United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Maricopa, AZ, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 18-0954

Issued: February 26, 2019

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 April 9, 2018 appellant, through counsel, filed a timely appeal from a March 15, 2018 

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 to consider the merits of this case.3

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq. 

3 The Board notes that following the March 15, 2018 decision, OWCP received additional evidence. However, the 

Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that 

was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board 

for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this evidence for 

the first time on appeal. Id.
2

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish a recurrence

of disability on January 27, 2017 causally related to her accepted December 1, 2011 left upper 

extremity employment injury; and (2) whether appellant has met her burden of proof to establish 

a left rotator cuff tear causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On October 18, 2011 appellant, then a 40-year-old rural mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that sometime before December 1, 2011, she suffered left 

elbow and shoulder pain due to repetitive upper extremity motions while casing and delivering 

mail.

Dr. Douglas E. Parkin, an attending internist Board-certified in pediatrics, treated appellant 

for left shoulder complaints beginning on December 20, 2011. He held her off work commencing 

March 1, 2012 due to a left rotator cuff tear with acromioclavicular impingement and pain.4 

Appellant returned to full-time modified-duty work on March 1, 2012 with no use of the left upper 

extremity.

By letter dated February 27, 2012, OWCP accepted that appellant had sustained sprains of 

the left rotator cuff, shoulder, and upper arm and assigned the claim OWCP File No. xxxxxx173. 

It paid her wage-loss compensation for intermittent work absences from January 26 to 

May 4, 2012.

On May 16, 2012 Dr. Peter Seipel, an attending Board-certified orthopedic surgeon,

performed an authorized arthroscopic debridement of a left rotator cuff tendon tear with 

arthroscopic subacromial decompression. OWCP paid appellant wage-loss compensation for 

intermittent work absences commencing May 17, 2012. Appellant returned to full-time, modifiedduty work on June 2, 2012 and to full duty on July 5, 2012.

On February 3, 2017 appellant filed a notice of recurrence (Form CA-2a) claiming that 

sometime before January 27, 2017, repetitive upper extremity motions, while processing and 

delivering her mail route in the performance of her federal duties, caused left shoulder pain. She

stopped work from January 20 to 22, 2017, returned to work, and then stopped work again on 

February 4, 2017. S.K., appellant’s supervisor, noted that from March 5 to December 10, 2016, 

appellant had been detailed to a full-duty position as a postmaster. She resumed full duty as a 

letter carrier on January 5, 2017 and had carried mail for approximately three weeks. Appellant 

stopped work on February 6, 2017.

 

4 A March 7, 2012 magnetic resonance imaging (MRI) scan of the left shoulder showed a possible partial thickness 

supraspinatus tear, a possible oblique tear within the anterior labrum, a Type 1 acromion with negative anterior 

sloping, mild acromioclavicular degenerative disease, and minimal impingement.
3

In a report dated February 6, 2017, Dr. Michael P. Ridge, an attending Board-certified 

internist, diagnosed a complete left rotator cuff tear. He limited appellant to light duty with no use 

of the left shoulder.

In a letter dated February 15, 2017, L.L., an employing establishment official, controverted 

the claim. She noted that from December 10, 2016 to February 3, 2017, appellant had worked 

only 17 out of 40 days. L.L. controverted appellant’s claims under File No. xxxxxx137 and 

xxxxxx805 in letters dated March 29, May 1, and 9, 2017. She alleged that appellant had provided 

an inconsistent history of injury.

By development letters dated March 2 and 17, 2017, OWCP advised appellant of the type 

of additional evidence needed to establish her claim for recurrence of disability, including a current 

medical report from her attending physician supporting a causal relationship between her accepted 

employment injury and her condition on and after January 27, 2017. It afforded her 30 days to 

submit the necessary evidence.

In response appellant provided a March 6, 2017 narrative statement. She described 

increasing left shoulder pain commencing in early January 2017. Appellant alleged that repetitive 

upper extremity motion and heavy lifting while casing and delivering mail had caused a left rotator 

cuff tear.

In a telephone memorandum (Form CA-110) dated March 20, 2017, OWCP noted that 

appellant requested to withdraw her claim for recurrence of disability and intended to claim a new 

occupational injury. Appellant explained in a letter dated March 20, 2017 that she had requested 

an occupational disease claim form (Form CA-2) on February 3, 2017, but an employing 

establishment official directed her to complete a claim for recurrence of disability (Form CA-2a). 

By letter dated March 28, 2017, OWCP notified appellant that to withdraw her claim for 

recurrence of disability, she must submit a statement stating that she was “withdrawing the 

recurrence claim so it can be deleted.”

On March 27, 2017 appellant filed an occupational disease claim (Form CA-2) alleging 

that, sometime prior to January 27, 2017, she sustained a left rotator cuff tear. OWCP assigned 

that claim OWCP File No. xxxxxx805.

In an accident report dated March 27, 2017, employing establishment official, S.K.,

contended that appellant’s March 27, 2017 occupational disease claim was a duplicate of her 

February 3, 2017 claim for a recurrence of disability.

In reports dated April 10 and 14, 2017, Dr. Ridge diagnosed a complete left rotator cuff 

tear. He prescribed medication.

An April 11, 2017 MRI scan of the left shoulder demonstrated moderate distal 

supraspinatus and infraspinatus tendinosis without a rotator cuff tear, moderate hypertrophic 

acromioclavicular joint osteoarthritis with spur causing mild deformity of the supraspinatus 

muscle, and a hyperplastic superior labrum without tear.
4

In a statement dated April 13, 2017, appellant attributed her claimed recurrence of 

disability to repetitive left upper extremity motions while casing and delivering mail while in the

performance of duty in January 2017.

5

By development letter dated April 21, 2017, OWCP notified appellant of the type of 

additional factual and medical evidence needed to establish her occupational disease claim, 

including a detailed factual statement describing the mechanism of injury, and a narrative opinion 

from her attending physician explaining how and why the identified employment factors would 

cause the claimed left shoulder condition. It afforded her 30 days to submit additional evidence.

In response, appellant submitted a report dated April 28, 2017 from Dr. Ridge. Dr. Ridge

noted that appellant worked as a letter carrier and had sustained an occupational shoulder injury 

“treated successfully years ago.” He opined that a left rotator cuff tear demonstrated by imaging 

studies was “a result of her work.”

In a statement dated April 30, 2017, appellant attributed her left shoulder condition to 

repetitive motion of the left upper extremity while casing and delivering mail while in the 

performance of her assigned federal job duties over a 15-year period. She remained off work. 

OWCP paid appellant wage-loss compensation for intermittent work absences through 

May 26, 2017.

Appellant also submitted a report dated June 16, 2017 by Scott McMillan, a physician 

assistant.

By decision dated June 28, 2017, issued under File No. xxxxxx805, OWCP accepted that 

appellant’s assigned federal work duties required repetitive upper extremity motions. It denied 

her occupational disease claim as the medical evidence of record did not establish causal 

relationship between the accepted employment factors and her diagnosed left shoulder condition

commencing in January 2017. 

By decision dated July 10, 2017, issued under File No. xxxxxx173, OWCP denied 

appellant’s claim for a recurrence of disability commencing January 24, 2017 as the medical 

evidence of record did not establish that her accepted left shoulder employment injury disabled 

her from work for the claimed period. 

In a report dated July 12, 2017, Dr. Thomas L. Erickson, an attending Board-certified 

orthopedic surgeon, noted appellant’s difficulties with activities of daily living. Appellant

developed left shoulder pain in January 2017 without a specific injury. On examination of the left 

upper extremity, Dr. Erickson found limited elevation of the arm, tenderness to palpation of the 

acromioclavicular joint and subacromial space, and positive impingement signs. He opined that a 

left shoulder MRI scan showed slight spurring of the anterior acromion without rotator cuff 

 

5

In a letter dated June 14, 2017, appellant asserted that she did not wish to withdraw her recurrence claim as the 

employing establishment and a union official advised her to file “both ways” and allow OWCP to determine which 

form of claim was appropriate. Employing establishment supervisor S.K. responded by letter dated July 10, 2017 

asserting that she had not advised appellant to file both a claim for occupational disease and a claim for recurrence of 

disability. 
5

impingement, significant acromioclavicular joint arthritis, and no visible rotator cuff tears. 

Dr. Erickson opined that appellant’s symptoms were “at least to some degree related to her 

previous rotator cuff tear” although he was “not sure exactly what caused the recent exacerbation. 

Certainly this could be related to her work as a mail carrier which requires repetitive use of the 

shoulder.” 

On July 24 and 31, 2017 appellant, through counsel, requested a telephonic hearing before 

an OWCP hearing representative regarding OWCP’s June 28 and July 10, 2017 decisions.

6

At the hearing, held on January 18, 2018, appellant noted that she had not sought treatment 

for her left shoulder from her return to full duty in July 2012 to January 2017. She attributed her 

left shoulder condition to casing and delivering mail beginning in January 2017. Appellant noted 

that she sometimes babysat her three grandchildren and was able to lift a child weighing 15 to 24 

pounds with either arm.7 She provided additional medical evidence including an August 15, 2017 

report from Mr. McMillan, a physician assistant.

In a letter dated August 30, 2017, Dr. Erickson advised counsel that he could not offer 

additional opinion regarding causal relationship.

In a report dated November 28, 2017, Dr. Ridge diagnosed a complete left rotator cuff tear. 

He prescribed medication.

By decision dated March 15, 2018, an OWCP hearing representative affirmed OWCP’s 

June 28, 2017 decision under File No. xxxxxx805, which denied appellant’s occupational disease 

claim, and its July 10, 2017 decision under File No. xxxxxx173, which denied her claim for a 

recurrence of disability commencing January 24, 2017. The hearing representative directed 

OWCP to double the two claims as they pertained to the same member of the body and crossreferencing of the evidence in both claims was necessary for a complete and accurate history.8

LEGAL PRECEDENT -- ISSUE 1

Section 10.5(x) of OWCP’s regulation provides that a recurrence of disability means an 

inability to work after an employee has returned to work, caused by a spontaneous change in a 

medical condition which resulted from a previous injury or illness without an intervening injury 

or new exposure to the work environment that caused the illness. 

 

6 On August 30, 2017 appellant claimed a schedule award (Form CA-7) under File No. xxxxxx173 for permanent 

impairment of the left upper extremity. By decision dated December 21, 2017, OWCP denied her schedule award 

claim as the medical evidence of record did not establish that the accepted left shoulder conditions had attained 

maximum medical improvement (MMI). On January 3, 2018 appellant, through counsel, requested a telephonic 

hearing before an OWCP hearing representative. Counsel provided a December 13, 2017 impairment rating by 

Dr. Mesfin Seyoum, a family practitioner. There is no subsequent decision of record before the Board on the present 

appeal regarding appellant’s schedule award claim.

7 OWCP’s hearing representative noted that the hearing would consider appellant’s claims under both File No. 

xxxxxx805 and File No. xxxxxx173.

8 OWCP administratively doubled the claims, with File No. xxxxxx173 serving as the master file.
6

When an employee claims a recurrence of disability due to an accepted employmentrelated injury, he or she has the burden of proof to establish that the recurrence is causally related 

to the original injury.9 This burden includes the necessity of furnishing evidence from a qualified 

physician who concludes that the condition is causally related to the employment injury.10 The 

physician’s opinion must be based on a complete and accurate factual and medical history and 

must also be supported by sound medical reasoning.11

ANALYSIS -- ISSUE 1

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

disability on January 27, 2017 causally related to her accepted December 1, 2011 left upper 

extremity employment injury.

None of the physicians of record attributed appellant’s diagnosed left shoulder conditions 

to a spontaneous change in medical condition which resulted from the previous injury, without an 

intervening injury or new exposure to the work environment.12 Both Dr. Ridge and Dr. Erickson

inferred that appellant’s condition was generally related to her federal employment duties that she 

performed in January 2017.

Dr. Ridge opined in an April 28, 2017 report that a diagnosed left rotator cuff tear was “a 

result of her work.” Dr. Erickson noted in a report dated July 12, 2017 that appellant’s left 

shoulder symptoms were somewhat related to the accepted December 2011 left shoulder injury, 

but that her condition as of January 2017 “could be related” to repetitive shoulder motions while 

working as a mail carrier.” These opinions were not sufficiently well rationalized to establish that 

appellant had a recurrence of disability causally related to her accepted left shoulder conditions 

sustained sometime before December 1, 2011.

13

 Neither Dr. Ridge nor Dr. Erickson indicated that 

appellant’s left shoulder condition as diagnosed in January 2017 was a spontaneous recurrence of 

the left shoulder conditions sustained on or before January 21, 2012. 

 

9 20 C.F.R. § 10.104(b); see Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapters 2.1500.5 

and 2.1500.6 (June 2013). 

10 L.C., Docket No. 17-1788 (issued September 19, 2018). See S.S., 59 ECAB 315, 318-19 (2008). 

11 L.C., id. S.S., id. at 319.

12 W.H., Docket No. 17-1390 (issued April 23, 2018). 

13 L.C., supra note 10. 
7

In support of her claim appellant also included reports from a physician assistant. 

However, these reports have no probative value as a physician assistant is not considered a 

physician as defined under FECA.14

The medical evidence of record therefore does not include bridging evidence to show a 

spontaneous worsening of the accepted conditions, or that the newly diagnosed condition occurred 

over time as a result of the December 1, 2011 employment-related left shoulder condition.

15

 The 

Board therefore finds that appellant has not met her burden of proof.16

LEGAL PRECEDENT -- ISSUE 2

An employee seeking benefits under FECA17 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.18 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.19

In an occupational disease claim, appellant’s burden requires submission of the following: 

(1) a factual statement identifying employment factors alleged to have caused or contributed to the 

presence or occurrence of the disease or condition; (2) medical evidence establishing the presence 

or existence of the disease or condition for which compensation is claimed; and (3) medical 

evidence establishing that the diagnosed condition is causally related to the employment factors 

identified by the employee.20

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 

 

14 See David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician assistants, nurses and 

physical therapists are not competent to render a medical opinion under FECA); 5 U.S.C. § 8101(2) (this subsection 

defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by state law). E.T., Docket No. 17-0265 (issued 

May 25, 2018) (physician assistants are not considered physicians under FECA). Appellant also provided medical 

literature on shoulder conditions.

15 L.C., supra note 10. See M.M., Docket No. 16-1851 (issued January 19, 2018). 

16 Id.; H.T., Docket No. 17-0209 (issued February 8, 2018). 

17 Supra note 2.

18 Alvin V. Gadd, 57 ECAB 172 (2005); Anthony P. Silva, 55 ECAB 179 (2003). 

19 See Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117 (2005); Ellen L. Noble, 55 ECAB 530 (2004).

20 J.I., Docket No. 18-0286 (issued September 17, 2018); R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 

623 (2000).
8

opinion evidence supporting such causal relationship.21 Causal relationship is a medical issue, and 

the medical evidence required to establish causal relationship is rationalized medical evidence.22 

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 employee.23 Neither the mere fact that a disease or condition 

manifests itself during a period of employment, nor the belief that the disease or condition was 

caused or aggravated by employment factors or incidents is sufficient to establish causal 

relationship.24

ANALYSIS -- ISSUE 2

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

cuff tear causally related to the accepted factors of her federal employment.

OWCP accepted that appellant intermittently engaged in repetitive employment activities 

as a letter carrier. Appellant alleged that she developed a left rotator cuff tear due to casing and 

delivering mail in January 2017. However, OWCP denied her claim because it determined that 

she had not submitted a rationalized medical report sufficient to establish a causal relationship 

between her diagnosed left shoulder conditions and her federal employment duties.

It is appellant’s burden of proof to establish that newly diagnosed conditions are 

employment related. The Board notes that she has explained that she did not seek medical 

treatment for her left shoulder condition between July 2012 and January 2017. Therefore, there 

was a four-and-a-half year gap in appellant’s medical treatment.

Dr. Ridge, in an April 28, 2017 report, opined that a diagnosed left rotator cuff tear was “a 

result of her work.” He did not offer medical reasoning in support of his conclusion. The Board 

has held that a report is of limited probative value regarding causal relationship if it does not 

contain medical rationale explaining how a given medical condition/disability was related to 

employment factors.25 For the reasons set forth above, Dr. Ridge’s report is insufficient to meet 

appellant’s burden of proof.

Dr. Erickson, in a report dated July 12, 2017, noted that appellant’s left shoulder symptoms 

were partially related to the accepted December 2011 left shoulder injury. He explained that her 

left shoulder condition as of January 2017 “could be related” to repetitive shoulder motions while 

working as a mail carrier.” The Board finds that Dr. Erickson did not provide adequate medical 

rationale to establish causal relationship as his opinion was equivocal in nature. Dr. Erickson’s 

 

21 J.I., id., I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).

22 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

23 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994).

24 Dennis M. Mascarenas, 49 ECAB 215 (1997).

25 See Y.D., Docket No. 16-1896 (issued February 10, 2017).
9

statement on causation failed to provide a sufficient explanation as to the mechanism of injury 

pertaining to this occupational disease claim as alleged by appellant, namely, discussing what letter 

carrier duties would cause or aggravate her left rotator cuff condition.

26

 Without explaining how 

physiologically the movements involved in any specific employment duties caused or contributed 

to appellant’s diagnosed condition and because he couched his opinion with the qualification that 

the condition “could be related” to repetitive shoulder motion, Dr. Erickson’s opinion on causal 

relationship is equivocal in nature and of limited probative value.27 Thus, Dr. Erickson’s July 12,

2017 report is insufficient to meet appellant’s burden of proof. 

On appeal counsel asserts that OWCP adjudicated appellant’s case in an inconsistent 

manner. As noted above, OWCP properly denied her claims as she submitted insufficient medical 

evidence to meet her burden of proof.

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

to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R. 

§§ 10.605 through 10.607.

CONCLUSION

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

disability on January 27, 2017 causally related to her December 1, 2011 left upper extremity 

employment injury. The Board further finds that she has not met her burden of proof to establish 

a left rotator cuff tear causally related to the accepted factors of her federal employment.

 

26 J.I., supra note 20; S.W., Docket No. 08-2538 (issued May 21, 2009).

27 J.I., supra note 20. See L.M., Docket No. 14-0973 (issued August 25, 2014).
10

ORDER

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

Programs dated March 15, 2018 is affirmed.

Issued: February 26, 2019

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