United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

I.L., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Middle Village, NY, Employer 

__________________________________________ 

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Docket No. 16-1668 

Issued: September 8, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 August 17, 2016 appellant, through counsel, filed a timely appeal from a June 23, 

2016 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. 

ISSUE 

The issue is whether appellant met her burden of proof to establish an injury causally 

related to an October 7, 2014 employment incident. 

 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

FACTUAL HISTORY 

On October 7, 2014 appellant, then a 31-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that date she pulled a muscle in her right elbow and felt 

sharp pain while delivering mail at work. She stopped work on October 7, 2014 and returned to 

light-duty work on October 17, 2014. 

In a letter dated October 8, 2014, appellant’s immediate supervisor indicated that the 

employing establishment was controverting appellant’s traumatic injury claim. He noted that 

appellant had only been on the job for three months and that appellant’s complaints might be due 

to a preexisting injury. 

In support of her claim, appellant submitted a duty status report (Form CA-17) completed 

on October 7, 2014 in which a physician with an illegible signature listed the date of injury as 

October 7, 2014, listed the diagnosis due to injury as right elbow pain and epicondylitis of right 

elbow, and indicated that she could not resume work. 

In a form report entitled “Authorization for Examination And/Or Treatment (Form CA16), an emergency medicine physician with an illegible signature listed the mechanism of injury 

as right elbow pain developed while delivering mail on cart. The physician did not provide a 

diagnosis, but found that appellant was totally disabled from October 7 to 14, 2014.3

 

In a Form CA-17 dated October 14, 2014, a physician with an illegible signature, 

specializing in orthopedic surgery, listed the date of injury as October 7, 2014, the mechanism of 

injury as pushing mail container, and listed the diagnosis due to injury as epicondylitis of the 

right elbow. The physician indicated that appellant could not resume work. 

In an attending physician’s report (Form CA-20) dated October 14, 2014, Dr. David V. 

Tuckman, an attending Board-certified orthopedic surgeon, listed the date of injury as October 7, 

2014, the mechanism of injury as “injured while pushing mail cart” and diagnosed right elbow 

medial epicondylitis (golfer elbow). He checked a box marked “Yes” indicating that the 

condition found was caused or aggravated by an employment activity and noted that appellant 

could perform light duty. 

By letter dated October 21, 2014, OWCP requested that appellant submit additional 

factual and medical evidence in support of her claim, including a narrative report from a 

physician containing a medical explanation as to how the reported work incident caused or 

aggravated a medical condition. 

 3

 The Board notes that where an employing establishment properly executes a Form CA-16 which authorizes 

medical treatment as a result of an employee’s claim for an employment-related injury, the Form CA-16 creates a 

contractual obligation, which does not involve the employee directly, to pay for the cost of the examination or 

treatment regardless of the action taken on the claim. See Tracy P. Spillane, 54 ECAB 608 (2003). The period for 

which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated 

earlier by OWCP. See 20 C.F.R. § 10.300(c). The record is silent as to whether OWCP paid for the cost of 

appellant’s examination or treatment for the period noted on the form. 
3

Appellant submitted a November 18, 2014 statement in which she further described the 

circumstances of her claimed October 7, 2014 injury. She indicated that she was pushing a mail 

cart on October 7, 2014 when she “suddenly felt something in my inner right elbow pulled.” 

Appellant indicated that she continued delivering mail for a few hours and stopped work when 

her right elbow pain became worse. She denied that she had a preexisting right elbow condition. 

In an October 10, 2014 report, Dr. Tuckman noted that appellant reported experiencing 

severe pain in her right elbow after pushing a mail cart at work on October 7, 2014. He indicated 

that, upon examination of the right upper extremity, there was full range of motion, 5/5 strength, 

and normal sensation without atrophy, swelling, or crepitus/effusion. There was marked medial 

epicondyle tenderness. Dr. Tuckman found that x-rays taken on October 10, 2014 showed no 

boney or soft tissue abnormalities and he diagnosed right elbow medial epicondylitis (golfer 

elbow). He indicated that appellant could return to light-duty work.4

 On October 31, 2014 

Dr. Tuckman noted that appellant could continue performing light-duty work. 

In a November 24, 2014 decision, OWCP determined that appellant failed to meet her 

burden of proof to establish a traumatic injury in the performance of duty on October 7, 2014. It 

found that she established the occurrence of an employment incident on October 7, 2014 in the 

form of pushing a mail cart and delivering mail, but that she did not submit sufficient medical 

evidence to establish that she sustained a specific medical condition due to the accepted 

employment incident.5

Dr. Tuckman requested that appellant undergo a magnetic resonance imaging (MRI) scan 

of her right elbow. The findings from the MRI scan obtained on November 28, 2014 showed red 

marrow hyperplasia in the proximal radial shaft and distal humeral shaft without malalignment, 

ligament tear, tendon tear, or acute fracture. The findings also noted, specifically, there is no 

common flexor tendon tear or evidence of medial epicondylitis. On December 9, 2014 

Dr. Tuckman again provided the diagnosis of right elbow medial epicondylitis (golfer elbow). 

Appellant submitted several notes and reports, dated between late-2014 and mid-2015, in 

which Dr. Tuckman diagnosed right elbow medial epicondylitis, prescribed pain medication, and 

indicated that she should continue with light-duty work. She visited the hospital on December 6, 

2014 with complaints of right shoulder pain and the findings of December 6, 2014 x-rays of 

appellant’s right shoulder showed “unremarkable radiographs of the shoulder.” 

In an April 5, 2015 Form CA-17, a physician with an illegible signature, specializing in 

physiatry, listed the mechanism of injury as pushing a mail cart and delivering mail on 

October 7, 2014 and the diagnosis due to injury as right elbow tendinitis and right shoulder 

tendinitis. The physician indicated that appellant could work with restrictions. 

 4

 In a Form CA-17 dated October 14, 2014, a physician with an illegible signature, specializing in orthopedic 

surgery, diagnosed epicondylitis of the right elbow and indicated that appellant could resume work on that date with 

restrictions. 

5

 OWCP indicated that appellant’s physician did not explain how her pushing a mail cart and delivering mail on 

October 7, 2014 caused, contributed to, or aggravated her diagnosed condition of right elbow medial epicondylitis 

(golfer elbow). 
4

Appellant requested a hearing with an OWCP hearing representative. During the hearing 

held on June 10, 2015, she testified regarding the symptoms she experienced on October 7, 2014 

and counsel argued that the medical evidence of record was sufficient to require further 

development of the claim. 

After the hearing, appellant submitted a July 1, 2015 report in which Dr. Neofitos 

Stefanides, an attending Board-certified orthopedic surgeon, noted that appellant reported right 

elbow and right shoulder pain which began on October 7, 2014 when she was working as a 

postal carrier. She indicated that she was doing quite a bit of work that day. Dr. Stefanides 

reported physical examination findings, including marked medial epicondyle tenderness to 

palpation, and diagnosed medial epicondylitis of the right elbow, and right shoulder 

impingement and bursitis. He indicated that she was partially disabled from her usual work and 

noted, “[I]t is my opinion based upon the patient’s history, physical examination, and 

radiographic findings, that there is a reasonable degree of medical certainty that the patient’s 

physical injuries are causally related to the accident noted above.” 

By decision dated July 21, 2015, OWCP’s hearing representative affirmed OWCP’s 

November 24, 2014 decision finding that appellant did not meet her burden of proof to establish 

a traumatic injury in the performance of duty on October 7, 2014. She found that appellant did 

not submit a rationalized medical report relating a medical condition to the accepted October 7, 

2014 work incident. 

In a January 26, 2016 letter, appellant, through counsel, requested reconsideration of the 

July 21, 2015 decision denying her claim. 

Appellant submitted a September 21, 2015 Form CA-17 in which Dr. Stefanides listed 

the mechanism of injury as pushing a mail cart when delivering mail on October 7, 2014 and the 

diagnosis due to injury as right shoulder joint pain and disorders of bursae/tendons of the right 

shoulder. He indicated that appellant could perform her regular work on a full-time basis 

without restrictions. 

In a November 6, 2015 report, Dr. Stefanides noted that appellant complained of rightsided neck, arm, elbow, and thumb pain which began on November 4, 2015 when she was 

delivering mail and had to constantly pull a heavy mail cart towards herself and sideways to 

prevent it from rolling away. He reported physical examination findings and diagnosed neuritis 

and cervical radiculitis of the upper extremities, right shoulder impingement and bursitis, and a 

sprain/strain of the right thumb/finger. Dr. Stefanides indicated that appellant was totally 

disabled from her usual work and noted, “[I]t is my opinion based upon the patient’s history, 

physical examination, and radiographic findings, that there is a reasonable degree of medical 

certainty that the patient’s physical injuries are causally related to the accident noted above.” 

In an undated Form CA-20, Dr. Stefanides listed the date of injury as November 4, 2014, 

the mechanism of injury as “continuous pulling, pushing of the mail cart,” and diagnosed 

cervical spine sprain/radiculopathy, right shoulder impingement/bursitis, and right elbow and 

thumb sprains. He checked a box marked “Yes” indicating that the conditions found were 

caused or aggravated by an employment activity and noted that she was totally disabled from 

November 4 to December 4, 2015. 
5

In a decision dated June 23, 2016, OWCP denied modification of its July 21, 2015 

decision, finding that appellant did not meet her burden of proof to establish a traumatic injury 

causally related to the October 7, 2014 employment incident. It noted that she did not submit 

rationalized medical evidence establishing such an injury. 

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 timely filed within the applicable 

time limitation period of FECA, that an injury was sustained 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.6

 These are the essential elements of each 

compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.7

 To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether the fact of injury has been established. 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that he or she actually experienced the employment 

incident at the time, place and in the manner alleged.8

 Second, the employee must submit 

evidence, in the form of medical evidence, to establish that the employment incident caused a 

personal injury.9

 Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence. 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.10

ANALYSIS 

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

injury causally related to an October 7, 2014 employment incident. 

 6 C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine Pendleton, 40 ECAB 1143 (1989). 

7 S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989). A traumatic injury refers to injury 

caused by a specific event or incident or series of incidents occurring within a single workday or work shift whereas an 

occupational disease refers to an injury produced by employment factors which occur or are present over a period 

longer than a single workday or work shift. 20 C.F.R. §§ 10.5 (q), (ee); Brady L. Fowler, 44 ECAB 343, 351 (1992). 

8 Julie B. Hawkins, 38 ECAB 393 (1987). 

9 John J. Carlone, 41 ECAB 354 (1989). 

10 See I.J., 59 ECAB 408 (2008); Donna Faye Cardwell, 41 ECAB 730 (1990). 
6

Appellant submitted a Form CA-20 dated October 14, 2014 in which Dr. Tuckman, an 

attending physician, listed the date of injury as October 7, 2014, the mechanism of injury as 

“injured while pushing mail cart,” and diagnosed right elbow medial epicondylitis (golfer 

elbow). Dr. Tuckman checked a box marked “Yes” indicating that the diagnosed condition was 

caused or aggravated by an employment activity and noted that she could perform light duty. 

The submission of this report fails to establish appellant’s claim for an October 7, 2014 work 

injury because Dr. Tuckman did not provide medical rationale in support of his opinion on causal 

relationship. The Board has held that when a physician’s opinion on causal relationship consists 

only of checking “Yes” to a form question, without more by the way of medical rationale, that 

opinion has little probative value and is insufficient to establish causal relationship. A claimant’s 

burden of proof includes the necessity of furnishing an affirmative opinion from a physician who 

supports his or her conclusion with sound medical reasoning.11 Dr. Tuckman did not discuss nor 

describe appellant’s activities at work on October 7, 2014 in any detail or describe the medical 

mechanism through which they could have caused the diagnosed medical condition.12 

Dr. Tuckman produced other reports in which he diagnosed appellant with a right elbow condition, 

but these reports do not contain an opinion on the cause of the diagnosed condition.13

In an April 5, 2015 Form CA-17, a physician with an illegible signature listed the 

mechanism of injury as pushing a mail cart and delivering mail on October 7, 2014 and the 

diagnosis due to injury as right elbow tendinitis and right shoulder tendinitis. The physician 

indicated that appellant could work with restrictions. The submission of this report would not 

establish appellant’s claim for a work-related October 7, 2014 injury because, although the 

medical specialty is listed, it is unknown whether the author of the report is a physician. The 

Board has held that a report bearing an illegible signature lacks proper identification and cannot 

be considered probative medical evidence.14 Thus, it is of no probative value. 

In a July 1, 2015 report, Dr. Stefanides, an attending physician, noted that appellant 

reported right elbow and right shoulder pain which began on October 7, 2014 when she was 

working as a postal carrier. He diagnosed medial epicondylitis of the right elbow, and right 

shoulder impingement and bursitis. Dr. Stefanides indicated that appellant was partially disabled 

from her usual work and noted, “[I]t is my opinion based upon the patient’s history, physical 

examination, and radiographic findings, that there is a reasonable degree of medical certainty 

that the patient’s physical injuries are causally related to the accident noted above.” However, he 

did not support this opinion on causal relationship with any further medical explanation. 

 

 11 Lillian M. Jones, 34 ECAB 379, 381 (1982). 

12 The provision of such medical rationale is especially necessary in this case as Dr. Tuckman obtained a report of 

a November 28, 2014 MRI scan of appellant’s right elbow in which it was noted, “Specifically, there is no common 

flexor tendon tear or evidence of medial epicondylitis.” 

13 The record also contains several form reports from early- to mid-October 2014 in which physicians with 

illegible signatures indicated that appellant sustained right elbow conditions due to pushing a mail cart and 

delivering mail on October 7, 2014. However, these reports are of no probative value as the author cannot be 

identified as a physician despite the reference to the medical specialties. See C.N., Docket No. 16-1597 (issued 

August 10, 2017); see also Merton J. Sills, 39 ECAB 572, 575 (1988). 

14 Id. 
7

Dr. Stefanides did not discuss appellant’s activities at work on October 7, 2014 in any detail or 

explain how specific objective findings on physical examination and diagnostic testing supported 

the occurrence of a work-related injury on October 7, 2014.15 The record contains a September 21, 

2015 report in which Dr. Stefanides related right elbow and shoulder conditions to appellant’s 

October 7, 2014 work activities, but it is also deficient because it lacks medical rationale in 

support of its opinion on causal relationship.16

For these reasons, appellant did not meet her burden of proof to establish a traumatic 

injury causally related to an October 7, 2014 employment incident. 

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 did not meet her burden of proof to establish an injury 

causally related to an October 7, 2014 employment incident. 

 15 In particular, Dr. Stefanides did not explain how the diagnosed right shoulder condition could have been related 

to the October 14, 2014 work activities given appellant’s above-noted history of reporting symptoms. 

16 Appellant submitted a November 6, 2015 narrative report and an undated form report in which Dr. Stefanides 

related right shoulder, cervical radiculopathy, elbow, thumb, and finger conditions to her handling of a mail cart at 

work on November 4, 2015. The record does not presently contain a claim for a November 4, 2015 work injury or a 

decision concerning a November 4, 2015 work injury and as such the matter is not currently before the Board. 
8

ORDER 

IT IS HEREBY ORDERED THAT the June 23, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 8, 2017 

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