United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.R., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

IMMIGRATION & CUSTOMS 

ENFORCEMENT, Indianapolis, IN, Employer 

__________________________________________ 

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Docket No. 16-0411 

Issued: June 10, 2016 

Appearances: Case Submitted on the Record

Joseph E. Allman, 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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On January 5, 2016 appellant, through counsel, filed a timely appeal from a July 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 the case.2

ISSUE 

The issue is whether appellant has met his burden of proof to establish an injury causally 

related to a January 30, 2013 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that appellant submitted new evidence on appeal. However, the Board cannot consider this 

evidence as its review of the case is limited to the evidence of record which was before OWCP at the time of its final 

decision. 20 C.F.R. § 501.2(c)(1); see Steven S. Saleh, 55 ECAB 169 (2003). 
2 

FACTUAL HISTORY 

In the present case, appellant filed two similar traumatic injury claims (Forms CA-1). On 

January 30, 2013 appellant, then a 45-year-old deportation officer, completed a traumatic injury 

claim (Form CA-1) alleging that he sustained a left shoulder injury in the performance of duty on 

January 30, 2013 (OWCP File No xxxxxx119). He noted that he was using “breaching tools” 

while being instructed on breaching doors. On February 6, 2013 he completed another 

Form CA-1 also alleging that he sustained a left shoulder injury using breaching tools, but noting 

the date of injury as February 6, 2013 (OWCP File No. xxxxxx695). On June 26, 2015 OWCP 

administratively combined the two claims, with OWCP File No. xxxxxx119 as the master file. 

The evidence from the January 30, 2013 claim indicates that appellant submitted a report 

dated February 21, 2013 from Dr. Ripley Worman, a Board-certified orthopedic surgeon. 

Dr. Worman provided a history of February 6, 2013 employment incidents that included 

breaking down doors and manual contact activities. He indicated that radiographs performed 

that day showed prior surgical changes and osteoarthritic changes. Dr. Worman diagnosed left 

shoulder pain and left shoulder osteoarthritis. The record indicates that Dr. Worman performed 

left shoulder hemiarthroplasty surgery on March 8, 2013, with a diagnosis of left shoulder 

osteoarthritis. 

By letter dated March 13, 2013, OWCP requested that appellant submitted additional 

factual and medical evidence. It noted that he had claimed an injury on January 30, 2013, but 

Dr. Worman referred to a February 6, 2013 incident. On April 16, 2013 appellant submitted 

statements from two coworkers that he was involved in a training course that involved 

instruction of door breaching techniques and using tools such as sledge hammers and battering 

rams. The coworkers reported observing appellant on January 31, 2013.3

By decision dated April 24, 2013, OWCP denied the January 30, 2013 traumatic injury 

claim (OWCP File No. xxxxxx119), finding that the medical evidence of record was insufficient 

to establish the claim. 

As to the February 6, 2013 traumatic injury claim (OWCP File No. xxxxxx695), on 

April 15, 2013 appellant submitted the February 21, 2013 report from Dr. Worman. By letter 

dated May 3, 2013, OWCP requested that appellant submit additional information. It noted that 

it had previously advised appellant of confusion regarding the date of injury in the January 30, 

2013 claim. 

By decision dated July 29, 2013, OWCP denied the February 6, 2013 traumatic injury 

claim on February 6, 2013 (OWCP File No. xxxxxx695), finding that the medical evidence of 

record was insufficient to establish the claim. 

On August 27, 2013 appellant, through counsel, requested a hearing before an OWCP 

hearing representative of the July 29, 2013 OWCP decision, in OWCP File No. xxxxxx695. A 

hearing was held on February 13, 2014. At the hearing appellant’s counsel asserted that the date 

of injury was January 30, 2013, not February 6, 2013. He indicated that appellant had seen a 

 3

 One coworker reported that the training course occurred from January 28 to February 15, 2013. 
3 

physician on February 6, 2013 and was “advised to file another CA-1.” The hearing 

representative indicated that she believed the issue presented was for an injury on February 6, 

2013, and she had not reviewed evidence from the January 30, 2013 claim. The transcript of the 

hearing indicates that the hearing representative stated, “I guess we [will] consider -- can 

consider this as an appeal related to that causal denial in the original case.” 

By decision dated April 14, 2014, the hearing representative affirmed the July 29, 2013 

OWCP decision in OWCP File No. xxxxxx695. She indicated that the issue was whether 

appellant had established an injury on February 6, 2013. The hearing representative found that 

appellant should pursue any further action for an injury on January 30, 2013 under that claim. 

On April 13, 2015 OWCP received an April 10, 2015 request for reconsideration from 

appellant’s counsel that identified both OWCP case files. Counsel did not identify a specific 

decision but noted the date of injury as January 30, 2013. The medical evidence submitted 

included a March 23, 2014 report from Dr. Worman, who opined that appellant sustained a left 

shoulder injury on January 30, 2013. Dr. Worman reported that appellant had hit a door using 

his left shoulder, and appellant had significant pain in the left shoulder. He indicated that 

radiographs showed prior shoulder surgery with significant osteoarthritic changes, and appellant 

underwent left shoulder surgery on March 8, 2013. Dr. Worman opined that appellant sustained 

an injury on January 30, 2013 that caused further cartilage damage to the shoulder requiring 

surgery. He noted that appellant did have preexisting arthritic changes, but had been doing full 

duties until his new injury. Appellant also submitted additional treatment reports from 

Dr. Worman. In a report dated September 8, 2014, Dr. Worman indicated that appellant was 

doing well and needed no further orthopedic intervention. 

By decision dated July 9, 2015, OWCP found that appellant was entitled to a merit 

review of the April 24, 2013 OWCP decision in OWCP File No. xxxxxx119. It found that 

because the hearing representative had mentioned at the February 13, 2014 hearing that she 

could consider this as an appeal regarding the original case, appellant was entitled to a merit 

review with respect to a claim for a January 30, 2013 employment incident. OWCP, however, 

denied modification, finding that the medical evidence of record was insufficient “to alter the 

decision dated April 14, 2014 (April 24, 2013)” and denied modification. 

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.”4 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 and in the course of 

employment.”5

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

he or she sustained an injury while in the performance of duty.6

 In order to determine whether 

 4

 5 U.S.C. § 8102(a). 

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

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

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.7

 

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.8

 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.9 

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.10

ANALYSIS 

In the present case, appellant filed two traumatic injury claims with different dates of 

injury: January 30, 2013 and February 6, 2013. Both claims alleged the use of breaching tools 

and a left shoulder injury, and two claim numbers were created. OWCP issued a decision dated 

April 24, 2013, denying the January 30, 2013 claim. After receiving a July 29, 2013 decision 

denying the February 6, 2013 claim, appellant requested a hearing before an OWCP hearing 

representative. 

At the February 13, 2014 hearing, appellant reported there was only one date of injury, 

January 30, 2013. OWCP has administratively combined the two claim files, with OWCP File 

No. xxxxxx119 serving as the master file.11 Thus the issue before the Board is whether appellant 

has established a left shoulder injury casually related to the January 30, 2013 employment 

incident. 

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

8

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3(c) (January 2013). 

9 Id., Chapter 2.805.3(d) (January 2013). 

10 Jennifer Atkerson, 55 ECAB 317, 319 (2004). 

11 See T.M., Docket No. 14-1310 (January 2, 2014) (OWCP procedures contemplate that duplicate cases should 

not be created and development should not occur under the duplicate case). 
5 

The Board finds that the medical evidence of record is insufficient to establish an injury 

causally related to the January 30, 2013 employment incident. Dr. Worman had initially 

provided an incorrect date of injury in his February 21, 2013 report. In the March 23, 2014 

report, Dr. Worman provided a history of the January 30, 2013 incident. However, he did not 

provide a rationalized medical opinion on causal relationship between a diagnosed left shoulder 

condition and the January 30, 2013 employment incident. As Dr. Worman noted, appellant had a 

history of prior left shoulder surgery and osteoarthritic changes. The diagnosis provided was left 

shoulder osteoarthritis. Dr. Worman did not clearly explain what injury occurred from the 

incident and why he felt it contributed to the need for surgery on March 8, 2013. He referred 

briefly to cartilage damage without further explanation.12 Dr. Worman also noted that appellant 

was performing regular duties prior to the incident. Being asymptomatic prior to an incident, 

however, does not establish causal relationship. A medical opinion stating that a condition is 

causally related to an employment injury because the employee was asymptomatic before the 

injury but symptomatic after is insufficient, without supporting rationale, to establish causal 

relationship.13 

The Board accordingly finds that the medical evidence of record is insufficient to meet 

appellant’s burden of proof in this case. The record does not contain a medical report with a 

complete and accurate factual and medical history, and a rationalized opinion on causal 

relationship between a diagnosed condition and the January 30, 2013 employment incident. 

 On appeal, appellant’s counsel argues that the medical evidence from Dr. Worman was 

sufficient to require further development. For the reasons discussed above, the Board finds the 

medical evidence is of diminished probative value to the issue presented. 

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 an injury causally related to a 

January 30, 2013 employment incident. 

 12 A physician should describe the pathophysiologic mechanism whereby the employment incident would 

contribute to the diagnosed condition. See K.M., Docket No. 09-0003 (issued April 9, 2009). 

13 T.M., Docket No. 08-0975 (issued February 6, 2009); Cleopatra McDougal-Saddler, 47 ECAB 480 (1996). 
6 

ORDER 

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

Compensation Programs dated July 9, 2015 is affirmed. 

Issued: June 10, 2016 

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