United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.M., Appellant 

and 

U.S. POSTAL SERVICE, AIRPORT STATION, 

Mobile, AL, Employer 

__________________________________________ 

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Docket No. 16-0548 

Issued: June 10, 2016 

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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On February 3, 2016 appellant, through counsel, filed a timely appeal from a 

November 4, 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 has met her burden of proof to establish a bilateral elbow 

injury causally related to factors of her federal employment. 

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

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

This case has previously been before the Board.2 In a November 7, 2014 decision, the 

Board affirmed a June 12, 2013 OWCP decision, finding that appellant did not meet her burden 

of proof to establish a bilateral elbow injury causally related to factors of her federal 

employment. The Board found that she had established that while working as a rural mail carrier 

her route included business stops and became an overburdened route with the addition of new 

apartment buildings. The Board further found that her work duties required standing, walking, 

heavy carrying, climbing, pushing, pulling, repeated bending, shoulder level reaching, use of 

both arms, and operating a motor vehicle. The Board found, however, that the clinic and 

progress notes of record from Dr. William A. Crotwell, III, appellant’s attending Board-certified 

orthopedic surgeon, did not provide a rationalized medical opinion to support his opinion that 

appellant sustained employment-related bilateral conditions. The facts and circumstances 

surrounding the prior appeal are incorporated by reference. The relevant facts are set forth 

below. 

On September 11, 2012 appellant, then a 59-year-old rural mail carrier, filed an 

occupational disease claim (Form CA-2) under OWCP File No. xxxxxx851 alleging that in 

June 2011 she first became aware of medial epicondylitis of the right and left elbows caused by 

her repetitive work duties.3 

Following issuance of the Board’s November 7, 2014 decision, appellant, through 

counsel, by letter dated October 22, 2015, requested reconsideration before OWCP. She 

submitted a September 29, 2015 progress note from Dr. Crotwell who reiterated his prior opinion 

that she had a work-related bilateral elbow condition. Dr. Crotwell also opined that appellant 

had an employment-related left shoulder condition. He diagnosed bilateral lateral epicondylitis 

post Boyd-McLeod procedure, chronic left medial epicondylitis, postoperative left shoulder 

labrum tear and debridement of the rotator cuff, postoperative left shoulder resection distal end 

of the clavicle for severe acromioclavicular joint arthritis, and postimpingement syndrome of the 

left shoulder. Dr. Crotwell advised that his diagnoses were supported by his examination 

findings and consistent with the repetitive work duties gathered from appellant and her 

December 30, 2002 employment-related left elbow injury. 

Hospital reports from Dr. Jonathan C. Rainer, a Board-certified physiatrist, and South 

Baldwin Regional Medical Center dated February 13 and April 27 and 30, 2015 addressed 

appellant’s back conditions and medical treatment. 

In a November 4, 2015 decision, OWCP denied modification of its denial of appellant’s 

claim for an occupational disease. It found that the medical evidence submitted was insufficient 

to establish that she sustained an injury caused or aggravated by the established employment 

factors. 

 2

 Docket No. 14-363 (issued November 7, 2014). 

3

 In a prior claim under OWCP File No. xxxxxx698, OWCP accepted that she sustained a left elbow contusion 

and lateral epicondylitis on December 30, 2002. In another prior claim under OWCP File No. xxxxxx39l, it 

accepted that appellant sustained right lateral epicondylitis on October 6, 2004. 
3

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof 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 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 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 medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.8 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.9

ANALYSIS 

The Board previously found that appellant had established that she was a federal 

employee and had implicated factors of employment, repetitive work duties, but had failed to 

establish that her diagnosed bilateral elbow conditions were causally related to the employment 

factors. Appellant requested reconsideration and OWCP denied modification of its prior 

decision. 

 4 Elaine Pendleton, 40 ECAB 1143 (1989). 

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

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

7 R.R., Docket No. 08-2010 (issued April 3, 2009); Roy L. Humphrey, 57 ECAB 238, 241 (2005). 

8 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006). 

9 I.J., 59 ECAB 408 (2008); supra note 5. 
4

The Board finds that appellant has failed to submit the necessary rationalized medical 

opinion evidence to establish that her diagnosed conditions were caused or aggravated by her 

repetitive work duties. Appellant submitted an additional progress note from Dr. Crotwell dated 

September 29, 2015. Dr. Crotwell again opined that she had a work-related bilateral elbow 

condition. He also opined that appellant had an employment-related left shoulder condition. 

Dr. Crotwell noted that her bilateral elbow and left shoulder diagnoses were supported by his 

examination findings and consistent with the repetitive work duties he gathered from her and the 

accepted December 30, 2002 employment-related injury. While he provided an opinion on 

causal relationship, he did not sufficiently explain how the diagnosed conditions were caused or 

aggravated by the established employment factors. Medical reports without adequate rationale 

on causal relationship are of diminished probative value and are insufficient to meet an 

employee’s burden of proof.10 The opinion of a physician supporting causal relationship must be 

based on a complete factual and medical background with affirmative evidence. The opinion 

must address the specific factual and medical evidence of record and explain the relationship 

between the diagnosed condition and the established incident or factor of employment.11 The 

Board finds that Dr. Crotwell’s progress note is insufficient to establish appellant’s claim. 

The hospital reports from Dr. Rainer and South Baldwin Regional Medical Center 

addressed appellant’s back conditions and medical treatment, but did not provide any medical 

opinion finding that the diagnosed back conditions were caused or aggravated by the accepted 

work factors. Medical evidence which does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value.12 

On appeal, counsel contends that OWCP’s November 4, 2015 decision is contrary to fact 

and law. Based on the findings and reasons stated above, the Board finds that counsel’s 

arguments are not substantiated. 

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 failed to meet her burden of proof to establish a 

bilateral elbow injury causally related to factors of her federal employment. 

 10 Ceferino L. Gonzales, 32 ECAB 1591 (1981). 

11 See Lee R. Haywood, 48 ECAB 145 (1996). 

12 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Jaja K. Asaramo, 55 ECAB 200 (2004); 

Michael E. Smith, 50 ECAB 313 (1999). 
5

ORDER 

IT IS HEREBY ORDERED THAT the November 4, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: June 10, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board