United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Edison, NJ, Employer

__________________________________________

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Docket No. 17-1936

Issued: August 13, 2018

Appearances: Case Submitted on the Record

Michael D. Overman, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 14, 2017 appellant, through counsel, filed a timely appeal from an August 8, 

2017 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.

 

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

ISSUE

The issue is whether appellant has met his burden of proof to establish that his right 

shoulder and cervical conditions were causally related to the accepted September 4, 2015

employment incident. 

FACTUAL HISTORY

On September 4, 2015, 2015 appellant, then a 58-year-old mail handler, filed a traumatic 

injury claim (Form CA-1) alleging that on that same date he sustained a right arm and shoulder 

injury while lifting mail trays and felt sudden sharp pain and numbness in his right arm and 

shoulder. He first notified his supervisor, stopped work, and sought medical treatment on the date 

of injury. On the reverse side of the form, appellant’s supervisor controverted the claim stating 

that reenactment of the accident disclosed that appellant was improperly lifting the mail tray. 

On September 4, 2015 the employing establishment issued appellant a properly completed

authorization for examination and/or treatment (Form CA-16), which indicated that he was 

authorized to seek medical treatment for his right shoulder strain with Dr. Lorelane Tindoc, Boardcertified in family medicine.3

 

A September 4, 2015 Hackensack UMC emergency department visit summary 

documented treatment for the right shoulder with a diagnosis of right shoulder strain. 

In a September 10, 2015 prescription note, excusing appellant from work, Dr. Tindoc 

reported that he was evaluated for right rotator cuff syndrome and possible radiculopathy. 

By development letter dated September 25, 2015, OWCP informed appellant that the 

evidence of record was insufficient to establish his traumatic injury claim. It advised him of the 

medical and factual evidence needed and afforded 30 days to submit the additional evidence. 

OWCP provided appellant a questionnaire for completion requesting further information 

pertaining to the employment incident. 

On October 5, 2015 appellant responded to OWCP’s questionnaire stating that he had 

difficulty balancing when lifting mail trays due to a prior injury which caused him pain. He 

reported no prior issues with the right shoulder or arm, noting that he previously had chronic 

 

3 A properly completed Form CA-16 authorization may constitute a contract for payment of medical expense to a 

medical facility or physician, when properly executed. The form creates a contractual obligation, which does not 

involve the employing establishment directly, to pay for the cost of the examination or treatment regardless of the 

action taken on the claim. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). On return of the case 

record OWCP shall determine whether appellant is entitled to payment of medical expense pursuant to this Form CA16 authorization.
3

numbness and pain on his left shoulder, arm, and neck which was documented under OWCP File

No. xxxxxx360 with a September 21, 2010 date of injury.4 

In an October 1, 2015 medical report, Dr. Tindoc reported that appellant presented for 

evaluation on September 5, 2015 due to an acute right shoulder injury that occurred on 

September 4, 2015. Appellant reported pulling a tray at work when he felt sudden severe right 

shoulder and arm pain, causing him to seek emergency medical treatment. Dr. Tindoc provided 

physical examination findings of limited range of motion and weakness of the right upper 

extremity. She reported that given the nature of how appellant was injured and his presenting signs 

and symptoms, he sustained a rotator cuff injury and shoulder bursitis with possible radiculopathy 

due to pain and numbness. Dr. Tindoc noted a history of cervical stenosis with cervical spine disc 

bulge with radiculopathy involving the left upper extremity. She recommended a magnetic 

resonance imaging (MRI) scan due to continued pain and limited range of motion despite physical 

therapy treatment. 

By decision dated October 21, 2015, OWCP denied appellant’s claim finding that the 

evidence of record failed to establish that his injury was causally related to the accepted 

September 4, 2015 employment incident.

On November 4, 2015 appellant, through counsel, requested an oral hearing before an 

OWCP hearing representative. OWCP thereafter received additional medical evidence. 

In a September 4, 2015 HUMC hospital report, Dr. David Forsh, a Board-certified 

orthopedic surgeon, diagnosed right shoulder strain and discharged appellant from treatment. 

In a September 4, 2015 diagnostic report, Dr. Patrick Toth, a Board-certified diagnostic 

radiologist, reported that an x-ray of the right shoulder revealed a bony spur along the interior 

margin of the acromion. Otherwise, he found no acute bony pathology. 

In an attending physician’s report (Form CA-20) dated October 30, 2015, Dr. Tindoc 

reported that, on September 4, 2015, appellant was pulling a heavy tray at work he had sudden 

right shoulder pain with numbness to the right arm. She reported findings of limited range of 

motion, right shoulder pain, tenderness on palpation of right shoulder, weaker grip of right hand, 

and less sensation on right arm compared to left. Dr. Tindoc reported no prior history of right 

shoulder injury and diagnosed right rotator cuff tendinitis, numbness of the right upper limb, and 

cervical radiculopathy. She checked a box marked “yes” when asked if the condition was caused 

or aggravated by the employment activity, explaining that the right upper extremity had no prior 

pain or injury and appellant currently had nerve function involvement and significant pain. In an 

October 30, 2015 duty status report (Form CA-17), Dr. Tindoc restricted him from returning to 

work. In an October 30, 2015 work capacity evaluation (OWCP-5c), she reported a history of 

prior cervical stenosis with left arm involvement and noted findings for appellant’s current right 

shoulder injury.

 

4 On September 21, 2010 appellant filed a traumatic injury claim (Form CA-1) alleging that on that same date he 

suffered a left hand, shoulder, and head injury when he was lifting flat tubs and trays of mail. By decision dated 

October 11, 2012, OWCP accepted his claim for resolved sprain of neck, OWCP File No. xxxxxx360.
4

In a November 23, 2015 report, Dr. Steve Lequerica, a Board-certified neurologist, 

reported that an electromyography (EMG) study of the right arm revealed signs of right C5-6 and

C6-7 cervical radiculopathy. He diagnosed cervical disc disorder with radiculopathy, strain of 

muscle at neck level, and sprain of ligaments of lumbar spine. 

A hearing was held on February 17, 2016 at which appellant testified regarding the 

circumstances surrounding the September 5, 2015 employment incident and subsequent course of 

treatment. He explained that, on the date of injury, he was lifting a tray that contained heavy mail 

weighing approximately 40 pounds when he felt sharp right shoulder pain. 

By decision dated March 30, 2016, an OWCP hearing representative affirmed the 

October 21, 2015 decision finding that the evidence of record failed to establish that appellant’s

diagnosed conditions were causally related to the accepted September 4, 2015 employment 

incident.

By letter dated June 27, 2016, received by OWCP on July 1 2016, appellant, through 

counsel, requested reconsideration of OWCP’s decision. Counsel noted submission of additional 

medical and diagnostic reports which established appellant’s traumatic injury claim. 

In a March 9, 2016 diagnostic report, Dr. Michael Pollack, a Board-certified neurologist, 

reported that a cervical spine MRI scan revealed mild multilevel degenerative disc disease and 

right-sided facet arthropathy at C2-3 and C3-4 leading to moderate right-sided foraminal 

narrowing at C3-4. 

In a June 16, 2016 medical report, Dr. Tindoc described the September 4, 2015 

employment incident when appellant was pulling a heavy tray and felt sudden sharp pain on the 

right shoulder and arm. She evaluated him on September 5, 2015 and noted physical examination 

findings of limited range of motion and weakness of the right upper extremity. Dr. Tindoc reported 

that, given the nature of how appellant was injured and his presenting signs and symptoms, her 

initial assessment was that of a rotator cuff injury and shoulder bursitis with possible radiculopathy 

as a direct result of heavy lifting at work. She noted that the radiculopathy component of the injury 

was part of an aggravation of his history of cervical spine stenosis. Dr. Tindoc noted a prior work 

injury, but that it involved left-sided radiculopathy. She further noted that appellant’s physical 

findings were new as she saw him for medical clearance on July 28, 2015 and he had good range 

of motion without extremity pain at that time. Dr. Tindoc described his course of treatment and 

reported that the cervical spine MRI scan was completed on March 9, 2016 which revealed 

right-sided spinal stenosis with mild multilevel degenerative disc disease. She reported that 

appellant could not resume his current job which required heavy lifting. Dr. Tindoc provided lightduty restrictions and reported that he had reached maximum medical improvement. 

In an October 20, 2016 medical report, Dr. Tony Wanich, a Board-certified orthopedic 

surgeon, provided physical examination findings pertaining to the right shoulder. He reported that 

an October 13, 2016 MRI scan of the right shoulder demonstrated a rotator cuff tear and 

recommended surgical repair. Dr. Wanich noted that the tear was “compatible and likely” causally 

related to appellant’s work injury suffered one year prior. 
5

By decision dated December 28, 2016, OWCP denied modification of the March 30, 2016 

decision finding that the evidence of record failed to establish that appellant’s diagnosed conditions 

were causally related to the accepted September 4, 2015 employment incident. 

On May 18, 2017 OWCP received counsel’s request for reconsideration of OWCP’s

decision. Counsel noted submission of a March 8, 2017 report from Dr. Tindoc and an April 4, 

2017 report from Dr. Wanich in support of appellant’s claim. 

In a March 8, 2017 medical report, Dr. Tindoc reported that she evaluated appellant on that 

date and noted that he had right shoulder surgery for rotator cuff repair on January 30, 2017. She

opined that the right shoulder pain from the rotator cuff tear was a direct result of the September 4, 

2015 work injury which occurred when he pulled and lifted a heavy tray and immediately suffered 

sharp right shoulder pain. Dr. Tindoc reported that appellant was right handed and most of the 

force and strength was on his right shoulder. She explained that forceful pulling and lifting could

injure the muscle and tendon of rotator cuff groups of muscles as they provided support and 

strength with the upper extremity pulling and lifting. Dr. Tindoc reported that appellant had no 

history of a right shoulder injury or pain prior to the September 4, 2015 work injury. She 

concluded that his chronic right shoulder pain was a direct result of the work injury. 

In an April 4, 2017 medical report, Dr. Wanich reported that appellant underwent right

rotator cuff repair on January 30, 2017. He opined that the right shoulder rotator cuff tear was a 

direct result of a work injury from lifting trays. Dr. Wanich explained that the mechanism of injury 

was consistent and causally related to the aforementioned accident within a reasonable degree of 

medical certainty. 

By decision dated August 8, 2017, OWCP denied modification of the December 28, 2016 

decision finding that the evidence of record failed to establish that his diagnosed conditions were 

causally related to the accepted September 4, 2015 employment incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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.6 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.7

In order to determine whether an employee actually sustained an 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 

 

5 Supra note 2.

6 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989).

7 Michael E. Smith, 50 ECAB 313 (1999).
6

another. The first component to be established is that the employee actually experienced the 

employment incident which is alleged to have occurred.8 The second component is whether the 

employment incident caused a personal injury and generally can be established only by medical 

evidence. 

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence supporting such causal relationship.9 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. 

This medical opinion must include an accurate history of the employee’s employment injury and 

must explain how the condition is related to the injury. The weight of medical evidence is 

determined by its reliability, its probative value, its convincing quality, the care of analysis 

manifested, and the medical rationale expressed in support of the physician’s opinion.10

ANALYSIS

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

shoulder and cervical conditions were causally related to the accepted September 4, 2015 

employment incident.11 

On the date of injury, appellant sought emergency medical treatment at HUMC emergency 

department for right shoulder pain. While Dr. Forsh’s September 4, 2015 report diagnosed right 

shoulder strain, he provided no opinion regarding the cause of appellant’s injury. Medical 

evidence which does not offer any opinion regarding the cause of an employee’s condition is of 

limited probative value on the issue of causal relationship.12 While the HUMC hospital report

reflects immediate treatment following the employment incident, it fails to relate any opinion 

regarding the cause of appellant’s condition and are therefore insufficient to establish his traumatic 

injury claim.13 

In medical reports dated September 10, 2015 through March 8, 2017, Dr. Tindoc described 

the circumstances surrounding the September 4, 2015 employment incident and discussed 

appellant’s course of treatment. She opined that his right shoulder pain from the rotator cuff tear 

was a direct result of the September 4, 2015 work injury when he pulled and lifted a heavy tray at 

work and immediately suffered sharp pain on the right shoulder and arm. Dr. Tindoc reported that 

appellant had no history of a right shoulder injury or pain prior to the September 4, 2015 work 

 

8 Elaine Pendleton, supra note 6 at 1143. 

9 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983).

10 James Mack, 43 ECAB 321 (1991).

11 See Robert Broome, 55 ECAB 339 (2004).

12 See R.U., Docket No. 17-0168 (issued January 9, 2018). 

13 J.P., Docket No. 14-0087 (issued March 14, 2014).
7

injury and as such, the chronic pain of the right shoulder had been a direct result of the work injury 

on that date.

The Board finds that the opinion of Dr. Tindoc is not well rationalized. Dr. Tindoc failed 

to provide a sufficient explanation as to the mechanism of injury pertaining to this traumatic injury 

claim. On the CA-20 form dated October 20, 2015 she checked a box marked “yes” indicating 

that the diagnosed conditions were caused by the employment injury. A report that addresses 

causal relationship with a check mark, without medical rationale explaining how the employment 

incident caused or aggravated the alleged injury, is of diminished probative value and insufficient 

to establish causal relationship.14 While Dr. Tindoc had some type of understanding of the 

September 4, 2015 employment incident, indicating that appellant was pulling a heavy tray or 

alternatively pulling and lifting a heavy tray, she failed to provide sufficient detail regarding the 

circumstances surrounding the incident pertaining to the weight and size of the tray and the specific 

movements, either lifting or pulling or both, involved which would result in his injury. She

reported that he was right handed and most of the force and strength was on his right shoulder, 

explaining that forceful pulling and lifting can injure the muscle and tendon of rotator cuff groups 

of muscles as they provide support and strength with the upper extremity pulling and lifting.15 The 

Board finds that this statement to be speculative, without sufficient detail explaining how these 

movements actually caused appellant’s injury. While the opinion of a physician supporting causal 

relationship need not be one of absolute medical certainty, the opinion must not be speculative or 

equivocal. To be of probative value, a physician’s opinion on causal relationship should be 

expressed in terms of reasonable medical certainty.16 Dr. Tindoc opined that appellant sustained 

a work-related injury because he had no right shoulder pain prior to the September 4, 2015 

employment incident, noting that she last evaluated him on July 28, 2015 with good range of 

motion examination findings. The Board has held that an opinion that a condition is causally 

related because the employee was asymptomatic before the injury is insufficient, without adequate 

rationale, to establish causal relationship.17 Without explaining how physiologically the 

movements involved in the accepted employment incident, specifically lifting, caused or 

contributed to appellant’s right rotator cuff tear, Dr. Tindoc’s opinion on causal relationship is 

equivocal in nature and of limited probative value.18 

With respect to the diagnosis of radiculopathy and cervical spinal stenosis, Dr. Tindoc 

explained that this was a preexisting condition which related to the left upper extremity only. As 

such, she determined that the September 4, 2015 employment incident caused an aggravation of 

appellant’s spinal stenosis and radiculopathy based on a March 9, 2016 cervical MRI scan which

 

14 Supra note 12. 

15 A medical opinion couched in such terms as might be, could be, or may be does not have as much probative value 

as an opinion stated unequivocally or with reasonable medical certainty. See G.M., Docket No. 15-1288 (issued 

September 18, 2015).

16 See D.F., Docket No. 17-0135 (issued June 5, 2017).

17 Supra note 12.

18 See L.M., Docket No. 14-0973 (issued August 25, 2014); R.G., Docket No. 14-0113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).
8

revealed right-sided spinal stenosis with mild multilevel degenerative disc disease. The Board 

notes that Dr. Tindoc failed to discuss whether his preexisting injury had progressed beyond what 

might be expected from the natural progression of that condition.19 It is unclear if appellant’s 

right-sided spinal stenosis with mild multilevel degenerative disc disease and radiculopathy were 

caused or aggravated by the September 4, 2015 employment incident, a result of a preexisting 

condition, or due to degenerative changes. A well-rationalized opinion is particularly warranted 

when there is a history of preexisting condition.20 As Dr. Tindoc’s reports lack the specificity and 

detail needed to establish that appellant’s right shoulder and cervical conditions were the result of 

the September 4, 2015 employment incident, her opinion is insufficient to establish his traumatic 

injury claim.

21

 

In medical reports dated October 20, 2016 and April 4, 2017, Dr. Wanich reported that an 

October 13, 2016 MRI scan of the right shoulder demonstrated a rotator cuff tear. He opined that 

the right shoulder rotator cuff tear was a direct result of a work injury from lifting trays, explaining 

that the mechanism of injury was consistent and causally related to the aforementioned accident 

within a reasonable degree of medical certainty. The Board finds that Dr. Wanich’s opinion is 

also not well rationalized. While he provided a sufficient diagnosis of rotator cuff tear based on 

diagnostic testing, he failed to note the date of the employment incident or adequately describe the 

details and circumstances surrounding the injury. Dr. Wanich did not evaluate appellant until over 

one year after the alleged employment injury and failed to provide any discussion of appellant’s 

medical history or course of treatment. Without any mention of the September 4, 2015 

employment incident, any findings made could not be related to his claim to establish causal 

relationship.22 Dr. Wanich’s statement on causation fails to provide a sufficient explanation as to 

the mechanism of injury pertaining to this traumatic injury claim, namely, how lifting a tray full 

of mail weighing approximately 40 pounds would cause or aggravate appellant’s right rotator cuff 

tear.

23

 As he failed to provide a rationalized and detailed discussion of appellant’s medical history, 

the employment incident, and cause of injury, his reports are insufficient to meet appellant’s 

burden of proof.

24

The remaining medical evidence of record is also insufficient to establish appellant’s claim.

Dr. Toth’s x-ray of the right shoulder simply interpreted diagnostic findings and also failed to 

provide any discussion on the cause of appellant’s injury.25 Dr. Lequerica’s November 23, 2015 

EMG study noted findings of right C5-6 and C6-7 cervical radiculopathy. While he provided 

 

19 R.E., Docket No. 14-0868 (issued September 24, 2014).

20 T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

21 P.O., Docket No. 14-1675 (issued December 3, 2015); S.R., Docket No. 12-1098 (issued September 19, 2012).

22 S.Y., Docket No. 11-1816 (issued March 16, 2012).

23 S.W., Docket 08-2538 (issued May 21, 2009).

24 S.R., supra note 21.

25 See P.T., Docket No. 17-1189 (issued December 27, 2017). The Board has repeatedly explained that diagnostic 

test reports are of limited probative value as they do not specifically address whether appellant’s diagnosed conditions 

are causally related to the accepted work incident.
9

diagnoses of cervical disc disorder with radiculopathy, strain of muscle at neck level, and sprain 

of ligaments of lumbar spine, he made no mention of the September 4, 2015 employment incident 

and provided no opinion regarding the cause of appellant’s conditions.

26

 Dr. Pollack’s March 9, 

2016 diagnostic report provided MRI scan findings pertaining to the cervical spine while the 

October 13, 2016 report detailed imaging studies of the right shoulder. While these medical 

reports are relevant to appellant’s claim, they are of no probative value as they interpreted 

diagnostic imaging studies with no opinion on the cause of his conditions.

27

 The Board has held 

that medical evidence that does not offer any opinion regarding the cause of an employee’s 

condition is of limited probative value.28 

An award of compensation may not be based on surmise, conjecture, speculation, or on the 

employee’s own belief of causal relation.29 Appellant’s honest belief that the September 4, 2015 

employment incident caused his right shoulder rotator cuff tear and cervical condition is not in 

question, but that belief however sincerely held, does not constitute the medical evidence necessary 

to establish causal relationship.30 

The evidence of record lacks rationalized medical evidence establishing a causal 

relationship between the accepted September 4, 2015 employment incident and appellant’s right 

shoulder and cervical conditions. Thus, the Board finds that he has failed to meet his burden of 

proof. 

Appellant may submit new evidence or argument with a written request for reconsideration 

to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 

C.F.R. §§ 10.606 and 10.607.

CONCLUSION

The Board finds that appellant did not meet his burden of proof to establish that his right 

shoulder and cervical conditions were causally related to the accepted September 4, 2015

employment incident. 

 

26 R.E., Docket No. 14-0868 (issued September 24, 2014).

27 It is not possible to establish the cause of a medical condition, if the physician has not stated a firm medical 

diagnosis. T.G., Docket No. 13-0076 (issued March 22, 2013).

28 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

29 D.D., 57 ECAB 734 (2006).

30 S.H., Docket No. 17-1447 (issued January 11, 2018). 
10

ORDER

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

decision dated August 8, 2017 is affirmed.

Issued: August 13, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board