United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.R., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Tucson, AZ, Employer 

__________________________________________ 

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Docket No. 16-1901 

Issued: April 17, 2017 

Appearances: Case Submitted on the Record

Johnny Gallego, for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On September 27, 2016 appellant, through his representative, filed a timely appeal from a 

May 16, 2016 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

Pursuant to the Federal Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 

501.3, the Board has jurisdiction to consider the merits of this case. 

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 
2

ISSUE 

The issue is whether appellant has established a left shoulder condition causally related to 

the accepted March 27, 2013 employment incident. 

FACTUAL HISTORY 

On July 30, 2013 appellant, then a 53-year-old housekeeping aid, filed a traumatic injury 

claim (Form CA-1) alleging that on March 27, 2013 he sustained a left shoulder condition when 

he fell against the wall after stepping on a stack of loose floor tiles. 

In support of his claim, appellant submitted a March 27, 2013 employing establishment 

health clinic note from Dr. Sonia M. Perez-Padilla, a Board-certified internist. He reported that 

at 6:35 a.m. that morning he had walked into his supply closet, there were some loose tiles on the 

floor, his foot slipped on the tiles, and he fell back hitting his left posterior shoulder on the wall. 

Appellant noted pain and stiffness in the shoulder with tingling into the left hand. Physical 

examination findings included normal, active range of motion of the left shoulder with some 

crepitus. Discomfort with palpation of the posterior left shoulder was noted which did not impact 

the cervical or thoracic vertebral area. Dr. Perez-Padilla diagnosed left shoulder contusion/strain 

and released appellant to full duty. 

In a July 25, 2013 note, Dr. William F. Rees, a Board-certified internist, indicated that 

appellant’s left shoulder, left ankle, and left knee pain were improving. He noted that appellant 

injured himself one to two months ago at work. Dr. Rees diagnosed left shoulder pain, suspect 

rotator cuff tear, ankle pain, improving left knee pain, hypertension, and post-traumatic stress 

disorder. Appellant also submitted a July 30, 2013 x-ray that was interpreted by Dr. Jennifer H. 

Alcala, a Board-certified radiologist, as lucency through the greater tuberosity, which could 

reflect an acute fracture site without significant displacement. 

By letter dated August 6, 2013, OWCP informed appellant that further evidence, 

including medical evidence, was needed to support his claim. Appellant was afforded 30 days to 

submit this evidence. 

By letter dated September 13, 2013, the employing establishment controverted the claim. 

In a decision dated September 16, 2013, OWCP denied appellant’s claim finding that the 

evidence of record was insufficient to establish that the incident occurred as alleged. 

On June 17, 2014 appellant requested reconsideration. In his request, he further 

described the employment incident and discussed his medical treatment. Appellant noted that 

after the incident he took ibuprofen and his pain decreased, but would not go away. He noted 

that he tried to use his left arm less, but that he would have pain in his left shoulder and would 

put ice on his shoulder every night. Appellant noted that he continued to work and on 

August 28, 2013 his work requirements were modified because of the pain he had in his left 

shoulder. He noted that he was given a light-duty limitation for lifting with the left arm. 

Appellant discussed the medical opinions and argued that they clearly established a causal 

relationship between his left shoulder injury and the employment incident. 
3

On June 17, 2014 OWCP received additional medical evidence. 

In an August 28, 2013 note, Nurse Barbara A. Bridges indicated that appellant should not 

lift over 15 pounds, or push and pull anything over 20 pounds until seen and evaluated by an 

orthopedist. 

In an August 29, 2013 report, a physician assistant ordered no heavy lifting with 

appellant’s left arm for six weeks. 

In a March 3, 2014 MRI scan report, Dr. Shahin S. Amanat, a Board-certified radiologist, 

found high grade partial thickness tear, versus small full-thickness tear, of the anterior fibers of 

the supraspinatus tendon approximately two centimeters from the insertion with at least bursal 

and articular-sided elements to the tear, possible post-traumatic avulsion fragments or osteophyte 

formation off the humeral head related to the anterior tear of the supraspinatus tendon, and 

biceps tenosynovitis. 

In support of his reconsideration request, appellant also submitted March 20, 2014 

handwritten notes from Dr. Patrick O’Brien, an orthopedic surgeon at the Southern Arizona 

Veterans Administration Health Care System. Dr. O’Brien noted that appellant fell at work one 

year ago and injured his shoulder, that a magnetic resonance imaging (MRI) scan revealed a left 

rotator cuff tear, and that appellant would need surgery to repair the tendon. He noted that 

appellant’s history of injury was consistent with this condition. Dr. O’Brien indicated that 

appellant would need to be off work for three months. 

In a September 15, 2014 decision, OWCP reviewed appellant’s claim on the merits. It 

determined that he had now established that the incident occurred as alleged and that he had a 

left rotator cuff tear. However, OWCP found that the claim remained denied as appellant had 

failed to provide sufficient evidence with regard to a causal relationship between the rotator cuff 

tear and the accepted incident of employment. 

On April 24, 2015 appellant requested reconsideration. In support of his request, 

appellant submitted a March 9, 2015 note from Dr. O’Brien which related that appellant suffered 

a fall at work two years prior when he slipped on loose tiles in his maintenance closet. 

Dr. O’Brien noted that appellant never had shoulder pain before the fall and that after that fall he 

sought help at the employee health unit. He noted that appellant has had various treatments since 

that time, but his pain had persisted, and that he recently had a left shoulder MRI scan 

confirming a rotator cuff tear. Dr. O’Brien indicated that appellant’s mechanism of injury was 

consistent with his complaints and his physical findings. He noted that appellant would need 

surgery to correct the damage. Dr. O’Brien related that there was no question in his mind that 

the fall caused the injury. 

On April 24, 2015 Kelley S. Ireland, a program manager for workers’ compensation at 

the employing establishment, noted that there was no possibility of knowing whether this injury 

happened in the performance of duty given the amount of time it took appellant to address it 

medically. The employing establishment contended that appellant alleged that the fall occurred 

on March 27, 2013, but he waited until July 30, 2013 to file his claim. 
4

By an appeal request form received on February 11, 2016, appellant again requested 

reconsideration. 

By letter dated April 15, 2016, OWCP referred appellant to Dr. John R. Klein, a Boardcertified orthopedic surgeon, for a second opinion. Appellant did not keep this appointment. 

By decision dated May 16, 2016, OWCP denied appellant’s claim. It determined that he 

had not established a causal relationship between the rotator cuff tear and the accepted 

employment incident. OWCP found that the diagnosis at the time of the employment incident 

was not that of rotator cuff tear. It noted that appellant did not seek treatment for four months, 

there was no interval history provided by the physician between his diagnosis and the date of the 

employment incident, and there was no explanation of any pathophysiologic changes because of 

the fall. OWCP also noted that appellant failed to report for his second opinion examination. 

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 of FECA, that an injury was sustained in the performance of duty as 

alleged, and that any disability and/or specific condition for which compensation is claimed are 

causally related to the employment injury. 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

 

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 or exposure, which is alleged to have occurred.4 

In order to meet his burden of proof to establish the fact that he sustained an injury in the 

performance of duty, the employee must submit sufficient evidence to establish that he actually 

experienced the employment injury or exposure at the time, place, and in the manner alleged.5

The second component is whether the employment incident caused a personal injury and 

generally can be established only by medical evidence.6

 The medical evidence required to 

establish causal relationship is usually rationalized medical evidence. Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on the 

issue of whether there is a causal relationship between the claimant’s diagnosed condition and 

the implicated employment factors. The opinion of the physician must be based on a complete 

 3 Jussara L. Arcanjo, 55 ECAB 281, 283 (2004). 

4 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of Injury, Chapter 2.803(2)(a) (August 2012). 

5 Linda S. Jackson, 49 ECAB 486 (1998). 

6 John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978). 
5

factual and medical background of the claimant, 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.7

ANALYSIS 

OWCP accepted that the employment incident of March 27, 2013 occurred as alleged. It 

further accepted that appellant was diagnosed with a rotator cuff tear. However, OWCP denied 

his claim as he failed to establish a causal relationship between the accepted employment 

incident and the accepted medical diagnosis. 

The Board finds that appellant has not established a left shoulder condition causally 

related to the accepted March 27, 2013 employment incident. 

Appellant was seen on the date of injury by Dr. Perez-Padilla at the employing 

establishment health unit. The health unit notes provide an accurate history of the employment 

incident. However physical examination findings were related as normal and appellant’s 

diagnosis was listed as left shoulder contusion/strain. No opinion was provided regarding causal 

relationship. The Board has held that medical reports are of limited probative value if they do 

not provide an opinion regarding causal relationship.8

The July 25, 2013 report of Dr. Rees is the first medical report in the record indicating 

that appellant sought further medical treatment. Dr. Rees suspected a rotator cuff tear at the 

time, but did not provide a rationalized medical opinion explaining how the March 27, 2013 

employment incident resulted in the suspected tear. Medical conclusions unsupported by 

rationale are of little probative value.9 Furthermore, Dr. Rees noted that appellant had left 

shoulder pain for one to two months, but the fall had occurred four months prior to the July 25, 

2013 appointment. He did not provide a clear opinion on causal relationship and thus his report 

is of little probative value. 

Appellant contended that the report of Dr. O’Brien established that his fall at work on 

March 27, 2013 caused his injury. However, Dr. O’Brien’s brief note does not establish causal 

relationship. He indicated that appellant was his patient, that he suffered a fall at work two years 

prior when he slipped on loose tiles, that he never had shoulder pain prior to that incident, and 

that he sought help at employee health on the day of the fall. Dr. O’Brien noted that, despite 

various treatments since that time, appellant’s pain persisted, and a recent MRI scan showed a 

rotator cuff tear. He concluded that appellant’s mechanism of injury was consistent with his 

complaints and his physical findings. Dr. O’Brien, however, did not explain how the mechanism 

of injury would have physiologically caused the diagnosed condition.10 While Dr. O’Brien 

opined that there was no question in his mind that the fall caused the injury, his report did not 

 7 Judith A. Peot, 46 ECAB 1036 (1995); Ruby I. Fish, 46 ECAB 276 (1994). 

8 G.M., Docket No. 14-2057 (issued May 12, 2015). 

9

 D.B., Docket No. 14-295 (issued April 25, 2014); see also Willa M. Frazier, 55 ECAB 379, 384 (2004). 

10 Id. 
6

contain sufficient rationale.11 Dr. O’Brien’s report is not sufficient to establish causal 

relationship. The opinion of a physician supporting causal relationship must rest on a complete 

factual and medical background supported by affirmative evidence, address the specific factual 

and medical evidence of record, and provide medical rationale explaining the relationship 

between the diagnosed condition and the established incident or factor of employment.12 

Dr. O’Brien contends that appellant did not have shoulder pain before the fall, and noted that he 

sought medical treatment from the employee health unit. The Board has held that a medical 

opinion that a condition is causally related to an employment injury, but symptomatic after it is 

insufficient, without supporting rationale to establish causal relationship.13 The notation of a 

rotator cuff tear first appeared in Dr. O’Brien’s handwritten notations on March 20, 2014, one 

year after the March 27, 2013 fall. There is no indication that Dr. O’Brien treated appellant 

during that year,14 nor did Dr. O’Brien explain why the tear was not diagnosed earlier. 

Neither of the radiologists who reviewed the diagnostic test results discussed causal 

relationship. Dr. Alcala interpreted a July 30, 2013 x-ray as showing lucency through the great 

tuberosity which could reflect an acute fracture cite without displacement. Dr. Amanat did find a 

high grade partial thickness tear of the anterior fibers of the supraspinatus tendon in an x-ray 

dated March 3, 2014. However, these reports are of limited probative value as neither radiologist 

provided an opinion on causal relationship.15 

Appellant submitted notes by a physician assistant and from a nurse. Evidence from a 

physician assistant or nurse does not constitute competent medical evidence under FECA as 

neither is considered as a physician as defined under section 8102(2) of FECA.16

The Board notes that OWCP attempted to further develop the medical evidence by 

referring appellant to Dr. Klein for a second opinion. However, appellant did not attend that 

examination. 

An award of compensation may not be based on surmise, conjecture, speculation, or on 

the employee’s own belief of causal relation.17 Appellant’s honest belief that the March 27, 

 11 Supra note 8. 

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

13 E.D., Docket No. 16-1854 (issued March 3, 2017); Cleopatra McDougal-Saddler, 47 ECAB 480 (1996). 

14 Supra note 8. 

15 G.M., Docket No. 14-2057 (issued May 12, 2015). 

16 5 U.S.C. § 8101(2) provides that a physician includes, surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

V.C., Docket No. 16-0642 (issued April 19, 2016); L.C., Docket No. 16-1717 (issued March 2, 2017) (nurses); 

Allen C. Hundley, 53 ECAB 551, 554 (2002) (physician assistant). David P. Sawchuk, 57 ECAB 316, 320 

n.11 (2006). 

17 D.D., 57 ECAB 734 (2006). 
7

2013 employment incident caused his medical injury is not in question, but that belief, however 

sincerely held, does not constitute the medical evidence to establish causal relationship.18

Appellant has therefore failed to establish that his rotator cuff tear was related to his 

accepted employment incident. Because he has not provided a rationalized opinion supporting 

causal relationship, he has not met his burden of proof.19

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 a left shoulder condition causally 

related to the accepted March 27, 2013 employment incident. 

ORDER 

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

Compensation Programs dated May 16, 2016 is affirmed. 

Issued: April 17, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 18 H.H., Docket No. 16-0897 (issued September 21, 2016). 

19 See J.E., Docket No. 16-0509 (issued September 16, 2016).