United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

N.K., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Buffalo, NY, Employer 

__________________________________________ 

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Docket No. 15-1532 

Issued: March 11, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On July 8, 2015 appellant filed a timely appeal from a May 19, 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.2

 

ISSUE 

The issue is whether appellant met his burden of proof to establish that he developed a 

right shoulder condition causally related to factors of his federal employment. 

                                                             1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that, following the issuance of the May 19, 2015 OWCP decision, appellant submitted new 

evidence. The Board is precluded from reviewing evidence which was not before OWCP at the time it issued its 

final decision. See 20 C.F.R. § 501.2(c)(1). 
2

FACTUAL HISTORY 

On August 15, 2014 appellant, then a 43-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed a right shoulder condition as a result of 

delivering mail in the performance of duty. He indicated that he first became aware of the 

condition and its relation to his federal employment on August 4, 2014. In an August 15, 2014 

narrative statement, appellant indicated that he began to feel pain in his right shoulder on 

August 4, 2014 while delivering mail midway through his route between 11:00 a.m. and 1:00 

p.m. 

In an August 12, 2014 attending physician’s report (Form CA-20), Dr. Daniel Alexander, 

an orthopedic surgeon, diagnosed right shoulder rotator cuff osseous abnormality and right 

proximal biceps tendon pain secondary to tendinitis. He checked a box “yes” indicating his 

support for causal relationship, noting that the injury occurred while appellant was on duty. 

Dr. Alexander restricted appellant from lifting or carrying more than 10 pounds with the right 

arm. 

On August 26, 2014 Dr. Alexander released appellant to work without restrictions. 

In a September 15, 2014 letter, OWCP notified appellant of the deficiencies of his claim 

and afforded him 30 days to submit additional evidence and respond to its inquiries. 

Appellant submitted physical therapy notes dated August 14 through September 24, 2014 

and two narrative statements. In his narrative statement dated October 2, 2014, he indicated that 

he had been employed as a rural carrier for 23 years and his federal duties included sorting and 

delivering mail which required twisting, bending, lifting, and reaching with the right arm six to 

nine hours per day, five to six days per week. Appellant alleged that he sustained a right 

shoulder injury on May 12, 2004 while reaching to grab the handle of a mailbox and pulling it 

open. He alleged another right shoulder injury on April 17, 2007 while repeatedly reaching 

longer distances than usual to insert mail into mailboxes due to a snow storm. Appellant did not 

seek any medical treatment at either time, nor did he have any loss of work. He attached his two 

previously filed traumatic injury claims (Form CA-1) for the alleged right shoulder injuries dated 

May 12, 2004 and April 17, 2007. 

In an August 12, 2014 report, Dr. Alexander diagnosed right shoulder rotator cuff 

tendinitis with mild impingement and right proximal biceps tendon pain secondary to tendinitis 

and noted that appellant had right shoulder pain “for some time, for about eight days, 

progressively getting worse.” Appellant reported that he was working as a rural carrier on 

August 4, 2014 when he started to develop significant right shoulder pain and denied prior injury 

to the shoulder. Dr. Alexander found full passive and active motion to the bilateral shoulders 

with 5/5 strength. He found a positive Speed’s test, mildly positive Hawkins’ test on the right, a 

negative O’Brien’s test, and negative crossover. There was no tenderness about the right 

acromioclavicular (AC) joint and appellant had mild-to-moderate tenderness over the right 

proximal biceps tendon. X-rays of the right shoulder taken in the office that day showed no 

significant osseous abnormality. Dr. Alexander reported that appellant was “pain free.” On 

August 26, 2014 he found that appellant’s right shoulder impingement had improved and opined 

that he was capable of returning to work without restrictions. On October 7, 2014 appellant 
3

presented with no apparent distress and examination of the right shoulder revealed full active 

range of motion in forward elevation and abduction. Hawkins’ testing was negative and 

Dr. Alexander found that appellant was neurovascularly intact distally. 

By decision dated November 20, 2014, OWCP found that the medical evidence was 

insufficient to establish causal relationship between appellant’s right shoulder condition and 

factors of his federal employment. 

On February 10, 2015 appellant requested reconsideration and submitted physical therapy 

notes dated August 17 through October 1, 2014. He also submitted progress reports dated 

November 18, 2014 through March 24, 2015 from Dr. Alexander. On November 18, 2014 

Dr. Alexander reported that appellant had full 5/5 strength of his rotator cuff muscles bilaterally, 

a radial pulse of 2+ and equal bilaterally, and brisk capillary refill bilaterally. On December 30, 

2014 he opined that appellant’s right shoulder condition was causally related to the repetitive 

reaching that he did at his job. In his reports dated February 10 and March 24, 2015, 

Dr. Alexander found that examination of appellant’s right shoulder revealed mild tenderness to 

palpation over the AC joint and full range of motion, but with some discomfort and a positive 

Hawkins’ sign. He requested a magnetic resonance imaging scan of the right shoulder. 

By decision dated May 19, 2015, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3 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 period of FECA, and that an injury4

 was sustained in the performance of duty. These 

are the essential elements of each compensation claim, regardless of whether the claim is 

predicated upon a traumatic injury or an occupational disease.5

 

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

occupational disease, an employee must submit the following: (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

 

                                                             3 Supra note 1. 

4

 OWCP regulations define an occupational disease or illness 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). 

5 See O.W., Docket No. 09-2110 (issued April 22, 2010); Ellen L. Noble, 55 ECAB 530 (2004). 

6 See D.R., Docket No. 09-1723 (issued May 20, 2010). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); 

Ruby I. Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989). 
4

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical evidence. The opinion of the physician must 

be based on a complete factual and medical background of the employee, 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 employee.7 

ANALYSIS 

The Board finds that appellant has not met his burden of proof to establish that he 

developed a right shoulder condition causally related to factors of his federal employment. 

The medical evidence appellant submitted fails to establish that fact of his federal 

employment caused or aggravated his right shoulder condition. Appellant submitted a statement 

in which he identified the factors of employment that he believed caused the condition, including 

twisting, bending, lifting, and reaching with the right arm, which OWCP accepted as factual. 

However, to establish a claim that he sustained an employment-related injury, he must also 

submit rationalized medical evidence which explains how his medical condition was caused or 

aggravated by the implicated employment factors.8 

In an August 12, 2014 attending physician’s report, Dr. Alexander diagnosed right 

shoulder rotator cuff osseous abnormality and right proximal biceps tendon pain secondary to 

tendinitis. He checked a box marked “yes,” noting that the injury occurred while appellant was 

on duty. The Board has held that a physician’s opinion that consists of checking a box on a form 

report is of diminished probative value in establishing causal relationship.9 No rationale or 

explanation was provided by Dr. Alexander on the issue of causal relationship.10 

In another report also dated August 12, 2014, Dr. Alexander diagnosed right shoulder 

rotator cuff tendinitis with mild impingement and noted that appellant had right shoulder pain 

“for some time, for about eight days, progressively getting worse.” He found full passive and 

active motion to the bilateral shoulders with 5/5 strength. There was no tenderness about the 

right AC joint and appellant had mild-to-moderate tenderness over the right proximal biceps 

tendon. X-rays of the right shoulder taken in the office that day showed no significant osseous 

abnormality. Dr. Alexander reported that appellant was “pain free.” 

An October 7, 2014 examination of appellant’s right shoulder revealed full active range 

of motion in forward elevation and abduction. Hawkins’ testing was negative and Dr. Alexander 

found that appellant was neurovascularly intact distally. 

                                                             7 See O.W., supra note 5. 

8 See A.C., Docket No. 08-1453 (issued November 18, 2008). 

9 See Calvin E. King, 51 ECAB 394 (2000). 

10 See Sedi L. Graham, 57 ECAB 494 (2006). 
5

In reports dated February 10 and March 24, 2015, Dr. Alexander found that examination 

of appellant’s right shoulder revealed mild tenderness to palpation over the AC joint and full 

range of motion but with some discomfort and a positive Hawkins’ sign. On December 30, 2014 

he opined that appellant’s right shoulder condition was causally related to the repetitive reaching 

that he performed at his job. However, Dr. Alexander failed to provide a rationalized opinion 

explaining how factors of appellant’s federal employment, such as twisting, bending, lifting, and 

reaching with the right arm, caused or aggravated his right shoulder condition. He noted that 

appellant’s condition occurred while he was at work, but such generalized statements do not 

establish causal relationship because they merely repeat appellant’s allegations and are 

unsupported by adequate medical rationale explaining how his physical activity at work actually 

caused or aggravated the diagnosed conditions.11 The Board has held that the mere fact that 

appellant’s symptoms arise during a period of employment or produce symptoms revelatory of 

an underlying condition does not establish a causal relationship between his condition and his 

employment factors.12 Dr. Alexander failed to provide a rationalized opinion explaining how 

factors of appellant’s federal employment, such as twisting, bending, lifting, and reaching with 

the right arm, caused or aggravated his right shoulder condition. Thus, the Board finds that 

Dr. Alexander’s reports are insufficiently rationalized to establish that appellant’s condition was 

caused or aggravated by factors of his federal employment. 

In his October 2, 2014 narrative statement, appellant alleged that he sustained an 

employment-related right shoulder injury on May 12, 2004 while reaching out to grab the handle 

of a mailbox and pulling it open and another employment-related right shoulder injury on 

April 17, 2007 while repeatedly reaching longer distances to insert mail into mailboxes due to a 

snow storm. The Board finds, however, that OWCP has not previously accepted a right shoulder 

condition in appellant’s case. 

In support of his claim, appellant submitted physical therapy notes dated August 14 

through October 1, 2014. Physical therapists are not considered “physicians” under FECA.13 

This evidence thus does not constitute competent medical evidence as it does not contain 

rationale by a physician relating his disability to his employment. 

As appellant has not submitted any rationalized medical evidence to support his 

allegation that he sustained an injury causally related to the accepted employment factors, he 

failed to meet his burden of proof to establish a claim. 

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. 

                                                             11 See K.W., Docket No. 10-98 (issued September 10, 2010). 

12 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

13 See 5 U.S.C. § 8101(2). Section 8101(2) of FECA provides as follows: “(2) ‘physician’ includes surgeons, 

podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the 

scope of their practice as defined by State law.” See also Paul Foster, 56 ECAB 208, 212 n.12 (2004). 
6

CONCLUSION 

The Board finds that appellant has not met his burden of proof to establish that he 

developed a right shoulder condition in the performance of duty causally related to factors of his 

federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the May 19, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 11, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board