United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.A., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SECURITY 

ADMINISTRATION, Hilo, HI, Employer 

__________________________________________ 

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Docket No. 15-1956 

Issued: February 3, 2017 

Appearances: Case Submitted on the Record

Andy T. Ahuna-Alofaituli, 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 September 25, 2015 appellant, through her representative, filed a timely appeal from 

an August 20, 2015 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.3

 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. 

3

 Appellant submitted additional medical evidence after OWCP rendered its August 20, 2015 decision. The Board’s 

jurisdiction is limited to reviewing the evidence that was before OWCP at the time of its final decision. 20 C.F.R. 

§ 501.2(c)(1). 
2

ISSUE 

The issue is whether appellant met her burden of proof to establish that her left shoulder 

condition was causally related to her accepted November 8, 2012 employment injury. 

FACTUAL HISTORY 

On November 9, 2012 appellant, then a 35-year-old transportation security officer, filed a 

traumatic injury claim (Form CA-1) alleging that on November 8, 2012 she lifted a heavy bag 

onto the conveyor belt and felt a pinch in her right arm and shoulder. OWCP assigned File No. 

xxxxxx300. It subsequently accepted the claim for a right shoulder and upper arm sprain and 

other affections of the right shoulder region, not elsewhere classified. Appellant received 

continuation of pay and then compensation benefits for wage loss. She returned to modified duty 

on February 4, 2013. On March 22, 2013 appellant underwent an authorized right shoulder 

subacromial decompression and limited synovectomy. She began receiving compensation 

benefits for wage loss. On June 10, 2013 appellant returned to light duty as a modified 

transportation security officer on a full-time basis. 

In a July 9, 2014 letter, appellant requested that OWCP expand her accepted condition to 

include a left shoulder condition. She stated that she injured her left shoulder while 

compensating for her right shoulder. Appellant indicated that she was forced to work with her 

shoulder condition as OWCP did not authorize pain as a viable reason to be off work. She 

indicated that her physician, Dr. Carol Orr, a family practitioner, was aware of her condition and 

that she had a magnetic resonance imaging (MRI) scan of her left shoulder.4

 

On November 9, 2012 a nurse practitioner noted that appellant reported right shoulder 

pain that radiated down her arm having injured it at work the previous night while lifting heavy 

luggage onto the conveyer belt. 

In a November 15, 2012 medical report, Dr. Orr diagnosed “sprain shoulder, rotator cuff, 

impingement syndrome of shoulder, and muscle spasm” as a result of the November 8, 2012 

work injury. 

A November 20, 2012 right shoulder x-ray report diagnosed right shoulder impingement. 

An MRI scan performed on December 11, 2012 of the right shoulder showed 

impingement of the supraspinatus tendon with secondary degenerative tendinosis and a tiny 

bursal surface tear. 

Dr. Orr noted, in a December 17, 2012 report, that appellant sustained a right shoulder 

injury on November 8, 2012 and had a history of left shoulder impingement. She reported that 

appellant was concerned that the recent lifting injury may have aggravated her earlier left 

shoulder impingement condition as she was lifting the bag with both arms. Dr. Orr noted that 

appellant had pain in the left shoulder with range of motion. 

 4

 Under File No. xxxxxx721, date of injury September 10, 2010, appellant has an accepted left shoulder rotator 

cuff sprain. OWCP combined the case records involving appellant’s bilateral upper extremity injuries and 

designated File No. xxxxxx300 as the master file. 
3

Physical therapy reports from December 6, 13, and 20, 2012 and January 3, 10, 17, 24, 

and 31, February 15, 20, and 27, and March 5, 2013 showed near full range of motion in the right 

shoulder with no tenderness. 

In a January 17, 2013 report, Dr. Orr reported a history of right shoulder injury on 

November 8, 2012 and a previous left shoulder impingement injury. She noted that appellant 

was compensating for her right shoulder and had increased pain in the left shoulder. 

The record substantiates that appellant returned to modified full-time work on 

February 4, 2013. 

In a February 8, 2013 report, Dr. Sydney Smith, an orthopedic surgeon, recommended 

right shoulder surgery. 

Dr. Orr again noted, in a February 19, 2013 report, that appellant stayed home due to 

right shoulder pain on February 13, 15, and 18, 2013. She also left work early on February 12, 

2013 due to right shoulder pain. 

A March 21, 2013 MRI scan of the left shoulder showed partial tears of the suprapinatus 

tendon and rotator interval and a superior glenohumerol ligament tear. 

On March 22, 2013 appellant underwent a right shoulder subacromial decompression 

surgery. 

In a March 28, 2013 report, Dr. Orr reported on appellant’s right shoulder condition 

postsurgery. She also noted that appellant continued to have pain in her left shoulder post MRI 

scan of the left shoulder with some bruising in front of the left shoulder post arthrogram. 

In an April 29, 2013 report, Dr. Orr noted that appellant continued to have pain in the left 

shoulder post MRI scan. She reported reduced range of motion of the left shoulder with 

weakness. An April 29, 2013 physical therapy report indicated that appellant had full external 

and internal rotation of the right shoulder. 

Dr. Smith noted on May 2, 2013 that appellant reported injuring her left shoulder at work 

when lifting luggage on September 10, 2010. He diagnosed left shoulder impingement/cuff 

tendinosis, as seen on MRI scan. 

In a June 6, 2013 report, Dr. Orr reported that appellant’s right shoulder pain had 

decreased postsurgery, and with physical therapy. She indicated that most of appellant’s pain 

was in her left shoulder. Dr. Orr noted that appellant believed she had also injured her left 

shoulder on November 8, 2012 and that symptoms increased on that side after that date. 

Appellant maintained that left shoulder pain never went away fully from the left shoulder injury 

of September 10, 2010 even though she was working full duty. She also indicated that OWCP 

was combining both shoulder claims. 

Appellant returned to full-time light-duty work on June 10, 2013. 

In a July 8, 2013 report, Dr. Orr indicated that appellant sustained a right shoulder injury 

on November 8, 2012 and that her left shoulder was also injured as she was lifting with the left 
4

shoulder as well. Postarthroscopy of the right shoulder was doing well. Dr. Orr recommended 

that physical therapy be approved by OWCP for both shoulders. She diagnosed left shoulder 

reoccurrence/aggravation of preexisting impingement/supraspinatus tear and superior 

glenohumeral ligament tear. 

In August 20 and September 12, 2013 reports, Dr. Orr noted that appellant sustained a 

right shoulder injury on November 8, 2012 and that her left shoulder was also injured at that time 

as she was also lifting with the left shoulder. She reported that appellant’s left shoulder 

dysfunction increased last week on August 17, 2013 while at work lifting empty bins. Dr. Orr 

opined that appellant had left shoulder recurrence/aggravation of preexisting impingement/ 

supraspinatous tear and superior glenohumeral ligament tear found on MRI scan. She also noted 

that there were objective findings on MRI scan of the left shoulder, as well as loss of 

function/range of motion, loss of strength, and swelling, after November 8, 2012. 

On June 17, 2014 Dr. Orr took appellant off work from June 17 through 18, 2014 due to 

her left rotator cuff syndrome, right shoulder pain for more than three months, and impingement 

syndrome of left shoulder and left glenoid labrum tear. 

In a letter dated October 14, 2014, OWCP noted the issue as whether a consequential left 

shoulder condition should be accepted from the date of injury of November 8, 2012 to 

August 16, 2013. It explained that the event of lifting empty bins at work on August 17, 2013 

constituted an intervening event after the date of the original injury (November 8, 2012) which 

would possibly be a new injury beginning on August 17, 2013, for which appellant may want to 

file a new left shoulder claim. OWCP advised that the current claim was accepted for right 

shoulder and upper arm sprains and other affections of the right shoulder not elsewhere 

classified. It noted that the evidence of record was insufficient to expand the accepted conditions 

to include a left shoulder condition, as there was no narrative medical report explaining how 

appellant suffered a consequential left shoulder injury. Appellant was requested to provide 

additional factual and medical information, within 30 days, including a narrative medical report 

from her physician which explained how her accepted right shoulder injury caused the left 

shoulder injury. 

In October 4, 2013 and January 27, June 17, September 19 and October 23, 2014 reports, 

Dr. Orr explained that appellant sustained a right shoulder injury on November 8, 2012 and that 

her left shoulder was also injured at that time as she was lifting with both shoulders. 

In her October 23, 2014 report, Dr. Orr indicated that appellant returned to modified duty 

on February 4, 2013, and on that same day she was compensating for her right shoulder with her 

left shoulder, which caused the left shoulder condition. She advised that the left shoulder should 

fall under the November 8, 2012 injury. Dr. Orr noted that the MRI scan of the left shoulder 

showed supraspinatus tear and superior glenohumeral ligament tear and that appellant had a 

preexisting impingement of the left shoulder that had never been surgically treated, which caused 

her to be at greater risk for development of the left shoulder injury on February 4, 2013 when she 

returned to work. She indicated that the left shoulder could be claimed as a new injury on 

February 4, 2013, but requested that a consequential left shoulder condition be accepted under 

the November 8, 2012 injury as appellant was compensating for the right shoulder injury. 
5

In her January 27, 2014 report, Dr. Orr opined that appellant was compensating for left 

shoulder pain while recuperating from right shoulder surgery which prolonged recovery of the 

right shoulder condition. She explained that the preexisting impingement from her prior left 

shoulder injury was aggravated by the November 8, 2012 injury. Dr. Orr noted that the 

supraspinatus tear and superior glenohumeral ligament tear of the left shoulder found on MRI 

scan were caused by this new injury. She presented positive examination findings for the left 

shoulder, but noted that OWCP had denied surgery of the left shoulder. Multiple treatment notes 

were also submitted from Dr. Orr. 

By decision dated August 20, 2015, OWCP denied appellant’s claim finding insufficient 

medical evidence to establish a consequential left shoulder condition causally related to her 

accepted right shoulder condition. It specifically found that while appellant’s treating physician 

opined that she sustained the left shoulder injury concurrently with the right shoulder injury on 

November 8, 2012, no mention was made of a left shoulder injury until June 6, 2013. 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA has the burden of establishing 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.5

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 which must be considered in conjunction with one another. 

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

allegedly occurred.6 The second component is whether the employment incident caused a 

personal injury.7 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.8

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

intervening cause attributable to the claimant’s own intentional misconduct.9

 Thus, a subsequent 

 5

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

6 Elaine Pendleton, 40 ECAB 1143 (1989).

7 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. 

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

9 Mary Poller, 55 ECAB 483, 487 (2004); 1 Lex K. Larson, Larson’s Workers’ Compensation Law § 10-1 

(Matthew Bender, Rev. Ed. June 2016). 
6

injury, be it an aggravation of the original injury or a new and distinct injury, is compensable if it 

is the direct and natural result of a compensable primary injury.10

ANALYSIS 

 Appellant alleges that she sustained a consequential left shoulder condition as a result of 

her accepted November 8, 2012 right shoulder injury. She has also alleged that she injured her 

left shoulder on November 8, 2012 at the same time she injured her right shoulder. OWCP 

denied appellant’s left shoulder claim finding insufficient medical evidence to establish that her 

left shoulder was injured on November 8, 2012. 

 The Board finds that appellant has not established that her left shoulder condition was 

caused or aggravated by the November 8, 2012 lifting event or that she sustained a consequential 

left shoulder injury. 

 A series of medical reports from Dr. Orr were received. In her December 17, 2012 

report, Dr. Orr noted that appellant had a history of left shoulder impingement and that appellant 

was concerned that her November 8, 2012 lifting injury may have aggravated the previous left 

shoulder condition because she was lifting a bag with both arms. She noted that appellant had 

pain in the left shoulder with range of motion. The Board finds that pain is a symptom and not a 

compensable medical diagnosis.11 Dr. Orr failed to explain with medical rationale and based 

upon contemporaneous medical evidence, that appellant sustained a left shoulder injury on 

November 8, 2012.12 

 While subsequent evidence from Dr. Orr appears to support that appellant sustained a 

consequential left shoulder condition on February 4, 2013 when she returned to modified duty, 

her reports are not rationalized. In her January 27 and October 23, 2014 reports, she explained 

that, when appellant retuned to modified duty on February 4, 2013, she was compensating for her 

right shoulder with her left shoulder, which caused the left shoulder condition. Dr. Orr noted 

that the MRI scan of the left shoulder showed a supraspinatus tear and a superior glenohumeral 

ligament tear and that appellant had a preexisting impingement of the left shoulder, which caused 

her to be at greater risk for development of the left shoulder injury on February 4, 2013. She 

explained in her 2014 reports that the aggravation of the preexisting impingement made 

appellant more likely to cause additional injury to the left shoulder. Dr. Orr further stated that 

the supraspinatus tear and superior glenohumeral ligament tear found on MRI scan was caused 

by this injury. However, she failed to provide a rationalized medical opinion, supported by 

objective evidence, explaining how the supraspinatus and superior glenohumeral ligament tears 

found on MRI scan were caused by the November 8, 2012 left shoulder injury or developed after 

appellant returned to modified duty on February 4, 2013. Rather, Dr. Orr generally concluded 

that appellant’s preexisting condition was aggravated, which made her more likely to cause 

injury to her left shoulder. The Board has found that medical evidence which states a 

 10 Susanne W. Underwood (Randall L. Underwood), 53 ECAB 139, 141 n.7 (2001). 

11 V.S., Docket No. 14-2028 (issued June 3, 2015). 

12 See E.L., Docket No. 12-791 (issued August 29, 2012). 
7

conclusion, but does not offer any rationalized medical explanation is of limited probative 

value.13

 Accordingly, the Board finds that appellant has not submitted sufficient medical evidence 

to establish that her left shoulder condition either arose as a direct result of the November 8, 

2012 employment injury or as a consequence of her return to modified duty on February 4, 2013. 

 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. 

CONCLUSION 

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

shoulder condition was causally related to her accepted November 8, 2012 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the August 20, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 3, 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 

 13 J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006).