of duty. 

FACTUAL HISTORY 

On August 26, 2013 appellant, then a 32-year-old rural carrier, filed an occupational 

disease claim. She claimed that picking up tubs and trays of mail caused a strain. Appellant 

 1

 5 U.S.C. § 8101 et seq. 
2

advised that she became aware of her condition on May 21, 2013. She stopped work on 

August 26, 2013. 

By letter dated September 20, 2013, OWCP notified appellant that evidence was 

insufficient to establish the claim. Appellant was instructed to return a questionnaire establishing 

the factual element of her claim and advised of the type of medical evidence needed. 

In an August 26, 2013 statement, appellant’s postmaster advised that appellant informed 

him that she injured her right arm on May 21, 2013 while pulling, opening, and closing 

mailboxes. The statement noted that appellant did not earlier report this May 21, 2013 injury. 

However, she reported a May 18, 2013 injury where she shoved her shoulder into a lock door but 

declined to file a claim or seek medical attention. An attached May 20, 2013 statement from the 

postmaster advised that appellant informed him that she was injured when she hit her shoulder 

on a door at work on May 18, 2013. Appellant was asked if she wanted to file a claim and seek 

medical attention, but she declined. 

On August 26, 2013 appellant advised that on May 21, 2013 she began to feel pain in her 

right arm while pulling on mailboxes during her delivery route. She noted that the pain shot 

from her elbow to her shoulder and into her lower neck. Appellant stated that her physician told 

her to take a week off from work at that time. She related that initially she seemed fine and 

returned to work, but on August 22, 2013 her symptoms returned while picking up tubs and trays 

of mail. 

Medical evidence submitted included a May 21, 2013 report from Dr. Joseph Perdigao, a 

Board-certified diagnostic radiologist. He advised that a cervical spine x-ray revealed no acute 

fracture, dislocation, significant degenerative disc disease, or degenerative joint disease. 

Dr. Perdigao noted that there was minimal age-related posterior spondylosis in the cervical spine. 

Appellant also submitted a May 21, 2013 report signed by a family nurse practitioner. 

In an October 1, 2013 report, Dr. Herbert Reiss Plauche, a Board-certified orthopedic 

surgeon, advised that appellant sustained a work-related injury to her right elbow on 

May 21, 2013. He noted that appellant reached out to the right side, pulled on a mailbox door, 

and felt a pop in her elbow. Appellant returned to work and, after two or three days, had 

recurrent elbow pain. She tried to work the next several months but developed elbow soreness 

with some radiating numbness down the right forearm and into the hand. Appellant also had 

shoulder pain in the upper trapezial area which she attributed to change in activity level and 

alteration in her use. Dr. Plauche advised that appellant had been off work since August. On 

examination he found tenderness in the trapezial area and anterior elbow at the radial head, no 

palpable spasm, full cervical flexion and extension, mild diminished sensibility in the median 

and ulnar distribution, and minimal Tinel’s at both the elbow medially and at the carpal canal. 

Dr. Plauche assessed right elbow pain with some numbness in the fingertips. He opined that the 

shoulder symptoms were likely muscular in nature and related to appellant’s modification of 

work activities and home duties. 

By decision dated October 25, 2013, OWCP denied the claim because medical evidence 

did not establish that a condition was diagnosed in connection with the alleged work events. 
3

Appellant’s counsel requested an oral telephone hearing which took place on 

May 19, 2014. He detailed the medical evidence submitted and reiterated that appellant’s 

physician opined that her condition was work related. 

Prior to the hearing, appellant submitted additional medical evidence. On November 12, 

2013 Dr. Plauche advised that appellant complained of pain in the elbow radiating up to the 

upper arm, shoulder, and neck down to the hand. He noted that she attributed her symptoms to 

repetition and overuse of the right arm and that she had been off work since August 2013. 

Dr. Plauche advised that appellant sorted and delivered mail and that on one occasion she 

reached out to open a mailbox and pulled a stuck door resulting in a sharp pain in the posterior 

elbow. On examination he found posterior and medial elbow tenderness, good cervical range of 

motion, tenderness along the left lateral neck, no gross paraspinous spasm, negative Spurling’s 

test, and no full elbow and shoulder motion. Dr. Plauche assessed right posterior olecranon 

tenderness, medial elbow tenderness, and pain with radiation discomfort in the upper lower arm. 

He recommended that appellant undergo a course of occupational therapy. 

In a November 6, 2013 report, Dr. Paul Mclean Jackson, a Board-certified diagnostic 

radiologist, advised that the magnetic resonance imagining (MRI) scan of the right elbow 

revealed mild tendinosis of the common extensor tendon origin at the lateral epicondyle. He also 

noted that appellant had a suspected small accessory muscle within the posterior aspect of the 

cubital tunnel which could result in impingement of the descending ulnar nerve. In a 

November 6, 2013 report, Dr. Jigar Patel, Board certified in diagnostic radiology, advised that a 

right shoulder MRI scan revealed no acute abnormality and mild early acromioclavicular joint 

degenerative changes. 

In a January 29, 2014 disability status report, Dr. Plauche advised that appellant was 

unable to return to work for the next 30 days. In a February 18, 2014 report, he advised that she 

had an overuse work-related injury on August 22, 2013 and reiterated the findings of earlier 

diagnostic testing. Dr. Plauche noted that appellant was being treated with physical therapy and 

recommended a functional capacity evaluation to find a more appropriate line of work as 

appellant believed her repetitive duties contributed to her condition. 

In a January 30, 2014 report, Dr. Jackson advised that a cervical spine MRI scan revealed 

slight straightening and kyphotic curvature of the cervical spinal column, shallow central 

subligamentous disc protrusion at C6-7, no significant spinal canal narrowing, foraminal 

narrowing, nerve root contact, or impingement at any level. 

Appellant submitted a March 13, 2014 functional capacity evaluation from a physical 

therapist who indicated that she could work full-time work in a light-duty capacity. 

By decision dated July 8, 2014, the hearing representative affirmed the October 25, 2013 

decision because the medical evidence was not sufficient to establish that elbow tendinosis, right 

shoulder degenerative changes, and cervical disc protrusion was caused by work factors. 

In an August 14, 2014 report, Dr. Plauche advised that appellant related that she had an 

over-use injury in May 2013 and was later reinjured in August 2013. He stated that he did not 

have any evidence to dispute her claim that her symptoms developed through her repetitive use 
4

at work and opined that her symptoms were likely due to the type of work she did. Dr. Plauche 

noted that appellant’s position included a lot of repetitive lifting. He advised that his report was 

in support of appellant obtaining workers’ compensation benefits so that she could obtain 

medical treatment and return to her previous position or to receive vocational training to obtain 

another position. 

By letter dated October 1, 2014, appellant, through counsel, requested reconsideration. 

Dr. Scott Sondes, a Board-certified physiatrist, on August 18, 2014, advised that 

appellant was injured in May 2013 while lifting bins at work and later reinjured in August 2013. 

On examination he noted trigger point palpation in the splenius cervicis and positive Spurling’s 

test. Dr. Sondes assessed cervical herniated nucleus pulposus, cervical radiculopathy, 

cervicalgia, neuropathy, neuralgia, and spinal enthesopathy. In a September 22, 2014 disability 

status report, he noted treating appellant for cervical radiculopathy and advised that she was 

unable to return to work. On October 13, 2014 Dr. Sondes advised that appellant continued to 

complain of headaches, severe neck and shoulder spasms, and pain in the right arm. He noted 

that she underwent trigger point injections to help with her symptoms. Dr. Sondes opined that 

given her job and injury, her condition appeared to be work related beyond reasonable medical 

certainty. 

In a November 12, 2014 report, Dr. Sondes advised that appellant complained of neck 

pain as a result of lifting bins full of mail in May 2013. He reiterated her treatment history and 

opined that given the nature of her injury and symptoms, her condition was caused and worsened 

by work-related duties beyond a reasonable degree of medical certainty. Dr. Sondes stated that 

he had no doubt in his mind of this causation. 

By decision dated February 18, 2015, OWCP denied modification of its July 8, 2014 

decision. 

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 Elaine Pendleton, 40 ECAB 1143 (1989). 

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

 

ANALYSIS 

Appellant claimed that she began experiencing right elbow and shoulder pain as a result 

of pulling on mailboxes and picking up tubs and trays of mail. There is no dispute that she 

opened and closed mailboxes and lifted mail as a part of her job. However, the Board finds that 

medical evidence of record is insufficient to establish that the medical conditions were causally 

related to the accepted work events. 

In his October 1, 2013 report, Dr. Plauche advised that appellant sustained a work-related 

injury to her right elbow on May 21, 2013 when she pulled on a mailbox door, and felt a pop in 

her elbow. He opined that the shoulder symptoms were likely muscular in nature and related to 

appellant’s modification of work activities. This report is insufficient to discharge appellant’s 

burden of proof because Dr. Plauche did not clearly explain why particular work duties caused or 

contributed to a diagnosed condition. On November 12, 2013 Dr. Plauche noted that appellant 

attributed her symptoms to repetition and overuse of the right arm. He advised that she sorted 

and delivered mail and that on one occasion she reached out to open a mailbox and pulled a stuck 

door resulting in a sharp pain in the posterior elbow. Dr. Plauche stated that appellant attributed 

her condition to repetition and overuse of the arm but he did not offer his own opinion as to the 

cause of her condition. 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 February 18, 2014 report, 

Dr. Plauche advised that appellant had an overuse work-related injury on August 22, 2013. He 

opined that her symptoms were likely due to the type of work she did and noted that her position 

included a lot of repetitive lifting. Dr. Plauche’s use of the word “likely” makes his opinion 

speculative. The Board has held that medical opinions which are speculative or equivocal are of 

 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). 

7 C.M., Docket No. 14-88 (issued April 18, 2014). 
6

diminished probative value.8 In none of his reports did Dr. Plauche provide medical reasoning to 

explain how particular work factors caused or contributed to a diagnosed medical condition. 

These reports are insufficient to establish appellant’s claim. 

In his November 12, 2014 report, Dr. Sondes advised that appellant complained of neck 

pain as a result of lifting bins full of mail in May 2013. He opined that given the nature of her 

injury and symptoms, appellant’s condition was caused and worsened by her work-related duties 

beyond a reasonable degree of medical certainty. Dr. Sondes stated that he had no doubt in his 

mind of this causation. This report is insufficient to discharge appellant’s burden of proof 

because Dr. Sondes does not provide medical rationale to explain how lifting mail caused or 

aggravated appellant’s cervical herniated nucleus pulposus, cervical radiculopathy, cervicalgia, 

neuropathy, neuralgia, and spinal enthesopathy. Dr. Sondes’ August 18, 2014 report advised that 

appellant was injured in May 2013 while lifting bins at work and later reinjured in August 2013. 

On October 13, 2014, Dr. Sondes noted appellant’s continuing symptoms and opined that given 

her job and injury, her condition appeared to be work related beyond reasonable medical 

certainty. These reports are of limited probative value as Dr. Sondes does not provide medical 

rationale to explain his opinion on causation. 

Multiple diagnostic and disability status reports were submitted. However, they are 

insufficient to discharge appellant’s burden of proof as they do not offer a physician’s opinion on 

causal relationship.9

OWCP also received evidence from a nurse practitioner and a physical therapist. 

However, physical therapists and nurse practitioners are not physicians as defined under the 

FECA.10 Thus, these reports have no probative medical value and are insufficient to discharge 

appellant’s burden of proof. 

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.11 The physician must accurately describe appellant’s work 

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

 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). 

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 A.C., Docket No. 08-1453 (issued November 18, 2008). Under FECA, a “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. § 8101(2). See Charley V.B. Harley, 2 ECAB 208, 211 

(1949) (where the Board held that medical opinion, in general, can only be given by a qualified physician). 

11 See supra note 5. 
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caused or aggravated his condition.12 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. 

ORDER 

IT IS HEREBY ORDERED THAT the February 18, 2015 decision of Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 1, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 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 S.T., Docket No. 

11-237 (issued September 9, 2011).