United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

I.L., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Middle Village, NY, Employer 

__________________________________________ 

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Docket No. 17-1113 

Issued: September 15, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On May 1, 2017 appellant, through counsel, filed a timely appeal from a March 10, 2017 

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 over the merits of this case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish that she sustained an 

injury on November 4, 2015 causally related to factors of her federal employment. 

 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

FACTUAL HISTORY 

On November 6, 2015 appellant, then a 32-year-old city carrier assistant, filed a traumatic 

injury claim (Form CA-1) for a right arm condition that allegedly arose in the performance of 

duty on November 4, 2015. She reportedly experienced pain in her right shoulder, elbow, and 

hand, which she attributed to pushing a mail cart and delivering mail. Appellant stopped work 

on November 6, 2015 and received continuation of pay. 

In an attending physician’s report (Form CA-20) dated November 5, 2015, Dr. Neofitos 

Stefanides, an attending Board-certified orthopedic surgeon, listed the date of injury as 

November 4, 2015 and the history of injury as continuous pushing and pulling of a mail cart. He 

diagnosed cervical spine sprain/radiculopathy, right shoulder impingement/bursitis, right elbow 

sprain, and right thumb sprain. Dr. Stefanides checked a box marked “Yes” indicating that the 

diagnosed conditions were caused or aggravated by the described employment activity. In a 

form entitled Authorization for Examination And/Or Treatment (Form CA-16) dated 

November 5, 2015, he listed the history of injury as repetitive and continuous pushing of a mail 

cart, diagnosed cervical spine radiculopathy, and checked a box marked “Yes” indicating that the 

diagnosed condition was caused or aggravated by the described employment activity. 

Dr. Stefanides found total disability from November 4 to December 4, 2015. 

In a November 6, 2015 narrative report, Dr. Stefanides indicated that appellant reported 

she was delivering mail while pushing and pulling a heavy mail cart on November 4, 2015 and 

felt a burning pain which radiated from her right neck down through her right shoulder, elbow, 

wrist, and thumb. He listed the mechanism of injury as “continuous and repetitive pulling, 

pushing, maneuvering mail cart with right arm” and noted that appellant denied any prior 

injuries. Dr. Stefanides reported the findings of his November 6, 2015 physical examination 

noting that appellant had 4/5 strength and intact sensation in her upper extremities, and 

tenderness to palpation in her right shoulder, elbow, and finger (unspecified digit). He diagnosed 

neuritis/radiculitis of the cervical region/upper limbs, shoulder impingement, bursitis, finger 

sprain/strain, and elbow sprain/strain and found that appellant was temporarily totally disabled 

from her usual work activities. Dr. Stefanides provided an opinion that, based on her history, 

physical examination, and x-ray findings, appellant’s physical injuries were causally related to 

“the accident noted above.” 

In a duty status report (Form CA-17) dated November 6, 2015, Dr. Stefanides listed the 

date of injury as November 4, 2015 and noted that appellant reported feeling pain in her right 

shoulder, elbow, and hand while delivering mail on that date. He listed the “diagnosis due to 

injury” as cervical spine radiculopathy and indicated that appellant was temporarily totally 

disabled. In a November 20, 2015 form entitled work capacity evaluation (Form OWCP-5c), 

Dr. Stefanides indicated that appellant could not work. Appellant was unable to engage in any 

lifting, carrying, pushing, or pulling. 

The employing establishment controverted appellant’s claim for a November 4, 2015 

work injury. In a November 10, 2015 letter, a human resources management specialist with the 

employing establishment noted that while appellant advised Dr. Stefanides that she had no prior 

injuries, appellant had previously filed claims with OWCP, including a claim for an October 7, 

2014 right arm injury assigned OWCP File No. xxxxxx446 which OWCP denied. The 
3

employing establishment representative further noted that appellant did not report her claimed 

November 4, 2015 injury until November 6, 2015. 

In a November 16, 2015 letter, OWCP requested that appellant submit additional factual 

and medical evidence in support of her claim. It asked her to complete a questionnaire which 

posed various questions regarding her work duties on November 4, 2015 and the nature of her 

claimed injury. On November 16, 2015 OWCP also requested additional information from the 

employing establishment. 

In a December 3, 2015 statement, appellant indicated that the mail cart she used on 

November 4, 2015 had no brakes and that she had to apply force to make the cart stop when 

going down hills. She reported that she pushed and pulled the cart for about four hours on that 

date. Appellant indicated that she did not report her claimed November 4, 2015 injury sooner 

because she initially thought her symptoms were from a prior accident. She also noted that 

Dr. Stefanides had previously treated her for a right elbow injury from 2014. Appellant clarified 

that Dr. Stefanides had not previously treated her for cervical sprain/radiculitis. 

OWCP also received additional medical evidence. A November 20, 2015 cervical 

magnetic resonance imaging (MRI) scan revealed straightening of the cervical lordosis without 

listhesis, degenerative disc disease at C4-5 and C5-6, and small central disc protrusions at C4-5 

and C5-6 without cord deformity, central canal stenosis, or foraminal stenosis. 

In a November 20, 2015 report, Dr. Stefanides indicated that he saw appellant in his 

office on November 20, 2015 and noted that the clinical evaluation showed that she had a 

herniated nucleus pulposus of a cervical disc and neuritis/radiculitis of the cervical region/upper 

limbs. He reported that appellant’s neck and right upper extremity symptoms were of cervical 

etiology and that cervical sprain/radiculitis was the only pathology causally related to “this work 

accident.” Dr. Stefanides indicated that he had not previously treated appellant for a cervical 

pathology, although he had previously treated her for an elbow pathology which had a “separate 

location and distinct etiology for pain.” He posited that appellant’s neck and right upper 

extremity pain were likely due to a pinched nerve in her neck. 

In a November 20, 2015 Form CA-17, Dr. Stefanides listed the date of injury as 

November 4, 2015 and noted that appellant reported feeling pain in her right shoulder, elbow, 

and hand while delivering mail on that date. He listed the “diagnosis due to injury” as cervical 

spine radiculopathy and indicated that appellant was temporarily totally disabled. In a 

December 4, 2015 Form CA-17, Dr. Stefanides also found that appellant was temporarily totally 

disabled due to the reported November 4, 2015 injury. On December 4, 2015 he reported 

findings of his examination on that date and noted that appellant still reported persistent cervical 

spine and right upper extremity pain. 

In a December 22, 2015 decision, OWCP denied appellant’s claim for a November 4, 

2015 work injury. It accepted that she experienced work factors in the form of pushing/pulling a 

mail cart and delivering mail on that date, but found that she failed to submit sufficient medical 

evidence to establish a causal relationship between the accepted work factors and a diagnosed 

medical condition. OWCP noted that the medical reports submitted by appellant, those of 

Dr. Stefanides, did not contain a rationalized medical opinion on causal relationship. 
4

Following the decision, OWCP received additional medical evidence. 

In a November 17, 2015 form report entitled Initial Examination, Dr. John J. McGee, a 

Board-certified physiatrist, noted that appellant reported feeling right arm pain after delivering 

mail with a cart on November 4, 2015. He provided findings on examination and diagnosed 

cervical sprain/strain, cervical radiculitis, and right shoulder impingement syndrome. 

Dr. McGee answered “Yes” in response to a question regarding whether the described incident 

was “the competent medical cause of this injury/illness” and indicated that appellant was totally 

disabled. 

In a December 9, 2015 report, Dr. Mark B. Eisenberg, a Board-certified neurosurgeon, 

noted that Dr. Stefanides had referred appellant to him and indicated that appellant reported that 

about one month prior she pushed a heavy cart and felt pain in her neck which radiated down her 

right upper extremity. He discussed appellant’s November 20, 2015 MRI scan of the cervical 

spine and recommended that she continue with physical therapy and pain management. 

In a State of New York form dated December 28, 2015, Dr. McGee listed a date of injury 

of November 4, 2015, diagnosed cervical neuritis or radiculitis, neck sprain/strain, and 

unspecified derangement of shoulder joint, and found 100 percent disability. He checked a box 

marked “Yes” indicating that the described incident was “the competent medical cause of this 

injury/illness.” On January 25, 2016 Dr. McGee diagnosed cervical region radiculopathy, sprain 

of cervical spine ligaments, and other specific joint derangements of right shoulder. He indicated 

that appellant was totally disabled. 

In Forms CA-17 dated December 30, 2015 and January 29, 2016, Dr. Stefanides listed 

the date of injury as November 4, 2015 and noted that appellant reported feeling pain in her right 

shoulder, elbow, and hand while delivering mail on that date. He listed the “diagnosis due to 

injury” as right cervical radiculitis and indicated that appellant was temporarily totally disabled. 

On February 26, 2016 Dr. Stefanides diagnosed shoulder impingement, bursitis, and neck 

sprains/strains.3

 

In a State of New York form report dated January 25, 2016, Dr. Dani Stekel and Dr. Arie 

Cohen, attending Board-certified chiropractors, provided diagnoses of sprain of cervical spine 

ligaments and contracture of muscle (unspecified).4

 Appellant also submitted reports from 

attending physical therapists who described physical therapy sessions conducted between 

November 19 and December 22, 2015. 

On December 12, 2016 appellant, through counsel, requested reconsideration of OWCP’s 

December 22, 2015 decision. He resubmitted copies of appellant’s physical therapy and 

chiropractic treatment records. 

 3

 A February 26, 2016 right shoulder MRI scan revealed tendinosis of the supraspinatus and subscapularis 

tendons, fluid at the biceps tendon sheath and glenohumeral joint, and laterally downsloping type II acromial 

configuration. 

4

 Both reports were countersigned by another chiropractor, Dr. John H. Kraft. 
5

In a March 10, 2017 decision, OWCP denied modification of its December 22, 2015 

decision denying appellant’s claim for a November 4, 2015 work injury. It noted that the new 

reports submitted by appellant did not contain a rationalized medical opinion relating a 

diagnosed medical condition to the accepted work factors. 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA5

 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence, including that an injury was sustained in the performance of duty as alleged and that 

any specific condition or disability claimed is causally related to the employment injury.6

To determine if an employee sustained a traumatic 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 that must be considered in conjunction with one another. The 

first component is whether the employee actually experienced the employment incident that 

allegedly occurred.7 The second component is whether the employment incident caused a 

personal injury.8

 An employee may establish that an injury occurred in the performance of duty 

as alleged, but fail to establish that the disability or specific condition for which compensation is 

being claimed is causally related to the injury.9

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.10 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.11 Additionally, chiropractors are considered physicians only to 

the extent that their reimbursable services are limited to treatment consisting of manual 

manipulation of the spine to correct a subluxation as demonstrated by x-ray.12

 5 Supra note 2. 

6

 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). 

7 Elaine Pendleton, 40 ECAB 1143 (1989). 

8 John J. Carlone, 41 ECAB 354 (1989). Causal relationship is a medical question that generally requires 

rationalized medical opinion evidence to resolve the issue. Robert G. Morris, 48 ECAB 238 (1996). A physician’s 

opinion on whether there is a causal relationship between the diagnosed condition and the implicated employment 

factor(s) must be based on a complete factual and medical background. Victor J. Woodhams, 41 ECAB 345, 

352 (1989). Additionally, the physician’s opinion must be expressed in terms of a reasonable degree of medical 

certainty, and must be supported by medical rationale, explaining the nature of the relationship between the 

diagnosed condition and appellant’s specific employment factor(s). Id.

9 Shirley A. Temple, 48 ECAB 404, 407 (1997). 

10 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). 

11 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). Federal (FECA) 

Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) (January 2013). 

12 5 U.S.C. § 8101(2); see Kathryn Haggerty, 45 ECAB 383, 389 (1994). 
6

ANALYSIS 

Appellant filed a traumatic injury claim alleging that on November 4, 2015 she sustained 

an injury to her right arm due to pushing/pulling a mail cart and delivering mail at work. In 

December 22, 2015 and March 10, 2017 decisions, OWCP denied appellant’s claim. However, 

it accepted that appellant experienced work factors in the form of pushing/pulling a mail cart and 

delivering mail on that date, but found that she failed to submit sufficient medical evidence to 

establish causal relationship between the accepted work factors and a diagnosed medical 

condition. 

The Board finds that appellant failed to submit sufficient medical evidence to establish 

causal relationship between the accepted work factors of November 4, 2015, i.e., pushing/pulling 

a mail cart and delivering mail, and a diagnosed medical condition. 

In a Form CA-20 dated November 5, 2015, Dr. Stefanides, an attending physician, listed 

the date of injury as November 4, 2015 and the history of injury as continuous pushing and 

pulling of a mail cart. He diagnosed cervical spine sprain/radiculopathy, right shoulder 

impingement/bursitis, right elbow sprain, and right thumb sprain. Dr. Stefanides checked a box 

marked “Yes” indicating that the diagnosed conditions were caused or aggravated by the 

described employment activity. Similarly, in a Form CA-16 dated November 5, 2015, he listed 

the history of injury as repetitive and continuous pushing of a mail cart, diagnosed cervical spine 

radiculopathy, and checked a box marked “Yes” indicating that the diagnosed condition was 

caused or aggravated by the described employment activity. Dr. Stefanides found total disability 

from November 4 to December 4, 2015. 

The Board notes that the submission of these reports do not establish appellant’s claim for a 

November 4, 2015 work injury because the reports lack sufficient probative value on this matter. 

The Board has held that when a physician’s opinion on causal relationship consists only of 

checking a box marked “Yes” to a form question, without more by the way of medical rationale, 

that opinion has little probative value and is insufficient to establish causal relationship. 

Appellant’s burden includes the necessity of furnishing an affirmative opinion from a physician 

who supports his or her conclusion with sound medical reasoning.13 As Dr. Stefanides did no 

more than check a box marked “Yes” to a form question, his opinion on causal relationship is of 

little probative value and is insufficient to discharge appellant’s burden of proof. He did not 

discuss the accepted November 4, 2015 work factors in any detail or describe the medical process 

through which they could have been competent to cause or aggravate the diagnosed conditions. 

Dr. Stefanides did support his opinion with objective findings on physical examination or 

diagnostic testing. 

In a November 6, 2015 narrative report, Dr. Stefanides indicated that appellant reported 

she was delivering mail while pushing and pulling a heavy mail cart on November 4, 2015 and 

felt a burning pain which radiated from her right neck down through her right shoulder, elbow, 

wrist, and thumb. He diagnosed neuritis/radiculitis of the cervical region/upper limbs, shoulder 

impingement, bursitis, finger sprain/strain, and elbow sprain/strain and found that appellant was 

 13 Lillian M. Jones, 34 ECAB 379, 381 (1982). 
7

temporarily totally disabled from her usual work activities. Dr. Stefanides provided an opinion 

that, based on her history, physical examination, and x-ray findings, appellant’s physical injuries 

were causally related to “the accident noted above.” This report is of limited probative value on 

the relevant issue of this case because Dr. Stefanides did not provide an adequate explanation for 

his opinion on causal relationship. The Board has held that a medical report is of limited 

probative value on the issue of causal relationship if it contains a conclusion on causal relationship 

which is unsupported by medical rationale.14 Although Dr. Stefanides generally referenced 

appellant’s history, physical examination, and x-ray findings15 in support of his opinion, he did 

not describe which specific aspects of these factors led him to conclude that appellant sustained a 

work injury on November 4, 2015. 

In Forms CA-17 dated November 6, 20, December 4, 30, 2015, and January 29, 2016, 

Dr. Stefanides listed the date of injury as November 4, 2015 and noted that appellant reported 

feeling pain in her right shoulder, elbow, and hand while delivering mail on that date. He listed 

the “diagnosis due to injury” as cervical spine radiculopathy and indicated that appellant was 

temporarily totally disabled. These reports of are of limited probative value with respect to 

whether appellant sustained a November 4, 2015 work injury because Dr. Stefanides did not 

provide any medical rationale in support of his opinion that appellant sustained a cervical 

condition on that date.16 

In a November 20, 2015 report, Dr. Stefanides indicated that appellant’s cervical 

sprain/radiculitis was the only pathology casually related to the November 4, 2015 “accident” 

and posited that appellant’s neck and right upper extremity pain were likely due to a pinched 

nerve in her neck. This report is of limited probative value because Dr. Stefanides did not 

explain how the accepted November 4, 2015 work factors could have caused or aggravated such 

a pinched nerve. He did not present objective findings to support his opinion on causal 

relationship.17

In a November 17, 2015 form report, Dr. McGee, an attending physician, noted that 

appellant reported feeling right arm pain after delivering mail with a cart on November 4, 2015. 

He diagnosed cervical sprain/strain, cervical radiculitis, and right shoulder impingement 

syndrome. Dr. McGee answered “Yes” in response to a question regarding whether the 

described incident was “the competent medical cause of this injury/illness” and indicated that 

appellant was totally disabled. In a December 28, 2015 form report, he listed a date of injury of 

November 4, 2015, diagnosed cervical neuritis or radiculitis, neck sprain/strain, and unspecified 

derangement of shoulder joint, and found 100 percent disability. Dr. McGee checked a “Yes” 

box indicating that the described incident was “the competent medical cause of this 

injury/illness.” The Board notes that these reports contain opinions on causal relationship which 

are of limited probative value in that Dr. McGee only checked a “Yes” box or answered “Yes” in 

 14 C.M., Docket No. 14-88 (issued April 18, 2014). 

15 The Board notes that Dr. Stefanides did not reference any diagnostic test findings in his report. 

16 Supra note 14. 

17 Id. 
8

response to a form question without providing medical rationale in support of his opinions.18 

Merely placing a checkmark in the “Yes” box will not suffice for purposes of establishing causal 

relationship.19 Dr. McGee did not discuss the accepted November 4, 2015 work factors in any 

detail or describe the medical process through which they could have been competent to cause or 

aggravate the diagnosed conditions. 

In forms dated January 25, 2016, Dr. Dani Stekel and Dr. Arie Cohen, attending 

chiropractors, provided diagnoses of sprain of cervical spine ligaments and contracture of muscle 

(unspecified). However, these reports do not support appellant’s claim for a November 4, 2015 

work injury because they do not constitute probative medical evidence within the meaning of 

FECA. Under section 8101(2) of FECA, chiropractors are only considered physicians, and their 

reports considered medical evidence, to the extent that they treat spinal subluxations as 

demonstrated by x-ray to exist.20 OWCP’s regulations at 20 C.F.R. § 10.5(bb) have defined 

subluxation as an incomplete dislocation, off-centering, misalignment, fixation or abnormal 

spacing of the vertebrae which must be demonstrable on any x-ray film to an individual trained 

in the reading of x-rays.21 The January 25, 2016 reports of Drs. Stekel and Cohen do not 

constitute probative medical evidence because they do not indicate that findings of subluxations 

were demonstrated by x-rays to exist. 

Appellant also submitted reports from attending physical therapists who described 

physical therapy sessions conducted between November 19 and December 22, 2015. However, 

physical therapists are not considered physicians under FECA and therefore their opinions do not 

constitute medical opinion evidence and have no weight or probative value on medical matters.22

For these reasons, appellant has not established a November 4, 2015 work injury and 

OWCP properly denied her claim.23

Appellant may submit additional 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. 

 18 See supra note 13. 

19 See D.D., 57 ECAB 734, 739 (2006); Deborah L. Beatty, 54 ECAB 340, 341 (2003). 

20 5 U.S.C. § 8101(2). See Jack B. Wood, 40 ECAB 95, 109 (1988). 

21 20 C.F.R. § 10.5(bb); see also Bruce Chameroy, 42 ECAB 121, 126 (1990). 

22 C.E., Docket No. 14-710 (issued August 11, 2014); Jane A. White, 34 ECAB 515 (1983). 

23 Where an employing establishment properly executes a Form CA-16 which authorizes medical treatment as a 

result of an employee’s claim for an employment-related injury, the Form CA-16 creates a contractual obligation, 

which does not involve the employee directly, to pay for the cost of the examination or treatment regardless of the 

action taken on the claim. See Tracy P. Spillane, 54 ECAB 608 (2003). The period for which treatment is 

authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated earlier by OWCP. 

See 20 C.F.R. § 10.300(c). 
9

CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she 

sustained an injury on November 4, 2015 due to factors of her federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the March 10, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 15, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board