United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Oakland, CA, Employer 

__________________________________________ 

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Docket No. 16-1704 

Issued: January 10, 2017 

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 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On August 24, 2016 appellant filed a timely appeal from a May 12, 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. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish bilateral wrist, left 

shoulder, and bilateral lower extremity conditions causally related to factors of her federal 

employment. 

FACTUAL HISTORY 

On October 5, 2015 appellant, than a 38-year-old mail processing clerk, filed an 

occupational disease claim (Form CA-2) alleging that on or before August 16, 2015, she 

 1

 5 U.S.C. § 8101 et seq. 
2

sustained bilateral wrist, knee, foot, and left shoulder conditions due to pulling down and setting 

up mail sacks, and walking and standing without proper floor mats. She stopped work on 

August 16, 2015. 

Dr. Michael E. Hebrard, an attending Board-certified physiatrist, held appellant off work 

through August 19, 2015, and released her to light duty. He provided work limitations on 

August 31, 2015 restricting appellant to lifting, pulling and pushing up to 10 pounds, limited 

reaching at or above shoulder level with the left arm, keyboarding no more than 10 minutes an 

hour, occasional pinch, grasp, and repetitive hand motions. 

In an October 14, 2015 letter, OWCP advised appellant of the evidence needed to 

establish her claim, including medical evidence diagnosing a condition related to the identified 

work factors and a report from her physician explaining how and why that incident would cause 

those conditions. It afforded appellant 30 days to submit such evidence. 

In response, appellant submitted an October 30, 2015 narrative statement, explaining that 

pushing and pulling heavy equipment, and lifting heavy sacks and trays of mail, caused bilateral 

wrist and left shoulder pain. She experienced bilateral knee and foot pain while walking up and 

down stairs to different divisions as part of her mail processing duties. 

By decision dated December 7, 2015, OWCP denied the claim, finding that fact of injury 

had not been established. It accepted that the identified work factors, including repetitive 

motions of pulling down and lifting up sacks of mail, walking and standing on the work floor 

without proper mats, and pushing heavy equipment, occurred as alleged. OWCP found, 

however, that appellant had failed to submit medical evidence sufficient to establish causal 

relationship between those factors and the claimed upper and lower extremity conditions. 

In a December 28, 2015 letter, appellant requested a review of the written record. She 

submitted additional reports from Dr. Hebrard. 

On August 31, 2015 Dr. Hebrard explained that repetitive reaching at and above shoulder 

level, in particular while loading conveyor belts, “led to chronic impingement of the left shoulder 

where the supraspinatus tendon at the myotendinous junction which lies beneath the acromion 

with any reaching at 100 degrees or higher to an arc of 140 which was required in the course of 

her employment led to chronic functional impingement of the rotator cuff interval, subsequently 

leading to increased inflammation.” He opined that repetitive flexion and extension of the wrists 

while reaching, pulling, pushing, and grasping “led to accumulative aggravation of the flexor 

tendons of the wrist which lie in the carpal tunnel, causing compression along the median nerve 

and leading to” paresthesias and a bilaterally positive Tinel’s sign. Dr. Hebrard noted that 

appellant also had a positive Adson’s test on the left, documenting compression of the 

neurovascular bundle emerging from the brachial plexus region. 

In an October 21, 2015 report, Dr. Hebrard diagnosed left shoulder impingement with 

bicipital tendinitis, and cervical brachial syndrome due to work factors. He noted work 

restrictions necessitated by left shoulder and bilateral knee conditions. On November 11, 2014 

Dr. Hebrard found appellant’s knee symptoms improved, but that she still had limited cervical 
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and lumbar motion, as well as limited elbow and wrist flexion and extension bilaterally. He 

limited appellant to sedentary work with occasional overhead lifting. 

Dr. Hebrard addressed the causation of appellant’s upper extremity conditions in a 

January 13, 2016 report. He opined that repetitive pushing, pulling, and reaching away from the 

body caused microscopic trauma and “subsequent inflammatory changes” to the long head of the 

biceps tendon due to friction in the intertubercular groove with repetitive pushing, pulling, and 

reaching away from the body. This process caused “impairment of weakness of shoulder 

abduction and forward flexion.” Dr. Hebrard added on February 24, 2016 that repetitive 

reaching at and above the shoulder level caused chronic mechanical rotator cuff impingement 

with subsequent weakness in both shoulders. 

By decision dated May 12, 2016, an OWCP hearing representative affirmed as modified 

OWCP’s December 7, 2015 decision, finding that Dr. Hebrard’s reports were insufficiently 

rationalized to establish causal relationship. 

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 and/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

An occupational disease is defined as a condition produced by the work environment 

over a period longer than a single workday or shift.4 To establish that an injury was sustained in 

the performance of duty in an occupational disease claim, a claimant must submit the following: 

(1) medical evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; (2) 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 employment factors identified by the claimant were the proximate 

cause of the condition for which compensation is claimed or, stated differently, medical evidence 

establishing that the diagnosed condition is causally related to the employment factors identified 

by the claimant. 

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is a causal relationship 

between the claimant’s diagnosed condition and the implicated employment factors. The 

 2 Joe D. Cameron, 41 ECAB 153 (1989). 

3 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999). 

4

 20 C.F.R. § 10.5(q). 
4

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.5

ANALYSIS 

Appellant claimed that she sustained bilateral wrist, knee, foot, and left shoulder 

conditions in the performance of duty on or before August 16, 2015. She attributed these 

conditions to repetitive heavy lifting, pushing, pulling, and prolonged walking and standing 

without proper floor mats. In support of her claim, appellant submitted work limitations from 

Dr. Hebrard, an attending Board-certified physiatrist. OWCP denied the claim by December 7, 

2015 decision, finding that the medical evidence of record was insufficient to establish causal 

relationship. 

Pursuant to a request for a review of the written record, appellant submitted additional 

reports from Dr. Hebrard, containing detailed explanations of the pathophysiologic mechanics of 

causation. Dr. Hebrard explained that repetitive reaching at and above shoulder level led to 

chronic impingement due to aggravation of the supraspinatus tendon at the myotendinous 

junction. He noted repetitive wrist flexion that “led to accumulative aggravation of the flexor 

tendons” in the carpal tunnel, compressing the median nerve. Dr. Hebrard opined that repetitive 

pushing, pulling, and reaching caused cumulative microtrauma and inflammation to the long 

head of the biceps tendon due to friction in the intertubercular groove, as well as chronic rotator 

cuff impingement. 

The Board finds that although Dr. Hebrard’s opinion is insufficiently rationalized to meet 

appellant’s burden of proof to establish causal relationship,6

 it is of sufficient probative quality to 

warrant additional development.7 Dr. Hebrard provided discussions of the pathophysiologic 

mechanisms whereby appellant’s specific work tasks would have caused the claimed injuries. 

However, OWCP did not undertake further development of the medical record, such as referring 

the record to an OWCP medical adviser, or referring appellant for a second opinion examination. 

Proceedings under FECA are not adversarial in nature and OWCP is not a disinterested 

arbiter. While the claimant has the burden of proof to establish entitlement to compensation, 

OWCP shares responsibility in the development of the evidence. It has the obligation to see that 

justice is done.8 The case must be remanded to OWCP for preparation of a statement of accepted 

facts including the physical requirements of her position and the working conditions, and referral 

of the matter to an appropriate medical specialist, consistent with OWCP’s procedures, to 

 5 Solomon Polen, 51 ECAB 341 (2000). 

6 See Frank D. Haislah, 52 ECAB 457 (2001) (medical reports not containing rationale on causal relationship are 

entitled to little probative value); Jimmie H. Duckett, 52 ECAB 332 (2001). 

7 John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 280 (1978). 

8 Jimmy A. Hammons, 51 ECAB 219 (1999); Marco A. Padilla, 51 ECAB 202 (1999); John W. Butler, 39 ECAB 

852 (1988). 
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determine whether appellant sustained the claimed conditions as alleged due to factors of her 

employment. Following this and any other development deemed necessary, OWCP shall issue 

an appropriate decision in the case. 

CONCLUSION 

The Board finds that the case is not in posture for a decision. 

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated May 12, 2016 is set aside, and the case remanded for additional 

development consistent with this decision. 

Issued: January 10, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board