United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.F., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Bellaire, TX, Employer

__________________________________________

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Docket No. 17-0113

Issued: April 10, 2018

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

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On October 25, 2016 appellant filed a timely appeal from a September 14, 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 claim.

ISSUE

The issue is whether appellant has established right upper extremity conditions causally 

related to the accepted factors of his federal employment. 

FACTUAL HISTORY

On January 19, 2016 appellant, then a 66-year-old bulk mail clerk, filed an occupational 

disease claim (Form CA-2) alleging that he sustained right shoulder, arm, wrist, hand, thoracic,

and elbow injuries from repetitive pushing and pulling of equipment, lifting tubs and trays, keying 

 

1 5 U.S.C. § 8101 et seq.
2

on a computer, stamping, and reaching above his shoulders in the performance of his federal 

employment duties. He did not stop work. Appellant’s supervisor noted that appellant was 

working modified duty six hours per day due to a previously accepted employment injury.2 The 

record reflects that appellant accepted a modified work offer on June 29, 2015.

In a January 28, 2016 development letter, OWCP advised appellant that additional factual 

and medical evidence was necessary to establish his claim. Appellant was asked to submit 

additional factual information along with a comprehensive narrative medical report from his 

attending physician which addressed how his claimed employment activities caused, contributed 

to, or aggravated a diagnosed condition. He was afforded 30 days to submit the necessary 

evidence.

In January 11, 2015 and February 4, 2016 statements, appellant described the development 

of his medical conditions and the duties he had performed during his federal employment. He 

indicated that his full-time work hours were reduced in November 2014 to two hours a day because 

of his 2009 employment injury, but were eventually increased to six hours a day in June 2015. 

OWCP received medical evidence in support of the claim. An April 14, 2015 cervical 

magnetic resonance imaging (MRI) scan report and December 8, 2015 electromyogram (EMG) 

report were submitted.

In a January 15, 2016 medical report, Dr. Ian J. Reynolds, a Board-certified orthopedic 

surgeon, discussed appellant’s cervical and lumbar complaints. 

Medical reports dated January 5 and 26, 2016 from Dr. Steven B. Inbody, a neurologist, 

were received. In his January 5, 2016 report, Dr. Inbody provided a clinical impression of cervical 

herniated nucleus pulposus with C4-7 radiculopathy (right) and thoracic outlet syndrome (right). 

He opined that appellant could continue to work in a modified position with reduced hours. 

Dr. Inbody noted that while appellant worked in a modified position with reduced hours, his 

symptoms of right cervical, trapezial and shoulder region pain and weakness progressed with 

referred pain down the interscapular region of the thoracic spine, pain, numbness and weakness of 

the right arm, forearm, and the extensor aspect of the forearm to the wrist with paresthesias 

affecting the fingers. He indicated that those symptoms directly correlated with appellant’s 

continued bulk mail clerk work activities. Dr. Inbody explained that the required movements, 

which appellant only performed with his right upper extremity, gradually led to a repetitive stress 

injury of the right shoulder, arm and cervical spine, with neuropathic symptoms affecting his entire 

right upper extremity. He noted that, while appellant had an intact cervical fusion at C4-5, C5-6, 

and C7, the April 14, 2015 cervical MRI scan demonstrated significant spurring both above and 

below the fusion and that the April 14, 2015 MRI scan and EMG studies showed more significant 

pathology. Dr. Inbody indicated that this was consistent with a more proximal compression on the 

 

2 Under OWCP File No. xxxxxx352, appellant has an accepted occupational disease claim for injury on October 6, 

2009 which caused neck sprain, brachial neuritis, or radiculitis; wrist sprain, left; sprain of shoulder and upper arm, 

left; displacement of lumbar intervertebral disc without myelopathy; displacement of cervical intervertebral disc 

without myelopathy; and enthesopathy of left elbow region. On March 10, 2016 the claim was updated to include 

cervical disc disorder with radiculopathy, mid-cervical region; other synovitis and tenosynovitis, right forearm; and 

radiculopathy, cervicothoracic region. Appellant stopped work as of January 24, 2016 and has received wage-loss 

compensation on the periodic rolls under this claim. This claim has not been combined with the current claim. 
3

right potentially at the costoclavicular region which explained the extensor aspect of the symptoms 

down into the forearm, wrist, and hand, including all fingers. This would presumably be due to

the myogenic neurovascular compression proximally as a result of a mechanical pain generator in 

the cervical spine which had continued to advance, as well as a result of the overuse of the 

originally asymptomatic right upper extremity.

In a January 26, 2016 report, Dr. Inbody requested that OWCP approve the diagnoses of 

cervical herniated nucleus pulposus with C4-7 radiculopathy (right) and thoracic outlet syndrome 

(right). He reiterated his findings contained in his January 5, 2016 report that appellant sustained 

significant new symptoms while at work as a bulk mail handler in his modified position. 

Dr. Inbody explained that appellant’s symptoms directly correlated with his continued workrelated activities. He noted that appellant performed repetitive pushing and pulling of heavy 

equipment, lifting tubs and trays of mail, keying on the computer, standing and reaching above his 

shoulders in his modified position which were within the physical restrictions he had ordered. 

Dr. Inbody indicated that appellant performed the required movements with only his right upper 

extremity, which gradually led to a repetitive stress injury of the right shoulder, arm, and cervical 

spine, with neuropathic symptoms affecting his entire right upper extremity. He stated the nature 

of the injury appeared to relate to the original cervical disc injury. Dr. Inbody explained that 

appellant’s dependence at work on the more asymptomatic right upper extremity increased and as 

he continued with rigorous work activities, nearly identical symptoms to those on the left began to 

evolve both in the cervical and right trapezial region, down the right arm, forearm, and the extensor 

aspect of the forearm to the wrist causing tingling and weakness of the right hand and all fingers. 

He also noted that diagnostic testing supported a finding that appellant’s symptoms had progressed 

in both the right and left upper extremities. Dr. Inbody opined that appellant’s condition was 

consistent with a more proximal nerve root compression potentially at the cervical spine or 

alternatively within the costoclavicular region, which explained the extensor aspect of the 

symptoms down into the right forearm, wrist, and hand including all fingers. He opined that 

appellant’s cervical disc herniation with radiculopathy C4-T1 and thoracic outlet syndrome were 

due to the repetitive pushing and pulling of heavy equipment, lifting tubs and trays of mail, keying 

on the computer, standing and reaching above his shoulder and was consequential of his initial 

injury of November 6, 2009. Dr. Inbody further opined that appellant was totally disabled from 

duty as of January 25, 2016, due to the new diagnoses of cervical disc herniation with 

radiculopathy C4-7 and thoracic outlet syndrome consequential to his initial injury of 

November 6, 2009.

By decision dated March 1, 2016, OWCP denied the claim as a medical diagnosis had not 

been established in connection with the accepted employment factors.

On March 29, 2016 OWCP received appellant’s March 23, 2016 request for review of the 

written record by an OWCP hearing representative. Duplicative evidence was received along with 

appellant’s February 4, 2015 statement, a January 28, 2016 cervical epidural steroid injection 

report, and diagnostic testing from May 11, 2012, June 27 and October 7, 2014, December 5 and

8, and April 14, 2015, February 23, April 14, May 4 and 5, 2016. 

In an August 24, 2016 letter, the employing establishment disagreed with appellant’s 

description of his modified job duties. It specified that it had provided and appellant had accepted 

a limited-duty job offer on June 29, 2015 for another claim. The job offer did not require lifting 
4

over five pounds for more than two hours. It allowed sitting for five hours, walking and standing 

for no more than one hour, and pushing and pulling for no more than two hours. The employing 

establishment indicated that appellant performed those duties until he stopped work on 

January 25, 2016. 

Additional progress and medical reports from Dr. Inbody were received. In an April 21, 

2016 letter, Dr. Inbody indicated that appellant chose to proceed with the current claim to obtain 

approval for occupational repetitive stress injuries sustained on or about September 16, 2015, 

which caused total disability. He noted the history of appellant’s November 5, 2009 traumatic 

injury, his medical course and the approved OWCP medical conditions. Dr. Inbody indicated that 

he continued to treat appellant for his original injuries and that appellant was gradually able to 

increase his limited hours at work with activity modification from two to four to finally six hours 

per day. He reported that appellant was able to meet his duties using primarily his far more 

functional right upper extremity to perform the rigorous physical duties of repetitive pushing and 

pulling of heavy equipment, lifting tubs and trays of mail, keying on the computer, standing and 

reaching above his shoulders, all within the physical restrictions he ordered up until 

September 16, 2015. As of September 16, 2015, appellant sustained the significant and sub-acute 

development of new symptoms which included right cervical paraspinal, trapezial and shoulder 

region pain and weakness which escalated while at work and was associated with pain, numbness 

and weakness of the right arm, forearm, and the extensor aspect of the forearm to the wrist with 

paresthesia affecting all fingers. He reiterated his opinion that appellant’s work activities, which 

he performed primarily with only his right upper extremity, gradually led to a repetitive stress 

injury to the right shoulder, arm, and cervical spine, with neuropathic symptoms affecting his entire 

right upper extremity. 

Dr. Inbody related that appellant’s original left upper extremity symptoms also appeared 

to gradually worsen during the same time frame. Appellant remained at work and continued with 

his physically rigorous duties up until January 25, 2015, when he was determined to be totally 

disabled. Dr. Inbody noted that appellant’s symptoms of right cervical and right trapezial region 

pain had been triggered and perpetuated by the unilateral use of his right arm for lifting, pushing 

and pulling and was secondary to his cervical disc herniation with radiculopathy and cervical 

postlaminectomy syndrome. He opined, “[o]bjective documentation in support of these requested 

diagnoses correlate with both the patient’s clinical symptoms as well as the mechanism of injury 

as it relates to his occupational duties. The patient’s symptoms of right cervical and right trapezial 

region pain have been triggered and perpetuated by the unilateral use of his right arm for lifting, 

pushing and pulling is secondary to his cervical disc herniation with radiculopathy at C4-T1 and 

cervical postlaminectomy syndrome.” Dr. Inbody noted that the current EMG study demonstrated 

right upper extremity sensory and motor ulnar and median nerve injury consistent with a proximal 

nerve compression within the costoclavicular which explained the extensor aspect of appellant’s 

symptoms. This would presumably be due to myogenic neurovascular compression of the lower 

brachial plexus proximally on the right, as a result of a mechanical pain generator in the cervical 

spine which has continued to degenerate as well as the overuse of the originally asymptomatic 

right upper extremity. Dr. Inbody concluded that appellant sustained further injury in the 

performance of his duties which resulted in cervical disc herniation with radiculopathy (C4-T1), 

cervical postlaminectomy syndrome; right brachial neuritis/radiculitis, and synovitis and 

tenosynovitis of the right forearm which were “directly or indirectly consequential” to his original 

injury of November 6, 2009 and rendered appellant totally disabled.
5

By decision dated September 14, 2016, an OWCP hearing representative modified the prior 

decision to find fact of injury established, but affirmed the denial of appellant’s claim. The hearing 

representative found the medical evidence presented failed to provide a well-rationalized opinion 

relating appellant’s diagnosed conditions to his federal duties based on a complete and accurate 

history of his reported work factors. 

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 is causally related to the 

employment injury.3 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.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) 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 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, generally, is 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 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

The Board finds that appellant has not established that his right upper extremity conditions 

were causally related to the accepted factors of his federal employment. 

Appellant had a prior 2009 employment injury under OWCP File No. xxxxxx352 which 

OWCP accepted for the conditions of neck sprain, brachial neuritis or radiculitis; wrist sprain, left; 

sprain of shoulder and upper arm, left; displacement of lumbar intervertebral disc without 

 

3

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

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

5 Victor J. Woodhams, 41 ECAB 345 (1989).
6

myelopathy; displacement of cervical intervertebral disc without myelopathy; and enthesopathy of 

left elbow region. It subsequently accepted, on March 10, 2016, the additional conditions of 

cervical disc disorder with radiculopathy, mid-cervical region; other synovitis and tenosynovitis, 

right forearm; and radiculopathy, cervicothoracic region. The employing establishment indicated 

that appellant was working limited duty six hours per day as a result of the accepted 2009 injury. 

Appellant’s restrictions were in effect from June 29, 2015 until he stopped work on 

January 25, 2016. He alleged that his right upper extremity conditions were due to repetitive 

pushing and pulling of equipment, lifting tubs and trays, keying on a computer, stamping, and 

reaching above his shoulders following his return to modified work after his 2009 injury. 

OWCP denied the claim finding that appellant failed to present rationalized medical 

opinion evidence, based on a complete factual and medical background, which showed a causal 

relation with the accepted work factors. 

In the present claim, appellant submitted several reports from Dr. Inbody. The record 

reveals that Dr. Inbody had treated appellant for his 2009 injury. Appellant returned to modified 

duty following Dr. Inbody’s medical restrictions and using primarily only his right upper 

extremity. In his January 5 and 26, 2016 reports, Dr. Inbody diagnosed cervical herniated nucleus 

pulposus with C4-7 radiculopathy (right) and thoracic outlet syndrome (right) and related 

appellant’s right-sided conditions to the original cervical disc injury. He noted that “this is 

consistent with a more proximal nerve root compression potentially at the cervical spine or 

alternatively within the costoclavicular region and thus explaining the extensor aspect of the 

symptoms down into the right forearm, wrist and hand including all fingers.” These reports are 

found to be insufficient to establish appellant’s claim. The Board has previously held that the need 

for rationalized medical opinion is especially important in cases wherein the employee had a 

preexisting condition.6 The Board has explained that in light of a prior injury, rationalized medical 

evidence is particularly important to explain how the current conditions resulted from alleged 

employment factors, and not the prior injury.7

In his April 21, 2016 report, Dr. Inbody offered new occupational injury diagnoses of 

brachial neuritis/radiculitis, right and synovitis and tenosynovitis of forearm, right. However, he 

failed to provide a rationalized medical opinion which explained the nature of the relationship 

between the diagnosed conditions and the specific employment factors identified. Rather,

Dr. Inbody continued to opinion that the new diagnoses were secondary or consequential to 

appellant’s cervical disc herniation with radiculopathy (C4-T1) and cervical postlaminectomy 

syndrome. He indicated that appellant’s symptoms of right cervical and right trapezial region pain,

which had been triggered and perpetuated by the unilateral use of his right arm for lifting, pushing,

and pulling, was secondary to his cervical disc herniation with radiculopathy at C4-T1 and cervical 

postlaminectomy syndrome. Dr. Inbody also concluded that appellant’s conditions of cervical disc 

herniation with radiculopathy (C4-T1), cervical postlaminectomy syndrome, right brachial 

neuritis/radiculitis, and synovitis and tenosynovitis of the right forearm were “directly or indirectly 

consequential” to his original injury of November 6, 2009. The Board finds that Dr. Inbody’s 

opinion on causal relation is of diminished probative value as he did not adequately explain or 

 

6 See W.W., Docket No. 17-0422 (issued October 13, 2017). 

7 See L.R., Docket No. 16-0736 (issued September 2, 2016).
7

describe physiologically how or why the modified working conditions appellant performed in his 

modified employment position caused the current conditions or aggravated appellant’s preexisting 

conditions from his other claim.8

The remaining medical evidence is insufficient to support appellant’s claim as it fails to 

contain a diagnosed condition or the established employment activities identified by appellant.9 

The diagnostic reports of record are also insufficient to establish appellant’s claim as the 

physicians interpreted diagnostic imaging studies and provided no opinion on the cause of 

appellant’s injury. Diagnostic studies are of limited probative value as they do not address whether 

the employment incident caused any of the diagnosed conditions.10

As there is no reasoned medial evidence explaining how appellant’s employment duties 

caused or aggravated a medical condition involving his right cervical and right upper extremity, 

appellant has not met his burden of proof to establish a medical condition causally related to the 

accepted factors of his federal employment. As noted, causal relationship is a medical question 

that must be established by probative medical opinion from a physician.11 The physician must 

accurately describe appellant’s work duties and medically explain the pathophysiological process 

by which these duties would have caused or aggravated his condition.12 The need for medical 

reasoning or rationale is particularly important given the fact that medical evidence of record 

indicates that appellant had preexisting conditions from another claim.

13

On appeal, appellant argues that Dr. Inbody’s reports support his claim. For the reasons 

discussed above, the medical reports are insufficient to meet appellant’s burden of proof as they 

are not sufficiently rationalized. 

Appellant may submit new evidence or argument as part of 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 his burden of proof to establish right upper 

extremity conditions causally related to the accepted factors of his federal employment. 

 

8 Solomon Polen, 51 ECAB 341 (2000) (rationalized medical evidence must relate specific employment factors 

identified by the claimant to the claimant’s condition, with stated reasons by a physician). See also S.T., Docket No. 

11-237 (issued September 9, 2011); A.D., 58 ECAB 149 (2006). 

9

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 

10 See J.S., Docket No. 17-1039 (issued October 6, 2017). 

11 Supra note 9. 

12 Solomon Polen, supra note 8. See also S.T., supra note 8. 

13 See L.M., Docket No. 16-0143 (issued February 19, 2016). 
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ORDER

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

Programs dated September 14, 2016 is affirmed.

Issued: April 10, 2018

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