United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

V.W., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Martinez, CA, Employer 

__________________________________________ 

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Docket No. 16-1444 

Issued: March 14, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On July 5, 2016 appellant filed a timely appeal from a May 23, 2016 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 her burden of proof to establish that her left upper 

extremity conditions are causally related to a March 22, 2016 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that appellant submitted additional evidence on appeal and to OWCP after the May 23, 2016 

decision was issued. The Board’s jurisdiction is limited to reviewing the evidence that was before OWCP at the 

time of its final decision. Therefore, the Board lacks jurisdiction to review this additional evidence. 20 C.F.R. 

§ 501.2(c)(1). 
2

On appeal appellant contends that she is still experiencing limitations, has a pain score of 

6 out of 10, which increases to 10 intermittently, and needs continued support to help access 

medical appointments. She further contends that supporting documentation, including doctor’s 

reports, were not submitted fully or on time on her behalf. 

FACTUAL HISTORY 

On March 29, 2016 appellant, a 52-year-old nursing assistant, filed a traumatic injury 

claim (Form CA-1), alleging that she sustained an injury to her left arm on March 22, 2016 as a 

result of demonstrating use of new slings for patient use. She stated that she was demonstrating 

with another nursing assistant when she gripped a patient transfer sheet to pull the patient up and 

strained her arm. Appellant did not stop work. The employing establishment controverted the 

claim as appellant had not established fact of injury. 

In a March 23, 2016 report, Dr. Rudolf Iskandar, a Board-certified physiatrist, diagnosed 

left shoulder strain, left elbow strain, left wrist strain, left hand and finger strain, neck strain, and 

mononeuritis of left upper extremity. In a work status report dated March 23, 2016, he released 

appellant to modified duty that day. On March 29, 2016 Dr. Iskandar asserted that appellant was 

injured at work on March 22, 2016 while lifting and using a patient repositioning system which 

aggravated left arm pain symptoms. Appellant complained of pain in the left arm, left hand, left 

wrist, and left elbow areas with numbness and tingling sensations mostly in the left hand and 

some pain radiating up to the neck, left shoulder, and left trapezius muscle areas. Dr. Iskandar 

noted that appellant had a past work injury on December 16, 2014 when a patient grabbed her 

left wrist and twisted her left arm while trying to pull away, straining her neck, left shoulder, 

upper arm, left elbow, left forearm, and left wrist areas. In a March 29, 2016 work status report, 

he released appellant to modified duty that day. 

Appellant submitted physical therapy reports dated March 30, 2016 in support of her 

claim. 

In an April 21, 2016 letter, OWCP advised appellant of the deficiencies of her claim and 

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

In response, appellant submitted a work status report dated April 8, 2016 from 

Dr. Iskandar who released her to modified duty that day. She further submitted a prescription 

from Dr. Iskandar also dated April 8, 2016. 

By decision dated May 23, 2016, OWCP accepted the incident, but denied the claim as 

the medical evidence was insufficient to establish a causal relationship between appellant’s 

diagnosed conditions and the accepted March 22, 2016 employment incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof in establishing 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 
3

applicable time limitation period of FECA, that an injury3

 was sustained in the performance of 

duty, as alleged, and that any disability or medical condition for which compensation is claimed 

is causally related to the employment injury.4

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it must first be determined whether a “fact of injury” has been established. 

A fact of injury determination is based on two elements. First, the employee must submit 

sufficient evidence to establish that she actually experienced the employment incident at the 

time, place, and in the manner alleged. Second, the employee must submit sufficient evidence, 

generally only in the form of medical evidence, to establish that the employment incident caused 

a personal injury. An employee may establish that the employment incident occurred as alleged, 

but fail to show that his or her condition relates to the employment incident.5

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

establish causal relationship is rationalized medical opinion 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.6

ANALYSIS 

OWCP has accepted that the employment incident of March 22, 2016 occurred at the 

time, place, and in the manner alleged. The issue is whether appellant’s left upper extremity 

conditions resulted from the March 22, 2016 employment incident. The Board finds that 

appellant failed to meet her burden of proof to establish a causal relationship between the 

conditions for which compensation is claimed and the accepted employment incident. 

In his reports, Dr. Iskandar diagnosed left shoulder strain, left elbow strain, left wrist 

strain, left hand and finger strain, neck strain, and mononeuritis of left upper extremity. In a 

March 29, 2016 report, he asserted that appellant was injured at work on March 22, 2016 while 

lifting and using a patient repositioning system which aggravated her left arm pain symptoms. 

Dr. Iskandar noted that appellant had a past work injury on December 16, 2014 when a patient 

grabbed her left wrist and twisted her left arm while trying to pull away, straining her neck, left 

shoulder, upper arm, left elbow, left forearm, and left wrist areas. The Board finds that 

Dr. Iskandar failed to provide sufficient medical rationale as to how lifting a patient while 

demonstrating new slings at work on March 22, 2016 caused appellant’s left upper extremity 

 3

 OWCP regulations define a traumatic injury as a condition of the body caused by a specific event or incident, or 

series of events or incidents, within a single workday or shift. Such condition must be caused by external force, 

including stress or strain, which is identifiable as to time and place of occurrence and member or function of the 

body affected. 20 C.F.R. § 10.5(ee). 

4 See T.H., 59 ECAB 388 (2008). 

5 Id.

6 Id.
4

conditions. Dr. Iskandar noted that appellant’s conditions occurred while she was at work, but 

such generalized statements do not establish causal relationship. They merely repeat appellant’s 

allegations and are unsupported by adequate medical rationale explaining how her physical 

activity at work actually caused or aggravated the diagnosed conditions.7

 The need for rationale 

is particularly important as the evidence of record indicates that appellant had a preexisting left 

upper extremity condition. Dr. Iskandar’s opinion was based, in part, on temporal correlation. 

However, the Board has held that neither the mere fact that a disease or condition manifests itself 

during a period of employment nor the belief that the disease or condition was caused or 

aggravated by employment factors or incidents is sufficient to establish a causal relationship.8 

Dr. Iskander did not otherwise sufficiently explain how the diagnostic testing and examination 

findings led him to conclude that the March 22, 2016 incident at work caused or contributed to 

the diagnosed conditions. Thus, the Board finds that the reports from Dr. Iskandar are 

insufficient to establish that appellant sustained an employment-related injury on 

March 22, 2016. 

Appellant submitted physical therapy reports dated March 30, 2016 in support of her 

claim. These documents do not constitute competent medical evidence because a physical 

therapist is not a “physician” as defined under FECA.9

 As such, this evidence is also insufficient 

to meet appellant’s burden of proof. 

On appeal appellant contends that she is still experiencing limitations, has a pain score of 

6 out of 10, which increases to 10 intermittently, and needs continued support to help access 

medical appointments. Appellant further contends that supporting documentation, including 

doctor’s reports, were not submitted fully or on time on her behalf. As noted above, appellant 

bears the burden of proof to establish an employment-related injury and that, even if she may 

have established that the employment incident occurred, as alleged, the facts fail to show that her 

condition relates to the employment incident.10 The Board finds that OWCP properly reviewed 

all of the medical evidence of record. As appellant has not submitted any rationalized medical 

evidence to support her claim that she sustained an injury causally related to the March 22, 2016 

work incident, she has failed to meet her burden of proof to establish a claim for compensation. 

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. 

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

8 See E.J., Docket No. 09-1481 (issued February 19, 2010). 

9

 5 U.S.C. § 8101(2); Jennifer L. Sharp, 48 ECAB 209 (1996) (physical therapists). See also Gloria J. 

McPherson, 51 ECAB 441 (2000); Charley V.B. Harley, 2 ECAB 208, 211 (1949) (a medical issue such as causal 

relationship can only be resolved through the submission of probative medical evidence from a physician). 

10 See supra notes 3-5. 
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CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish that her left 

upper extremity conditions are causally related to a March 22, 2016 employment incident. 

ORDER 

IT IS HEREBY ORDERED THAT the May 23, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 14, 2017 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board