United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.C., Appellant 

and 

DEPARTMENT OF THE ARMY, MATERIAL 

COMMAND, Anniston, AL, Employer 

__________________________________________ 

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Docket No. 16-1797 

Issued: March 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 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On September 9, 2016 appellant filed a timely appeal of an August 19, 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 to consider the merits of the case. 

ISSUES 

The issues are: (1) whether appellant has met his burden of proof to establish additional 

right upper extremity conditions resulting from his March 7, 2008 employment injury; and 

(2) whether OWCP properly denied authorization for the requested right shoulder surgery. 

FACTUAL HISTORY 

On June 16, 2008 appellant, then a 25-year-old general equipment mechanic helper, filed 

a traumatic injury claim (Form CA-1) alleging that he sustained a right rotator cuff tear on 

 1

 5 U.S.C. § 8101 et seq.
2

March 7, 2008 while using an air jackhammer in the performance of duty. He indicated that he 

experienced pain from his shoulder to his chest. 

Appellant filed a recurrence claim (Form CA-2a) on September 18, 2008 requesting 

medical treatment due to his March 7, 2008 employment injury. He noted that he was 

performing light duty and that his pain had not stopped. 

The employing establishment terminated appellant on October 14, 2008 due to the 

expiration of his appointment. 

By decision dated November 13, 2008, OWCP accepted appellant’s claim for bicipital 

tenosynovitis on the right. It authorized intermittent wage-loss compensation benefits from 

April 7 through October 23, 2008. Appellant continued to request wage-loss compensation after 

October 23, 2008. 

In a report dated June 10, 2010, Dr. Morton S. Rickless, an orthopedic surgeon, noted 

appellant’s March 8, 2008 employment injury and described an external rotation injury to his 

right upper extremity. He reviewed appellant’s right shoulder x-rays, which demonstrated slight 

deformity of the distal clavicle. 

By decision dated July 29, 2010, OWCP denied appellant’s claim for compensation 

benefits from October 24, 2008 finding that he had failed to establish total disability for that 

period due to his accepted condition. 

Dr. Rickless reviewed appellant’s electrodiagnostic testing dated July 30, 2010 and 

diagnosed carpal tunnel syndrome. Appellant underwent a right shoulder magnetic resonance 

imaging (MRI) scan on July 22, 2010 which demonstrated tendinopathy or delamination tear of 

the supraspinatus tendon, but no full thickness tear or under surface tear of the right shoulder. 

His bones and labrum were unremarkable, but there was some moderate acromioclavicular (AC) 

joint arthropathy. 

In a note dated August 16, 2010, Dr. Rickless mentioned appellant’s March 8, 2008 

employment injury and noted that appellant’s position required repetitive work with tools 

including wrenches and jackhammers. He opined that appellant required carpal tunnel release. 

Dr. Rickless noted, “It is the opinion of this office, that since [appellant] did repetitive work with 

his hands that the carpal tunnel is related to his job.” He again recommended carpal tunnel 

release on October 4, 2010. On November 15, 2010 Dr. Rickless diagnosed traumatic AC 

arthritis and carpal tunnel syndrome. He noted appellant’s March 8, 2008 employment incident, 

appellant’s ongoing reports of right arm pain and numbness, as well as his job duties of repetitive 

work with power and hand tools. Dr. Rickless recommended a Mumford Neer acromioplasty. 

On November 22, 2010 he requested authorization from OWCP for the procedure. 

On November 24, 2010 OWCP’s medical adviser reviewed appellant’s claim and noted 

that the accepted condition was bicipital tendinitis. He noted that appellant’s AC joint was not 

mentioned. OWCP’s medical adviser recommended that OWCP deny the proposed surgical 

procedure. 
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In a letter dated December 6, 2010, OWCP noted that additional medical evidence was 

required to support appellant’s request for right shoulder surgery. It noted no further 

consideration of the surgical request would be made until the requested medical evidence was 

received. 

Dr. Rickless completed a report on December 20, 2010 and noted appellant’s March 8, 

2008 employment injury. He reported appellant’s right shoulder pain and decreased range of 

motion and diagnosed traumatic AC arthritis and carpal tunnel syndrome. On April 4, 2011 

Dr. Rickless indicated that appellant recently sustained a fall with a direct blow to his right 

shoulder. 

Dr. Milka E. Martinez Arache, a Board-certified internist, examined appellant on 

October 9, 2012. She mentioned his March 8, 2008 employment injury and his right shoulder 

pain. Dr. Arache found that appellant had right shoulder tenderness and mild pain with motion. 

She examined him on November 14, 2012 and reported that his right shoulder pain was 

aggravated by lifting and movement. Dr. Arache prescribed pain medication for appellant’s right 

shoulder on January 4, 2013. 

Dr. Rickless examined appellant on March 20, 2013 and noted that his symptoms of right 

shoulder pain began on March 7, 2008. He diagnosed shoulder pain and carpal tunnel syndrome. 

Dr. Rickless again requested shoulder surgery on April 8, 2013. 

In a letter dated April 10, 2013, OWCP instructed appellant that additional medical 

evidence was necessary to establish that the requested surgery was causally related to his 

accepted employment injury. In a May 2, 2013 letter addressed to Dr. Rickless and to 

Dr. Arache, it advised the physicians of the medical evidence needed with respect to appellant’s 

request for surgery. OWCP afforded 30 days for a response. 

Dr. Stanley W. Jett, a family practitioner, examined appellant on April 29, 2013 and 

found tenderness over the anterior portion of the shoulder inferior to the distal clavicle. He noted 

that range of motion was limited by pain and that lifting was limited to less than 10 pounds. 

Dr. Jett found crepitation with range of motion of the right shoulder. He diagnosed pain in joint 

involving shoulder region. Dr. Jett continued submitting status reports. 

On June 6, 2013 OWCP received a copy of its May 2, 2013 letter that was sent to 

Dr. Rickless’ office. Handwritten notations on the letter included a diagnosis of traumatic 

arthritis of the right shoulder and a request for authorization to perform Mumford Neer 

arthroplasty. The letter was not signed and there is no indication of who provided the 

handwritten notations. 

By decision dated August 21, 2014, OWCP informed appellant that pain was not an 

accepted diagnosis under FECA. It denied his claim finding that the medical evidence of record 

was insufficient to establish that any additional medical conditions were due to his March 7, 

2008 employment injury. OWCP further denied appellant’s requested shoulder surgery. 

Appellant requested reconsideration on April 9, 2015. In support of his reconsideration 

request, he submitted an affidavit noting that on March 7, 2008 he injured his right shoulder at 

work. Appellant indicated that he had no prior shoulder injuries and had no new traumatic 
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injuries to his shoulder since March 7, 2008. He indicated that he had not been released from 

light duty. Appellant also submitted medical evidence dated from March 30, 2015 through 

June 17, 2010. In a September 30, 2014 note, Dr. Rickless opined that appellant had an on-thejob injury, which resulted in pain in the right shoulder due to traumatic arthritis and tendinitis of 

the rotator cuff. He diagnosed unspecified disorder of the bursae and tendons in the right 

shoulder as well as arthritis of the right shoulder. On March 30, 2015 Dr. Rickless diagnosed 

bicipital tenosynovitis and traumatic arthritis due to the March 2008 work injury. He noted that 

appellant worked with power tools, which could have caused damage to his right shoulder. 

Dr. Rickless indicated that the Mumford Neer arthroplasty was medically necessary as appellant 

had documented arthritis in the right AC joint with no tear. 

Dr. Jett completed a report dated March 30, 2015 and diagnosed right bicipital 

tenosynovitis and traumatic arthritis of the right shoulder caused by the March 2008 employment 

injury. He explained that appellant developed bicipital tenosynovitis of the right shoulder using 

an air chisel and jackhammer. Dr. Jett opined that the repetitive use of heavy equipment with the 

bicipital tenosynovitis led to chronic traumatic arthritis of the shoulder. He recommended a 

Mumford Neer Arthroplasty to remove a portion of appellant’s shoulder bone. Dr. Jett noted that 

the partial arthroplasty would relieve the pressure on the bicipital tendon and allow some relief 

of pain, increasing activity, and helping with the arthritic pain in the shoulder. 

OWCP’s medical adviser reviewed appellant’s request for surgery on May 27, 2015. He 

found that there was no clear documentation of what was causing appellant’s shoulder pain and 

that the accepted condition of tenosynovitis of the biceps tendon would not account for traumatic 

arthropathy. 

In a decision dated June 1, 2015, OWCP denied modification of the August 21, 2014 

decision denying appellant’s claim for an additional right shoulder condition and his request for 

surgery. It found that there was no rationalized medical opinion evidence supporting that the 

March 7, 2008 work injury, accepted for biceps tenosynovitis, resulted in appellant’s ongoing 

right shoulder condition or the need for the Mumford Neer arthroplasty. 

Appellant requested reconsideration and submitted additional medical evidence on 

May 11, 2016. In Dr. Rickless’ November 9, 2015 note, he indicated that appellant’s initial 

claim was bursitis, and that his MRI scan showed impingement syndrome. He noted that 

impingement syndrome consisted of several problems including bicipital tendinitis, pain at the 

AC joint, and rotator cuff tendinitis. Dr. Rickless further noted that appellant used a jackhammer 

and that the constant vibration of this tool could cause a shoulder injury. He opined, “This 

presented with the initial claim for tendinitis and was found to include other structures beside the 

tendon on MRI [scan].” 

In a report dated June 6, 2016, Dr. Jett noted that appellant sustained an injury on 

March 8, 2008 resulting in bicipital tenosynovitis on the right and bilateral carpal tunnel 

syndrome. He opined, “These injuries are a result of the repetitive operation of the air chisel 

jackhammer [appellant] used to perform his job.” Dr. Jett recommended surgery. 

By decision dated August 19, 2016, OWCP denied modification of its prior decisions, 

which denied surgical authorization and additional work-related conditions. It found that 
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appellant had filed a traumatic injury claim, but that the medical evidence suggested that his need 

for surgery was due to repetitive injuries occurring over the course of more than one work shift. 

LEGAL PRECEDENT -- ISSUE 1 

Appellant bears the burden of proof to establish that a condition not accepted or approved 

by OWCP is causally related to an employment injury.2

 Causal relationship is a medical issue, 

and the medical evidence generally required to establish causal relationship is rationalized 

medical opinion evidence.3

 The opinion of the physician must be based on a complete factual 

and medical background of the claimant,4

 must be one of reasonable medical certainty5

explaining the nature of the relationship between the diagnosed condition and the specific 

employment factors identified by the claimant.6

OWCP defines a traumatic injury as, “[A] condition of the body caused by a specific 

event or incident, or series of events or incidents, within a single workday or shift. Such 

condition must be caused by external force, including stress or strain which is identifiable as to 

time and place of occurrence and member or function of the body affected.”7 

ANALYSIS -- ISSUE 1 

The Board finds that appellant has not met his burden of proof to establish an additional 

condition resulting from his March 7, 2008 employment injury. 

OWCP accepted appellant’s March 7, 2008 traumatic injury claim for bicipital 

tenosynovitis on the right. Subsequently, appellant has submitted medical evidence documenting 

additional conditions of the right shoulder and upper extremities including right shoulder pain, 

bilateral carpal tunnel syndrome, moderate AC joint arthropathy, traumatic AC arthritis, and 

unspecified disorder of the bursae and tendons in the right shoulder. In order to meet his burden 

of proof to establish additional conditions resulting from his accepted March 7, 2008 

employment injury, he must submit medical opinion evidence establishing a causal relationship 

between these diagnosed conditions and his March 7, 2008 employment injury. 

In support of his additional claimed conditions of right shoulder pain, appellant submitted 

reports from Drs. Jett and Arache. The Board has held that the mere diagnosis of “pain” does not 

constitute the basis for payment of compensation.8

 To the extent that these reports only 

 2 See V.B., Docket No. 12-0599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200 (2004). 

3 John J. Montoya, 54 ECAB 306 (2003). 

4 Tomas Martinez, 54 ECAB 623 (2003); Gary J. Watling, 52 ECAB 278 (2001). 

5 Supra note 3. 

6 Judy C. Rogers, 54 ECAB 693 (2003). 

7

 20 C.F.R. § 10.5(ee). 

8 Robert Broome, 55 ECAB 339 (2004). 
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diagnosis pain, the reports are insufficient to meet appellant’s burden of proof to establish a 

traumatic injury claim. 

Appellant also submitted a series of reports from Drs. Jett and Rickless addressing his 

ongoing right shoulder conditions of moderate AC joint arthropathy, traumatic AC arthritis, and 

unspecified disorder of the bursae and tendons in the right shoulder as well as bilateral carpal 

tunnel syndrome. These physicians opined that appellant’s diagnosed conditions were due to his 

employment, but did not attribute the conditions to appellant’s work shift on March 7, 2008. 

Both Dr. Jett and Dr. Rickless indicated that appellant’s employment duties over a period of 

time, including the use of jackhammers and other tools, contributed to his bilateral carpal tunnel 

syndrome and his various right shoulder conditions. Dr. Rickless noted that appellant did 

repetitive work with his hands and that his job duties required repetitive work with power and 

hand tools. Dr. Jett attributed appellant’s upper extremity conditions to the repetitive use of 

heavy equipment. As appellant’s physicians indicate that his ongoing upper extremity conditions 

were due to a series of events or incidents, which did not occur within a single workday or shift, 

these reports cannot establish additional conditions due to the accepted traumatic injury on 

March 7, 2008. Instead, these reports suggest that the physicians are supporting that appellant’s 

employment may have caused an occupational disease.9

 In any event, the physicians did not 

explain how the March 7, 2008 work injury caused or contributed to the additional conditions. 

LEGAL PRECEDENT -- ISSUE 2 

Section 8103 of FECA provides that the United States shall furnish to an employee who 

is injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree, or the period of disability, or aid in lessening the amount of monthly compensation.10 

While OWCP is obligated to pay for treatment of employment-related conditions, the employee 

has the burden of establishing that the expenditure is incurred for treatment of the effects of an 

employment-related injury or condition.11

In interpreting this section of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided under section 8103, with the only limitation on 

OWCP’s authority being that of reasonableness.12 Abuse of discretion is generally shown 

through proof of manifest error, clearly unreasonable exercise of judgment, or actions taken 

which are contrary to both logic and probable deductions from established facts. It is not enough 

to merely show that the evidence could be construed so as to produce a contrary factual 

conclusion.13 To be entitled to reimbursement of medical expenses, a claimant has the burden of 

 9 See 20 C.F.R. § 10.5(q) (occupational disease or illness means a condition produced by the work environment 

over a period longer than a single workday or shift). 

10 5 U.S.C. § 8103; see Thomas W. Stevens, 50 ECAB 288 (1999); P.F., Docket No. 16-0693 (issued 

October 24, 2016). 

11 Kennett O. Collins, Jr. 55 ECAB 648 (2004). 

12 See D.K., 59 ECAB 141 (2007). 

13 Minnie B. Lewis, 53 ECAB 606 (2002). 
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establishing that the expenditures were incurred for treatment of the effects of an employmentrelated injury or condition. Proof of causal relationship in a case such as this must include 

supporting rationalized medical evidence.14 In order for a surgical procedure to be authorized, a 

claimant must submit evidence to show that the surgery is for a condition causally related to an 

employment injury and that it is medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.15

ANALYSIS -- ISSUE 2 

The Board finds that OWCP properly denied authorization for the requested right 

shoulder surgery. 

Drs. Jett and Rickless opined that appellant required a Mumford Neer procedure on his 

right shoulder due to the condition of traumatic AC arthritis. Appellant must submit evidence 

that shows that the requested medical procedure is both due to a condition causally related to an 

employment injury and that it is medically warranted. In the preceding analysis, the Board 

explained why the medical evidence did not support that his AC arthritis or other shoulder 

condition was causally related to his accepted condition. As the requested surgery has not been 

established to be causally related to appellant’s employment injury, OWCP did not abuse its 

discretion by denying his requests for surgery. 

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 his burden of proof to establish an additional 

injury resulting from his March 7, 2008 employment injury. The Board further finds that OWCP 

properly denied authorization for the requested right shoulder surgery. 

 14 M.B., 58 ECAB 588 (2007). 

15 R.C., 58 ECAB 238 (2006). 
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ORDER 

IT IS HEREBY ORDERED THAT August 19, 2016 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: March 10, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board