United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.M., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Cleveland, OH, Employer 

__________________________________________ 

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Docket No. 17-0532 

Issued: April 17, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 January 10, 2017 appellant, through counsel, filed a timely appeal from a 

November 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 over the merits of this case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish injuries to her neck 

and left upper extremity 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 January 23, 2015 appellant, then a 63-year-old secretary, filed an occupational disease 

claim (Form CA-2) alleging that she sustained injuries to her neck and left upper extremity due 

to constant, repetitious use of the telephone and computer in the performance of duty.3

 She 

indicated that as a secretary she was constantly on the telephone providing service to various 

individuals and that the number of incoming calls was always high. Appellant further explained 

that she noticed increased left-side neck, shoulder, and upper extremity pain when she held the 

telephone between her left ear and shoulder, while simultaneously working on the computer. 

She identified April 8, 2013 as the date she first became aware of her claimed conditions. It was 

also the date appellant first realized her conditions were employment related. On the claim form, 

appellant’s immediate supervisor advised that the employing establishment controverted the 

claim because there was no medical evidence to support the existence of a work-related 

condition.4

 Appellant did not stop work.5

In a letter dated February 18, 2015, OWCP requested that appellant submit additional 

factual and medical evidence in support of her claim, including a physician’s opinion supported 

by a medical explanation as to how her work activities caused or aggravated her claimed medical 

conditions. 

Appellant submitted the findings of November 4, 2011 x-ray testing of her left shoulder, 

which contained an impression of degenerative changes of the left acromioclavicular joint. 

In a report dated November 4, 2011, Dr. Elizabeth Mease, an attending Board-certified 

internist, noted that appellant reported having neck pain for the prior five or six months and that 

she had a habit of holding the telephone receiver at work between her left shoulder and head. 

She diagnosed left shoulder pain, possible impingement syndrome, possible bursitis, neck pain, 

and probable degenerative joint disease. On May 25, 2012 Dr. Mease diagnosed left shoulder 

pain, impingement syndrome, degeneration of the left acromioclavicular joint, and cervical pain 

(without excluding degenerative cervical spine disease). On December 4, 2014 she diagnosed 

cervalgia and pain of the left shoulder and intermittent left arm dysesthesias. 

In a decision dated March 20, 2015, OWCP denied appellant’s claim for a work-related 

occupational disease. It accepted her employment factors as alleged, but denied her claim 

because she failed to submit adequate medical evidence to establish a diagnosis in connection 

with the accepted employment exposure. 

 3

 Appellant advised that x-rays showed that she had a pinched nerve in her neck which caused “electrical current 

to go to my elbow.” 

4

 The record contains a March 13, 2015 letter in which appellant’s immediate supervisor further discussed the 

employing establishment’s challenge of appellant’s claim. 

5

 The record reveals that, under a separate claim filed on November 10, 2011 (OWCP File No. xxxxxx839), 

appellant alleged that she sustained a left shoulder condition alleged to have occurred on July 21, 2010 due to 

operating a telephone device at work. Under another claim (OWCP File No. xxxxxx531), appellant filed an 

occupational disease claim on June 15, 2012 alleging that she sustained neck and left shoulder injuries due to using a 

telephone receiver at work. Appellant indicated that she first became aware of this claimed occupational disease on 

October 7, 2010. OWCP denied both claims, and they are not the subject of the present appeal before the Board. 
3

Appellant submitted the findings of x-ray testing of her cervical spine obtained on 

January 19, 2015 and a magnetic resonance imaging (MRI) scan of her cervical spine obtained 

on February 27, 2015. The studies showed degenerative changes between the C2-3 and C6-7 

levels. 

In a report dated May 6, 2015, Dr. Nicholas Ahn, an attending Board-certified orthopedic 

surgeon, diagnosed left cervical radiculopathy with cervical stenosis with cord compression and 

discussed the findings of diagnostic testing and physical examination which he felt supported 

these diagnoses. He also diagnosed several lumbar spine conditions. 

In a report dated May 19, 2015, Dr. John H. Paul, an attending Board-certified orthopedic 

surgeon, noted that appellant reported acute neck pain radiating into her left upper extremity with 

numbness, tingling sensation, and weakness of the left upper extremity. He diagnosed 

“complicated medical care injury” and indicated that he would conduct a review of the medical 

evidence of record. 

In a report dated December 2, 2015, Dr. Al-Amin Khalil, an attending Board-certified 

anesthesiologist, diagnosed lower back pain and lumbar stenosis with neurogenic claudication. 

In a letter dated March 8, 2016 received by OWCP on that date, appellant, through 

counsel, requested reconsideration of the March 20, 2015 decision. 

Appellant submitted additional medical evidence, which was received by OWCP on 

March 15, 2016. 

In a report dated September 21, 2010, Dr. Ahn described the lumbar spine surgery he 

performed on that date. In a report dated December 13, 2013, he indicated that appellant 

continued to complain of low back pain. In reports dated January 19 and October 1, 2015, 

Dr. Ahn diagnosed various conditions including cervical pain and cervical stenosis with cord 

compression. 

By decision dated November 16, 2016, OWCP found that the newly submitted medical 

evidence from Dr. Ahn established a diagnosis of cervical radiculopathy and stenosis. However, 

the medical evidence of record was insufficient to establish causal relationship between 

appellant’s accepted employment factors and the diagnosed cervical conditions. 

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 the injury was sustained while 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.6 To establish fact of injury, an employee must submit 

sufficient evidence to establish that he or she experienced a specific event, incident, or exposure 

 6

 5 U.S.C. § 8101(1); B.B., 59 ECAB 234 (2007); Elaine Pendleton, 40 ECAB 1143 (1989). 
4

occurring at the time, place, and in the manner alleged.7

 An employee must also establish that 

such event, incident, or exposure caused an injury.8 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.9

OWCP regulations define the term “[o]ccupational disease or illness” as a condition 

produced by the work environment over a period longer than a single workday or shift.10 To 

establish that an injury was sustained in the performance of duty in an occupational disease 

claim, an employee must submit the following: (1) medical evidence establishing the presence 

or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence 

or occurrence of the disease or condition; and (3) medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the employee.11

The medical evidence required to establish causal relationship generally is rationalized 

medical opinion evidence.12 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 established employment factors.13

ANALYSIS 

Appellant filed an occupational disease claim alleging injuries to her neck and left upper 

extremity as a result of performing her secretarial duties. Specifically, she attributed her neck 

and left shoulder/arm conditions to using the telephone at work, including cradling the unit 

between her head and left shoulder, while she simultaneously worked on the computer. OWCP 

accepted appellant’s employment factors as alleged, but denied her claim because she failed to 

submit sufficient medical evidence to establish a causal relationship between her diagnosed 

cervical condition(s) and the accepted occupational exposure. 

The Board finds that appellant did not submit sufficient medical evidence to establish a 

work-related occupational disease to her neck, left shoulder, and/or left upper extremity. 

Appellant submitted reports from several attending physicians in support of her claim. In 

reports dated November 4, 2011, May 25, 2012, and December 4, 2014, Dr. Mease diagnosed 

 7 J.C., Docket No. 16-0057 (issued February 10, 2016); E.A., 58 ECAB 677 (2007). 

8 Id. 

9 R.H., 59 ECAB 382 (2008); Ellen L. Noble, 55 ECAB 530 (2004). 

10 20 C.F.R. § 10.5(q); see also Federal (FECA) Procedure Manual, Part 2 -- Claims, Initial Development of 

Claims, Chapter 2.800.2b (June 2011). 

11 D.H., Docket No. 15-1876 (issued January 29, 2016); D.I., 59 ECAB 158 (2007); Victor J. Woodhams, 41 

ECAB 345 (1989). 

12 F.S., Docket No. 15-1052 (issued July 17, 2015); Tomas Martinez, 54 ECAB 623 (2003). 

13 P.K., Docket No. 08-2551 (issued June 2, 2009); John W. Montoya, 54 ECAB 306 (2003). 
5

conditions such as left shoulder impingement syndrome, degeneration of the left 

acromioclavicular joint, possible bursitis, neck pain, and probable degenerative cervical joint 

disease. Dr. Mease noted that appellant reported having neck pain for the prior five or six 

months and that she had a habit of holding the telephone receiver at work between her left 

shoulder and head. However, Dr. Mease did not provide an opinion of whether the diagnosed 

conditions were related to such employment factors. The Board has held that medical evidence 

that does not offer a clear opinion regarding the cause of an employee’s condition is of limited 

probative value on the issue of causal relationship.14 Therefore, Dr. Mease’s reports fail to 

establish appellant’s claim for occupational diseases of the neck, left shoulder, and left upper 

extremity. 

In reports dated January 19, May 6, and October 1, 2015, Dr. Ahn diagnosed conditions 

such as left cervical radiculopathy with cervical stenosis with cord compression and discussed 

the findings of diagnostic testing and physical examination which he felt supported these 

diagnoses. The reports of Dr. Ahn are insufficient to establish appellant’s claim because they do 

not contain an opinion that the diagnosed conditions were related to the accepted employment 

factors.15 

In a report dated May 19, 2015, Dr. Paul noted that appellant reported acute neck pain 

radiating into her left upper extremity with numbness, tingling sensation, and weakness of the 

left upper extremity. He diagnosed “complicated medical care injury,” but did not provide any 

other diagnosis or offer an opinion that appellant suffered an occupational disease due to 

employment factors.16

Appellant submitted reports of other attending physicians, but these reports did not 

discuss the condition of her neck, left shoulder, or left upper extremity. For example, in a report 

dated December 2, 2015, Dr. Khalil diagnosed lower back pain and lumbar stenosis with 

neurogenic claudication. Such reports provide no indication that the diagnosed conditions were 

related to employment factors.17

For these reasons, appellant did not submit sufficient medical evidence to establish a 

work-related occupational disease of her neck, left shoulder, or left upper extremity and OWCP 

properly denied her claim. 

CONCLUSION 

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

her neck and left upper extremity causally related to factors of her federal employment. 

 14 See Charles H. Tomaszewski, 39 ECAB 461 (1988). 

15 Id. 

16 Id.

17 Id. 
6

ORDER 

IT IS HEREBY ORDERED THAT the November 16, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 17, 2017 

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