United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Miami, FL, Employer

__________________________________________

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Docket No. 17-0624

Issued: December 19, 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 January 26, 2017 appellant filed a timely appeal from a November 29, 2016 merit 

decision of the Office of Workers’ Compensation Programs. Pursuant to the Federal Employees’

Compensation Act1and 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 a right shoulder injury 

on June 29, 2016 causally related to an accepted employment incident.

FACTUAL HISTORY

On July 2, 2016 appellant, then a 48-year-old letter carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on June 29, 2016 she sustained a right shoulder rotator injury when 

 

1

5 U.S.C. § 8101 et seq.
2

she felt something rip in her shoulder as she was unloading her vehicle. She first received 

medical care on June 29, 2016 and stopped work on June 30, 2016. 

In a June 29, 2016 urgent care report, Dr. Roy Dubash, Board-certified in family 

medicine, reported that appellant presented with a work-related injury when she bent over to pick 

up a tub of mail and developed pain in her right shoulder and upper back. He noted limited right 

shoulder range of motion and muscle tenderness to the right upper back. Dr. Dubash diagnosed 

right shoulder pain and discharged appellant with a treatment plan. 

In a July 2, 2016 report prepared by a physician assistant that electronically signed by

Dr. Robert N. Turner, Board-certified in family medicine, reported that appellant had presented 

to the emergency department with right shoulder pain onset three days prior after lifting a heavy 

load of mail at work. Appellant had no relief following her visit despite medication and use of a 

sling as directed. Dr. Turner noted decreased range of motion and tenderness over the anterior 

biceps tendon with ecchymosis present over the mid portion of the biceps with tenderness. He 

diagnosed right biceps tendon rupture and shoulder pain. In an accompanying workers’

compensation form, Dr. Turner checked a box marked “yes” when asked if the right biceps 

tendon rupture and shoulder pain were work related, noting that the injury occurred after lifting a 

heavy object. 

In an August 30, 2016 medical report, Dr. Michael G. Dennis, a Board-certified 

orthopedic surgeon, reported that appellant was a letter carrier and presented for a right shoulder 

evaluation. He explained that on June 28, 2016 she was lifting tubs into her truck at which time 

she felt something pop in her shoulder/arm. Appellant was treated in urgent care due to the 

development of significant pain and swelling. She experienced minimal relief and complained of 

continued pain with intermittent swelling of her upper arm. Dr. Dennis noted that x-rays of the 

right shoulder revealed no fractures, dislocations, or degenerative changes. He diagnosed right 

shoulder pain and internal derangement with likely long head biceps tendon tear. Dr. Dennis 

restricted appellant to light-duty work and ordered a magnetic resonance imaging (MRI) scan of 

the right shoulder and upper arm. 

By letter dated October 26, 2016, OWCP informed appellant that the evidence of record 

was insufficient to support her claim. Appellant was advised of the factual and medical evidence 

necessary. She was afforded 30 days to submit the necessary evidence. 

OWCP thereafter received additional medical evidence. In an October 19, 2016 

diagnostic report received on November 1, 2016, Dr. Jonathan Luchs, a Board-certified 

diagnostic radiologist, reported that an MRI scan of the right arm revealed high signal within the 

deltoid and biceps muscles suggesting muscle strain and partially visualized superior paralabral 

ganglion. 

In another October 19, 2016 diagnostic report, Dr. Luchs reported that an MRI scan of 

the right shoulder revealed supraspinatus tendinosis without full thickness tear, subdeltoid 

bursitis, and superior labral tear extending into paralabral ganglion in the spinoglenoid notch 

extending into suprascapular notch and intimate to the suprascapular neurovasvular structures. 
3

By decision dated November 29, 2016, OWCP denied appellant’s claim as the evidence 

was insufficient to establish that she sustained an injury because she failed to submit any medical 

evidence containing a medical diagnosis in connection to the accepted June 29, 2016

employment incident. Thus, fact of injury was not established. OWCP further noted that the 

medical evidence submitted was from a physician assistant which is not considered a qualified 

physician under FECA unless the report is countersigned by a physician. 

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 filed within the applicable 

time limitation, that an injury was sustained while in the performance of duty as alleged, and that 

any disability or specific condition for which compensation is claimed are causally related to the 

employment injury.2 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on 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 which is alleged to have occurred.4 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment event or incident, the employee must submit rationalized 

medical opinion evidence based on a complete factual and medical background, supporting such 

a causal relationship.5 The opinion of the physician must be based on a complete 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. This medical opinion 

must include an accurate history of the employee’s employment injury and must explain how the 

condition is related to the injury. The weight of medical evidence is determined by its reliability, 

its probative value, its convincing quality, the care of analysis manifested, and the medical 

rationale expressed in support of the physician’s opinion.6

 

2 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989).

3 Michael E. Smith, 50 ECAB 313 (1999).

4 Elaine Pendleton, supra note 2. 

5

See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983).

6

James Mack, 43 ECAB 321 (1991).
4

ANALYSIS

OWCP has accepted that appellant felt a rip in her right shoulder while she was 

unloading her postal vehicle on June 29, 2016. It denied the claim as she had not established a 

diagnosed medical condition causally related to this incident and; therefore, facts of injury was 

not established. 

The Board finds that appellant failed to establish that she sustained an injury causally 

related to the accepted June 29, 2016 employment incident. 

In support of her claim, appellant submitted multiple medical and diagnostic reports 

dated June 29 through October 29, 2016. In its November 29, 2016 decision, OWCP found that 

she failed to establish a firm medical diagnosis. It further noted that the medical evidence 

submitted was from a physician assistant which was not considered a qualified physician under 

FECA unless countersigned by a physician. The Board finds, however, that Dr. Turner’s July 2, 

2016 urgent care report establishes a sufficient diagnosis of right biceps tendon rupture.

7

 While 

the document was authored by a physician assistant, it was cosigned by Dr. Turner on 

July 2, 2016.

8

 Given that appellant has established a diagnosed condition, the question becomes 

whether the June 29, 2016 employment incident caused her right biceps tendon rupture. Thus, 

she must submit rationalized medical evidence to establish that her diagnosed medical condition 

is causally related to the June 29, 2016 employment incident.

In his July 2, 2016 urgent care report, Dr. Turner described the June 29, 2016 

employment incident, provided findings on physical examination, and diagnosed right biceps 

tendon rupture. In an accompanying workers’ compensation form, he checked the box marked 

“yes” when asked if the right biceps tendon rupture and shoulder pain were work related, noting 

that the injury occurred after lifting a heavy object. The Board has held that a report that 

addresses causal relationship with a checkmark, without medical rationale explaining how the 

work condition caused the alleged injury, is of diminished probative value and insufficient to 

establish causal relationship.9 Dr. Turner failed to explain the mechanism of injury by detailing 

how lifting a tub of mail would cause appellant’s injury. Without explaining how the 

movements involved in the employment incident caused or contributed to the diagnosed 

condition, Dr. Turner’s opinion is of limited probative value and insufficient to meet appellant’s 

burden of proof.10 

Dr. Dennis’ August 30, 2016 medical report is also insufficient to establish causal 

relationship. While he provided a diagnosis of right shoulder internal derangement, he failed to 

provide an opinion on causal relationship. Dr. Dennis only generally repeated appellant’s 

 

7 F.G., Docket No. 15-1712 (issued November 20, 2015).

8

See D.D., 57 ECAB 734 (2006); Merton J. Sills, 39 ECAB 572, 575 (1988), (unsigned medical evidence with no 

adequate indication that it was completed by a physician is not considered probative medical evidence).

9

See Calvin E. King, Jr., 51 ECAB 394 (2000); see also Frederick E. Howard, Jr., 41 ECAB 843 (1990).

10 See L.M., Docket No. 14-0973 (issued August 25, 2014); R.G., Docket No. 14-0113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).
5

recitation of the employment incident. Such generalized statements do not establish causal 

relationship because they merely repeat her allegations and are unsupported by adequate medical 

rationale explaining how this physical activity actually caused the diagnosed conditions.11 The 

Board has held that medical evidence that does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship.12 Thus,

Dr. Dennis’ report is of limited probative value and insufficient to meet appellant’s burden of 

proof.13

The remaining medical evidence of record is also insufficient to establish appellant’s 

claim. Dr. Dubash’s June 29, 2016 urgent care report only provided a diagnosis of right shoulder 

pain. The Board has consistently held that pain is a symptom, rather than a compensable medical 

diagnosis.14 As Dr. Dubash is attributing appellant’s symptoms to her employment duties rather 

than the diagnosed medical condition, any opinion on causal relationship is of limited probative 

value.15 Dr. Luchs’ October 19, 2016 diagnostic reports are also insufficient to establish 

appellant’s claim as the physician interpreted diagnostic imaging studies and provided no 

opinion on the cause of her injury.16 

Although appellant has established a firm medical diagnosis of right biceps tendon 

rupture, the record, however, is without rationalized medical evidence establishing a causal 

relationship between the June 29, 2016 employment incident and her right shoulder injury. 

Thus, appellant has failed to meet her burden of proof.17

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.605 and 10.607.

CONCLUSION

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

sustained a right shoulder injury causally related to the accepted June 29, 2016 employment 

incident.

 

11 K.W., Docket No. 10-0098 (issued September 10, 2010).

12 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

13 See supra note 10. 

14 C.F., Docket No. 08-1102 (issued October 10, 2008).

15 M.R., Docket No. 14-0011 (issued August 27, 2014).

16 J.P., Docket No. 14-0087 (issued March 14, 2014).

17 Any medical opinion evidence appellant may submit to support her claim should reflect a correct history and 

offer a medically-sound explanation by the physician of how the specific employment incident, in particular 

physiologically, caused or aggravated her right shoulder injury. T.G., Docket No. 14-0751 (issued 

October 20, 2014).
6

ORDER

IT IS HEREBY ORDERED THAT the November 29, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

18

 

Issued: December 19, 2017

Washington, DC

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

18 Colleen Duffy Kiko, Judge, participated in the original decision, but was no longer a member of the Board 

effective December 11, 2017.